don't take the fun out of dys/fun/ctional!

A trip down the hallway on the 5th floor of the building where I am living is an interesting experience for my nose. Upon opening the door of my apartment the first smell to hit me is that of nasty cigarette smoke. Then as I make my way towards the laundry room I catch more pleasant smells... someone is cooking bacon and someone else is frying fish. And the folks behind door number 506 are smoking something even nastier than cigarettes. I'm guessing they opened up the tin of roaches and rolled something up. In the laundry room I am assailed by the overwhelming scent of "bounce" dryer sheets or some other chemical fabric softener. I put two dollars in a washer add detergent and a load of clothing then follow my nose back down the hall. I close my eyes and walk slowly wondering if I will know when I get to my door. When I catch the scent of amber insence I reach for the doorknob and open my eyes. I'm home.

A few weeks ago now, after my first blog post I think, Gina asked me a question via email and I have been pondering it from time to time. How have our homes changed now that we no longer give birth in them? Of course there are some few people who still do give birth in their homes. But most do not. On Friday night over dinner Cynthia told a story of growing up in Scotland. She is one of the older children in a large family and enough babies followed her that she came to understand that when a box with the words "Do not open until confinement" appeared in her mom and dad's room that meant that a new baby was coming soon. She was old enough to read those words and somehow young enough to think that the new baby was in the box! Across the table from Cynthia, Bernie tells us that he was born at home in Germany, that his father had been sent to fetch the midwife. It was a long walk for him and he walked back with the old midwife, carrying her bag. He has been told that his mother was greatly comforted by the arrival of the midwife and that his birth was a good experience for his mother. His siblings, all younger, were born in hospitals after his family emmigrated to Canada and his mother remembers being afraid and being left alone with no support. Bernie's father was there when he was born, but was not allowed to attend the hospital births of the other children.

You know what else doesn't happen at home much anymore? Death. Just as most births happen in the institution we call a hospital so do most deaths. What is it that we have lost? How have our homes changed? We may have lost a sense of connection with life... a sense of the rhythmic cycles of birth and life and death and birth and life and death...

Gina also reminded me of a quote from an Inuit Elder... something I had seen before and was moved by. I am sorry that I cannot find the email from Gina to be sure that I quote her correctly and I cannot remember her name but what the Elder woman said (more or less) was this: "I can understand that some of you think that birth in remote places is dangerous, but you must understand that life without meaning is also dangerous." There is no life without birth and all that which is born will one day die.

So, those are today's meanderings...

And now, for those who are still reading, a story. A little chapter from the life of a midwife in Iqaluit. This is a story about the creation of tension and misunderstanding. In the telling of the story I hope to find a path to peaceful resolution.

On Friday morning I went to the hospital rounds... the rounds that I had been told one day that I should not attend. "This is coming from the doctors" I was told. Well after a day or two I went back to my supervisor and told her that the rounds were an important part of my orientation to the hospital. I asked for her support for my right to be there. She did support me and I learned that it was only one doctor who had emailed her with the suggestion that the midwife should not be at rounds. I do not know which doctor. It doesn't matter. This is not the first time that I (and every other midwife that I know) has been made to know that some doctors do not welcome her as a member of the team of health care providers. Anyway, as the rounds progressed I became aware that there was a woman who appeared to be in labor that morning. I have been welcomed warmly by the nursing staff and as part of my orientation I was invited to attend a delivery as a "shadow" to the nurse. So after the rounds were over I spoke to the unit manager and to the nurse caring for the woman in labor and I obtained permission to attend this delivery. I then went into the patient's room, introduced myself and asked her if she would mind. After talking with her and her husband for a while it became obvious to me that she was not in active labor. She had come in because she thought her water had broken and she had "taken blood out". I went to the nurse's station and began to look at her medical chart. I was just getting to know a bit about her history, her previous births, her general health, how far along she was etcetera. I engaged in quiet conversation with a doctor who is here in Iqaluit in a locum position and who appears to be getting involved in the care of pregnant and birthing women. We discussed the woman's birth history and the fact that this would be a "late preterm" baby at 36 weeks gestation and I wondered aloud if antibiotics would be started now because her active labor could be pretty quick or if they would wait until she was in active labor to start antibiotics. Either of those approaches would be completely acceptable, I was only wondering. I was also looking at the chart because in the near future I will be caring for patients here, writing orders, writing narrative notes, and documenting assessments and care plans. I saw this opportunity to shadow the nurse as part of my orientation.

The unit manager appeared at my left side and whispered quietly that she had been told by Dr. X that as a "shadow" I was not allowed to look at the chart! I was shocked to say the least. I was also hurt. I felt very disrespected and even a little angry. The unit manager was also surprised. She said she had never heard of anything like this happening before. At the same time as she and I were discussing this I saw Dr. X take the new locum Doctor and the Doctor who was managing the care of this patient down the hall for a chat. I did not know what to do. I was stressed and very troubled by this. I fussed a bit around the nursing station, trying to understand why Dr. X would just make up a new rule like that, just for me and trying to decide what I should do. I thought "I have to talk to her"... I need to understand what is going on. But I knew that I needed to calm down first. So I headed off to the other side of the hospital to talk with my supervisor. I guess I should not have been surprised to discover that she already knew why I was there. She had been the first one Dr. X called. She told me that as a professional hired to work in this hospital I had absolutely every right to examine the charts of people that I was involved in the care of. But Dr. X had played the "she is not lisenced in Nunavut" card. "Okay" I said to Cynthia "that is a problem that will go away because I soon will be lisenced in Nunavut, but the problem of Dr. X's resistance is not so easy."

When I returned to the inpatient unit all of the nurses were aware of what had happened and they were all angry on my behalf. I found myself calming them down and justifying Dr. X's decision but not the way that she behaved. Dr. X has been nothing but polite, even sweet, and very calm and serene in her face to face dealings with me. There have been "signs" that there was something else going on behind that lovely face, rumors and innuendos. But there was nothing subtle about that behaviour. I find myself choosing my words very carefully here, aware that as a published blog post, these words could make their way back to her. Although I have not used her name she would, of course, recognize herself. I have tried to be honest and fair. I have tried not to say anything here that I would not say to her face.

Tomorrow I will go to her and tell her that I have been thinking a lot about what happened. I will tell her that I am a person who values peaceful and respectful relationships. I will tell her that I would prefer, in the future, if she has a concern about something that I am doing, if she would please come to me directly it would likely help to reduce tension and misunderstanding. And if I am really courageous I will ask her why she does not welcome midwives to the team of health care providers.

It had an interesting effect on me, encountering that resistance. A week ago I might have cried and considered packing and heading for the airport. This week, thanks in part to the strong support of the nurses and my supervisor, I found myself feeling strenghtened. Thanks also to the many strong midwife role models that I have known and continue to admire. We continue to claim and reclaim our places on the team of people caring for pregnant and birthing women because it is the right thing to do and because it is our right.

And because it is important to keep the fun in dys/fun/ctional I raised an $8.50 glass of red wine to Dr. X at the bar on Friday night!

This midwifery project in Iqaluit really feels like an icebound ship these days. It seems like everyone that I need to help me push it forward is either away from work right now, on a leave or a vacation, or out of town for medical reasons, or else they are working and just too busy to get back to me. Yikes! Waiting around for something to happen is quite a challenge for me. Today I have my laptop and the portable modem in my office. Lots of time for blogging, but not very much to say.

Passing the time in Iqaluit... I finished my first quilt! I had tried hard to finish it before coming up here but those last days and weeks were just so busy. I loved quilting and was proud to post it to my wee grand nephew, now nearly 6 months old, in London, Ontario. I hope his Gramma Holly notices and admires it! I brought a quilt top that was already created - something Val had stored in a closet. I have finished assembling and quilting it and now I sleep under it every night.