What I have learned and reflected upon so far since I started school and work up here in New England

PRIORITIZATION

1. Prioritization is a key component of public health leadership, particularly when dealing with finite resources and competing interests. 
2. Too often, policy makers rely on anecdotal evidence, "gut feelings", special interests-backed information, and incomplete data to prioritize populations' health issues.
3. Personal and societal values unavoidably come into play when identifying criteria to be used when prioritizing. But at least, when criteria are defined prior to the prioritization process taking place, more rational and efficient decision-making can take place.
4. Politics and economics always have a spot at the table... it really can't be just about the health and well being of populations.
5. There are some really neat tried and tested prioritization models out there waiting to be used by more people for the purpose of achieving improved  health outcomes for issues that matter most.

LAW AND ETHICS

1. There is never a straight answer about whether something is right or wrong... it is quite mind-boggling!
2. Where does the fine line fall between individual liberty and population health interests? Still mind-boggling...
3. Principles used to support a certain Supreme Court decision may not be used in the same way in other similar Supreme Court rulings. A lot depends on the societal norms and culture of the time.
4. The work I am doing (supervising intense case management of high risk pregnancies) may not be deemed as ethical or moral by some people... I am struggling with this myself as I strive to understand where I stand in terms of female empowerment, gender development, reproductive health rights, and maternal and infant health. 
5. How ethical, moral, and just is DCF involvement in many newborn-removal cases where the mother does not have all the support, tools, and resources necessary to provide a stable environment (as defined by current societal norms)? Why does DCF care about the baby and not a lick about the mother? Wouldn't it be a lot more beneficial in the long term if the mother-baby dyad were treated as one inseparable unit to be supported and nurtured? 
6. A woman who just gave birth six days ago, was encouraged to bond with and breastfeed her child, was subsequently separated from her newborn right before a three-day weekend during which no work was done to advance the case and assure reunification. In the meantime, she has been experiencing depression and anxiety while coping with incredible loss, as well as an incredibly non-supportive partner who kicked her out  into the streets... in a town where all shelters are full and unable to provide the much needed safety net and shelter. Without a place to stay at tonight (or in the days to come) she doesn't even have a way to store her precious pumped breast milk so that she can be made to feel like she is still taking care of her child in this time of hardship, while allowing the baby to get the much needed breast milk from his own mother. Is this system just incredibly incapable of supporting fellow human beings in a time of need or what? It is very discouraging and quite immoral... how can we, as a society, as agencies, as families and fellow human beings let this happen? It is very troubling... and humbling.

Where there's a will, there's a way... I will find a way to positively affect change in my community for mothers, children, and their families while making the best, most ethical, most efficient, and most effective use of limited resources in an environment of competing interests. Bird by bird... keeping my eye on this prize: improved health outcomes, dignity, psychological and social well being of women and their offspring. 

Serendipity

"If you do follow your bliss you put yourself on a kind of track that has been there all the while, waiting for you, and the life that you ought to be living is the one you are living. Follow your bliss and don't be afraid, and doors will open where you didn't know they were going to be."
— Joseph Campbell

I recently moved to a different state, in a town that is not so ideally located in relation to where my doctorate program is taking place, and yet I have felt "at home" from the very beginning and it has been very easy to adjust to life in our new community so far. Serendipity is playing a really large role in my professional career at the moment, as an opportunity has been presented to me, not too long after I moved here, somewhat by chance and destiny-led processes. I am currently exploring the feasibility of it, as it is a full-time opportunity, albeit flexible in nature and potentially closely linked to the work I could be conducting during my doctoral studies.

The opportunity consists of managing a city-based program aimed at reducing infant mortality, infant morbidity, and the number of low birth weight babies born in the city, particularly amongst the largely at-risk population. In this case, the label "high risk" materializes in the form of battered and abused women, socially and economically isolated new immigrants (some legal and some not), users of illegal substances, women living in poverty and suffering from food insecurity, and so on. Through intensive comprehensive case management and coordination with other local MCH services prenatally, intrapartum and postpartum, women enter the program through word of mouth, as well as professional referrals, free of charge, and on a strictly confidential basis. The services provided are quite diverse and include those that would normally be provided by a childbirth educator, a birth doula, a postpartum doula, a lactation counselor, a case worker, a Healthy Start professional, a friend, a family member, all wrapped up into one figure: the Neighborhood Outreach Worker (NOW).


Since its inception thirty years ago, the program has registered a 0 deaths per 1,000 live births rate of infant mortality, compared to the city's 9.8 rate (and the state's and US rates of 6.1 and 6.0 respectively). By the way, the stark differences between the city and the rest of the state as well as the national infant mortality rates are a screaming indicator of health disparities affecting the local population, even when compared to its immediate neighbors in the county itself. As one official put it, "this city is treated as the dumpster of the state."  

No studies or evaluations of the program have been conducted so far and the Director of the Department of Health and Human Services for the city has expressed interest in me conducting doctoral-level research on it to identify possible practices that are contributing to these positive results. Regardless of my dissertation work, for which the topic has not been decided (and is still far from being decided!) I can already think of classes I am currently taking where I could potentially weave this program into assignments for the term. One example is the Health Economics and Financial Management for Public Health class that I am taking this semester: can we make an economic case for the scaling up of programs of this nature? If so, how? Exploring this and figuring out the underlying economic and financial aspects of it will be one of my challenges this semester if I choose to focus on this community program and even moreso if I decide to take on this particular work opportunity!

So it seems like a serendipitous opportunity that was just meant to be, one that I may have even been yearning for the past year at least, but at the same time I am struggling with identifying the right combination and load of work that I feel I can realistically take on and carry out with high quality, strong potential for future development, and fruitful long-lasting relationships and network strengthening.


I'm on the fence... do I leap and believe that the net will appear (adapted from a Taoist proverb) or do I step back, acknowledge my limitations, and choose to forego a really good opportunity that I am just not ready to take on at this point in time because of prior commitments (i.e. commencing a brand new doctoral program with a really cool mentor who also offered me more limited and manageable work opportunities)?

Can you really walk away from something that feels like is meant for you?

Beliefs and plans for this blog

There is no doubt in my mind that through childbirth a mother is born along with her child, and that the hormonal peaks and valleys associated with labor, delivery, and the early postpartum period are a necessary cycle of nature's master plan to create a lifelong bond between mother and child through a deep intricate weaving of bodies, minds, hearts and spirits.

Having gone through this life-changing process myself and having witnessed countless other women tell the stories of their births and breastfeeding experiences, I have an intimate understanding of and passion for physiologic birth and the early postpartum period, along with the powerful energy that this continuum can harbor for a woman and her family's healthy functioning for years to come. It is my belief that birth is not a "one day matter", it is rather a milestone that will be forever branded in a mother's being, subconsciously shaping her daily relationship with her child throughout life and significantly impacting a number of other spheres of her identity.

As I wrap up my Master's in Public Health and prepare to start a new chapter in my professional and academic training pursuing a Doctorate in Public Health (DrPH) with a focus on Maternal and Child Health, I find myself wondering how to best use these upcoming years to maximize my leverage and influence in the realm of birth and breastfeeding. My overarching goal is to become an agent of change to support and promote women's reproductive rights for all women of all races, ethnicities, socio-economic backgrounds, religious beliefs, and sexual orientation. These women deserve nothing but the best, most dignified, respectful, safe, healthy, caring,  individualized, and positively life transforming maternity care delivered to them prenatally, intrapartum as well as postpartum.

This blog is intended as a means for me to further develop my critical thinking and writing on matters related to birth, breastfeeding, and beyond as well as to share with others thoughts, information, experiences and ideas. I look forward to using this blog as a forum for discussion and action on issues that are critical to advancing maternal health in the U.S. and abroad.