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 Momentarily, I entertained the idea of marking my “X” there despite knowing that she had withdrawn.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?