Monday, October 12, 2009

Sowing the seeds of distrust

I have been working on a post lately about why you shouldn't count on being able to advocate for yourself in labor. I worked on it a lot and then started rereading it and thought it, "This is too negative. It is based on fear. I don't want to write posts based on such deep suspicion of all care providers. Many of them are great, and since I want people to be confident and trust in their birth, why should I write a post based in distrust and fear?"

Then I read At Your Cervix's post on delivering babies early because of inaccurate fetal lung maturity testing. I thought, Oh my god. What if those doctors were taking care of my friends or my relatives? And this happened to someone I know? As one of the commenters suggested in that post, there's absolutely a role for staff/public health people to play in establishing systems and safety checks so that no one can practice this way. But in the meantime, am I wrong for not wanting to go to everyone I know who will ever have a baby and say, "Please, please, please! Do your research and choose someone who will treat you with evidence-based care, with respect for you and your baby! And they may be the sweetest, nicest person you have ever met, beloved by everyone you know, and you may want to trust them - but please educate yourself and make sure you are FULLY informed before you consent to medical intervention."

When I was working as a bra fitter, women would come in during their last month of pregnancy to get nursing bras they could use right after birth. I probably worked with hundreds of them over the course of a year. They were beautiful, healthy, round, and looked whole to me in a way that made me sad. In a quiet moment at the store, I once asked the other doula who worked there, "Do you ever look at all these happy pregnant women and feel sad at what's likely to happen to them during birth?" She thought about it for a moment and said yes. We both felt sad, because one out of every three women was going to undergo surgery, perhaps without a good reason but still believing it was necessary. And even if they avoided surgery, most of these women were going to be tied to the bed with catheters and IVs, monitored, pumped full of drugs... and I sensed that even the ones who didn't particularly mind a medicalized birth, didn't fully realize the extent to which it was going to happen.

It is such a relief to me to meet someone who is planning a birth in a setting I know is trustworthy, if only because then I don't have to think about all the things I want to warn them about (but am not going to because they didn't ask). ("Don't agree to an induction unless it's absolutely necessary, drink lots of water before ultrasounds to avoid a diagnosis of low amniotic fluid, don't go to the hospital too early in labor," etc. etc. etc.) And now I've read the above post and I am adding to that mental litany, "Be cautious about an elective early delivery based on fetal lung maturity testing".

Since I usually don't say anything anyway, I can't just use that convenient X-Files line of "Trust No One". But if I was going to say something, and if I am ever going to finish that post, what should I say? "Trust someone, and make sure it's a good one"? "Trust yourself, and hire a doula"?

1 comment:

Sheridan said...

Hmm, thought provoking post. I like how you ended it. Trust yourself and hire a doula! That about sums it up.

I would just add, Educate yourself, trust your intuition and hire a doula.