FROM
YOUR BIRTH RIGHTS
Mothers and Doctors
Relationships between women and their doctors take on an extra dynamic during pregnancy. Up until that point a woman has probably been used to managing her own health and that of her family (and possibly even her friends) alone, and often with great skill.
People often look to the women in their lives as the first point of contact when they are ill. Many illnesses are never reported to the doctor because women deal with them at home. The fact that most of these illnesses are minor does not make the job of tending to them any less skilled. As researcher Helen Roberts has pointed out:
Women may not be taking out the appendix, treating the duodenal ulcer, or stripping the varicose veins, but they are doing the bulk of health care in our society, the bulk of preventative work and, possibly, even giving the bulk of advice. This advice is so much a part of our everyday lives that we hardly even see it as advice: 'Don't eat that, Sam, it will rot your teeth', 'Try rubbing in some oil to get rid of his cradle cap', 'A dry biscuit in the morning first thing when I was pregnant used to stop me feeling so sick. Why not try that?' There is, though, a real cold war over women as producers of knowledge about health care. Doctors have long warned us about going to another woman for advice...
Curiously, though, when women need professional help and go to doctors for advice they are not always given what they need. Often they are given reassurance rather than information or they are made to feel like irritating little girls who are taking up the doctor's valuable time with trivial worries, instead of grown women asking legitimate questions. This is a paradoxical attitude from a profession determined to preserve its image as 'expert'.
Of course, what is said here (and throughout this book) about doctors can also apply to midwives, health visitors and all other practitioners whose training emphasises their role as experts who are in charge of a 'situation', rather than partners in a unique, natural process.
The relationship between women and doctors is further complicated during pregnancy by the presence of an unseen third party: the baby. The concept of the baby as a patient is relatively new: It evolved when x-rays, and later ultrasound, enabled doctors to see a child in utero for the first time. The fact that the baby is now seen, rather than imagined, to be a living thing makes differences of opinion between mothers and doctors potentially quite significant, giving rise as it does to conflicting sets of emotions and values.
For instance, while most women might assume that a doctor would only advise a Caesarean with the safety of mother and baby uppermost in his mind, research shows that fear of litigation is the primary reason why doctors perform this operation. Equally, a doctor's enthusiasm for antenatal testing, or offering a termination as a 'solution' to a baby with abnormalities, may come from pressure put upon him to keep hospital statistics for abnormalities below the national average, rather than a concern for the mother and baby. A mother may have more complex and personal reasons for agreeing to tests and choosing or refusing a termination.
While some medical advances have certainly helped in the management of complicated pregnancies, for the majority of women with straightforward pregnancies and healthy babies it has meant simply that doctors now have power over two lives instead of one. For a woman to be involved in making decisions about her care, practitioners must relinquish some of that power. It is a concept that can be deeply threatening to the majority of practitioners (particularly obstetricians) of both sexes.
Some practitioners have even less rational reasons for the things they say and do. For, example, a doctor who expresses disapproval of labouring in water or home births may simply be trying to hide the fact that he has no professional or personal experience - or indeed any training - in these areas. A midwife who tells a moaning woman in labour not to make so much noise may be uncomfortable with her own sexuality and thus the sexual noises a labouring woman makes. A health visitor who encourages a mother to bottle feed an infant may have 'failed' to breastfeed herself and thus have difficulty accepting that other women can succeed'.
In addition, few of us realise how traumatic medical education can be. The hours are long and the level of stress is enormous, and, particularly in obstetrics and gynaecology, the focus is always on the abnormal and the times when things go wrong. Most practitioners are trained to act, not to observe. So when they are called upon to exercise the kind of expectant watchfulness appropriate to maternity care, they feel anxious, disempowered and under-employed. The extent of the psychological damage that the system inflicts on practitioners, and the way this is passed on to mothers, should not be trivialised or ignored.
As a result of their education and experience, each of the three main types of practitioner - midwife, GP and obstetrician - has a very different perspective on birth. Broadly speaking, for the midwife birth is a personal and social event; for the obstetrician it is a medical one; for the general practitioner it falls somewhere in between.
What is more, birth can look very different placed in different contexts. A hi-tech atmosphere, so common in hospitals, breeds fear of the process. Among those who work in such an atmosphere, there is daily a feeling of being involved in a medical emergency, which is, in turn, used to justify the current trend of 'managing' labour by placing upper time limits on each stage of labour and the early and unnecessary use of interventions. Such actions serve to make the doctor or midwife feel powerful, useful and heroic, believing that through their actions they have saved the woman from potential disaster.
A medically orientated practitioner stepping out of this environment into a smaller GP- or midwife-led unit might easily feel fearful about the lack of intervention and the tendency to allow labours to go on longer before interfering. The same practitioner might feel terrified watching a woman give birth at home, at her own pace and in her own way where she is totally in control. As a result there is as much conflict between people within the maternity services as there is amongst those who observe and campaign for change from the outside.
It is certainly relevant to be aware of these power issues, as long as you are also aware that you are not obliged to become too entangled in them. You do not need to feel sorry for the midwife who has a busy clinic or who has been up all night, the consultant who has just presided over a disastrous birth, the overworked junior doctor or health visitor who can't give you the time or information you need. It is not your job to understand or listen to problems that, after all, come with the job.
When considering the range of professionals who can attend you during pregnancy and birth it may also be helpful to remember that whether you are using the NHS or private healthcare you are paying for a service, either directly or through your taxes. Healthcare practitioners are there to attend you, to advise and discuss with you, not to lay down the law. Ironically there is very little law governing the actions of doctors and the rights of patients. But what little there is, is very clear. No practitioner has the power to force you to do anything against your will. Nor can you be given any treatment without your consent. To do so constitutes an assault under common law for which the doctor or midwife can be prosecuted.
The information throughout this book has been compiled with all these issues in mind. It takes into account the social, professional, legal and ethical agendas that make a mother's choice of practitioner so crucial. Remember, if you find that you are unsatisfied with the practitioner(s) you have chosen (or, as is much more common, been allocated), you have the right to change to another carer at any time during your pregnancy or even during labour (though few women can realistically be expected to feel secure enough to do this). You do not need anybody's permission to change your mind. It is entirely your prerogative.