Last year, I wrote a post called, “Time Out for Bad Behavior” which was supposed to be the first in a series. And then it didn’t really pan out that way. I’ll be honest here – I have a hard time writing about these issues. I was raised in a household that used the dreaded phrase ‘be a good girl’ which has taken quite some time to get over. If I got angry or upset, I was told, “quit yer cryin’.” Also, it was made quite clear that no one wanted to see a woman get angry because then everyone would think you were (God forbid) a bitch. But now I have daughters, and if I don’t talk about the problems I see with our maternity care system, they will have to get pregnant and give birth under the same messed up conditions that I did. So, I have to talk about it! I have met folks in the birth-y world who very strongly believe that we ought to just keep it positive and plug along, don’t talk about the problems, don’t be negative. And that’s exactly why nothing is changing. That’s more of the same ‘be a good girl’ thinking that keeps us stuck. How can anything improve if we don’t talk honestly about what is not working? Being almost 40, I have been given the gift of time and wisdom, and I’ve come to realize that it really doesn’t matter what other people think of me, what matters is what I think of me. And I have also realized that not talking about it makes me feel miserable, makes me feel like I am part of the problem. So, let’s talk about providers in the hospital setting. . .
I recently had a conversation with a physician (we’ll call him Dr. X) who had quit obstetrics and opened a birth center. Yay! He also said that while he was practicing obstetrics, his c-section rate was only 5% – again, Yay! But, he then shared the fact that he had colleagues who had c-section rates close to 50% – boo. And Dr. X claimed he understood why – huh? Dr. X said he was recently named in a lawsuit from a birth that happened years ago because the child was diagnosed with ADHD and the family was claiming birth trauma was to blame. He said that if it wasn’t for such a ‘litigious society,’ physicians would not feel so much pressure to perform cesareans. WHA?! I get it – doctors who get sued have to deal with really high insurance rates, and might even get sued personally. That really sucks. But the key word here is MIGHT. They might NOT get sued. And if it is perfectly acceptable for a physician to perform defensive medicine in order to protect his own livelihood, why don’t we talk about the countless women whose livelihoods MIGHT be impacted by an unnecessary cesarean? Why is this physician’s livelihood/lifestyle more important than the women he serves? What of all of the women who end up with physical issues stemming from surgery that last a lifetime? Is a physician’s life more important because we value doctors more than we value women?
And another thing – why aren’t the providers taking some responsibility for the ‘litigious society’ that they helped create? If you are going to claim that the hospital is the safest place to have a baby, to claim that you have all of these fancy machines designed to prevent anything from going wrong, then you better have a good explanation when things inevitably do go wrong. Essentially, women are being told, “Trust me. Just lie back and let us take care of everything for you.” If you ask a woman to give up her power to you, she is participating in your version of birth where the woman is just a vessel and your only goal is to take a live baby out of her. But somewhere along the line, she is going to realize that what happens to her in birth is going to stay with her forever. And you lied to her – you told her to trust you and that everything would be okay if she does exactly what she is told. If she is a ‘good girl.’ So of course she is going to be upset when she does what she is told and something horrible happens. In her mind, you were doing everything TO her, so it is your responsibility, not hers. Of course you’re going to get sued! You promised she wouldn’t have to participate in her own birth, that you would do all the work.
But there are no guarantees in birth. No matter how many fancy machines you have, injury and death are always a possible outcome. And no matter how much you might want to control birth to prevent a bad outcome, it is never really the care provider’s work to have control over. It’s that woman’s labor, and the work needs to be HER work. It took us a long time to forget this important fact, and it’s going to take a lot of work to help women and the people who care for them to remember and act accordingly. So, let’s start talking about it.