The Shaming Has to Stop

soapbox7

Get ready for a major soapbox post.

I get it. Those of us who choose to birth outside the box are different. We make choices that don’t necessarily follow mainstream society norms. Our choices may not be in alignment with what is embraced by the obstetrical model of care. Our choices may make medical professionals feel uncomfortable, challenged, exposed. I get it, really I do.

But…

That doesn’t give a healthcare professional the right to deny care in order to shame women and midwives, to bully us, or to punish us into submission because a laboring woman didn’t choose what the medical professional thinks we should do for ourselves, for our children, or for our clients.

Yes, this really happens. All. The. Time.

And, it never should. Ever.

For the most part, people who choose to give birth outside of the hospital feel that giving birth in a hospital is like using a sledgehammer push a thumbtack into a cork board—way too much fuss for something that most people can do on their own—and that a healthy woman having a normal birth in a hospital is asking for trouble. It isn’t that doctors have bad intentions. Most of the time, doctors and nurses have the very best of intentions. But, once a woman walks into a hospital, she will need to be “treated.” And, once a normal labor is “treated” (read, “interfere with”), risk is introduced.

People who choose to give birth outside of the hospital view the medical community as a necessary resource if the normal process doesn’t go normally. Most of us don’t hesitate to seek medical care if there is a need. Yet, why would a woman hesitate? Why do so many of home birthers/birth center birthers distrust the medical community? The lack of trust in the medical community exists because women have been burned many times, and women share their stories with each other.

As a midwife, I’ve personally seen patients yelled at, forced to have vaginal exams despite an explicit refusal, and verbally abused (put down, shamed, coerced, threatened). Doctors have yelled at me, attempted to discredit me in front of my clients, and threatened me with complaints. Why? Is it because something was done wrong? No, quite the contrary. All of these things happened because of a hospital transfer when a mom needed non-emergency help. Yes, these examples occurred during non-emergency transfer situations.

You might think, “Well, during a birth, the hospital staff acts this way because they worry about liability.” OK, let’s assume a medical professional was upset about that. Does that warrant abusive treatment of women and midwives? Quite honestly, does their bias or fear of liability even matter? Their job is to treat whoever comes through the doors of the hospital. Federal EMTALA laws protect a woman’s right to be treated in labor. ACOG supports patient autonomy even if the provider feels the woman’s choices are in conflict with the provider’s belief that her choices are unwise. A practitioner’s unprofessional behavior actually increases the provider’s liability by failing to respect patient autonomy and by refusing to provide the same level of care they would give to any other patient they serve.

This lack of professionalism experienced in the hospital sometimes extends beyond the birth. This is where I feel like the treatment is almost entirely punitive. While I can understand the frustration and stress of a provider who receives an in-labor hospital transfer, this type of post-birth discrimination seems like coercion and punishment for a family making choices that a provider does not personally support.

After a normal, healthy birth, the midwife’s scope of practice is normal newborn care throughout the first 6 weeks. The midwife conducts all of the usual assessments and then recommends the family see a pediatrician for a normal well baby visit at the end of the six-week period. The family calls to make an appointment.

Hold the phone! Wait a second, they won’t see the baby? Why not? Some practices won’t see the baby because the baby was born at home. Say what? They won’t see the baby for 6 months because they didn’t get the vitamin K shot? You’ve got to be kidding me!

Do physicians have the right to deny those people care because they disagree with their choices? For instance, is it OK for a pediatrician to refuse to accept a patient into care because the mother doesn’t breastfeed her baby? Would it be OK if a pediatrician refused care for families who homeschool? No, of course not. Yet, in many cases, with the population of families we serve, if a family has refused for their newborn anything from the mainstream model (such as a Vitamin K shot or erythromycin eye ointment or hepatitis B vaccine), they encounter judgment, fear, or a refusal of service.

It is unethical to refuse care in an attempt to coerce or bully a patient into consenting to care they have refused. It is unethical to refuse care as a way to punish families for their choice to give birth in a way that you do not agree with. It’s morally wrong.

The shame that is heaped on families who’ve chosen a path outside of the mainstream standards has created a culture of resistance and distrust, and that’s not good for anyone. Women and their families should be able to count on a multi-tiered model of care. If a woman plans to give birth at home and the labor takes a turn, she should be given a high quality of care during her transfer, and when she becomes a patient at a hospital. What if instead of shaming, a medical professional chose compassion? Understanding? And what if the medical professional were trained to see themselves as an important part of the picture for women who choose to birth at a birth center or at home?

The shaming has to stop. The punishment has to stop. Is it any wonder we don’t trust you? The distrust has been built on years of mistreatment. It rests on the shoulders of those in the medical community who lack professionalism, who don’t separate their own personal choices and/or training from the choices of the women and midwives who come to them in good faith and in order to see a labor to a successful and safe conclusion.

This dynamic needs to change. Show women that you can treat them with the same respect their midwives show them. Help women to make informed choices, and then respect their right to informed refusal (without trying to make them feel bad about the final decisions). Welcome us—the birth team and the laboring women—so we feel we can come to you for help when it’s needed. Welcome us, so we don’t feel like we want to wait a little longer to see if things get better because we’re scared of how we’ll be received when we arrive at the hospital. Welcome us, so we know we can share our stories fully and honestly with you, without fear of mocking or teasing—or retaliation against our clients.

If the goal is truly to provide good care and not to punish people whose views differ from your own, it’s time to do something to make a change for the good. Every time we interact with you, you have a golden opportunity to let the medical profession shine. Don’t blow it. Help us walk towards you instead of away from you.

If you’re a doctor or a nurse and you support families who make choices that aren’t in alignment with your protocols, this post is not about you. Or, maybe it is. Maybe this is a love story about you. You are the people who give me that glimmer of hope that change is possible and that midwives, consumers, and the medical community can work together to make outcomes better for mothers and babies, and make the experience better for all of us.

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Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

A Traditional Hospital Birth is an Oxymoron

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

When I ask someone whether they’ve considered having their baby at home or at a birth center, I often hear them respond with something like, “I decided to have a traditional birth in the hospital.” This generally makes me smile, because giving birth in a hospital is hardly the traditional way to give birth! Traditionally, women have been the healers in communities. Women have traditionally held the wisdom of the healing power of herbs, and carried the rich oral history of birth and healing from generation to generation. Traditionally, older women taught younger women how to care for their own families and neighbors, thus training the next generation of community healers. Women tended to the sick and the dying, as well as to the birthing women in their communities. The experimental way to give birth is this relatively new idea of giving birth in the hospital with doctors. It has been only recently that healing became the more male-oriented profession of medicine.

Nigerian Midwife Assisted Birth

Note the upright position adopted by Nigerian women. U.E. Egwatuatu.

Midwives have been helping women give birth since before recorded history, and most of the people alive today were born into the hands of midwives. Just a little over a century ago, in 1900, midwives attended half of the births in the US, and only about 5% of births happened in hospitals. By 1939, about half of women gave birth in hospitals, virtually all with twilight sleep. By 1960, 97% of births happened in hospitals. Why the dramatic change? Was it because hospital birth was safer?

No. In fact, when doctors first began attending births, and births began their shift to the hospitals, outcomes for mothers and babies worsened significantly for a while. The experiment was a horrible failure! Part of this decline in safety was due to a lack of care taken in prevention of the transmission of infections. Doctors would go from doing autopsies straight to catching babies, without even washing their hands. It was no wonder that infection became rampant. Once the connection was made between hygiene and infection control, outcomes began to improve. Men in obstetricsOne big reason births moved to the hospital was women’s desire for pain control. It was an attractive option for those who could afford it, which made hospital birth a show of affluence and status, as well as a desirable choice for women who were afraid of the pain of childbirth. The use of “twilight sleep,” where women were given amnesic medications during labor and knocked out for the birth, became a popular option. Doctors would have to use forceps to help the babies be born, because the mothers were unconscious and unable to push the babies out themselves. Of course, these deliveries were risky, causing a lot of damage both to mothers and babies.

Now, we have generations of people in the United States who have only known hospital births for their family members. Looking at my own extended family, I believe I may have only one living relative (other than my own children) who was born at home, and she will be 104 years old this year. Most people’s reference point for birth is that it is a medical procedure. In the media, we see hyped up shows like “Maternity Ward” and “A Baby Story” that show highly interventive, medicalized, often scary births. Most people see that as traditional, normal, and oddly somehow safer than an out-of-hospital birth, rather than what midwives know as the truth of birth: birth with midwives is traditional, normal, and safe, emergencies are rare, and birth almost always works or there wouldn’t be so many people on the planet. Midwives, and more specifically midwives who attend out-of-hospital births, are the birth practitioners who are guardians of traditional, natural, physiologic birth. We’re the only health care providers who ever see births that are truly natural.

Hospitals have made huge improvements over the years in trying to make birth more family-centered, but even the most natural-minded hospital-based practices don’t come close to a home birth or freestanding birth center experience. When was the last time you heard of a hospital birth where a woman with no IV (or saline lock) gave birth attended by the midwife she’d seen for all of her prenatal visits, birthed her baby in a quiet, dimly-lit room, and caught her own baby in a birth pool in whatever position she wanted to be in? We home birth and birth center midwives see that kind of stuff all the time. Fortunately, as people become more educated about midwifery and about the benefits of the midwifery model of care, the tide is beginning to turn. People are increasingly seeking the help of midwives for their babies’ births, and are returning to traditional care. Modern day midwives are increasing in numbers, especially in out of hospital settings. The Internet, films like The Business of Being Born and Orgasmic Birth, as well as help from organizations like The Big Push for Midwives, MANA, and NARM have all helped to increase awareness of birth options for families. The links below are full of historical information about midwifery, traditional birth, and about continuing struggles for the freedom to choose where and with whom a woman may give birth. Something to think about the next time says they want a traditional hospital birth.