Labour is not comparable to running a marathon

I know a lot of friends/family won't want to read about the birth story of my baby girl, and that's fine, but know that you've been warned at this point if you're uncomfortable with the topic to stop reading. I believe that birth should be shared and this might help women like myself to be able to better accept birth as natural and normal. I will also go over what I have learned throughout my experience and what I hope to change for the next time around. All of this means if you do continue to read my post, I would appreciate no rude or discriminating comments (not that I've gotten any, but this is very personal and my sharing this with the world is a ginormous step for me). Thank you.
Physically, things went amazingly well through my pregnancy. I was shocked because you are typically supposed to have all sorts of awful symptoms and you wouldn't have a doubt in your mind that you were pregnant (I'm sorry if you did experience these!). I was so convinced that I must be dying of some end stage female cancer that it honestly never crossed my mind that I could be pregnant though I knew with my presenting symptoms that my doctor would be doing a pregnancy test. My only symptoms were that I caught a nasty cold that I couldn't get rid of which made it hard to breathe and the reason I thought I had some female cancer related to this was short periods (3-4 days) and the fact that I could feel pressure in my low right pelvis.

I went into labour thinking throughout my pregnancy that because I was able to complete a half marathon, that labour would take the same strength and dedication. I mean, everyone tells you that labour is like running a marathon. I figured since I had completed a half marathon that I was set!

Me finishing my first half marathon!

Once labour was established, I was fine, it was painful- don't get me wrong, but at this point it was totally manageable (started about 6pm). At 11pm when my water finally broke, I was 6 cm dilated and the pain rose exponentially. At this point, I realized that labouring and giving birth was nothing like running long distances. They are completely different, but maybe if I was able to train for my labour like I did for my half marathon, I would have had a better go.

Training for my half marathon wasn't easy, but I had plenty of it (training) and felt quite prepared. During labour and birth I got so lost because of my personal fears and lack of being around natural births and natural birthing information. So, by 3 am I was begging to go to the hospital for something, anything. We live 35 minutes away from the hospital and I don't think I could sit down much less put a seatbelt on. I was in so much pain that I was vomiting and proceeded to do so in the car, too! This was definitely an awful car ride (I imagine it was for Baby Daddy too! Sorry hun!). How I wish I had close friends to call in the middle of the night who knew about this natural birth I so needed.


We go to the hospital and I'm wheeled up on what felt like the coldest night (yes, this was June!) to the perinatal unit. It was such a blur and I am still irrationally aware that people I work with may see me in a compromised/indisposed state. I am so happy that we aren't going through the ER but when we get up to the unit I desperately try not to look around for people I know until I get into my room. I end up getting an epidural because that's what I'm offered and I can't think clearly anymore of other options. I'm shaking because of the pain and am terrified that I'm going to become paraplegic because the anesthesiologist will miss and hit my spine. I am temporarily taken away from these thoughts because as I lean over more amniotic fluid gushes over my midwife's shoes and pants. I am SO embarrassed. Fortunately, the pain goes away, but this makes me realize what's going on and how exposed I will be in the setting I really did not want to end up in. There was nothing going wrong except that I couldn't handle the pain. I remember saying something like this upon my arrival and all the nurses in unison awwwed and one said, "You aren't a failure, hunny. You are doing the best you can." Or something like that. I felt like a failure. I still kind of do because I wish I had learned more and opened up more before trying to do it all on my own.

Okay, so, I get the epidural and it was a great one at that. I have since found out it's called a 'walking epidural'. Don't let the name fool you, you're not allowed to walk. I am then strapped down with fetal monitors and have a nurse feeling my belly with every contraction that I can no longer feel. Everything felt like it was 'pins and needles' and if I just moved a bit more, I could wake up my legs and walk around. No dice, I just made the nurses job harder as with all my moving around they had to keep adjusting the fetal monitors. I also had to have a catheter put in which my mind is screaming "germs! Easy path for infection!" But that goes in anyway. I still to this minute don't know if they deflated the catheter balloon when I was pushing. I can only assume they did for my pelvic floor and for my baby's head's sake.

After the epidural was in, everybody was able to rest. Of course, everyone besides me and the nurses. I couldn't sleep so I chatted a bit with the nurses and had to know everything they knew. I at least was resting from the pain and was able to lay down now. At 6 am I was checked for end of shift routines and I was almost ready to push whenever I "felt" ready. I waited, like any good nurse would, for shift change and as the new nurses were coming on I was asked: "Your old classmate (whom I've gone to school with for 4 years!) is supposed to be your nurse this morning. She's okay with it if you are." I'm thinking, of course she's okay with it! But, why would I be? It's not like I was ever close enough with anyone in my class to let them see me push a baby out of my vagina while supporting me like I needed. Obviously, my answer was a resounding no. Then what felt like two minutes later another nurse comes in and asks me if a student could come and watch. I just looked up desperately to Baby Daddy and he says, "You don't have to say yes." Which I reply, "Of course I'm NOT going to say yes! I would appreciate it if everyone would stop bothering me with redundant questions!" (This is paraphrased. I doubt I was able to manage such a long sentence after being awake for more than 24 hours!)

After I settle back into things with the morning shift nurses and am checked for (what felt like) the millionth time I have the go ahead that I can push as the baby is in the right position. I haven't a clue how to push I am pulling up on the bar in a squatting position, I am laying back on the bed, I am laying on my side and then the other, but in this position I must keep my leg up on the incredibly high bar that my foot can barely reach which makes staying in this position incredibly tiring. I end up pushing for 2 hours when a new anesthesiologist comes into my room and as she's nattering off who she is she is giving me more medication to numb me. No one consulted me. A ton of people then entered the room, half of whom I know. I started bawling, I didn't want to be seen like this. No one spoke to me at this point other than to tell me I was having another contraction and should be pushing. I was exhausted and could no longer feel 'pins and needles' I felt nothing. I felt less than human. I had to relearn how to push - make my muscles work when I couldn't feel them even in the slightest anymore. I felt betrayed. I felt completely out of control. I hated the decision "I" made to have an epidural. I should have known how to deal with this pain, I should have done what was right for my baby. After another half of an hour of trying my hardest to push DD out I was done. I couldn't do anything anymore. I had been in labour for 16 hours and was ready to let them cut me open. Instead of a c-section, they gave me an episiotomy. This is where they figured I'd end up and why the anesthesiologist gave me more medication without my consent. DD was born after 2 and a half hours of pushing.

My midwife put the baby on top of me and I didn't know what to do with this little peanut but I remember sobbing, choking out the words to DH that she was the most beautiful thing I'd ever seen. She was perfectly healthy and loved snuggling from the first time we held each other.

Thank you to all who helped me along this journey and continue to do so. Even if I haven't been able to have my preferred birth, I appreciate all the help and continue to learn from my experiences.

How could I not be thankful to have this happy, healthy little girl?

How Nursing Changed My Life (about Talking Trash)

So, you may be wondering why a nurse would bother learning about waste as this is where I focused my public health classes of my third and fourth years in the BScN program. Well, I guess it's not that far of a stretch for nurses to focus on waste of the hospital as we do a lot of focusing and colourful charting on the wastes of our patients! Let me enlighten you on what I have learned... (about garbage, not excrements!)


***NOTE: I am aware that this is just the surface of a HUGE discussion. I'm not really giving many answers here, just exploring options about what happens with the options we have now and how else we can do things, mainly in hospitals. There are many things I won't go in to detail about, but please comment as I'll write more about those topics later. But please, don't comment on the terrible choppiness in tone of this post. I made the terrible mistake of trying to convert an essay while keeping a lot of what I originally wrote. Anyway, you may proceed, but be warned!

Introduction

The facts are pretty clear now and I think that most of us agree that it is necessary to do something to counteract the process of climate change. We propelled this unnatural process during the industrial revolution and have created many new technologies that have made our lives easier and allows us more time to do other interesting things (like you know, reading blogs!). This has meant that there have been steady gains in the human population but because industries and people’s new way of living, immense amounts of garbage and pollution have been produced. The contribution of waste, specifically in medical facilities, proliferated when HIV/AIDS became epidemic in North America in the 1980’s (De Boer & Spink, 2008). There was little known about the disease and how it was contracted. People’s response was fear because there was limited knowledge of how HIV was transmitted (as is what happens anytime there is something we don't know how to control - we find a way to feel like we're in control; Think the plague and killing dogs). This fear strengthened the trend for the use of disposable medical supplies right alongside our wasteful habits at home. While this problem cannot be seen in the same light as the pandemic of HIV/AIDS or any other disease/illness, it is a problem that has been quietly affecting people’s health (which had happened before this time regarding other illness/disease and to see an interesting time-line of garbage, go here). 


Interesting facts to note:

• The World Health Organization (WHO) estimates more than 150,000 deaths and approximately 5 million ‘disability-adjusted life years’ (DALYs) annually as a result of increasing incidences of disease and malnutrition caused by global warming (Physicians for Social Responsibility, 2007).

• Infectious medical waste, “such as sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials need to be treated before being incorporated into the landfill” (WHO/ Pruess, A., Giroult, E., & Rushbrook, P., 1999, p.78). Incineration is widely used around the world and is usually selected to treat wastes that cannot be recycled, reused, or disposed of in a landfill site (WHO et al., 1999, p.78). Properly incinerated waste drastically reduces the spread of disease and infection, which is a great thing because as we all know cleanliness is something hospitals pride themselves on.

So, where do these statistics come from resulting in deaths and DALYs?


Part of the issue is when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride ( PVC same plastic generally found in shower curtains ) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions and/or in bottom or fly ash (ash that is carried by air and exhaust gases up the incinerator stack) (WHO, 2008).


There are many adverse health effects that happen because of exposure to these toxins, and dioxin is a known carcinogen (aka cancer causing agent) which “poses a host of health problems as it is bioaccumulated in the environment and eventually consumed by people” (Sattler, 2007, p.3). This information is not known or understood by the general public which adds to the ignorance of not implementing proper and safe recycling practices at hospitals.


Also, an interesting fact: "Excessive costs of waste management in countries that over-regulate medical waste management –based more on political issues than on scientific data– [are] draining health budgets, which are particularly meager in developing countries” (Volkow, 2003, p.121).


Should we be putting this stuff in landfills instead? 


No, the practice of filling up landfills with disposable product and incinerating hazardous waste both create more work for health care professionals by unintentionally harming people through the practices that aim to heal. According to the WHO, 75-90% of healthcare waste is similar to domestic waste (2008). This is referred to as health care general waste which is made of “paper, plastic, packaging, food preparation, etc. that has not been in contact with patients” (WHO, 2008). Did you hear that? Never been in contact with a patient! But what do many of us envision when we think of medical waste? The biohazardous material that has a high possibility of being infectious or laden with disease, this is what I thought too before getting into health care. This misconception is also part of the reason why purchasers of recyclable material are hesitant to accept the 75-90% of medical waste from hospitals that is fully recyclable. Education plays a big role to implement change regarding this false belief, so I hope some of this is sinking in!


I'm sure many of you have heard from someone that garbage in landfills doesn't break down and that you can find 25 year old hot dogs and 50 year old newspapers in decent condition. That is true and you can read about the University of Arizona's Garbology project that started shortly after the first earth day here. But landfills (which are different and slightly better than just an open dump) do breakdown on the outside and what we throw away does leach out when it is broken down, to combat the toxins from being produced, this is a general idea of how most landfills work:

“A thick plastic liner is placed on the bottom of the landfill and perforated pipes are laid down to collect the leachate for treatment at the wastewater treatment plant. This reduces the impacts to groundwater and surface water. Gas generated in the landfill from anaerobic bacteria is collected for burning or generating energy. The main component of landfill gas is methane which is 21 times more potent a greenhouse gas than carbon dioxide. A clay cover is placed on top of closed portions of the landfill to reduce the escape of the methane. Soil material, including ground wood waste and biosolids, are placed on top of the clay to provide a surface for grass to grow and enable methanotrophic bacteria to capture the methane that seeps through” (Regional District of Nanaimo, 2008).

This system only reduces the effect on our environment; it cannot completely keep the waste out of our air, water, and soil. As a nurse, I know that I throw out a LOT of garbage for every patient I have (generally 4 patients per nurse). We use countless styrofoam cups, straws, and lids, food, medical supplies, paper for the never ending charting, and the list goes on. With this knowledge gaining public attention, more people should be concerned with our environment and know that landfills can only get so big before we are living in our own waste. More programs are starting up and people are supporting these to help reduce the strain on the landfills and in turn, promote health in our environments.


Many of the employees working at hospitals are very focused on cost, this is a business despite many people's vision of Canada's public government funded system who think they deserve everything for free there. Because hospitals care of the sick is and should always be a hospitals first priority, management of waste is not seen as a high priority. 


So, what can we do?


Wait for my next post on garbage (Hopefully won't be as long of a wait as this one was!)


Until next time, 
Karlily