Category Archives: Cultures

“I Cain’t Go Home”

(The following essay was written several years ago, inspired by a patient affected by another senseless murder. Identifying information was changed. )

“They killed my brother this evening! You cain’t send me home!” Ashana insists. Her right forearm flicks up and down rapidly at her side. “I’m not safe! I might hurt myself!”

19 year old Ashana refuses to leave the triage hospital bed. A few hours ago, an ambulance brought her to our unit. She is due to give birth to her second baby in a month or so. We determined that she and her unborn child are healthy. She’s not in labor and is medically cleared to go home.

“Why would you hurt yourself?” I ask, resting one palm upon her denim covered shoulder.

“I might do something. I don’t trust myself now.” Her fingers click as her right arm absent-mindedly flails, alternately thumping the mattress below and swatting her own ripe abdomen. She turns her head side to side. “No, no, I have to stay here!” She stops moving for a moment. “I don’t know what I’ll do if you send me away. I’m upset. The cops, they don’t do nothing. It ain’t right! He just be walking down the street, someone shot him from a car and drove away. Ain’t nobody seen nothing and my brother be dead. I need to stay here. I’m afraid I might hurt myself or do something to hurt my baby!”

Ashana agrees to wait a few minutes for me, while I negotiate on her behalf.

I find Sean, with furrowed eyebrows, walking down the hall.

“Are you available for a non-urgent consultation?” I ask, approaching my obstetrician partner for the night.

After Sean nods for me to talk, I begin. “I have someone in crisis because her brother was just murdered. She’s medically stable at 36 weeks gestation. I want to admit her overnight for a Psych evaluation in the morning.”

“We can’t keep her.” Sean responds as I expected. “There is no medical indication. We are too crowded already. And no insurance nor medicaid will pay for a psych admission on an OB unit. We have too many non-billable expenses. She’s a Psych case, not an OB case.”

“Sean, you know the Psych unit won’t accept patients this late in pregnancy. She needs to stay overnight and get a hold of herself. Her brother was just murdered, for God’s sake.”

Sean shakes his head, “We practice obstetrics. She doesn’t need us today.”

“Sean” I flirtaciously lock his eyes with mine,“We dedicated our careers to keeping mothers and babies healthy. Ashana is asking for our help. She had nowhere to go. She is here alone. Believe me if I could avoid this, I would. Unfortunately, this hospital’s protocols require me to consult with you for a non-labor situation.”

“I won’t authorize it.” He responds, “We are not a psych unit!”

“That’s news to me!” I smile and tilt my head to the right. We both roll our eyes and chuckle remembering various family dynamics we daily encounter. “Seriously Sean, I refuse to discharge her home. So, it’s your choice. I can transfer her to you right now. Then you can discharge her. Let’s see how you feel when she’s found injured or dead after you sent her home.”

Sean leans his head back, looking toward the ceiling. He doesn’t have time for this. “If we admit her, the chart will be reviewed for a non-billable diagnosis.”

“Fine.” I quip. “I’ll talk with the hospital’s interrogation board the same way I’m talking to you.”

“What do you suggest?” He sighs.

My cheeks broaden to a smile, knowing I’ve won my friend over, “I’ll keep her overnight for fetal observation, per your consultation. She’ll eat dinner, then I’ll order either Ativan for anxiety, or Morphine to knock her out for a night’s sleep. In the morning, Psych can make a plan for her. She’ll be here less than 24 hours so the cost will be minimal.” After a brief pause, I add, “Sean, your heart knows this is the right thing to do.”

Sean’s shoulders relax. He nods assent.

I give him a quick thank-you hug, then turn to walk back to triage.

Sean calls out, “Don’t make a habit of this!”

First and last breath – May holiday murders bring renewal

This week the western world prepares to celebrate the birth of a child born into poverty from an underage teenage mother who was traveling with an older man. After he grew to adulthood, this baby was crucified because he dared preach of a peaceful world.

The recent plight of America’s holiday murders finally opens public discussion about firearm access. America must face ugly realities already familiar to inner cities because an armed madman opened fire on innocent children and teachers at Sandy Hook Elementary School. America is shocked that this happened in the mostly caucasian middle class town of Newtown Connecticut. Only the week before there was a shooting at a shopping mall in a Portland suburb, and today another in small town Pennsylvania.

Sadly, American inner cities are accustomed to the slow slaughter of their youth. This video, less than 8 minutes long, addresses the increasing homicides in Oakland California and grass roots efforts toward solutions. Increasingly, children are collateral damage to the casual violence.

These inner city deaths occur with such frequency, either singularly or with only a few victims at a time to poor people with brown skin, that the press does not celebrate them. Murderers usually escape without investigation. Their annual death toll come to many times that of last week’s innocent deaths in Newtown Connecticut.

As of late November 2012, Oakland’s homicide count alone was already at 115 (link here).

The problem is greater than “gun control”. It’s a multifactorial issue of poverty, lack of opportunity, lack of direction, lack of educational resources, deeply embedded anger in a growing segment of our population, and more.

A nurse co-worker of mine recently posted this photo on facebook:

Oakland photo by Jennifer Carraher, November 2009, printed with permission

Oakland photo by Jennifer Carraher, November 2009, printed with permission

My work gives me the privilege of welcoming new babies in the economically and racially diverse Bay Area. Every week families discuss memories of a recently murdered loved one who will never meet the new baby to be born into my hands. The absent family member who was murdered within the last year is usually a husband, brother, father, cousin, nephew, uncle or son.

Bystanders are also shot but not necessarily killed. One laboring woman incessantly scratched at a tangled scar which had grown over shrapnel embedded in her arm. Several years before she did her best to dig shrapnel out of her arm herself, after she tired of the 10 hour wait to be seen in Highland Hospital’s emergency room. She had been splayed in crossfire because in her words “I was walking down the wrong street at the wrong time.”

Too many of my patients say, “It’s not safe to walk in my neighborhood” when I suggest they take a daily walk as part of an exercise regimen to help their diabetes or blood pressure.

Our nation is complicit in senseless shootings through collective acceptance of easy access to firearms and inadequate educational and work opportunities for the poor. Social inequities, lack of opportunity, mental illness, and poverty have historically been a recipe for small and large revolts. Small constant revolts have been occurring in America’s inner cities for years. The media pays attention now that this violence spills over to white communities.

During this season of rebirth, may we remember the only guarantee when a baby takes his or her first breath — there will be a last breath. Society can minimize the chances of a premature last breath caused by preventable violence.

Hopefully the mourning community of Newtown Connecticut inspires national discussion and some active solutions. For all our sakes.

Maybe therein lies today’s celebrated end of the Mayan calendar – the end of the world as we know it.

Robin Lim Accepts Birthkeeper Award

Robin Lim, CPM and 2011 CNN Hero of the Year, accepts the first Jeannine Parvati Memorial Birthkeeper award from the Association for Prenatal and Perinatal Psychology and Health, in San Francisco on November 16, 2012.

Robin Lim is an outspoken advocate for accessible and gentle maternity care. With unstoppable dedication, she authored over 20 books and speaks around the world, trains midwives and physicians to provide respectful competent maternity care. Robin founded Bumi Sehat, a nonprofit organization which provides perinatal care, birth services, a host of ancillary services such as literacy education and geriatric yoga groups in Nyuh Kuning Village outside of Ubud Bali, Indonesia. Bumi Sehat was among the first responders to provide health care services in Aceh, Indonesia after the 2004 tsunami devastation. She works exhaustingly to run her organization and promote accessible and gentle maternity care.

Conference attendees clamored for photo opportunities with CNN’s midwife hero. Yet, there was a notable absence of journalists for Robin’s scheduled press conference. Robin used the time to speak extemporaneously with a group of admirers. She discussed her work in Bali and the e-votes which created a consumer landslide for her 2011 CNN Hero of the Year award. As always, Robin encouraged health advocates to continue working for accessible health care, health maintenance and preventative programs. She told birth stories and discussed challenges of working cooperatively with Indonesia’s health care system.

As birth guru to those who promote healthy and respectful childbirth, especially home birth. Robin Lim and Ina May Gaskin are living embodiments of the women’s self-care revolution that began in the 1960s and 1970s.

Robin spoke of the importance of love, sparking a personal cord in the hearts of her listeners. She said birth advocates should love adversarial physicians and legislators, rather than speak against them, to build bridges for midwifery practice. Some of Robin’s admirers openly criticized and validated one another’s remarks such as, “Hospitals take the baby away,” “Hospitals don’t treat women as people,” “There is no privacy,” rather than seeking common ground from which to build rapport between health care providers.

Stemming my own frustration at a destructive us vs. them mentality, but honoring Robin’s authority, I contributed only, “There are respectful providers within the hospital system also.”

Robin’s admirers’ awe reminded me of ancient Birth Cults. While good can be wrought from inspirational movements, one should never relinquish critical thinking.

Robin and I have a deep and abiding friendship, commitment to each other’s families, and are passionate about our work. Like many close friends, we don’t always agree.

Our long complex history began in 1974 at Goleta’s Dos Pueblos High School near Santa Barbara. Robin was the young campus political activist while I was the teenage ideal respresentataive for Maharishi Mahesh Yogi. We were in awe and intimidated by one another. Robin’s mother would not allow her to visit my home because she feared the cult of Transcendental Meditation. I lived with my mother at Maharishi International University’s makeshift campus in a rented stucco apartment building in nearby Isla Vista.

In time, Robin and I both spent time on the fringes of Maharishi’s Transcendental Meditation (TM) Movement where our lives crossed every few years. We were teenage destitute mothers who divorced abusive meditators. We both coincidently became midwives who practiced midwifery in Fairfield Iowa’s TM community (at different times). Thanks to Robin’s support, she allowed me to conduct medical anthropology research in 1997 (over 20 years after we met), documenting indigenous birthing practices in Bali for my graduate thesis through the University of California, San Francisco.

One of Robin’s favorite topics is Lotus Birth. “Lotus birth” means never cutting a newborn’s umbilical cord at birth. Robin speaks of lifelong attachment trauma from severing the cord. Robin advocates keeping the placenta attached to a newborn baby until the cord and attached placenta fall off, possibly a week after birth. At the minimum, Robin suggests to delay cutting the cord for several hours after birth. Robin referred to, in her view, needlessly “violent” images of scissors cutting an umbilical cord in otherwise lovely photos of gentle births.

Robin promises a peaceful future from the practice of Lotus Birth. This makes no sense! The placenta is an organ to support life inside the womb only. Every mammal cuts or eats the umbilical cord and placenta at birth. It is a far stretch to imagine lifelong trauma from cutting an umbilical cord.

Lotus birth is not scientifically valid, nor is a delay of several hours after birth before cutting an umbilical cord. For all of Robin’s fabulous work, it’s a shame that she avidly promotes this. The extreme practice of leaving a dead placenta attached to a baby can be hazardous. There is a very real risk of causing coagulopathy (dangerous clots or bleeding) by keeping a newborn attached to a dead useless placenta for a prolonged period. “Lotus birth” is a modern new-age ritual that lacks scientific basis. Promoting such radical practices can undermine the credibility of any well-intentioned health care provider, and can prove risky for babes.

Research and logic value delaying cutting the umbilical cord until it ceases pulsing oxygen and blood into a newborn (the number of minutes varies with each birth). Placental function keeps a newborn brain oxygenated while the lungs adjust to extrauterine life. Placental blood is baby’s blood; it maximizes newborn iron stores. But dead meat, e.g. a nonfunctional placenta for a mythical “Lotus Birth”, creates a needless risk.

Last evening, Robin invited me to join her for dinner with other home-birth goddesses : Nan Koehler, Robbie-Davis Floyd, and the adult children of late luminaries Jeannine Parvati Baker and Mary Kroeger.

Robin laughed with the group over dinner, “Of course I vote from Iowa, it’s a swing state. Every vote counts.”

Robin still lists the Transcendental Meditation community of Fairfield, Iowa as her American address, voting from Indonesia via absentee ballot. Earlier this week, Fairfield Iowa’s mayor declared November 13 as “Robin Lim Day”.

Robin then reached across the table, holding my hand. She smiled “Gina, can you imagine? I spoke about orgasmic birth, women’s health, sperm and contraception to Maharishi School and in Fairfield High School’s packed gymnasium. I thought of you all those years ago, as the first ‘Ru to attend high school there when you were the only TM teenager.”

“Something good is happening” I responded, quoting Maharishi. We laughed, raising our beer and hot sake to toast for divine retribution over grilled Ahi. Others at the table would never imagine our family’s shared victories over twisted cult histories.

Only last week, Robin spoke at several events in our former home-town, the home to Transcendental Meditation’s Maharishi University of Management (MUM). Robin is an inspirational, funny and charismatic speaker. Her heart warms to share her passion with a community that was integral to her family. Decades ago, the TM community valued celibacy and families were marginalized. She is (as am I ) gratified to see Fairfield’s meditation community acknowledge the importance of women and children’s issues. After our battles for children’s issues years ago, maybe there is hope. Our beloved community is awakening. Robin plans to actively maintain connection with her Fairfield supporters.

In the early 1980s, the TM community marginalized Robin, a few others, and me for our outspoken advocacy on behalf of children. Our concerns conflicted with Maharishi’s instructions to abandon children for hours daily to attend group Program (meditation) and Maharishi based meetings, atop necessary employment. Robin’s home, others’, and mine became de-facto orphanages for many TM neglected youth. Many young adults who were raised in Fairfield during those years developed very real problems.

Ironically Maharishi University of Management’s website now highlights Robin’s recent Fairfield honor, as can be seen here. MUM capitalizes on any local notoriety.

In her public talks in Iowa, Robin decried that her Fairfield honor is in a state where the practice of (non-nurse) midwifery can be tried as a felony, for practicing medicine without a license. Whereas, Certified Nurse-Midwives, like myself, are legally recognized in Iowa. A side note, Ina May Gaskin, the original advocate for home birth through her influential hippy-era book, Spiritual Midwifery, is an Iowa native.

Robin’s husband, Wil, and I stood behind Robin’s adoring crowds during the AAPPPH conference events. We caught up on family news while Robin met with other friends and adoring fans.

“That sport coat looks great on you!” I complimented Wil on his elegant jacket of raw silk.

“I picked it up at Fairfield’s Bargain Box for four dollars.” He said. We laughed with shared memories of a favorite thrift shop, where penny conscious shoppers purchase the pre-owned cast offs of Maharishi’s wealthy followers.

“That makes sense. That’s a used Raja jacket.” Bowing with my hands in prayer position over my heart, “Raja Wil. You are beaming today.” I teased him as a lofty Raja, a title with gold crown bestowed upon those who paid one million dollars for several months of prolonged meditation with Maharishi.

Will shrugged, “No one here knows that.” Fortunately, Wil never learned Transcendental Meditation.

“Hey, You can’t beat four dollars for a tailored silk jacket. That’s even less than it originally cost for custom tailoring in India.”

Old friends are the best!

For those in the Bay Area — On Sunday evening November 18, 2012, a fundraiser to support Bumi Sehat’s work, will be held in Santa Rosa, California. For information about this event, please look here.

Donations to Robin Lim’s Bumi Sehat foundation can be made here.

United… States, Nations, World

Well dressed young people with briefcases and cell phones speak openly in native Spanish, Arabic, Korean & French. Pretty blond baristas sing out coffee orders to overhead Cuban jazz. There are no shameful foreign whispers in Starbucks this morning.

United … States, Nations, World… I suppress a tear as I sip my nonfat latte.

Multiethnic professionals are beginning their workday with hope, moving forward after President Obama’s successful reelection yesterday. This is America’s future.

Our country has hard work ahead. No strangers to hard work, today’s young adults lived their family stories of overcoming hardship. Together they face their generation’s very real problems, putting aside hatred to heal for personal and common good.

With a little caffeine and Cuban jazz, they build the future.

I am both tired and inspired.

Mother’s Day for Peace

Mother’s Day began as an anti-war protest. Fifty years before America granted women the right to vote, mothers protested that they did not give birth only to send their children to war. Mourning mothers who lost sons and husbands in war directed their pain by advocating for peaceful methods of conflict resolution.

Hallmark came later.

Following the carnage of the American Civil War and the Franco-Prussian War, the lyricist for the “Battle Hymn of the Republic” wrote her 1870 “Mother’s Day Proclamation” to incite women to demand peace, rather than send offspring to war.

As we honor our devoted mothers with flowers and champagne, may we remember to assume co-responsibility to shape society and unite our voices – to protect all children.

Mothers’ Day Proclamation: Julia Ward Howe, Boston, 1870

Arise, then, women of this day! Arise all women who have hearts,
whether our baptism be that of water or of fears!

Say firmly: “We will not have great questions decided by
irrelevant agencies. Our husbands shall not come to us, reeking
with carnage, for caresses and applause. Our sons shall not be
taken from us to unlearn all that we have been able to teach
them of charity, mercy and patience.

We women of one country will be too tender of those of another
country to allow our sons to be trained to injure theirs. From
the bosom of the devastated earth a voice goes up with our own.
It says “Disarm, Disarm! The sword of murder is not the balance
of justice.”

Blood does not wipe our dishonor nor violence indicate possession.
As men have often forsaken the plow and the anvil at the summons
of war, let women now leave all that may be left of home for a
great and earnest day of counsel. Let them meet first, as women,
to bewail and commemorate the dead.

Let them then solemnly take counsel with each other as to the
means whereby the great human family can live in peace, each
bearing after their own time the sacred impress, not of Caesar,
but of God.

In the name of womanhood and of humanity, I earnestly ask that a
general congress of women without limit of nationality may be
appointed and held at some place deemed most convenient and at
the earliest period consistent with its objects, to promote the
alliance of the different nationalities, the amicable settlement
of international questions, the great and general interests of
peace.

Julia Ward Howe
Boston
1870