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By 'bad' I meant -choices that I or most midwives
would disagree with - such as social (non-medically indicated) induction or
elective C/S.
They might be 'bad' choices in my view but there
are plenty of intelligent women out there whose views are opposite to
mine. I may disagree, I may attempt to inform (and I do, often), I may
even avoid caring for them, but I cannot ultimately make their choice for
them. They are making choices regarding what happens to their own bodies,
not anyone else's, so it cannot be put in the same context as rape or child
beating - I know that these choices affect babies too, but
because they are so commonplace it is hard to convince women that their choice
to intervene unecessarily might also impact negatively on the baby.
An example was on front of me recently: a mum had a
child with Leukaemia, was due to birth the second one. Life was getting very
hard with the care of sick child and increasing pregnancy, she asked to be
induced early to make this time easier, for all sorts of personal reasons as
well as medical ones. This was not the best option for babe-to-come, not
the best birthing option for mum-to-be but it was the best option for the family
unit as a whole. Who would deny this woman's choice in this
situation?
Have you ever tried to talk a smoker into
quitting? The evidence is undisputably in their face but the choice to
continue or not is theirs to make.
Yes, misinformation must be fought. Yes, women must
have good support and advocacy. Yes, to all those things but do we want to be
accused of forcing 'our' beliefs on women?Because our truth is not necessarily
their truth.
Love this stimulating discussion - and please know
that I am in no way trying to offend anyone, just playing Devil's
advocate :-)
Sue
----- Original Message -----
Sent: Saturday, June 17, 2006 3:21
PM
Subject: Re: Re: [ozmidwifery] ctg
stuff
"if
we truly support choice then surely even 'bad' choices should be
respected?"
Why? Solely in the name
of blindly supporting "choice" as a concept? How does this benefit Mothers and
babes? We also have the choice to beat our children, men have the choice
to rape women, and we can also choose to be cruel to helpless animals if we
like. Should we respect these "choices" so as to indiscriminately uphold
the paradigm of choice? Of course not. Why are innately harmful birthing
choices (that affect not only the birthing woman but also her child) any
different? If a Mother has made the decision to bring her child to birth, then
shouldn't the Mother and babe be able to do so as optimally and safely as
possible - why is the "choice" to do so by mutilation and trauma even
available, where it is not optimal practice?
Besides which, do women
birthing truly have "choice"? Or are the options they are TOLD they have
presented to them by a patriarchal system directed at pacifying and
controlling them in order to maintain the status quo and secure the balance of
power; rewarding "good" (compliant) behaviour and brutally punishing "bad"
(well-informed and assertive) behaviour? Women aren't making their "choices"
in a vacuum and the incredible external pressures and aggressive campaign of
misinformation they face strongly influences any directions they may
take. We're far too focused on the choice and not focused enough on the
Mothers and babes at the mercy of those choices.
We need to stop singing
about "choice" and focus on the facts; change the system, squash the
misinformation, advocate for safety of Mother and baby, place the power
back in their hands, and not be afraid to get REAL. Political
correctness has no place in birth and nor does beauracracy.
----- Original Message -----
Sent: Saturday, June 17, 2006 2:20
PM
Subject: Re: Re: [ozmidwifery] ctg
stuff
Choice is an interesting concept: if we
truly support choice then surely even 'bad' choices should be
respected? One of our obs has joked about having a sign made for the
ANC saying 'please do not ask for an induction as a refusal often offends'
because the request comes so often.
However, the other obs will often agree to a
woman's request without too much argument. I have seen instances
where the Ob has told the woman - you are not ready to birth, there is no
reason to induce and if we try you will have a lengthy and horrible
labour. The reply was "I DONT CARE- I WANT TO BE INDUCED" How can
the ob refuse in this instance? The reverse is not true - if a woman
reaches T+10 she is booked for IOL - there is little 'choice' within our
policy for anyone who wishes to wait longer - despite the evidence or the
individual circumstances. Occasionally requests
for 'social' induction can be for very valid personal reasons and
such instances should also be respected.
I have discussed with some of
our obs the mentality of agreeing to elective C/S for no other reason
than maternal request, given that we are a public hospital - should
we be wasting taxpayers money on non-essential surgery etc etc.
Again the question of choice. If a woman demands an elective C/S despite
discussion of the pros and cons, the usual route is to go with her wishes
- presumably for fear of litigation if the birth does not go well. I
did challenge one ob who agreed without hesitation to a woman's request
for repeat C/S and asked him what his attitude would have been if she had
asked for VBAC - did not get much in the way of response!
Not saying that I agree with this you
understand but it does cause some tricky moral dilemmas.
I feel the key issue is one of respect and
honest discussion - ah but that is all too often missing within the
medical model of care. That and education - women don't know that they
have choices to challenge the usual practice of whoever their care
provider happens to be, sadly those who do challenge are often seen as
'troublesome radicals' if their challenge is against 'routine'
interventions. (Of course they are not seen the same way if their
challenge is to request unecessary interventions! :-))
Sue
----- Original Message -----
Sent: Saturday, June 17, 2006 8:49
AM
Subject: Re: Re: [ozmidwifery] ctg
stuff
hi all
i have just finished the 'obstetrics' term of my
course and over the 9 weeks i repetitively brought up my disgust with the
use of CTGs against all the very high quality evidence that is out there
against them, that noone refutes they just ignore. the wonderful
obstetrician who was my supervisor (only one ive ever met that i like)
agreed and said it is only collective inertia and fear that has led to
everyone still using it. the fact that it has sneakily become the best
practice standard. in the big cochrane review on the subject the only
benefit seen was a reduction in neonatal seizures seen in the CTG group.
this was used as evidence that it may reduce the incidence of cerebral
palsy in this group also. actually, there was follow up studies done on
all the studies included in the review some years later and it actually
showed no difference in cerebral palsy rates in most studies. one study
amazingly actually showed a higher rate of cerebral palsy in the CTG group
!! this has been conveniently forgotten. CTGs are still sold to women as
being a safety net to prevent cerebral palsy despite the fact that there
is absolutely no evidence whatesoever of this being the case
all that
remains to be the benefit of CTGs is for care providers. it makes many
people feel safe to have a neat little print off documenting what has been
happening. the other thing is that apparently in the court system, parents
can only be 'compensated' if a no fault verdict is made and that requires
a CTG.
anyway i wrote a huge article about this titled 'the irony of
obstetric risk analysis' and handed it in with my end of term work.
i am waiting with bated breath to hear the feedback and whether i will
fail for being so blatently anti-obstetrics to my obstetric supervisors!!!
but i figured theres less harm saying it all now, on my way out :)
the
reason im writing this is that the (good) obstetrician wants me to put
together my views on social inductions and social elective caesars and how
we should respond to women who sometimes demand these things and whether
it is ethical to refuse. im really struggling with it because if we all
always say inform and then follow the mothers wishes, what right do we
have to refuse this? it is often for what i see as ridiculous reasons (ie
the woman recently who demanded an induction so she wouldnt birth on
6/6/06 and threatened to kill herself if we didnt) but who am i to judge
women's choices like others judge non-interventionalist choices?
id
love to know everyones thoughts on this one
love emily
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