Thursday, April 30

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.

7 comments:

Julie said...

Well said. I see the homebirthing issue as an integral part of the way the western society as a whole is going down the shitter, so to speak. For too long (I feel) we've been dictated to to all manner of 'experts' about how we (not just women, mind) *should* think, feel, act, buy... and look at the way it's all turning out.

I see the rise in homebirthing linked with the rise in homeschooling, the number of people rejoining churches &/or re/discovering faiths and the rise in people living a more simple, less consumerist way of life (anti-establishmentarianism?!). It seems we are starting to realise at last that there is no one-size-fits-all approach to life and are starting to listen to ourselves and our bodies again.

Reminds of that birthing skit in the Monty Python movie, The Meaning of Life - the mother asks 'What should I do?' and the Dr replies (in a highly condescending manner), 'Nothing dear, you're not qualified'.

innercitygarden said...

I'm so glad you were there.

I'll never get my head around the idea that as labour gets more and more intense you're supposed to get in a car, and I did it (brith centres: the homebirth you have to drive to). My whole body was screaming to stay put though.

Kel said...

julie- yup its all a part of modern disfunction as i see it too. Public health is impt as are restrictions and impositions for public good, but working with evidence should always inform these decisions!!!!

kate- I made an identical comment on the night and it was excatly that what opened up the whole debate. why we make women leave home when every part of our bodies says just stay put and bunker down...just like the cat n dog! and vets recommend leaving them alone so as not do disturb and inhibit labour...go figure.

Rixa said...

"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."

Wow, so true. I'm not dismissing the whole safety angle, but there is so much more than just perinatal/neonatal/maternal mortality at issue here.

Jen said...

Thank you Kel, for sharing your convictions, and educating a few static and conservative doctors...

Its so good to hear that there are still women in the world prepared to argue for their beliefs in a social setting where one is expected to 'be nice' (ie: complicit)

And you are so right... its about choice...

Em said...

your last sentence resounds so strongly with me Kel - do you think that it's b/c they are men that they don't get that bit? Or is it something else.

I love reading about you following your ethics into battle, thankyou.

Kel said...

rixa- i know you know you know! lol but it certainly is.

jen- thnaks for the thumbs up mate- its so difficult to do it sometimes, so much easier just to smile and laugh along but as they say 'bad things happen coz good people do nothing' Yes, choice is so impt, part of our underpinnings of democracy...just not womens bodies and birth apparently (nor wine!)

em- its exactly that discourse which i had to resist on the night- i knew to have any credibility i had to fight medicine with medicine ( science with science) and to mention any of these 'feminine' things would immediatley have put me in the 'ok to be discounted' category. I dont think it was male, the way it was expressed maybe and the vehmence possibly but i have come across many female medicos with the same thinking. Its about training and professionalism and its the rare doctor who questions any part of their education.