Women's Health Care Philosophy

I just concluded a class in my women's health nurse practitioner program called Contemporary Framework in Women's Health. I want to share my final paper here as it is speaks to my practice philosophy. It's kind of long, I apologize in advance for that :)

Cornerstones of Women’s Health Care Philosophy

The health of the women in any society is the most essential piece of the health care system in countries around the world. This is my belief and the belief of a leading human development expert, Joseph Chilton Pearce. Several years ago I had the honor of hearing Joseph Chilton Pearce speak to the midwives in Austin about how the birth process affects mothers and babies. Mr. Pearce is a firm believer that women, given the fact that they bear the children of the world, hold the power of creating a more peaceful world through the birth process. I was touched to the depths of my soul in hearing him say that if women are nurtured, fostering a sense of content security during their pregnancies, and allowed to nurture, breastfeed, and bond with their babies in the physiologic way that nature intended, women will bear children who have more robust forebrains. Science has shown that a larger forebrain allows humans to have the capacity to think and feel on a deeper level, therefore leading to the potential for a deeper, more compassionately intelligent human kind. (Chilton Pearce, 1992, 2003). Similarly, Dr. Sarah Buckley states “birth is a culturally and politically powerful act, whose domination represents domination of the feminine principle” (Buckley, 2009, p. 25). These ideas, more than anything else, have helped form my philosophy about what caring for women, especially when they are pregnant, really means.
I believe that truly compassionate care of women and babies can help change the world and bring about an increased level of human connection to each other and the earth. The compassionate care of women, when pregnant and not pregnant, includes: empowering women to take care of their own bodies and make decisions for themselves, connecting on a personal level to encourage a strong relationship with her healthcare partner, and ensuring care that is completely accessible and affordable. These are the tenets that immediately came to my mind a few months ago, and still resonate with me as the most important factors in providing care to women. During the course of this class, new thoughts have occurred to me and I would like to expand on each topic and explore them a bit further in the following paragraphs.
“Empowerment refers to increasing the spiritual, political, social or economic strength of individuals and communities. It often involves the empowered developing confidence in their own capacities.” (Whatley, 2010, para 1). This definition speaks to the necessity of women feeling confident in caring for themselves and their families in order to feel empowered. Women must live into their ability to make decisions for themselves. Not only do the providers need to let go of the notion that they are in charge of the care situation, but women also must seize hold of the opportunity and take responsibility. This might require a large paradigm shift, depending on what part of the world the healthcare provider-client relationship is emerging in. I know a midwife who recently returned from Haiti where she was assisting at births. The Haitian women are accustomed to birthing their babies in, what US midwives would consider, a very undignified manner. This midwife spent much of her time trying to find ways to add a little dignity back into the birth process for these mothers so they might be able feel a little sense of empowerment. An example of this action was placing a plastic bag under the birthing women to collect blood and bodily fluids so the mothers did not have to lie in the fluids after the birth (Iorillo, 2010).
In some societies this shift will be slow and take time to help build women’s confidence in her own abilities to care for herself and her family. It might take gentle, yet firm, teaching of practical skills, and much encouragement. In other societies, such as the community I live in, most women want to and do make their own decisions. I see my role as a midwife, and soon to be women’s health nurse practitioner, as an assistant to the autonomous decision making process of informed consent; to lay out the options of care for them, answer their questions, give my opinion (if asked), and support them once their choice has been made.
An essential part of this empowerment process is helping women understand how their bodies work. Self-knowledge on a physical and emotional level helps women feel in control of the things that can be controlled and helps them to let go and accept the things that cannot be controlled. Truly informing women of all of their options of care, including the plan of doing nothing at all to “fix” something, is the most important, empowering step in actualizing women’s autonomy.
Pregnancy and childbirth is a crucial time in a woman’s life for her to explore empowerment. Each pregnancy and birth is different for each mother and sometimes it takes time, sometimes years, for women to figure out their feelings and thoughts about being a woman and what actions are called for to live into Womanhood. In her book, Birth as an American Right of Passage, Robbie Davis-Floyd touches on this empowerment process through birth. She, in fact, suggests similar ideas that Joseph Chilton Pearce promotes. Davis-Floyd (2003) writes "The core values and beliefs of both individual women and the wider society in which they live condense into visible, focused form in childbirth, where their perpetuation is either assured or denied. It is both my belief and my hope that in the end—or the beginning—the salvation of the society which seeks to deny women their power as birth-givers will arise from the women who, nevertheless, give that society birth" (p. 307).
A society that holds women in high esteem and honors them for their innate creative abilities is a society that will flourish. When maidens, mothers, and crones feel empowered and deeply supported in taking care of themselves and their families, feelings of fear and insecurity are dispelled and clarity of thoughts and actions to support wellness prevails.
Women-centered care must also foster a clear intention of connection. The relationships women have with their care providers should be close, trust-filled, and extremely respectful. The best way to encourage this kind of relationship is to ensure a positive experience from the beginning with thoughtful therapeutic communication. Mark Brennan, project director for community support training at the Missouri Institute of Mental Health in St. Louis, suggests four key elements to therapeutic communication: Being empathic, Being genuine, Being respectful, and Being concrete. I use the word “Being” in front of each communication characteristic intentionally because it might just be the most important part. Often simply sitting with someone, quietly “being”…listening, is very healing. There is connection that occurs in silence. So many times women just want their stories to be heard and acknowledged. Brennan eloquently explains each of the core dimensions of therapeutic communication as follows: Empathy is “understanding someone’s experience through your own emotional and feeling states,” genuine is the ability to “accept this situation, this relationship in the loving and trustful way it was intended,” respect is “positive regard- treat [others] how you would want to be treated,” and he describes concrete as being as “clear as possible in boundary and limit setting, telling the client what they should expect from your relationship and what you should expect that they do.” (Brennan, 2006, time 1:54 to 8:52). When these elements of communication are utilized, both parties involved in the conversation feel they are an important, equal part in the exchange.
A slightly more practical aspect of caring for women that lies at the heart of quality care is affordability; if women cannot pay, they are often left uncared for. This notion leads to the even broader discussion of accessibility to care. According to Amnesty International (2010), “in 2009, an estimated 52 million people in the USA-more than one in six-had no health insurance.” (p. 6). Another piece of data shows that Medicaid paid for 42% of women who gave birth in the US in 2005 (Childbirth Connection, 2010Sakala & Corry, 2008). This is sobering because so many women in the US would not have access to care without government assistance. And, even when women have financial coverage for maternity care, it is often not high quality care. The maternal mortality rate in the US is higher than virtually every other industrialized country and African-American women “are nearly 4 times more likely to die of pregnancy-related complications than white women.” (Amnesty International, 2010, p. 3). Often the paperwork of Medicaid and private insurance companies is so overwhelming that women decide not to deal with it, forfeiting the only means to pay for their health care.
Although an aspect of my women’s health theory supports women being confident and knowledgeable enough to care for themselves on many levels, there are times throughout their lives when women cannot and must not be their own care takers and should seek help. Limited access to care can be a huge hindrance. Of the women who have financial access to health care, many of them are required to see providers who are covered by their insurance even though they do not feel empowered by or connected with them. It is important for women to see care providers of their choosing, whether these professionals are medical model providers or have a holistic background. There are many health care business models that allow for differing fee scales depending on a woman’s economic or social situation. I implore nurse practitioners to find a way to provide high quality, woman-centered care at a fair and reasonable rate to all women.
This exercise of fleshing out my women’s health philosophy over the last few months in this class has been a helpful process in discovering what I will choose to focus on in my midwifery and full scope women’s health practice. Mr. Pearce’s ideas will continue to guide my vision of helping women and society see the vital importance of women being strong, healthy participants in caring for themselves, their families and society.


References
Amnesty International. (2010). Deadly Delivery: The Maternal Health Care Crisis in the USA Summary. New York, NY.

Brennan, M. (Presenter). (2006, June 15). YouTube. Therapeutic Communication Skills. Podcast retrieved November 529, 2010 from http://www.youtube.com/watch?v=xpFkrD02t1A

Buckley, S. J. (2009). Gentle birth, gentle mothering. Berkeley, CA: Celestial Arts.

Childbirth Connection. (2008). Evidence-Based Maternity Care: What It Is and What It Can Achieve. New York, NY: Sakala, C. & Corry, M.

Chilton Pearce, J. (1992). Evolutions end. New York, NY: Harper Collins.

Chilton Pearce, J. (2003). Proceedings from Central Texas Midwives: Fetal/Newborn Brain Development. Austin, TX.

Davis-Floyd, R. (2003). Birth as an American rRight of pPassage. Berkeley, CA: University of California Press.

Iorillo, M. (2010, September 1). Nou La [Blog comment]. Retrieved November 30, 2010 from http://wisewomanchildbirth.blogspot.com/2010/09/nou-la.html

Sakaka, C., & Corry, M. (2008). Evidence-based maternity care: What it is and what it can achieve. New York, NY: Childbirth Connection.

Whatley, L. (2010). Definition: Women eEmpowerment. Retrieved November 2429, 2010 from http://www.selfgrowth.com/articles/Articles_Women_Empowerment.html