The Journal of Midwifery & Women's Health (JMWH) is the official journal of the American College of Nurse-Midwives.Within a culture of inclusion and antiracism, JMWH advocates for health equity, access to quality care for all persons, and excellence in midwifery.Articles published in JMWH include new research and current knowledge across a broad range of clinical and interprofessional topics including perinatal care, sexual and reproductive health
ABSTRACT Estrogen is the central component in 6 of the 100 most widely prescribed medications in the United States today. This steroid has several therapeutic uses including contraceptive applications, treatment of menopausal symptoms, and the prevention of osteoporosis. A wide variety of estrogen replacement therapy (ERT) and estrogen plus progestational hormonal replacement therapy (HRT) preparations are available. In addition, there are an increasing number of products with estrogenic properties that are being promoted as alternatives to drugs containing estrogen, such as phytoestrogens and selective estrogen receptor modifiers (SERMs). This article reviews the physiology of estrogenic effects, estrogen metabolism, and the pharmacokinetics of marketed preparations.
Midwifery can be a consuming profession. The work of midwives is challenging across many dimensions. Providing evidence-based clinical care, teaching midwifery and other health professions students, conducting research, directing practices and education programs, and the many other jobs done by midwives are intellectually demanding. Being present for people through some of the happiest and sometimes darkest days of their lives can be emotionally draining. Working long hours and providing hands-on labor support is physically taxing. Navigating the complex US health care system, or lack thereof, is frustrating. Interprofessional relationships, even under the best of circumstances, require dedication to build and maintain effective collaboration. Many midwives consider the profession to be a calling, not necessarily in a religious sense, but more to express how strongly we were drawn to becoming a midwife. Being a midwife is central to many midwives’ identity. It isn't just what they do, it is who they are. Midwives tend to be passionate, which is a double-edged sword, because it can fuel our work and exhaust us. Between midwives' responsibilities and common qualities midwives possess, it is easy to see how our work can dominate our lives. This can contribute to burnout, which is common among midwives and other health care providers.1, 2 I have allowed myself to have an overshadowing focus on work in my midwifery career. I spent many years pouring an enormous amount of my time and energy into my work. I am proud of my accomplishments but still regret the events I missed and relationships I neglected when I put work first. The counter to overworking is often touted as work-life balance, a concept that I find problematic. This expression implies a false dichotomy in which work and life are opposing forces. Balance suggests there is some sort of perfect weighting between work and the rest of life, yet it is never clear exactly what the scale is or how to know you have achieved the right proportions. A work versus life equation seems unsolvable. Instead of work-life balance, my mantra is “my work is not my life.” This stems from a line I heard on television. I am sure I had heard something similar before, but sometimes you hear the right words at the right time. And sometimes great wisdom comes from unusual sources. In this case, I was watching a rerun of the show ER. In this episode, it is the last day of work for a physician who has an incurable brain tumor. One of his parting comments to a colleague is “Never let your work become your life.”3 I've since heard this expressed other ways, such as “work to live, don't live to work” and “Don't get so busy making a living that you forget to make a life” (the source of the first quote is unknown, the second is by Dolly Parton). How to keep our work from becoming or being our life looks differently for each of us. For work to be part of our life, we have to create and nurture the other parts. Here are 3 of the ways I have successfully made this shift. First, I am clear on my priorities. Family, friends, and my physical and mental health top my list. Those things are intertwined because connection with other people is crucial for our health, as former US Surgeon General Dr. Vivek H. Murthy discusses eloquently in a recent book4 and podcast episode.5 Connecting feels particularly challenging right now when we are in the midst of the coronavirus disease 19 (COVID-19) global pandemic that necessitates physical distancing. However, I've been amazed by the creativity and resourcefulness people have used to connect despite being physically separated. While technology certainly has its downsides, video calls, using virtual meeting platforms for gatherings with friends and family, and social media are great ways to stay connected. I have reached out to old friends and contacted acquaintances I've wanted to know better, both strategies I highly recommend for building your connections. In addition, there are countless online digital communities, including recurring groups such as book clubs. While phone calls and snail mail are less common than in years past, both are wonderful alternatives to digital communication for staying connected. Personally, I love writing and receiving handwritten letters. Second, I know what I need to do to detach from work. For those of us who midwife from our computers, it is easy to stay at them incessantly. For those in clinical practice, there are times when a laboring person wants you to stay after the end of your shift or come in on your day off. Regardless of your type of work, most midwives have an endless stream of incoming emails. Two detachment strategies that work well for me are having clearly delineated days off and turning off work email on my phone on those days. Having our phones with us most of the time can make it hard to truly feel like we are out of the office. Having to physically go to my computer to check email helps me maintain separation from work. Third, I have a number of activities I enjoy outside of work. It is challenging to detach from work when we don't have fulfilling ways to spend our time. The COVID-19 pandemic has limited a number of my favorite leisure activities, such as spending in-person time with people I love and going to exercise classes, but also has provided an opportunity to find new hobbies and resume ones I have put aside. Now that I am spending more time than ever at home, I've rediscovered needlepoint and discovered audiobooks, 2 activities that can conveniently be done at the same time. This year, I am celebrating my 20th anniversary of becoming a certified nurse-midwife. I wish I had embraced that my work is not my life earlier. If you haven't done this already, it is never too late to start. Our life is the big picture, and we decide how our work fits into our life. Taking tangible steps to make this mentality our reality helps each of us bring our best self to work. Putting our lives first isn't just good for us, it is good for the midwifery profession.
