its all about autonomy

That was the bit that really got up my nose, the straw that broke the camels whatsit and where it started getting a bit crazy. This post descibes some of the dinner conversation had with GPs which i posted about a few days back.

Well, what also got up my nose early on was the fact that they were all just oozing such a sense of entitled and unchallenged priviledge. So when they started ordering expensive wine from the menu and then judging it with sniffs and swirls (i was paying and they not once asked me if i would like to choose the wine -what would i know about wine- they assumed that responsibility for themsleves and before i knew it...ordered!)and beginning to diss off at midwives and irresponsible homebirths i just waded in. All that priviledge and expectation of being unchallenged had to be resisted! Upon hearing what i percieve to be 'mistruth' and ignorance speaking, I felt like i really couldnt sit with my own integrity intact and not say a word. I felt/knew we were equals, different professions, but equals non the less and i had as much right to wade in on the discussion as they did and i wasnt just going to shut up when they came back with a counter claim. Give them the last word just bcause...they were doctors? Hell, i teach critical reading and thinking, epidemiology and public health and i have a very up to date knowledge of the literature around birthing statistics and the homebirth debate and im a woman with 3 births under my belt. Game on!

What was very obvious, very quickly, was their underlying paradigm that women shouldnt have a choice in birthing "the day that homebirths become approved is the day i give up obstetric practice" i mean what was that all about? Loss of control??? I nearly said 'well that might not be such a bad thing then' but i didnt. But when confronted with the truth of their position 'seems you believe that women shouldnt be free to choose where they birth and should be made to give birth in a hospital?' they weren't comfortable with that either. Conflicted paradigms and unresolved principles...i struggle to get students to recognise their contradictions in logic all the time when im teaching, not with a bunch of comfortable professionals...

We moved through maternal and neonatal death rates being higher for homebirths, then when i didnt concurr and cited some contemporary literature (i dont think they appreciated journal, author and date references in a social situation) they suggsted instead we should be looking at neonatal morbidity, i didnt concurr. We moved onto the 'no time to deal with an emergency' argument and women being selfish and midwives encouraging irresponsible behaviour, i didnt concurr, repeating often that homebirth midwives are professionals, just as they were, trained in birth (doh)know when to transfer and have more experience in deliveries than most community GPs. Kapow! To top it off i suggested that women essentially have a right to choose the birthing care they want!

I think the big silent moment came when i suggested that contrary to their opinion that it was the midwives fault that there was no seamless relationship with hospitals in times of transfer from home to hospital "they dont want consultant support, its just outrageous" but that the system made it very difficult to have such a relationship. I spoke of negative reactions towards women and her midwife under circumstances of home to hospital transfer and that it just might not be due to midwife attitudes of 'defiant and egocetric irresponsibility' but possibly due to the adversarial and judgemental behaviour of specialists and the system that discourages such a relationship. The system does not support independent midwives and its not the midwives fault that she is not supported , she wants it, yet she must bear the brunt of not having it!

It was an interesting night. I never shy away from a good debate but only when i feel i have a leg to stand on. I felt i had about five in this case. What was really interesting for me was that the deeper languages of love, privacy, intimacy and respect for the process of natural birth and motherhood had no place at the table.