Saturday, March 08, 2008

Holding Court

I attended the local CNM conference last night to view Ricki Lake's film. What a powerful evening. The film was powerful, but what came afterwards was even better. After the film, they had a panel that included three CNMs, one MD, and a homebirth consumer. The homebirth consumer spoke very eloquently on why she chose homebirhth. What I found surprising were the responses of the professional members of the panel. The MD, who practices alongside CNMs, said basically that doctors are demonized (my word, not hers) and that they shouldn't be because they don't have all the power. I agree with her to a degree. Docs are bullied on everyside, the insurance companies tell them how to practice, the hospitals close them in, their patients come with birth plans, yada, yada, yada. I really do understand the pressures that come to bear on physicians. On top of everything else, they always have to be on red alert for that lawsuit coming down the pike. However, they have fallen into a mode of practice that shifts the burden from them to the patient. I have to say, they've taken the easier route, they haven't really fought for women. As for the CNMs- I'm moved by their plight. I get that they are between a rock and a hard place. CNMs have it worse than physicians. They have to appease their physician collegues, while trying to maintain some resemblance of the midwifery model of care, often in environments that are hostile to their presence. But even in the hallowed halls of midwifery, some have chosen to go along with the status quo to keep the peace, be seen as an equal, whatever, but the net result is the same- women lose options, and are subjected to unneccessary medicalized treatment that puts them and their babies at risk. A few step out and do homebirths, fewer still keep fighting for change within institutions. Look I get all this, I really do, I've seen it all up close and personal. Hospital-based midwives have to fight hard for their little piece of the pond with the big sharks always hovering waiting for them to fuck up. I'm grateful to the hospital-based CNMs- I just don't think it's enough. Women need more options. All these people keep saying they don't have the power, but dammit somebody's got it! The docs don't think they have it, the midwife doesn't think she has it, the L&D nurse sure doesn't think she has it, and the doula doesn't think she has it either. Now each may have a share (some bigger than others) but ultimately WOMEN possess the greatest share of power. BIRTHING WOMEN HAVE THE POWER. It's just that they often don't know they have it, and are easily tricked into giving it away. That's the premise upon which I build my mission. I want another social movement powered by birthing women. Women can vote with their feet and their pocketbooks by not settling for status quo medical treatment. Then things will change because the market responds to consumer demands. If women stood up and demanded the births they wanted, all their allies would 'come out of the closet' and lend some power to the equation. As things are now, women have given up birth, they fear it too much to fight for it. Fear is a powerful catalyst. Most people think the antithisis of love is hate. It isn't, it's fear. Where fear rules, love cannot abide. American women need a love affair with their bodies that puts them at peace with birth. One midwife got it right when she said we need to start with teaching young girls. Most American girls are socialized to disdain their bodies instead of being in awe of them. Birth becomes a betrayal, an affirmation that their bodies don't work right.

The words of Morningstar keeps echoing in my ears "All the midwives' daughters are having cesareans..." (Hell, even the young midwives themselves are getting inductions and cesareans- I say this without blame or malice, just stating an observation.)

They problem is systemic, so the solution will have to be also.

We have so much work to do.


Anonymous said...

How can a woman stand up with no choices now? I mean, women just think they can go to the hospital with their birth plans and they will be okay. They run into a nurse with an agenda and a hospital policy, and they have to go against their very nature and argue with her. Then, they only see their provider for a total of 20 minutes. The provider might say things to sway the woman but often (if it's an OB in my experience) the provider could speak up for the woman but doesn't. Nurses do have much of the power I see from my standpoint as a patient. Once in labor in the hospital, a woman has very little power. The power she might have comes before going to the hospital, but then the fear is there as you say. The unknown (which birth often is) is scary. What if my baby is the one who has a cord slip into my vagina and I need an emergency c-section? Though it's rare, women know about this. They don't really know the risks of going to the hospital, but they sure know what can go wrong. They do not understand what the monitor is saying (and how ineffective it is) but are told the hospital must monitor them. So, when the monitor gives a low number, they don't know they can get that number up by changing positions many times. They also don't know that they never had to be on the monitor in the first place. Women trust. That's what we do. We trust that the nurses, doctors, and midwives in the hospital will do what's best for us. Often times the medical model does what is most convenient for the medical people. It's not really for the mom. Even my nurse this last time said, "I'm keeping the monitor on you for me, it's not really for the baby anymore, it's for me so I can feel more comfortable." What? Of course, I was already there, already feeling bad for arguing with her. I didn't want to be a bad patient. And remember I had a false positive on a stupid screen that said my baby might have Trisomy 18. I didn't want to have my baby at home and have her die right away if I could buy more time in the hospital. However, my baby didn't have t-18.

I don't think women are stupid for going to the hospital, but they are ignorant of their rights. I was told after the birth that I could have signed the fetal monitoring away, could have signed a lot of it away. No one tells a woman this.


Anonymous said...

Oh, my comment comes in light of the lack of choices in the on the Kansas side no birth centers. So, it's the risks of homebirth or hospital. Which one to choose? Both have risks, I weighed them last time and went to the hospital. I have a healthy baby but was put at great risk. I would go to a birth center now instead, but that choice is gone. Also, the social expectation is to go to the hospital. Though you are out here, you are read by people who WANT to read you.

You are right, educate the young. Get the nurses into the public schools talking about birth in sex ed in a REAL way. Even in college, no one talked about home birth. We learned about vaginal mucous, but not homebirth. Classes for birth also are hospital focused (often sponsored by the hospital, duh). There needs to be more classes offered out of the hosptial setting. The options need to be shared outright. OB's need to be freed to back up midwives who attend births at home. Midwives who really act like midwives need to be allowed in the hospital.


Laborpayne said...

All your comments are valid. What I meant and didn't say is that women have power "en masse" not neccessarily as individuals. See my next post.