Pregnancy

Your entire being must have quaked when that angel showed up in brilliant glory. You couldn’t have been more than a teenager; a young, plain Jewish girl. Betrothed to a man who knew you not. And when Gabriel appeared and knocked you to your knees, it says you were perplexed by his strange salutation. He called you favored one, but your favor stretched beyond that moment. You were born with it.

You recognized his words, the ancient ones, written on tablets from long ago, written on doorframes and on your heart. The King was coming. You knew He would. And yet you had no idea that He would be coming through you.

You ran to Elizabeth’s house, confident that she would understand the miracle, because she was on the journey, too. Her formerly barren body was bursting with new life and you must have known that she would be expecting you. And when you came reeling through the door, the little babe inside of her leapt because he recognized your voice. The voice of the woman carrying our King.

And as women do, I’m sure you dissolved into tears and held each other tightly. And stared incredulously at each other’s swollen breasts and flat bellies, wondering what toll this would take on your youthful frames, and how you would ever make it through the next nine months.

It says that you stayed there for three of those nine, without your mother. Without the man who was planning to divorce you silently. You needed to be next to someone who was full of belief. You needed another woman, a sister. You needed her strength to pull you through, to remind you of the words written long ago. Someone who would help you remember, when the progesterone and estrogen were at immeasurable heights, that you were favored among women. Someone who would lie beside you in bed and whisper the prophecies of old when you were too tired to repeat them yourself. Someone who would sing over you, “For the Mighty One has done great things for me; And holy is His name,” over and over, while holding your hair as you threw up in a bucket.

What happened when you left there? When your clothes were getting too tight and people were starting to whisper? When you had to walk around in the city with a protruding belly and no man beside you?

Perhaps you stayed up late into the night, feeling tiny hands and feet and hiccups on the inside. Rubbing your belly and struggling to get comfortable on scratchy sheets with swollen feet and heartburn. All the while knowing that the Messiah was growing within you. That every nutrient you placed in your body was sustaining Him, that your very blood was carrying all of His unmet needs and that soon His would be shed for yours.

Nine months cannot be long enough to comprehend carrying the Savior of the World. And yet you tried. You pieced things together, pondering them and storing them up in your heart.

And then it was time. And in the midst of this, you had to drag your contracting body onto a donkey and ride miles and miles to a town far away through the cold, dark night. And when you finally arrived to the City of David, I can only imagine the pain-stricken look on your face as Joseph carried you door to door, trying to find a place to lay your weary self down. Filled with dreams of hot water and clean sheets and quiet.

But instead, you were led to a barn, where you had to stretch yourself out with the animals. And with every labored breath, you inhaled the stench of dust and excrement. And as you twisted and writhed on the hay, you must have been crying out in disbelief that the King of all Kings would be born here. In the midst of this mess. In the midst of your mess. And my mess. Amongst all things unworthy.

And yet He was.

And still is time and again.

And you had no idea that your anguished cries would be matched by His own someday and that the blood that you spilled for Him would pale in comparison to the blood He would spill for you.

I was asked by The Maternal Health Task Force to guest-write an article in honor of International Nurses Day on May 12. The following post was what I submitted.

One of the most wonderful things about being a nurse is the unique role we have with our patients. This role automatically encourages vulnerability and transparency from patients to express things that they may not express to their physician. Furthermore, it is a role that comes with immense responsibilities to be both compassionate caregiver and attentive advocate. Part of that responsibility means acknowledging the disparities in access and quality of care that many minorities face—an often overlooked and underlying factor that can contribute to poor maternal health. Increasingly, studies are showing that patients who face cultural and language barriers have worse maternal and infant health outcomes.

Generally, research has demonstrated that patients report high levels of satisfaction with their nurses. However, a recent study by Wikberg, et al released in 2010, explored approximately 1160 female patient perspectives from over 50 countries on the provision of intercultural maternal care in the Nordic countries and found that this area of care had been extremely neglected by nurses. These results seem especially disturbing given that pregnancy, labor and delivery are some of the most sensitive, unguarded times for any woman and should be handled with the utmost respect by clinicians.

Similar to Alice in Wonderland…

The researchers compared the women in the study to Alice from Alice in Wonderland. Like Alice, these pregnant women find themselves caught up in the wonder of a foreign land – not knowing where to go or whom to trust, experiencing communication problems, and meeting strange or unkind people – all the while desperately needing medical and emotional attention. The common feeling these women described was powerlessness: not knowing what was happening to them, not being listened to, and not being able to influence the situation. Consequently, these women became silent, passive, and avoided or interrupted the care being provided to them.

A few nursing considerations…

Education of different cultures is not enough because there is a risk for stereotyping when differences are focused upon. Nurses need to not only learn more about the specific cultures of their patients; they must learn what their patients need, want, and expect on an individual basis. During the initial visit, the nurse must inquire after the patient’s personal wishes and concerns surrounding her care.

Secondly, professional interpreters of the same sex need to be available for the patient. When this is absent, true communication that promotes the relationship between nurse and patient cannot occur. Educational materials in other languages must be available, as well, so the patient has a variety of resources to ensure complete understanding of what is to be expected during pregnancy, birth, labor, and the postpartum period.

Finally, a culturally diverse staff of nurses is also important so that when situations arise like a patient who has undergone the trauma of female circumcision, culturally and medically competent clinicians are available to provide optimal care.

In conclusion…

Walking through pregnancy, labor and birth with a woman is a privilege and an honor for any person, especially one who is responsible for providing medical attention and care. As nurses, we must strive to protect this vulnerable and beautiful time for every woman by honoring her personal wishes and providing her with the highest quality care despite language or cultural barriers; thus preserving every woman’s dignity – and even our own.