Monday, April 4, 2016

Yes, My Panties Are in a Bunch

So I've started blogging over at: - in opposition to a Sewage Treatment Plant plan at Clover Point Park. A Plant that will literally be on my front door step, and less than 100 meters away from my home.

Tuesday, March 8, 2016

Detour Ahead

We were at the point where I was going to go to half-time this coming June. We were at the point where we were going to put in motion plans to build our new house. We were at that point where I was going to start doing more "work outside of work" - more writing, more work in support of cesarean by choice, more work in support of my husband's business (social media marketing, miscellaneous analysis, etc.), more work in support of my daughter's school's PAC, work to do more independent consulting, and a better balance for me.

All of that must now wait again - relegated to the side of my desk once again.

At least the work I am doing at work has improved substantially. At least my marriage is as strong as ever. The kids are healthy. I'm healthy. My husband is healthy. We have what matters most. At least this is happening now, rather than in a few years when the damage would have been far worse (and while the situation is bleak, it could be far worse). In the long-run, we will be stronger. In the short term, it is stressful. In the short term, it is uncertain. In the short term, things that seemed within reach just a month ago are now going to have to wait.

We will get through this. That is the one thing I am certain of - that the now is merely a setback. That we will learn, we will build, we will get to where we're going. It isn't what is best for us financially right now that matters (particularly if that means sacrificing a core value) - what matters is building a business and protecting it, fostering the right team to provide services that meet the needs of clients, services that enable them to focus on recovering as best as possible and maintaining those services through this transition - fostering a sustainable business means that there are sacrifices that need to be made now. Sometimes, in order to grow, you must identify the areas that need to be pruned.

Resiliency and optimism are a powerful combination.

Monday, February 8, 2016

A Lovely Detour

October 2014, I was painfully aware of the need to make shifts if I were to get to a place where I would be happy with what I did, who I did it for and how I did it and the balance between my work life and my outside of work life. I dropped alcohol from my diet, joined a boot camp and set about trying change my workplace for the better with a collaborative “deck the halls with art” project. It was clear that if I could not change where I was, I needed to change where I was. There was also a kind of clarity around what I genuinely wanted to do and I felt as though I was making strides in the right direction.

By May 2015, I had dropped 20 pounds and had navigated into a secondment at a different Ministry. Now, 8 months into that secondment, with promise of my position formally transferring over in the near future – I have learned a lot and have enjoyed the work I’ve done. However, I am again looking at where I am at and where I wish to be. I’ve regained 15 of the 20 pounds lost (note: I did reintroduce moderate alcohol consumption and got a bit lazy diet and exercise wise). While I am doing good work, in a good environment – there is still something lacking and a feeling of there just not being enough hours in the day to do work at work, as well as the work outside of work. My life lacks balance. I am still not in that “Sweet Spot” where what I do truly resonates with who I am and what I wish to achieve. It is, as I thought it might be, moving from one ministry to another but remaining with government; I am happier but not happy. It has been a lovely detour – and it is nice to know now, that I will not be leaving out of some kind of desperation, but rather out of genuine desire to live a different kind of life. I long to get back on the path I first envisioned, a path filled with the work outside of work with the hope of making a life while finding some way to also make a living.

So if I know the destination – then, is it merely a matter of taking steps once again towards that destination? First step get back to getting healthier (back to developing good habits and dropping some less than good ones). Once again alcohol has made the “no drink” list. Once again the kitchen scale has come out to measure. Once again, I’m logging into MyFitnessPal. Once again, I have found another boot camp that works with my schedule. I look forward to again mounting my bike and ditching the car for my daily travels. Having seen what I can do before – I’m confident that I’ll again be running the TC 10K, and if I stick with it, can be in better form for my 40th birthday (now just three short years away), than I have ever been.

Step two – scale back work at work to make more room for work outside of work. The plan is half-time as soon as feasible. It looks like that will happen in the next 3-4 months. That might be enough, that might bring enough balance between the work at work and the work outside of work. At the least it will create a much better balance.

Step three – get back to growing and engaging in work outside of work. There is nothing more satisfying than knowing that you have helped someone else - that you have made their life a bit better. The work I do outside of work, does that. So finding ways to contribute to this world that resonate with who I am and helps others is profoundly important to me - being able to focus on what matters, matters. This is the part that excites me. The part that has the potential to bring purpose back to what I do. The part that fills my soul – for life is short, and I wish to love what I do and find a way to work a life worth living.

Thursday, January 7, 2016

What will you fill your life with?

Of all the resources that are scarce, time is perhaps the most valuable. I have not been blogging much lately, far less than I'd like. Not for lack of material, but rather for lack of time. Life has filled my hours with mothering, and work, and more work and mothering and being a wife. Things I'd like to get done get shoved, postponed - the car goes without an oil change for a couple months past due, the house isn't nearly as organized as I'd like, I'm not as on top of a variety of things as I would like (Christmas cards, what Christmas cards?) - but the mission critical things are getting done. The bills are getting paid. Work is in a much better spot than it was. The kids are being read to, fed, dressed and to school on time. The Cesarean by Choice Awareness Network on Facebook continues to flourish as a community of support. My husband has been able to focus on building the business - and in time we will get to where we need to be.

I would like to take a step back, to find a few hours to think about what the future might look like - to identify and set aside time to do the things I'd like to do. To identify the things that will bring me joy - and to find ways to have those things fill more of my time. To identify the things that are not bringing satisfaction, and to find ways to have those things take less of my time.

More blogging seems to be in order.

Saturday, December 26, 2015

To What Was, What Is and What Will Be - Farewell 2015

Every year, without fail, between Christmas and New Years my mind turns to the year that was, and the year that is to come. Almost always, there is a combination of thankfulness for all that has been learned (particularly true in the most challenging years), for my family, for friendships and hope for the year that is to come. I think about the sorts of things that will move me towards my goals - personal goals, professional goals and purpose goals. I think about what has held me back, and if there is anything that can be done about those things.

In recent months I haven't been blogging as much as I would have liked - not because there has not been anything to write about (indeed there has) but rather because lack of time, leads to a kind of neglect. Indeed, there have been numerous posts began, but never finished - on work, on maternal request cesareans, on the health system, on Parent Advisory Councils and the education system and on life. Posts have been begun, stale-dated and never posted - and I have missed blogging. The space where ideas are let loose publicly - the exercise of writing, both for my own understanding and to share my ideas with others. I hope to do more blogging again in the year to come.

On the work front, I am once again, reasonably happy. Once again, I find myself working for someone who is the kind of leader I would hope to be. Someone who truly values the abilities of his staff (and understands what those abilities are), gives meaning to work, and fosters a good work climate. Once again I am engaged - and for that I am thankful. Yet, I find myself thinking that less would be far more - and so in the year to come, I am hoping to move away from a full-time schedule so that I can make more room for work outside of work - the work on the this blog, the Cesarean by Choice Awareness Network, the work I do for my husband's firm, for writing and mothering & life. Simply put, there's 24 hours in a day, and in order to find balance and perhaps do more that means more, I must adjust - I must make time and space for that work outside of work. It appears at last, that that opportunity will come to pass in the year to come.

I am incredibly thankful to be in a position where that is possible - where I will be supported to find a better balance, and I am incredibly hopeful for what that means in the year to come. I am incredibly thankful for the people and circumstances in my life that has made the year ahead possible. Indeed, looking back at 2015 - the foundation has been laid for an incredible 2016.

To 2016 - and beyond, wishing all the best - health, happiness, friendship, love, hope and success.

Monday, October 19, 2015

Election 42 - Go Vote!

I am usually a decided voter long before I enter the polls. This year I was a decided voter, until I was not. Until my preferred candidate withdrew from the race, after the nomination deadline – leaving me yet again, undecided, except for clear knowledge of who I would not vote for. I brought both my children with me – my daughter for the second time, and my son for the first time. I entered the gym of my daughter’s school and approached the table where I was directed to present my voter registration card and ID. The election worker neatly crossed my name off with a ruler and handed me a ballot. I proceeded to the box, and unfolded the ballot. I checked to ensure it was as it should be – unmarked. I then made a choice, my pencil alternating between two of the candidates before I clearly marked an X beside one. I folded my ballot again and put it into the box - narrating the process for my daughter.

Her name was still on the ballot – there was no prominent notice of her withdrawal at the polling station I attended. Momentarily, I entertained the idea of marking my “X” there despite knowing that she had withdrawn. I felt remorse and a degree of anger – after all, her reason for withdrawal was that comments she had made on facebook had been taken out-of-context and paraded about. It was not anything that she had done in the course of her work, nor in the course of her public duties – but rather her private life that had put an end to her political career. Further, it was comments made years before she was a candidate – comments that may not have even reflected her current beliefs. Comments that should have been given the same amount of deference as comments made at a dinner party.

And yet, she withdrew.

I still wanted to vote for her – for her party – in some measure because of what had happened. I wanted to vote for her, because, I believe people have a right to their personal lives – even and perhaps especially those who run for office. I wanted to vote for her, because, I believe people should be able to “live out loud” – and that their careers, their actions in public – should speak much louder than what they might have said or wrote in their private lives (including on facebook with the intended audience of friends and family). I believe that people continue to mature – that the views once held, change over time – and that what matters, truly, is a willingness to grow and learn from one’s experience. Her name was the one I wanted to mark my “X” beside – even though she withdrew.

If only she had not withdrawn. If only the party had stood behind her in some measure. If only…

Because, those who express themselves are at least willing to have their views challenged. They are at least willing to let it be known what they believe, and often why. The candidates with facebook pages are not the ones to be feared – rather, it is, the candidates who live their lives in guarded fashion who are worthy of skepticism. Those who dare not speak what they think, because of the political repercussions – for they are not willing to have their ideas challenged. Do not be fooled, guarded candidates still hold personal beliefs and opinions, but unlike those who post to facebook, they are not willing to have those beliefs challenged.

If we want a transparent government, we could start by supporting those who live their lives transparently.

Saturday, October 3, 2015

Do Stand Alone Birth Centres Make Sense? Do they ensure quality care?

St. Paul's hospital in Vancouver is being redeveloped. As part of those plans, is a stand-alone birth centre that will be supported by midwives and family practitioners. It is a non-hospital facility. It is intended for low-risk births not expected to have complications.

As a non-hospital facility it will not offer epidurals. As a non-hospital facility it will likely have a high-rate of transfers to the hospital facility adjacent to it - to facilitate either pain relief or surgical delivery when necessary. It is largely conceived with the idea that births that do not involve interventions - will save money, and that the best way to avoid interventions is to remove birth from hospital facilities and have births attended by practitioners who do not view birth as being inherently in need of intervention for low-risk women.

Designing maternity care services with the view to limit the use of intervention is not going to deliver quality care to BC Women or their babies, but rather is going to increase the number of mothers who ultimately have poor experiences of care and longer term consequences as a result of that care. The harm caused by failing to intervene in a timely way when it is needed versus the harm caused by intervening too soon is an order of magnitude worse. A mother who leaves with empty arms or who will be caring for a profoundly disabled child for the rest of her life, has suffered a far greater harm than a mother who might have had a cesarean sooner had she been giving birth in a fully integrated, hospital based maternity ward.

Further it segregates care in a way that is likely to lead to lesser quality care. When family practitioners and midwives who deliver maternity services are segregated from OBGYNs it often leads to less collaboration in care - fewer opportunities to discuss their patients and develop professional relationships that benefit their patients. At it's worse, it can lead to situations where women and babies die because OBGYN's are seen as rivals rather than colleagues.

Lastly, it segregates women, new mothers from one another. It is one more way in which one mother can goad another - where how a woman gave birth is advertised merely by where she chose to give birth. It is one less thing for mothers to have in common when they meet at the neighbourhood park or coffeeshop.

If quality care is the goal, collaboration between those who provide maternity services is key. If quality care is the goal, timely care is paramount. If quality care is the goal - how maternity services are structured must be integrated, not segregated. Women should be empowered to make the choices that best meet their needs - and not coerced into making the choices that best meet the needs of the system.

What is the goal? Quality care or to save money?

Thursday, July 30, 2015

Victoria's Plan for Topaz Park Deserves a Public Policy Darwin Award

This past week Victoria’s mayor and Victoria’s city council passed a motion 8 to 1 to consider establishing a designated tenting area in Topaz Park for Victoria’s homeless population. Since then, there has been a public outcry about the proposal –because a “designated temporary tenting area” by another name is a “tent city”.

At first blush, it would seem to be a quick and inexpensive fix to the problem. The homeless need shelter, a tent provides shelter and a designated tenting area has to be better than random encampments throughout the city – doesn’t it? Why not use a city park to provide land for the shelters of the homeless?

It really is rather incredible, that a problem as intractable and pervasive as homelessness has such an easy fix. After all, if the problem was as easy as a “temporary tenting area” why has it not been tried before? (Never mind that the “tent cities” that sprung up at the Cridge Center, St. Ann’s Academy, Beacon Hill Park in the past were unmitigated disasters that cost nearly a half-million in policing costs – but those were “tent cities” not formally “designated temporary tenting areas”).

After all – what could go wrong with congregating a population that has a high incidence of addiction, mental health struggles, and various other problems in a public park? What could go wrong with failing to provide showers and food and adequate washroom facilities (never mind the intensive counselling and assistance many of these people would need to actually end their struggle with homelessness)?

So will the city be on the hook when the surrounding neighbourhood finds that property crimes skyrocket? Will the city be on the hook when a child is injured by a needle discarded in an adjacent play area? What about when one of the residents of the “temporary tenting area” assaults another? After all, such problems are foreseeable – does the city not have a responsibility to ensure the health and safety of the residents of the “temporary tenting area” and the neighbourhood around it?

On further thought, not only is a “temporary tenting area” a very bad idea, it is a complete non-solution to the problem while creating a multitude of other problems – both for the homeless and for the surrounding neighbourhood. Further, if a “temporary tenting area” is established at Topaz park then, what park is next?

This idea deserves a "Public Policy Darwin Award" - for taking a serious problem and making it worse.

Wednesday, July 22, 2015

Sun Peaks Hit and Run Leaves Groom-to-Be in Serious Condition

There’s a bride-to-be who was less than 6 weeks away from what was supposed to be her wedding day. This time was supposed to be the start of a new life together – filled with planning and anticipation. This time was supposed to be the time when she should have been imagining the years ahead, of hoping and dreaming about their future together.

This past weekend, their dream turned into a nightmare. While at Sun Peaks, her fiancé was celebrating the upcoming nuptials with close friends. On the walk back to where he was staying, at about 3am on Sunday July 19, 2015, he was struck by a truck and sustained severe injuries.

The bride-to-be is now sitting by her fiancĂ©’s side in a Kamloops hospital room. Praying, pleading for his health; he is in serious condition. The bright future that laid ahead for the couple, just a few days ago – now seems incredibly uncertain. The months ahead will be focussed on recovery and healing – coping as best as possible.

The prospect of the future is made even more uncertain as the person responsible for his injuries remains at-large. The driver of the truck that struck him did not remain on the scene and has not come forward – making a tragic and heartbreaking situation an order of magnitude worse.

It is hoped that the damage will be mitigated. That he will recover as best as possible from his injuries. That the person responsible will come forward, or that information will lead to his/her identification and that he/she will be held accountable. The family has posted a $10,000 reward for information that leads to the driver responsible being held accountable.

Anyone with information is asked to call Lambert and Williams Law Corporation at 250-589-2174 – information that leads to a criminal or civil conviction of the driver will be considered for a $10,000 reward. Police are seeking anyone with information about this hit and run as well.

Sunday, July 19, 2015

Pushing Back for the Best Choice - Cesarean by Choice in Canada Deserves Respect, Compassion - Not Mocking

Canadians, and Cesarean by Choice moms in particular, should be outraged at what is considered to be appropriate behaviour by research institutions and hospitals in Ontario. A website has been created - - and supported by the University of Ottawa, McMaster University, the Canadian Institute for Health Research, the Canadian Health Services Policy Research Foundation, Markham Stoufville Hospital, and Queensway Carleton Hospital. It is deeply offensive and mocks patients while purporting to "Push for the Best Choice".

The content of the webpage is as follows:

Caesarean section (CS) is an efficacious option for birth, but is not without risks to mothers and their babies, including maternal mortality, infection, hemorrhage, maternal or fetal injury, increased recovery time postpartum and difficulty breastfeeding. Given these risks, it is problematic that CS birth currently accounts for more than 28% of all births in Ontario in 2010/11, which is nearly double the 15% target recommended by the World Health Organization.

I should note that vaginal birth (VB) is also an efficacious option for birth, but is not without risks to mothers and their babies, including maternal mortality, infection, hemorrhage, maternal or fetal injury, increased recovery time postpartum and difficulty in a wide variety of areas. But this article completely neglects the risks of vaginal delivery - and then proceeds to declare the prevailing rate of cesareans as problematic, while trotting out the WHO's zombie statistic that was quietly retracted in 2009 as having no evidence to support it only to be brought back to life this past year, despite having questionable evidence to support it. There is no "ideal cesarean rate" - and despite wide criticism this number continues to pervade popular media and policy circles alike.

The common perception that this large and increasing proportion of CS births is attributable to maternal requests for CS does not reflect the available evidence, particularly in a Canadian context. Maternal factors that are more likely to contribute to the increase in CS birth include increased maternal age, use of assisted reproductive technology, incidence of obesity and gestational diabetes. While these maternal factors are likely attributable to changes in sociodemographic and health status in developed countries, of particular concern are the obstetrical practice changes that have led to an increased use of technological intervention during birth. Such interventions (including increased use of labour induction, augmentation, epidural analgesia, and electronic fetal monitoring) are associated with an increased risk CS, even in cases of otherwise low-risk birth.

I agree that maternal factors (changes in the incidence of medical indications for CS) likely contribute to the higher rates that are observed in Canada. However, the article then goes on to criticize the use of technology in birth. What the article fails to consider is what happens in the absence of that technological intervention. More stillbirths (rare, but the incidence of still birth increases after 39 weeks), more neonatal asphyxia, more 3rd and 4th degree tears (and likely more pelvic organ prolapses subsequently), more PTSD as a result of extreme and uncontrolled pain... but, I guess all of that is justified to achieve a higher rate of vaginal delivery. Given the choice between many of these outcomes and undergoing a cesarean - many women would choose the cesarean and the use of technology as it best meets their needs.

Despite evidence of effective individual strategies to curb inappropriate childbirth interventions that focus on either patients, maternity care providers, or hospital policies, little is known about the cumulative effect of a multifaceted strategy to reduce CS birth.

Inappropriate by whose standard? Is it inappropriate to respect patient autonomy? Is it inappropriate to avoid the worse set of outcomes by minimizing their risk and increasing the risk of cesarean? Inappropriate to provide adequate pain relief? Little is known about the cumulative effect of a multifaceted strategy to reduce CS birth - but it is absolute foolishness to think that such a strategy is going to come without some harm. Maternity care needs to focus on what really matters, and that is not "mode of delivery" - it is healthy and happy outcomes that best meet the needs of individual mothers and babies.

As a final slap in the face, a cartoon accompanies the article (below) - a complete caricature of a doctor and a patient making a medical decision. Under the cartoon is the disturbing statistic - 10 percent of mothers (without prior cesarean) would choose it, fewer than 2 percent of mothers actually have a cesarean as a result of maternal choice.

Sunday, June 28, 2015

Living a Life with Purpose: Jenn Hooper

One of the things that has been really incredible over the last few years, is meeting people (either in person or virtually, as the case may be) who are truly living their lives with purpose. Living their lives beyond themselves and taking their own experiences to help others. The sort of people who are living the kind of life that is remarkable and inspirational, the kind of life that is humanity at its best.

Jenn Hooper, Charley's mom, the founder of the Action to Improve Maternity in New Zealand is a remarkable woman (also on Facebook). As a result of lapses in care while she was pregnant and delivering Charley, her daughter was born profoundly disabled. A heartbreaking tragedy - Jenn and her family were failed by New Zealand's maternity care system and her daughter paid the price and faces a lifetime of disability. The kind of situation that is overwhelming and crushing - that destroys whatever expectations a person has about how life should be. What is remarkable is how Jenn has taken the reality of her life, as it is, with what has happened to her daughter - and through Action to Improve Maternity New Zealand has tirelessly worked so that other families might be spared the same outcome and so that other families who are failed by the system and facing the prospect of raising profoundly disabled children have the support they need.

Jenn is also an amazing mom, Charley, due to her disabilities lacks core stability. As a result, Jenn created a brace for her daughter, the "Charley Wrap" and in doing so made a product that helps other children. It is clear, that Charley is truly loved, and that Jenn does what she can to make Charley's life as best as possible, but also seeks to make the lives of others better, in whatever ways she can.

Jenn and her family - her husband, and her two younger sons - spend their winters (as they are in New Zealand, winter is June, July, August) in Bali. While they are in Bali - they employ a nanny to assist with Charley and the baby (Jenn recently gave birth to her youngest son). Once again, Jenn is seeking to help someone else. This morning Jenn made the following Facebook post:

Sulikah is Charley's much loved nanny while we are in Bali. We have known her and her family for a good few years now after meeting her as she did her normal daily job of collecting bottles and cans from the rubbish tips and bushes along the beach and roads near our rented home. She needs to collect 100 small water bottles to make 60c and 60 cans to make $1. They have nothing, and ask for nothing, but always manage smiles and love towards us and everyone they encounter.

The land their current house is on has been sold and they now have 3 weeks to get out. The landlord has already started demolishing it. Sulikah and her husband now sleep in their Warung (shop) at the front - their heads are about 3 meters from the main bypass traffic. They also don't have beds. They sleep on bamboo mats directly on the broken concrete floor.

They have worked hard in the 10 months since we were here last and have secured rent on another piece of land for 10 years. It came with the very beginning foundations of a small house, which Hasan (never having built anything before) is making into their new home. He's doing it alone because they have no money to pay for labourers.

My mission right now is to gather as much money as I can - even if that means to just keep enough materials coming in so that Hasan can keep working on it.

Please look through the pics and read the comments on each one and consider what life must be like for them. Then consider giving a little (or a lot) and help me to help secure their home and livelihood for the next decade - they so deserve it.

If possible, I'm aiming at raising a few thousand dollars. It may mean that you go without a cup of coffee next time you're at Wild Bean. It may mean a dinner of beans on toast instead of steak one night this week. Or it could mean a day's pay goes to them instead of saving for those extras this Christmas. You might consider asking at your workplaces or through your church groups - every little bit helps.

Donations can be paid into my PayPal account - - or directly into my NZ bank - 12-3278-0004747-00 - and I will get it changed to Rupiah.

You can't change the world, but you can change THEIR world. And God knows they need it.

Thanks for reading


I wish Jenn the best on her mission to improve the life of Sulikah and her family. Jenn is living a life with purpose, and demonstrating that doing so can make the world a better place.

Wednesday, June 17, 2015

No Longer Funny, the Stereotypical CS by Choice Mom - "Baby City" book review

Recently, I was asked to review a book Baby City, written by Dr. Frieda McFadden (previous books include The Devil Wears Scrubs, Suicide Med and who blogs at and Dr. Kelley Stoddard. I will admit, that I only read about 150 pages of the book – for reasons unknown to me my electronic copy became unavailable the other day, as such my comments will be limited to the portions of the book I read (but if/when I manage to find my e-copy I likely will read the rest of it). I will also admit that I tend to stay away from books/movies that include portrayals of childbirth – as I know that I am sensitive to those circumstances. It is fiction, and as such personalities and situations are exaggerated –in general , this book is in line with other medical fictions that have a comedy bend to them (ie. Popular sitcoms The Mindy Project, and Scrubs come to mind).

The book follows an OBGYN junior resident – Dr. McCoy and her colleagues at a maternity ward in a New York city hospital. One of the first “cases” Dr. McCoy and her team handle is a patient who is dubbed “The Princess”. I know that the personalities and situations are exaggerated, however, I could not help feeling really offended by the portrayal of this patient and her care. “The Princess” is a mother who has requested a primary elective caesarean delivery – or a maternal request caesarean. Sadly, every harmful stereotype about maternal request mothers is used to portray “The Princess”. “The Princess” is impeccably groomed. “The Princess” is absorbed by her iPhone and appears to be self-centred, asking for her caesarean to be performed at 37 weeks because she is itchy and fears stretch marks (note, ideally, unless there are good medical reasons for an early elective caesarean, waiting until 39 weeks reduces the risk to the infant). “The Princess” has specified how long and where she wants the caesarean to be done by drawing on her body with a sharpie. She is portrayed as controlling, and at the same time is patronised in the course of her care. Dr. McCoy is critical of the high caesarean rate that the doctor who is providing care to “The Princess” has – but admits that the patients love him. Ultimately, without talking to “The Princess” during the surgery, the doctor extends the line the patient has drawn by an inch on either side – and “The Princess” is portrayed as being completely ignorant of the change after the fact.

I found myself, having to remind myself, that this is a work of popular fiction and to cut it some slack. That portraying maternal request moms as they really are, is not really funny – and that while I take the issues of patient care and maternal request CS very seriously, that there is no obligation for others to do the same. But. But how popular media portrays childbirth and motherhood is part of the problem. How this mom was portrayed in this book is part of the problem. I was disappointed that Dr. McCoy did not make an effort to connect with this mom – to really understand her, to understand the real reasons for her medical choice and to engage in a conversation about the real risks and benefits of the choices that were being made. I was disappointed that Dr. McCoy failed to address the real risks to the baby of an early elective caesarean – namely respiratory problems, and chose to patronise the patient by offering a cream that might reduce the risk of stretch marks. I was disappointed when without so much as a word – the caesarean incision line was extended by the doctor doing the surgery.

The thing is real caesarean by choice moms, are not this stereotype. They are moms who are truly worried about 3rd and 4th degree tears, urinary and fecal incontinence. They are moms who are worried about brain injuries to their children. They are moms who have survived birth trauma. They are moms who have survived sexual assault. They are moms who are educated and reasonable and who want patient centered care where their role as medical decision makers and partners in their own care is respected. They are also moms who are stigmatized and who have an incredibly hard time finding care providers who are willing to work with them to meet their needs. They are moms who do not deserve being caricatured by a stereotype that perpetuates all of the myths about them.

The thing is, had the book taken a slightly different slant, I might have enjoyed it – it was an easy read and the kind of sitcom that I usually find enjoyable. Instead – I was left feeling like popular media will never move past the stereotype of caesarean by choice moms. That an opportunity to portray the CS mom by choice as a likeable character was once again forgone in favour of the cheap shots at who this mom is and perpetuation of all the harmful stereotypes about her; the stereotypes about CS by choice moms that make being a real CS by choice mom a really hard slog for so many women.

I appreciated the opportunity to review the book – and thank Frieda McFadden for providing me a copy to review. I wanted to like it, I just found myself unable to like it and unable to have much more than loathing for the protagonist, Dr. McCoy. The one thing, I really, truly do like about the book is that a share of the proceeds are going to a charity that supports fistula care.

Friday, May 22, 2015

Gone, but not really

I packed up my office today. Took down the degrees. Placed my text books - now ancient volumes on Economics in a cardboard uHaul box. Miscellaneous other stuff (cute kid photos and what nots took up another two boxes). All of which is now sitting in the basement. It likely will not go anywhere, anytime soon, as my new haunt does not have cubicles or offices that are assigned. Rather, employees float from place to place and have a locker that is assigned to them. It is a a departure that does not feel like a departure...I suppose because technically I am still an employee, merely on secondment with a slated return in early December - but on the same token this leaving feels far more permanent than my maternity leaves.

And yet, my leaving lacked closure. Typically when staff leave, there's a gathering in the lunchroom - a card is sent around to be signed and an envelope takes up a collection. Veggies with dip. Cupcakes. Coffee. Parting words.

My parting words were limited - to a quick, "by the way I won't be here on Monday" tacked on to the divisional "stand-up" yesterday and a rather informal e-farewell I sent this afternoon before I shut my office door for the last time. A formal email had not even gone our by the time I had left early this afternoon (Friday's are half days for me - a modified flex schedule).

A decade, and...goodbyes were foreclosed upon. The formal paperwork only just signed yesterday.

Thankful for my colleagues, who have taken the time to do informally what could not be done formally.

In everything there is tuition value - some of the most valuable lessons bruise the soul.

Tuesday, May 19, 2015

Compassion and Support in Short Supply for Victoria Parents Caught Off-guard

There are times when people step up to the plate to do what needs to be done to see another person through, and then there are times when people demonstrate a lack of compassion and sheer contempt for another person’s plight. Sadly, the tale of Wesley Branch, Ada Guan and baby Chloe is a tale where a young couple is thrown into parenthood without preparing themselves, where the details of their lives are put under a microscope and judged – and ultimately where people are choosing to shove another person down instead of giving that other person a hand up. What is really sad, is that the person who is likely to be harmed the most, weighs less than 10 pounds and did not ask for the circumstances into which she has been born.

Being a parent is not easy – even when a person has had the better part of 9 months to prepare for it. Giving birth is not easy – and I cannot imagine it was easy doing so on board a plane enroute to Japan (there are no epidurals at 30,000 feet). Being under the intense scrutiny of the media is not easy. Being a new mom is not easy. Being young and living in a basement suite in a city that is notoriously expensive to live in is not easy. Indeed, it is difficult to not have some sympathy for this couple and their plight.

Should Ada have known that she was pregnant? Probably. Can I understand how that would be the last thing a 23 year-old young unmarried woman of Asian descent living away from home would want to find out? Absolutely. It is not unimaginable that she was on birth control, possibly even birth control that supressed her periods and it failed – for whatever reason. It is not unimaginable that she may have dismissed her symptoms and neglected to seek medical attention. Was it the right thing to do? No. Is it understandable? Yes. Did it mean that her baby was put at risk? Yes – prenatal care has proven benefits to babies in that mothers who are aware they are pregnant can take steps to ensure a healthy pregnancy, birth and transition into motherhood, baby Chloe as a result of her mother’s lack of awareness or willingness to seek medical care was denied access to prenatal care. Further, if there had been any complications during delivery – Baby Chloe had an increased risk of death due to lack of access to appropriate medical care. Did it mean that Ada was put at risk? Yes. Having an unplanned pregnancy and birth is dangerous to mothers. What would have happened had Ada had a post-partum hemorrhage after the birth or some other complication that merited emergency medical care? Ada, as a result of being unaware of her pregnancy status, also put her own health and well-being at risk.

Both Ada and Chloe are incredibly lucky that the pregnancy and birth did not result in far more adverse outcomes for either one of them. However, both Ada and Chloe continue to be in a high-risk situation.

Ada is now a mother, with all that goes with being a mother. It was not a choice that she made after consideration of what she wants in her life, nor a choice that she has had time to prepare for but rather a choice that has been made for her –at a time when her life has been under intense scrutiny. What choices does Ada now have, under these circumstances and under what circumstances will the outcome for baby Chloe be good?

How can Ada and Wesley be empowered to focus on the best interests of their child and be supported in making the decisions that need to be made and doing the things that need to be done to ensure that baby Chloe’s needs are met?

The community response to date is chilling -people have found it in themselves to not only, not have sympathy but to have sheer contempt and judgement for this couple. Wesley Branch is unemployed and on disability. Ada Guan is a student who works part-time. They are 24 and 23 years of age. And until this past week, were living lives that are pretty typical of 24 and 23 year olds in Victoria. They had the audacity to take a trip to Japan – and to unwittingly become parents.

The community has not stepped up to the plate by doing what needs to be done to support and empower this couple at their time of need. Sadly, the couple’s GoFundMe page has raised a meagre $2,070 to date and has a $5,000 goal – a fraction of the expenses associated with new parenthood. Further, the campaign to raise funds has generated considerable backlash – and has likely left the couple feeling isolated and alienated. Perhaps, sadder still is that money is a small part of what new parents need to succeed – and that these new parents have some considerable challenges ahead. Challenges that crowd-funding is poorly equipped to handle.

Either Wesley or Ada (or both) need stable employment that can provide an adequate income to provide safe, clean housing and adequate nutrition – the living wage in Victoria for two parents working full-time to adequate provide for two kids is currently $18.93 per hour. Wesley and Ada likely need career counselling to determine the jobs that they can qualify for and to give them the tools (ie. a refined resume, training, and help with job searching and interviews) they need to get those jobs. Ideally, they would be able to find jobs that also provide extended health benefits, as many prescription drug costs & dental costs are not covered under the provincial medical services plan. Or perhaps an employer could come forward with an offer of employment to assist this young couple? Alternatively, they may need to apply for employment and income assistance.

Wesley and Ada need to get up to speed on caring for an infant. They likely need a reliable family doctor (sadly I note that none are currently accepting new patients) and would likely benefit from training in infant first aid, basic infant care and parenting information.

Assuming Wesley and Ada find adequate employment, they will need reliable, safe childcare. Finding childcare in Victoria is notoriously difficult with spaces for infants being the most difficult to find. Many parents get on waitlists months in advance of their due date in order to have a space available when they need it. Worse yet, childcare in Victoria tends to be notoriously expensive with many infant spaces costing more than $1,000 per month. Again, Ada and Wesley would be wise to look into the BC Child Care Subsidy to mitigate this expense.

Wesley and Ada need adequate housing – they are currently living in a basement suite in Fernwood and might find that it is inadequate for the needs of a family of 3. Most 2 bedroom units in Victoria rent for more than $1000. Wesley and Ada would be wise to contact BC Housing to apply for a subsidized unit to move into.

Wesley and Ada likely need a range of baby goods including a safe crib, a stroller, a car seat (what I’ve just listed often tallies to more than $1,000 alone), clothing, bedding, diapers, formula (or alternatively a breast pump and nursing bras and clothing and bottles if Ada is to continue working), baby toys, etc., etc., etc. As a parent with small children, I can attest that the list of needs for an infant is nothing short of staggering. Some items may be purchased used and that can save some money or better yet, some items might be donated.

Lastly, Wesley and Ada need a communities of of support like those at the Young Parents Support Network and Parent Support BC and Ada needs to find other moms who can help her figure out motherhood for herself and she might also benefit from the baby and toddler groups offered by Mothering Touch or other local drop-in play groups. I would also encourage Ada and Wesley to check out and access Strong Start .

The decisions in the days, weeks, months and years to come are not easy choices and will require guidance, maturity and hard work – a complete departure from the lifestyle they once knew just a few short weeks ago. While their fundraising campaign drew a considerable amount of backlash as the amount originally asked for was thought extravagant, the reality is that this couple is going to need a lot of support going forward. Ideally, the community would step-up to the plate and offer a hand-up to young parents – the kind of support that helps to ensure that their kid does not suffer as a result of being born into the wrong circumstance.

This couple deserves a second chance and a hand-up – or at the very least their baby does not deserve to bear the consequences for the poor judgement and past decisions of its parents. The very least we can do is step-up for the sake of children and we could start by stepping up for the sake of this child. For the sake of baby Chloe, I am hoping that her parents are empowered and enabled to do what is in her best interests.

Sunday, May 10, 2015

A System that Fails to Care, Will Fail When it Matters Most

Hospitals, doctors, nurses - the entirety of the health system is under incredible strain. Back when I started working as a health economist in 2004/05, an "ideal" occupancy rate for a hospital was seen to be 85 percent. This was a level that was thought to be the sweet spot of providing quality care, a level that allowed for surges in demand to happen and would minimize the number of elective procedures that might need to be cancelled due to a lack of capacity. Even back in 2004/05 occupancy rates often ran above 85 percent - but rarely did occupancy rates exceed 100 percent. Fast forward a decade, and the hospital occupancy statistics in British Columbia are nothing short of disturbing. For many hospitals in British Columbia an occupancy rate less than 100 percent would be a dream. Many hospitals are running over-capacity - and significantly so. Numbers well above a 100 percent in British Columbia are no longer rare.

What does an occupancy over 100 percent mean for patients? It means stays in the Emergency Room that do not last hours, but rather last days and might last the entirety of the care encounter. It means elective surgeries being cancelled or deferred as there is simply no bed to admit a patient to. It means discharging patients without adequately considering what will happen after the discharge. When care capacity is stretched too thin in hospitals - it means quality care, the care that patients deserve and trust that they will receive does not happen. When care capacity is stretched too thin - it means those who work in the system, the doctors, the nurses, the porters, the technicians, the care aides (really everyone), are also put under incredible strain and the risks of error and burn out dramatically increase. Ultimately, when a system tries to do too much with too little - it loses the humanity it needs to delivery quality care and to perform well.

It is heartbreaking to read Mrs. Brenan's tale of care in the Manitoba health system. Mrs. Brenan spent the entirety (4 days) of her care encounter in the Emergency Department of the Grace Hospital, she collapsed on her front doorstep and died of a blood clot that moved to her lungs. Others have been discharged to cabs, only to freeze to death on their porches.

Is the hand-off of care of patients to taxi drivers appropriate - is a taxi service adequately prepared, trained or compensated to handle what needs to be done? Is it the act of a "caring" system or is it what a system stretched beyond capacity does to save a few dollars?

It is easy to reduce the transportation from hospital to home as just being transportation. However, patients are not packages to be couriered from one place to another - and the mere reality of being a patient in an overburdened system is that what is adequate for "an average person, a non-patient" may be entirely inadequate for a patient who has been discharged. The reality is that many patients who are discharged from hospital, are not "non-patients" but rather are still patients who are merely going from one place of care (the hospital) to another place of care (home). As such, the standard of care for transportation from one place of care to another place of care is different from what should be expected from a taxi - the taxi standard of care is a failure, as demonstrated by the experience of Mrs. Brenen and others. I would argue that if "the system" is going to discharge people before they are "non-patients" and treat patient residences as extensions of the healthcare system, that transportation from one place of care to another place of care is also part of the system.

Quality care demands that the reality of patients is considered and that their needs are met. Discharge to taxi is a failure to provide quality care - a failure that needs to be remedied, and a failure that likely results from a system that is simply too lean to care.