21 Days from the Old to the New Normal, Week 2: “Really? That seems crazy” to “Yes, obviously,” within days. (Over and over.)

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Part 1 of this series is here

Saturday, March 7

This day was not quite three weeks ago, and it feels like forever. We were supposed to have arrived in India to spend three weeks with our family, but woke up at home in the U.S. after canceling at the last minute. Instead, we went to my older son’s basketball playoff game (they won!). My younger one had practice that night. We were grateful the kids could focus on being in the playoffs after all, to soften the blow of not being with their family in India. At that point, no one was questioning going to small sporting events or gathering kids and families outside of schools.

Moday, March 9

Governor Raimondo declared a State of Emergency. My kids went to school—there was no formal talk of school closures yet. Articles were coming out about New York, saying closing schools there would be a last resort because of all the children who would not eat if they were not at school. This and many other stories began to reveal what this pandemic tells us about ourselves—much of which activists have been screaming into the wind to no avail.

We were starting to see the ramifications for our pregnant patients. Visitor restrictions were applied—one support person only for labor and birth. We were successful in advocating for doulas to be recognized as part of the care team and not subject to visitor restrictions. But of course not everyone can afford a doula (hopefully this will change—see below!), nor is that the preferred support situation for every woman. We had our first patient sobbing and devastated at being forced to choose between having her partner or her mother at her birth.

At that time, most of the concerns we heard were related to the visitor restrictions. In the coming weeks, more and more of our prenatal visits would be dedicated to supporting women not just through crushing disappointments, but also through fears and very real grief over the burdens this pandemic has placed on their pregnancies.

Tuesday, March 10

This was the day I saw the first graphic about “flattening the curve.” (At that time, we were using this information to understand the cancelation of huge events like conferences and festivals, rather than the suspension of public life as we know it.) This was also the last day I hugged someone outside my family, something I’m grateful to remember. I remember it because it was such a good hug, and because right after, we looked at each other and said “We probably shouldn’t have done that.”  The fist and elbow bump thing was just becoming the new norm.

That happened during one of the last public events I attended—a press event to honor grants awarded by the City of Providence to expand access to doula care in pregnancy and birth. That night, I attended my very last public event—a House finance committee hearing in support of state legislation for Medicaid and private insurance coverage of doula services. It was a packed hearing—standing room only for those waiting to testify.

I was glad to be able to give testimony on behalf of our chapter of the American College of Nurse-Midwives (ACNM), since I was in town after all. I don’t think anyone in that room gave a thought as to whether we should really be there, at a proceeding held by the State and attended by the Mayor with his toddler in tow.

Within days, a public assembly like that would be unthinkable.

Wednesday, March 11

My first 24-hour on-call shift at the hospital since I got back on the schedule. In the morning, I was wondering if the babies would see fit to stay put in their uteri just for a couple hours in the evening so I could scoot out for my younger son’s basketball game. No matter. At 3:30, I got the text that per the City Parks and Recreation department, games were postponed until further notice.

Breaking news:

NCAA March Madness to be closed to spectators (only it didn’t happen at all). Senate Blocks Emergency Paid Sick Leave Bill.  NBA Season: Cancelled (WHOA). And the horrifying reports from Italy—doctors in the impossible, heartbreaking position of having to decide who was most worthy of intubation—were coming in. The epidemiologists said we were on track to be in the same situation within a couple of weeks. And two weeks later, this is what New York is beginning to look like. It appears New Orleans is next.

Thursday, March 12

On my way out in the morning, I just happened to see an N95 fit-testing station set up in the hospital hallway. I was sleep deprived and already leaving an hour late, so I almost didn’t do it, thinking I’d get to it later—can you imagine? I asked if I really needed to, since I knew my size and haven’t had any big weight changes since the last fitting. They said yes, anyone who hasn’t been fit tested in the last year should do it. I’m so glad I did. I got ONE precious N95 mask out of the deal—they give you the one they used to fit test you, since otherwise they would have to throw it away. So I put it in the paper bag, to be saved in case I really need one and there are none available, not really thinking that could actually happen.

Fast forward for a moment…as it is now, two weeks later, the latest COVID-19 bulletin from my employer says that all patient care staff are to wear regular masks even when caring for patients who are confirmed COVID-19 positive. Yes, even the symptomatic ones who are coughing. N95’s are now reserved only for use during aerosolizing procedures. Meanwhile, yesterday in New York, a 48-year-old nurse died of COVID-19 in a hospital where the staff is using garbage bags for PPE.

Here. In the richest, “greatest” country in the world.

Also that day, in our little microcosm… there was more and more general talk of avoiding unnecessary gatherings. Basketball rec league decisions had been made for us, but the first practice for AAU season was set for the weekend. We were starting to wonder if we felt in good conscience we could send our kids, but it wasn’t yet cancelled. Those few days were characterized by a lot of scenarios like this, weren’t they? With people having different alarm thresholds for just about everything and no one knowing what was necessary or best, under-reaction or overkill.

I dreaded the possibility of telling my boys, “It’s still happening, but you’re not going” and the meltdowns that would surely ensue. I felt both guilty and ridiculous for being preoccupied with such petty, inconsequential concerns when people all over the world were in such desperate, traumatizing, life-or-death situations. And yet, I still had to continue parenting and managing the day-to-day stuff with my kids.

Friday, March 13

At work that day, I did a few GYN problem visits, but mostly prenatals. We had started postponing annual preventive care visits. None of the women I saw that day happened to be close to term, but I was struck by how none of them asked about COVID-19. I had to bring it up to find out what they knew and if they were taking any precautions. Data was limited (still is) and the CDC hadn’t yet placed pregnant people in the higher-risk categories with people age 65 and over and those with certain underlying conditions. They now have, but even before that, we obviously wanted to prevent pregnant women becoming infected, for many reasons. The patients I saw that day didn’t seem to have it on their radar quite yet.

It was an odd place to be as a midwife. There is excessive fear in our culture around pregnancy and especially birth, much of it unfounded. It’s pretty much my mission to take the fear OUT of pregnant women. And here I was trying to put some in—if not fear, at least vigilance.

At the end of the work day, it was announced that all providers and staff were to wear regular surgical masks for all patient care. Due to a nationwide supply shortage, we were to wear the same disposable mask for two consecutive work days (This would soon change to “until visibly soiled or nonfunctional.”)

That afternoon, the Governor announced the schools would be closed the following week (soon to be extended of course) and issued guidelines to avoid gatherings of 25 or more and stay home as much as possible. This was clearly the right move for larger gatherings of people in all age groups, and it made clear what we were supposed to do about smaller gatherings. Because as long as we were still putting hundreds of kids together in school buildings, how did it make sense to cancel a birthday party or a basketball practice with less than 20 kids? I felt relieved when the school closure and related guidelines brought the clarity we were all lacking: the clarity that said, “Yes. Seriously. It ALL stops.”

Also? I was thanking God for my husband’s foresight to cancel our India trip. The Indian government closed their borders on the 12th. No flights in would surely mean no flights out. If our flight to India on the 6th had been scheduled for just a day earlier, we would have gone and we’d be there indefinitely as we speak. Today, March 27, is the date of our now canceled return flight back to the U.S.

By that day—Friday the 13th— it was beginning to sink in that a precaution may feel like an overreaction in any given moment, and it would likely become a no-brainer within days. That’s what kept happening. Over and over.

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P.S. Along with all the alarming information and constant change, here are a few things that gave me LIFE that week:

Elizabeth Warren and Kate McKinnon

All the Gen X love, but especially this: Gen Xers, Unite! Or Don’t. Whatever.

Wash Your Hands, by Dori Midnight. Soul salve. I keep going back to it.

Part 1 of this series can be found here.

(Part 3 to follow…)

© Camille Williams and Wake Up, Mama! 2020

Are Women Free to Make Noise in Labor on Maternity Wards?

 

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One of my blog posts from last year was published in The Huffington Post today. It’s one of my favorites, about women feeling free to use their voices in labor and birth.

http://www.huffingtonpost.com/camille-williams/are-womens-birth-sounds-s_b_9678662.html

© Camille Williams and Wake Up, Mama! 2016

Stories About Circumcision: A Tale of Two Brothers

This is the second post in the series on circumcision. The first explores circumcision in general and tells the story of my first experience with it as a nursing student, and how I counsel expectant parents now as a midwife. To read it, click here.

Julie (name changed for privacy) is a 40-year-old mother of two boys, ages 11 and 7. Her older son was circumcised, and her younger son was not. She agreed to talk with me about her experience and how she and her husband made both decisions.   Continue reading

Stories About Circumcision: One Midwife’s Perspective

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Circumcision can be a touchy subject. Parents are in the unenviable position of having to make this important and permanent decision for their sons with a lot of conflicting information. Those who choose to fully investigate the issue find an overwhelming spectrum of opinions amidst the facts, and most will encounter heated debate in the media, their social circles, or even within their own families. They hear from staunch defenders on medical, cultural, or religious grounds. They hear from others who consider the procedure unnecessary but relatively benign.  They hear from those who see it as a human rights violation, ethically no different from female circumcision common to other cultures.

As you may have guessed, I am among those who hopes cultural change will make circumcision a distant memory. In the future, I suspect we will all be scratching our heads in disbelief that this is what we used to do to almost all our baby boys.   Continue reading

Are Women’s Birth Sounds Silenced in the Hospital?

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Attention birthing women: This will be the hardest work of your life. It will test you on every level. Childbirth education is very helpful, yet there’s no way to know how you will feel physically and emotionally until you’re in it. There are many schools of thought on how to cope, what to call the forces of labor (contractions or surges?), and how to label the feeling (pain or sensation?). I like to keep it simple: it’s really hard, and yeah, it hurts. And, you are stronger than you know, and you can do it. Whether or not you plan to use pain medication or epidural anesthesia, know that you have what it takes within you to get through however many contractions you choose to feel fully.   Do your preparation, trust in the birth process, and believe in yourself.

But once you get to the hospital, whatever you do, for God’s sake, maintain some decorum and do it quietly! And if you can’t do that on your own, we’ve got something for you that will fix that problem quite nicely.  Then, we can ALL be comfortable.

Is that the unspoken message women receive from hospital staff during labor?   Continue reading

Maternal-Child Health Studies from the Department of “Duh,” and Musings on the Disempowered State of Midwifery

Two articles drove me crazy this week.   Let me say at the outset: the title of this post is not a jab at the researchers. I am grateful for their tireless work, in awe of their professional accomplishments, and happy that they are proving what should be self-evident. What I am lamenting is the fact that these things are not obvious to all.

Continue reading

There’s the delivery report. Then there is the Birth Story.

The other day, I sat down to document a birth in the medical record. I was still all abuzz inside from witnessing the two kick-ass women I had the privilege of attending that night.   It suddenly struck me, the flatness of what I was about to write compared to what actually happened.  I get that we have to document in a certain way, and that’s OK.   But wouldn’t it be amazing to say what we really see, for each and every birth?  Continue reading