Time out for bad behavior

This is the first in a series of posts exploring the maternity care crisis in the United States. We will begin by looking at ways to address the two groups of people that need the most educating in order to fix things – medical providers and the women under their care.

I heard recently that someone was afraid of being associated with us because we had a reputation for “doctor bashing.” Really? I thought what we were doing was pointing out when people behave inappropriately. Our local hospital had a policy requiring that doctors stay at the hospital when a midwife was with her patient, but doctors complained about having to be there. We didn’t say, “Bad doctor!” We said, “Hey guys, if you don’t like to sit there, then change the policy.” Just like when your kid does something wrong, you don’t say, “Bad kid!” But you darn sure point out the bad behavior and suggest a better way.

Most people want to stand up for injustice, yet why are we, as a society, so afraid to stand up to physicians? They’re just people, like you and me. They went to school for a really long time and have a great deal of knowledge, but that does not make them better people. They sometimes have bad days and they make mistakes just like we do, and when we make mistakes or behave badly, someone usually points it out to us. So, if two grown ups are in a delivery room with a woman in labor, and one behaves inappropriately, someone ought to say, “Hey, that’s not right!”

Why are we training doulas to provide women with information and to be an advocate for them in the delivery room and then asking them to sit by and watch as their clients are talked to disrespectfully or worse, violated? And if a doula tells a physician he or she is out of line, the doula may be banned from the hospital or get all doulas banned from the hospital. If doulas cannot speak for their clients because they are trained to let the woman speak for herself, it would be nice if nurses spoke up on behalf of the women in their care. But the nurses are in a similar position as doulas, and in many hospitals can lose their jobs if they question the physicians. And I’m sorry, but I’ve had two babies and when you are in labor, you aren’t necessarily in the right frame of mind to stand up for yourself. So if we don’t stand up for the rights of pregnant and laboring women, who is going to do it?


7 thoughts on “Time out for bad behavior

  1. Good points.

    Being specific helps–with both positive and negative feedback.

    It might be time to change your name and take on broader objectives: your midwives are back where they started, right? Still attending births in the hospital, right? So maybe it’s not about looking for your midwives or calling doctors out for their behavior that had eliminated midwives from the hospital, but now it’s about calling on everyone to step up to the plate to improve a maternity care system. That great work will require identifying both the things that ARE working and the things that ARE NOT working, primarily for babies and mothers, but also for fathers, partners, extended family, nurses, doulas, midwives, physicians, hospitals, etc. Once you all know what to preserve and what to change, then the work of change begins. Doctors are going to complain as things change, because they have the most to lose in the reform process.

  2. Thanks for bringing up these important points, Kirsti. Thank you so much, also, Dr. Alleman for your comments. You give us a lot to think about and discuss. (Would you mind if we at WMM? copy/pasted your comments over to Facebook?)

    You’re right that we should identify both what works and what doesn’t work.
    My feeling is that when we witness injustice, we are so flabbergasted by it, that it’s all we can think about. I have been struck mute at times and have struggled later with what I could have done or said differently. The “rough exam” many of us and our clients experience seems almost commonplace. I have heard stories from friends of having their own or their clients’ membranes stripped prior to labor without consent. Rupturing of membranes without consent happens all the time. At one birth I attended, a practitioner pulled a woman’s cervix out of her vagina using sponge forceps “to check for lacerations.” After a beautiful, unmedicated VBAC, all of us in the room were shocked. There was no apparent excessive bleeding. The practitioner must have forgotten that she didn’t have an epidural. Another client was repeatedly told that if she didn’t have a c-section, her baby would “surely die” (because the baby was a footling breech and she had arrived at the hospital complete with a bulging bag.) She pushed out her very much alive baby in 2 pushes 10 minutes later.

    I will be honest and say that when I feel alone, it is harder to find my voice. I wonder if I’m the only one witnessing what I’ve witnessed, or the only one experiencing it that way. I always have to remember also that what matters, ultimately, is my client’s perception and experience of the events. I also know, that when I’m supported by a collective group, I feel much stronger. When my voice joins the chorus, raise our voices together, I feel stronger.

    Are these feelings the vestiges of the bullying that we all were inevitably either victims of, or bystanders to, as children? How do we find our voices as individuals to say, “STOP! That’s NOT ok?” What do we say? When do we say it? These are questions each one of us has to ask ourselves. We have to be advocates for our clients, but if we’re thrown out at that moment or banned, how can provide support and advocacy?

    I want us to get to the point in maternity care where the expectation is that ALL patients will be treated respectfully, without fear or bias. I also look forward to the day when all maternity care practitioners, regardless their training background actually practice evidence-based maternity care, and provide informed consent to ALL of their patients/clients. Yes, practioners are human, and they make mistakes, but mothers and babies deserve our very best.

  3. The morning I received the phone call from my childbirth student asking me, “Where’s my midwife? Why am I scheduled to see a doctor today and not my midwife?”, my blood started pumping and I told her I would find out all I could. I was shocked partly because I have been traumatized by experiences in the hospital as a doula trying to advocate and “protect” my client from what I viewed as abuse. Hearing her shaky voice on the phone just days from her EDD basically pissed me off. She should be focusing on her last few days of pregnancy with joy and support, not the loss of her birth attendant causing her to feel worry.
    To me the mission of Where’s My Midwife is to bring back the Midwifery Model of Care that was stolen from mothers a century ago when our capitalist medical system took over birth.
    Don’t change the name. We are not against … we are for… expanding access to nurturing, patient, individualized care from all who support a family in their most intimate, sacred, life-bringing event, the BIRTH of THEIR BABY.

    “The Midwives Model of Care

    The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

    The Midwives Model of Care includes:

    * Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
    * Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
    * Minimizing technological interventions
    * Identifying and referring women who require obstetrical attention

    The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

    1996-2008, Midwifery Task Force, Inc.”

    More information is available at http://www.cfmidwifery.org

  4. Thanks, Dr. Alleman, for your thoughtful response. We considered changing our name to be more all-inclusive, and even birthed a separate local organization called Women in the Center to try to appeal to a broader group of folks in our community. However, as Carmen points out, we were born out of an injustice done to midwives and it was the type of care that they provide that inspired a small army of women to unite and stand up for themselves and each other. In order to begin a paradigm shift where birth is concerned, I believe it is time to begin telling more truths, to begin openly questioning the status quo. While the professionals spend time doing research to prove what we already know, it will be up to us regular folks to start reclaiming our right to birth where and with whom we choose. We decided as an organization to begin addressing the injustices we see at every level of maternity care because our initial acts of dissent were a direct result of a corrupt system completely disregarding and disrespecting the wants and needs of the very people it claims to serve.

    It is our hope that by hitting the streets with flash mobs, and performing other random acts of mayhem, we will begin to draw in a new audience and reach the women who may not otherwise know there even is a problem with birth in our country.

    Stay tuned for more on these subjects – this is just the beginning!

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