If having a relationship with your physician is essential to building trust, who should initiate the relationship? The patient? The physician?
I didn't form a relationship with my former OB. I went to my appointments. I was honest. I took his advice. I asked questions when I had them, but being the last of my friends to become a parent left me with most of my questions answered. I read books. I searched the internet. I didn't write a birth plan because I recognized that each complication eliminated choices, and there was no point in getting myself hung up on a specific vision of the birth when I knew how quickly things could change. Was it my fault we didn't form that relationship?
I walked into my first appointment with him scared because I'd spotted over the weekend. It stopped after an hour, so I didn't feel it was necessary to go into the ER to get it checked. I simply set up an appointment for right away Monday morning. Throughout my whole investigation into choosing a new doctor, it had never occurred to me that I would stay with this one. My thoughts from the get go were simply to find someone to help me get this baby out safely. I had every intention of going back to a family practitioner after the baby was born. Was that the "fatal" flaw in my thinking? Should I have been committed to this relationship before it started?
I saw the situation similar to that of needing any other specialist. The family practice doctor refers you to a specialist for a specific condition. The specialist helps you resolve that condition, and you go back to your original doctor. There's no need to see an ENT if you sprain your ankle, right? Was I wrong in considering my pregnancy to fit this model? Or, was he wrong in not instigating it? Should he have done more than ask the specific diagnostic questions that helped him guide me down the path. Was he responsible for bringing up his birth philosophy to me, his patient?
After I left his care, I interviewed several doctors around the metro. I checked out doctors at the large urban hospitals. I checked out doctors that my co-workers saw. I didn't "click" with any of them. Instead of being reassured, I felt devalued. Instead of being calm, I felt anxious. Instead of feeling autonomous, I felt trivialized. Even my family practice physician, someone I'd seen for 15 - 20 years, contributed to my feelings of betrayal. He made a huge mistake in referring me to my former OB's wife for counseling, and this destroyed our relationship. I felt uncomfortable seeing him. I was afraid to be betrayed again, so I kept trying to figure out what to do since I knew I couldn’t remain in that relationship.
I was surprised when I met Dr. B for the first time. She really initiated the beginning of our relationship. When I tried to trivialize my experience, she forced me to expound on it. When I tried to change the topic, she circled me back around to the problem. She made sure I was getting help. She offered different options for treatment based on my current issues like flashbacks, anxiety, and dissociation. She made sure I was comfortable. She didn’t rush me out the door. She made sure I was okay with my daughter. She made sure I was okay with my husband. She looked for emotional well-being as well as the physical which ended up being easily cured.
As for my old OB, well, I have to accept some portion of the responsibility for not building a relationship with him.
Maybe we failed each other.
Monday, October 13, 2008
Friday, October 10, 2008
Trust
Do you trust your doctor?
Is trust essential to the doctor – patient relationship?
I’ve read several blog posts by healthcare providers talking about trust. In one, the author basically requires trust from her patients. She believes that she works hard to develop a trusting relationship throughout her client’s pregnancies, and in an emergency those clients should immediately acquiesce to her demands because she’s built a relationship on trust, and in an emergency she shouldn’t have to stop to explain the complications, the patients should simply react. In another blog, the caregiver demands that patients who don’t trust him should find other care. In a third blog, the caregiver wants to find a way to study a trusting relationship, and bring the concept into evidence based practice. However, is trust too strong a word for what they really want?
Trust is difficult for me to give. I don’t trust my parents. I sometimes trust my husband, but not always. I don’t trust my daughter. After all she’s only one, and she doesn’t have any concept of the long term consequences to her behavior. I don’t know that I’ve ever trusted a physician. I respect them. I’ve found most of them to be well-educated in matters that I’m not educated in. I’m willing to take their advice because I believe that they’re actually looking out for my best interests, although I have been willing to negotiate other treatment options with them when I believe it’s justified. Isn’t that enough?
I lost all trust I had in my former OB after my daughter’s birth. His lack of communication in an emergency destroyed my respect for him. Without communication, information, or knowledge there is no consent. Without consent, there is only anger, fear, and violation.
My husband lost his trust as well. His was lost due to non-verbal communication during the emergency. He recognized the "Oh shit, I'm fucked" look on the doctor's face before he started verbally communicating. At that point, my husband checked out of the room. It brought up all of his barriers, and he never heard anything the doctor said after that.
Communication, especially during an emergency, diminishes fear. It keeps the patient feeling like they’re still in control even though chaos may be swarming around them. It gives them something to cling to when they’re fading in and out of consciousness. Open and honest communication during an emergency, even if it’s not a full explanation, can keep a patient calm, focused, and rational enough to comply with the needs of the medical staff. Knowing what and why things are happening helps patients to process the event as medical procedures.
It took me several months to find a new caregiver after I left my former OB and my former family practice doctor. I found that I couldn’t stand the thought of having a man examine me. I just kept waiting for the other shoe to drop despite the 15 – 20 year relationship I had with my former family practice doctor. Our relationship wasn’t strong enough to withstand the distrust I now experience with male doctors. I even interviewed a new OB at a different hospital. He tried to sound positive and uplifting, but instead came off as patronizing. The last thing I needed was another doctor who believed that he is or was infallible.
It was a fluke that I found this new doctor. I called the clinic to make an appointment to see any female doctor, and this is the one that had an opening. It wasn’t well-researched, but she listened to me. She didn’t let me off with the dismissive practiced answers I had for my pregnancy. She ferreted out answers, and as a result I switched my and my daughter’s care to her. Patients need to develop a relationship with their doctors. I don’t know that it has to be built on trust. I do believe that respect is a strong enough bond. However, it’s difficult to build a relationship when you only see a physician once or twice a year. By having her care for my daughter I increased the number of times I see her in a year to almost once a month. I don’t trust her. I don’t trust any doctor, but I respect her knowledge. I respect her training. I respect her ability to listen to my concerns, and help steer me down a path that meets my needs.
Maybe it is trust, I don't know. Personally I think it's too strong a word, and yet when I researched this issue for the presentation I'm giving at the hospital, this is the word used in all of the articles I found on improving patient care. Patients who trust their doctors are more compliant. Patients who trust their doctors are less likely to file a malpractice claim. Patients who trust their doctors get better care. However, hospitals are adding patient advocates to help facilitate communication between doctors and patients. I wish my hospital had instigated this program before I was a patient.
If it is trust, I know it takes a long time to build, and only seconds to destroy. It's kind of like handing your sixteen year old the keys to the car for the first time only to have them call you 5 minutes later to tell you they've been in an accident. More than likely it will be a long time before you let them drive by themselves again. Eventually you might give them a second chance. I never let my doctor have one.
Is trust essential to the doctor – patient relationship?
I’ve read several blog posts by healthcare providers talking about trust. In one, the author basically requires trust from her patients. She believes that she works hard to develop a trusting relationship throughout her client’s pregnancies, and in an emergency those clients should immediately acquiesce to her demands because she’s built a relationship on trust, and in an emergency she shouldn’t have to stop to explain the complications, the patients should simply react. In another blog, the caregiver demands that patients who don’t trust him should find other care. In a third blog, the caregiver wants to find a way to study a trusting relationship, and bring the concept into evidence based practice. However, is trust too strong a word for what they really want?
Trust is difficult for me to give. I don’t trust my parents. I sometimes trust my husband, but not always. I don’t trust my daughter. After all she’s only one, and she doesn’t have any concept of the long term consequences to her behavior. I don’t know that I’ve ever trusted a physician. I respect them. I’ve found most of them to be well-educated in matters that I’m not educated in. I’m willing to take their advice because I believe that they’re actually looking out for my best interests, although I have been willing to negotiate other treatment options with them when I believe it’s justified. Isn’t that enough?
I lost all trust I had in my former OB after my daughter’s birth. His lack of communication in an emergency destroyed my respect for him. Without communication, information, or knowledge there is no consent. Without consent, there is only anger, fear, and violation.
My husband lost his trust as well. His was lost due to non-verbal communication during the emergency. He recognized the "Oh shit, I'm fucked" look on the doctor's face before he started verbally communicating. At that point, my husband checked out of the room. It brought up all of his barriers, and he never heard anything the doctor said after that.
Communication, especially during an emergency, diminishes fear. It keeps the patient feeling like they’re still in control even though chaos may be swarming around them. It gives them something to cling to when they’re fading in and out of consciousness. Open and honest communication during an emergency, even if it’s not a full explanation, can keep a patient calm, focused, and rational enough to comply with the needs of the medical staff. Knowing what and why things are happening helps patients to process the event as medical procedures.
It took me several months to find a new caregiver after I left my former OB and my former family practice doctor. I found that I couldn’t stand the thought of having a man examine me. I just kept waiting for the other shoe to drop despite the 15 – 20 year relationship I had with my former family practice doctor. Our relationship wasn’t strong enough to withstand the distrust I now experience with male doctors. I even interviewed a new OB at a different hospital. He tried to sound positive and uplifting, but instead came off as patronizing. The last thing I needed was another doctor who believed that he is or was infallible.
It was a fluke that I found this new doctor. I called the clinic to make an appointment to see any female doctor, and this is the one that had an opening. It wasn’t well-researched, but she listened to me. She didn’t let me off with the dismissive practiced answers I had for my pregnancy. She ferreted out answers, and as a result I switched my and my daughter’s care to her. Patients need to develop a relationship with their doctors. I don’t know that it has to be built on trust. I do believe that respect is a strong enough bond. However, it’s difficult to build a relationship when you only see a physician once or twice a year. By having her care for my daughter I increased the number of times I see her in a year to almost once a month. I don’t trust her. I don’t trust any doctor, but I respect her knowledge. I respect her training. I respect her ability to listen to my concerns, and help steer me down a path that meets my needs.
Maybe it is trust, I don't know. Personally I think it's too strong a word, and yet when I researched this issue for the presentation I'm giving at the hospital, this is the word used in all of the articles I found on improving patient care. Patients who trust their doctors are more compliant. Patients who trust their doctors are less likely to file a malpractice claim. Patients who trust their doctors get better care. However, hospitals are adding patient advocates to help facilitate communication between doctors and patients. I wish my hospital had instigated this program before I was a patient.
If it is trust, I know it takes a long time to build, and only seconds to destroy. It's kind of like handing your sixteen year old the keys to the car for the first time only to have them call you 5 minutes later to tell you they've been in an accident. More than likely it will be a long time before you let them drive by themselves again. Eventually you might give them a second chance. I never let my doctor have one.
Friday, September 26, 2008
A letter to my doctor
I wanted to take a few minutes to let you know why I decided to file a complaint against you this winter, and explain to you the lasting consequences of your actions the night of May 11, 2007.
I trusted and chose you to be a part of my transformation from a woman to a mom. I know for you it was just another delivery. It was just another series of complications to overcome, but for me it was a life changing event. For 32 minutes, I experienced the joy that comes with that transformation, and then you forced me into another transformation, a rape survivor. I know that wasn’t your intent. You were trying to avoid worrying me with another complication when you believed that you could easily and painlessly eliminate it. However, a yellow plastic gown, latex gloves, and a medical school diploma hanging in your office don’t make you God. It was my body that you violated. You humiliated and shamed me in front of my husband, daughter, best friend, and the nursing staff. I was vulnerable and trusting, and you betrayed me. Instead of treating me like an adult capable of making decisions, you treated me like an unfeeling object. Epidural or not, labor or not, my vagina is private. It’s up to me to decide who and what invades it. You abused your power, and denied me the opportunity to consent. You denied me the ability to process the event as a medical procedure. There was no warning, no understanding. The pain was indescribable. I know you tried to explain what was happening afterwards, but the pain was an incredible barrier to my understanding. The blood loss was too great, the change in blood pressure too rapid for me to process what was happening. I became legally incompetent so rapidly, that I can’t even figure out who signed the consent form for the D & C.
My primary care physician told me once that he really enjoyed delivering babies. It’s one of the few times that someone goes home with something after being in the hospital. I went home with a lot of things. I went home with a newborn. I went home with nightmares. I went home with flashbacks. I went home isolated because births like mine are not to be discussed. You don’t discuss birth rape over a cup of coffee at Caribou with an infant beside you.
Do you want to hear my version of Jennavive’s birth? I’m sure my version differs from yours?
“One more push to get the shoulders out.” I hear the doctor say. Despite not having any breath left, I try once again to push. I feel myself tear as the baby slides out, and they lay this gooey baby on my stomach. I’m in shock, she looks like an alien. There was nasty gooey mucus covering her whole body along with streaks of blood. I wish I could say I loved her at the point, but I was appalled by how she looked. I was relieved when the nurse took her away to be measured, weighed, tested, and cleaned up. At 11:45 pm, the doctor asked the nurse to tell him when 15 minutes had passed. I thought it was kind of odd at the time, but I was really starting to feel a sense of accomplishment and joy. I was watching the nurse cleaning her up while my friend took pictures. I was starting to feel a little odd, but I remember telling the doctor that “his 15 minutes was up”. The nurse asked me if I wanted to hold the baby, but I said no because I was feeling really woozy. My friend brings her over for me to touch. I reach my hand out to her. PAIN!!!! My hands are fisting in the sheets, and I’m fighting not to scream. My breathing is ragged, and I don’t know why the doctor’s hand is in my hoo-ha. I try to get away, I’m scrabbling with my hands trying to drag my body up the bed, but with the numbness in my legs I can’t escape. My vision is blurry, and I start seeing spots when I hear the doctor tell the nurse to get the surgical team. I’m struggling to stay conscious to focus on my daughter, but everything fades to black. Why do I need surgery? I don’t know what’s happening. The baby’s already here. I can’t leave her. I hear the angry voice of the doctor, “what took so long, where are they?” The nurse answers, “They left for the night. It will take an hour to get back to the hospital.” Why is he so angry? I don’t understand what’s happening. The pain is so intense it takes my breath away. They strap the oxygen mask over my face, and I feel the pricking of needles. Are they doing a hysterectomy? I still can’t see. Where’s my baby? I can’t abandon her. I hear fear in the doctor’s voice. “Where the hell are they”, he yells at the nurse. I’m so scared now. Am I dying? I can’t abandon my baby. My husband will never forgive her if something happens to me. I have to stay here to raise her. Do whatever it takes, but keep me here to raise her. Alarms are going off. What’s happening? I hear a new voice, and I feel the bed moving. They’re rolling me down the hallway to the operating room. I sense the bright lights, and feel myself being transferred to the operating table. The voices are frantic. I feel more needles pricking me, and everything fades to black…
This is what you left me with. Each year on her birthday, this is the story that I will remember. Do you remember your children’s births? Do you remember the joy you felt? I don’t. It was so fleeting. I remember the pain, anger and fear. I’m glad that you’re skilled enough to have kept me alive. I’m glad that I’m here every day to enjoy my daughter, but I can’t forgive you for the pain you caused.
I wrote the complaint to the state medical board because you crossed a line that should never be crossed. It’s my small attempt to remind the medical establishment that patients have rights. I wanted to remind you of the Hippocratic Oath. Isn’t there a line in there about “doing no harm”? You caused harm that night. It’s my small way of facing my attacker, and while you’ll probably get off scot-free at least I tried to change it for the women who will tread this path after me.
I wrote this several months ago, but I'm finding myself struggling again. My co-worker's induction is scheduled for next week, and I'm worried about how things will go for her. I just don't want to see her end up in the same place I am.
Reading this today made me realize just how much anger I still harbor towards the doctor. I guess the PTSD comes in waves. I feel strong for a while, but then something sucks me back down. I know part of the problem is a story on my SOLACE forum that really struck a nerve. A mom went through a post-birth experience similar to mine, and has never felt validated in her feelings. Reading her story, and feeling her pain, anger and fear radiating through it just smacked into me.
Sometimes criminal activities take place in the bright lights of a hospital. It's not intended to be that way. I know there's no intent, but the action itself is criminal. If a patient is fighting to get away from you, they're in pain. If they're screaming at you to STOP, stop. If you're more worried about what their family members are seeing there's something wrong with your morals. Patients are humans. We're autonomous. We have feelings. We're not objects. Treat us with the respect that you expect us to treat you with. Listen to us. Answer our questions. Allow us to trust you. Don't betray us in the heat of battle.
I trusted and chose you to be a part of my transformation from a woman to a mom. I know for you it was just another delivery. It was just another series of complications to overcome, but for me it was a life changing event. For 32 minutes, I experienced the joy that comes with that transformation, and then you forced me into another transformation, a rape survivor. I know that wasn’t your intent. You were trying to avoid worrying me with another complication when you believed that you could easily and painlessly eliminate it. However, a yellow plastic gown, latex gloves, and a medical school diploma hanging in your office don’t make you God. It was my body that you violated. You humiliated and shamed me in front of my husband, daughter, best friend, and the nursing staff. I was vulnerable and trusting, and you betrayed me. Instead of treating me like an adult capable of making decisions, you treated me like an unfeeling object. Epidural or not, labor or not, my vagina is private. It’s up to me to decide who and what invades it. You abused your power, and denied me the opportunity to consent. You denied me the ability to process the event as a medical procedure. There was no warning, no understanding. The pain was indescribable. I know you tried to explain what was happening afterwards, but the pain was an incredible barrier to my understanding. The blood loss was too great, the change in blood pressure too rapid for me to process what was happening. I became legally incompetent so rapidly, that I can’t even figure out who signed the consent form for the D & C.
My primary care physician told me once that he really enjoyed delivering babies. It’s one of the few times that someone goes home with something after being in the hospital. I went home with a lot of things. I went home with a newborn. I went home with nightmares. I went home with flashbacks. I went home isolated because births like mine are not to be discussed. You don’t discuss birth rape over a cup of coffee at Caribou with an infant beside you.
Do you want to hear my version of Jennavive’s birth? I’m sure my version differs from yours?
“One more push to get the shoulders out.” I hear the doctor say. Despite not having any breath left, I try once again to push. I feel myself tear as the baby slides out, and they lay this gooey baby on my stomach. I’m in shock, she looks like an alien. There was nasty gooey mucus covering her whole body along with streaks of blood. I wish I could say I loved her at the point, but I was appalled by how she looked. I was relieved when the nurse took her away to be measured, weighed, tested, and cleaned up. At 11:45 pm, the doctor asked the nurse to tell him when 15 minutes had passed. I thought it was kind of odd at the time, but I was really starting to feel a sense of accomplishment and joy. I was watching the nurse cleaning her up while my friend took pictures. I was starting to feel a little odd, but I remember telling the doctor that “his 15 minutes was up”. The nurse asked me if I wanted to hold the baby, but I said no because I was feeling really woozy. My friend brings her over for me to touch. I reach my hand out to her. PAIN!!!! My hands are fisting in the sheets, and I’m fighting not to scream. My breathing is ragged, and I don’t know why the doctor’s hand is in my hoo-ha. I try to get away, I’m scrabbling with my hands trying to drag my body up the bed, but with the numbness in my legs I can’t escape. My vision is blurry, and I start seeing spots when I hear the doctor tell the nurse to get the surgical team. I’m struggling to stay conscious to focus on my daughter, but everything fades to black. Why do I need surgery? I don’t know what’s happening. The baby’s already here. I can’t leave her. I hear the angry voice of the doctor, “what took so long, where are they?” The nurse answers, “They left for the night. It will take an hour to get back to the hospital.” Why is he so angry? I don’t understand what’s happening. The pain is so intense it takes my breath away. They strap the oxygen mask over my face, and I feel the pricking of needles. Are they doing a hysterectomy? I still can’t see. Where’s my baby? I can’t abandon her. I hear fear in the doctor’s voice. “Where the hell are they”, he yells at the nurse. I’m so scared now. Am I dying? I can’t abandon my baby. My husband will never forgive her if something happens to me. I have to stay here to raise her. Do whatever it takes, but keep me here to raise her. Alarms are going off. What’s happening? I hear a new voice, and I feel the bed moving. They’re rolling me down the hallway to the operating room. I sense the bright lights, and feel myself being transferred to the operating table. The voices are frantic. I feel more needles pricking me, and everything fades to black…
This is what you left me with. Each year on her birthday, this is the story that I will remember. Do you remember your children’s births? Do you remember the joy you felt? I don’t. It was so fleeting. I remember the pain, anger and fear. I’m glad that you’re skilled enough to have kept me alive. I’m glad that I’m here every day to enjoy my daughter, but I can’t forgive you for the pain you caused.
I wrote the complaint to the state medical board because you crossed a line that should never be crossed. It’s my small attempt to remind the medical establishment that patients have rights. I wanted to remind you of the Hippocratic Oath. Isn’t there a line in there about “doing no harm”? You caused harm that night. It’s my small way of facing my attacker, and while you’ll probably get off scot-free at least I tried to change it for the women who will tread this path after me.
I wrote this several months ago, but I'm finding myself struggling again. My co-worker's induction is scheduled for next week, and I'm worried about how things will go for her. I just don't want to see her end up in the same place I am.
Reading this today made me realize just how much anger I still harbor towards the doctor. I guess the PTSD comes in waves. I feel strong for a while, but then something sucks me back down. I know part of the problem is a story on my SOLACE forum that really struck a nerve. A mom went through a post-birth experience similar to mine, and has never felt validated in her feelings. Reading her story, and feeling her pain, anger and fear radiating through it just smacked into me.
Sometimes criminal activities take place in the bright lights of a hospital. It's not intended to be that way. I know there's no intent, but the action itself is criminal. If a patient is fighting to get away from you, they're in pain. If they're screaming at you to STOP, stop. If you're more worried about what their family members are seeing there's something wrong with your morals. Patients are humans. We're autonomous. We have feelings. We're not objects. Treat us with the respect that you expect us to treat you with. Listen to us. Answer our questions. Allow us to trust you. Don't betray us in the heat of battle.
Choices
Should patients be “allowed” to make their own choices about their care? Should they be entitled to make the final decision? There are some situations that are truly emergent. In those situations, does the patient lose their right to choose?
Obviously, each situation is unique. There are times when different doctors have different opinions about how to treat a patient. Isn’t that why we “get a second opinion”? We’re trying to decide what course of treatment to follow. Do we have surgery, take medicine, or ignore it and do nothing? In my case, the doctor tried three different treatments before he successfully corrected the problem. Shouldn’t it have been my choice which one to try? He tried applying cord traction, he tried to manually remove the placenta, and he finally performed a D & C before he got it out. Was this a reasonable course of treatment? He did start with the least invasive procedure, but if there was time to try three different treatments there was time to talk to me about it before he started performing them. He didn’t believe it was emergent when he started on the cord traction. He didn’t believe it was emergent when he tried prying it out. He didn’t label it as emergent until he needed surgical assistance, and even then it was HIS choice, not mine. Maybe if we’d discussed it right away it wouldn’t have been so chaotic. If he’d talked about it right away maybe we could have requested help BEFORE it became emergent. Maybe I would have processed the whole thing as a medical procedure instead of a rape, a violation, an abuse. Maybe if he’d discussed it, he would have known the anesthesia wasn’t working and recommended a different course of action. Would I have chosen going straight to surgery? I don’t know. I probably would have followed the course he thought was best, but at least I would have had the opportunity to ask questions, provide necessary information about pain relief, and OWN my decision. I would have understood, who, what, why, when and where. I wouldn’t have been locked in darkness, despair and fear.
We deserve to make our own choices. When we choose, we can accept our responsibility for what happened. We “own” the choice. It’s hard to own someone else’s choice. It’s hard to take responsibility for someone else’s actions. I wish I owned the choices that night, but I was nothing, a uterus, a vessel, a doll.
I didn’t deserve to be objectified. I didn’t deserve to be ignored. I didn’t deserve to be treated like a liar and an over-reactor. I didn’t deserve to be deceived.
I did deserve the opportunity to participate in making my own healthcare decisions. I did deserve them listening to me. I did deserve owning my decision. I am and was an autonomous, capable, intelligent woman who was more than able to make difficult decisions regarding my care. I didn’t need a protector, a god, or a physician dictating my choices. It should have been my choice. I paid him to guide me. I wanted his advice. I didn’t give him the right to take away my choice, my power, or my autonomy.
Obviously, each situation is unique. There are times when different doctors have different opinions about how to treat a patient. Isn’t that why we “get a second opinion”? We’re trying to decide what course of treatment to follow. Do we have surgery, take medicine, or ignore it and do nothing? In my case, the doctor tried three different treatments before he successfully corrected the problem. Shouldn’t it have been my choice which one to try? He tried applying cord traction, he tried to manually remove the placenta, and he finally performed a D & C before he got it out. Was this a reasonable course of treatment? He did start with the least invasive procedure, but if there was time to try three different treatments there was time to talk to me about it before he started performing them. He didn’t believe it was emergent when he started on the cord traction. He didn’t believe it was emergent when he tried prying it out. He didn’t label it as emergent until he needed surgical assistance, and even then it was HIS choice, not mine. Maybe if we’d discussed it right away it wouldn’t have been so chaotic. If he’d talked about it right away maybe we could have requested help BEFORE it became emergent. Maybe I would have processed the whole thing as a medical procedure instead of a rape, a violation, an abuse. Maybe if he’d discussed it, he would have known the anesthesia wasn’t working and recommended a different course of action. Would I have chosen going straight to surgery? I don’t know. I probably would have followed the course he thought was best, but at least I would have had the opportunity to ask questions, provide necessary information about pain relief, and OWN my decision. I would have understood, who, what, why, when and where. I wouldn’t have been locked in darkness, despair and fear.
We deserve to make our own choices. When we choose, we can accept our responsibility for what happened. We “own” the choice. It’s hard to own someone else’s choice. It’s hard to take responsibility for someone else’s actions. I wish I owned the choices that night, but I was nothing, a uterus, a vessel, a doll.
I didn’t deserve to be objectified. I didn’t deserve to be ignored. I didn’t deserve to be treated like a liar and an over-reactor. I didn’t deserve to be deceived.
I did deserve the opportunity to participate in making my own healthcare decisions. I did deserve them listening to me. I did deserve owning my decision. I am and was an autonomous, capable, intelligent woman who was more than able to make difficult decisions regarding my care. I didn’t need a protector, a god, or a physician dictating my choices. It should have been my choice. I paid him to guide me. I wanted his advice. I didn’t give him the right to take away my choice, my power, or my autonomy.
Friday, September 12, 2008
Why does the concept of advocacy haunt me?
I don't know why, but I continue to struggle with the concept of advocacy. I just can't seem to find any peace. I know that advocating for yourself does not mean diagnosing yourself. It doesn't mean being more knowlegeable than the doctor. It has to do with knowing your limitations, and communicating your needs in an appropriate manner.
I came across this old, from 3 - 4 months ago, piece of writing, but I'm still struggling with it. Maybe putting it here will help.
One of the issues I've struggled with over the last year is the concept of advocacy. In other forums, I've been attacked on the issue of “properly” advocating for myself during the birth. My last two counseling sessions, we’ve worked on this issue. Trying to eliminate / mitigate the shame I feel when I’m reminded of this attack, but it’s left me with a lot of questions.
I've struggled to figure out where I failed, or even if I did fail to advocate for myself. Did I set myself up for the experience that I had? Is it now a requirement to become educated in the most obscure pregnancy complications before setting foot in a hospital? Are the doctors, midwifes, and nurses no longer responsible for educating their patients? Does a care giver only need to provide answers to the questions their patients ask, or should they offer up more information? Whose responsibility is it to initiate the communication between a doctor and a patient? Is it now the patient's job to ferret out the details of their own health? What about when a patient is unable to advocate for themselves? Does that mean that the doctor is free to do whatever they wish with no thought for the patient? Is it okay for the health care providers to intentionally avoid answering questions? Is it okay for them to sneak medications or perform procedures when the patient's view is completely blocked without notifying the patient of their intent? Is it now the responsibility of anyone supporting the patient to provide the patient with a blow-by-blow account of everything going on, so that the patient can effectively advocate for themselves?
Looking back, I did a pretty darn good job of advocating for myself when I was aware of what was going on. I was handling the pain really well, but my blood pressure was skyrocketing. I knew that we had to bring it down, or I’d end up with a c-section. When the doctor suggested the epidural, I thought okay. I can try it, hope that it lowers my blood pressure, and end up with a vaginal delivery, or I can choose not to have it, and end up needing it anyhow for the c-section. It seemed like a pretty smart move to try it, and see if it would work. However, the anesthesiologist disagreed with my doctor’s suggestion. When he asked if I wanted it I said, “Yes, the doctor wants to try it to bring down my blood pressure.” He gave me song and dance on the risks of epidurals. I was lectured on not using it for anything other than pain relief. I was unwavering in my insistence that he give it to me. I went toe to toe with him while the contractions were coming right on top of each other. They pass the stupid things out like candy, why on earth was he being so stubborn? I finally lied. He knew I was lying, but he caved. It’s kind of hard to dispute pain with a laboring woman. Ultimately, I was successful. I understood the severity of the situation, and I was willing to go to bat for my decision. I also successfully advocated for myself during the pushing stage. I knew there was something prohibiting my daughter from descending, and I asked for assistance. It turns out her head was crooked. I might have been able to do it myself in a few more hours, but I was exhausted. It was a relief to have them assist me with the vacuum, and have the pushing stage be over.
The problems arose when the medical staff chose not to provide information. I was surprised when I received my medical records to find that they had been giving me IV blood pressure medication during labor. It seemed so odd to me because they were very precise when giving me oral medication to tell me exactly what each pill was. They lined them up in the little paper cups. “This is your thyroid medicine. This is your allergy pill. This is the stool softener. This is…” You get the idea. Why is it okay to not tell a patient that you’re putting medicine in the IV if you have to tell them exactly what you’re giving them orally? Shouldn’t the same standard be applied? What about notifying patients before performing invasive procedures? The doctor chose not to tell me that the placenta was stuck. I was just the patient. Why would I need to know that there was a problem? He thought he could be a hero. I had a difficult pregnancy. I’d been plagued by complications. In some ways I can see where he thought he was “doing me a favor” by not having me face another one, but I probably wouldn’t be here today if he’d shared the information with me. Especially since his efforts failed, and in failing he exacerbated the situation. The rate of hemorrhaging increased because he tore the umbilical cord off the placenta, and we think this might have caused the uterine inversion. His attempt to manually remove the placenta caused so much pain because the epidural didn’t work that I couldn’t comprehend what was happening. I couldn’t advocate for myself through the pain because I couldn’t find my voice. Instead of screaming, I clammed up. My brain was compromised by the hemorrhaging. It was too busy keeping me alive to send the right signals to my mouth to form questions. It was like someone took hold of my throat, and wouldn’t let any air through it. Even when the doctor did try to explain what was going on, he spoke to the room in general while focusing on my hoo-ha. He didn’t try to get MY attention. He didn’t come up to my face, and speak to ME. There was no effort to have a nurse re-explaining it to me or my husband. There was no discussion of how to deal with the problem, he simply announced, “I need the surgical team.” I didn’t know why. I didn’t know the name of the procedure.
The secretiveness didn’t end there. When I came out of surgery after they re-installed my uterus, managed to remove the placenta, accomplished getting the uterus to contract back down which stopped the bleeding, and restored my blood pressure to a reasonable pressure, the first thing I asked was, “what happened?” I can understand my husband not being able to tell me. His fear was so great the he couldn’t comprehend the doctor any more than I could. He told me he’d get a nurse to explain it since the doctor had already left. The only thing she told me was, “you had a lot of bleeding”. They didn’t tell me what procedure they’d performed. They didn’t tell me why they’d performed it. They didn’t tell me how serious it was. They didn’t tell me it could happen again. I have to admit that while I attempted to advocate for myself at this time, I didn’t do a good job. I was so weak from the blood loss that I didn’t even think to ask all of the questions I should have, but they knew how severe the situation was. Why should the responsibility be placed on the patient to question them when they know how compromised the patient is? Should they really be able to fall back on the, “well you should have advocated for yourself” excuse? Where does the patients responsibility end and the medical community’s responsibility start?
I keep coming back to the need for good communication in order to be a successful advocate. There has to be a level of trust and honesty between the caregiver and the patient. The patient needs to answer questions honestly, listen to the recommendation, and ask questions if they don't understand or want more detail. However, the caregiver needs to do the SAME thing. They need to ask probing questions. They need to listen to the patient's verbal and non-verbal cues. They need to answer questions honestly. They need to explain why they're making this specific recommendation. They need to speak to their patient, and not the room in general. They need to recognize that their patients are autonomous, individual, and unique. They need to recognize that what works for patient number two won't work for patient number four. They need to realize that we each have different ways of analyzing risk, and they need to be honest about their doctoring philosophy. They need to be trustworthy.
Trust is difficult to build. It takes more than having a patient pee in a cup, get their blood pressure taken, measure a belly, and listen to a heartbeat. It comes from initiating difficult discussions. It comes from asking questions. It comes from giving honest answers. It comes from being open. It comes from not making assumptions. It requires open and honest communication. However, it helps everyone get through a difficult situation.
There was no good communication on the night of my daughter's birth, and this resulted in a failure on my part and their part for me to advocate for myself.
I came across this old, from 3 - 4 months ago, piece of writing, but I'm still struggling with it. Maybe putting it here will help.
One of the issues I've struggled with over the last year is the concept of advocacy. In other forums, I've been attacked on the issue of “properly” advocating for myself during the birth. My last two counseling sessions, we’ve worked on this issue. Trying to eliminate / mitigate the shame I feel when I’m reminded of this attack, but it’s left me with a lot of questions.
I've struggled to figure out where I failed, or even if I did fail to advocate for myself. Did I set myself up for the experience that I had? Is it now a requirement to become educated in the most obscure pregnancy complications before setting foot in a hospital? Are the doctors, midwifes, and nurses no longer responsible for educating their patients? Does a care giver only need to provide answers to the questions their patients ask, or should they offer up more information? Whose responsibility is it to initiate the communication between a doctor and a patient? Is it now the patient's job to ferret out the details of their own health? What about when a patient is unable to advocate for themselves? Does that mean that the doctor is free to do whatever they wish with no thought for the patient? Is it okay for the health care providers to intentionally avoid answering questions? Is it okay for them to sneak medications or perform procedures when the patient's view is completely blocked without notifying the patient of their intent? Is it now the responsibility of anyone supporting the patient to provide the patient with a blow-by-blow account of everything going on, so that the patient can effectively advocate for themselves?
Looking back, I did a pretty darn good job of advocating for myself when I was aware of what was going on. I was handling the pain really well, but my blood pressure was skyrocketing. I knew that we had to bring it down, or I’d end up with a c-section. When the doctor suggested the epidural, I thought okay. I can try it, hope that it lowers my blood pressure, and end up with a vaginal delivery, or I can choose not to have it, and end up needing it anyhow for the c-section. It seemed like a pretty smart move to try it, and see if it would work. However, the anesthesiologist disagreed with my doctor’s suggestion. When he asked if I wanted it I said, “Yes, the doctor wants to try it to bring down my blood pressure.” He gave me song and dance on the risks of epidurals. I was lectured on not using it for anything other than pain relief. I was unwavering in my insistence that he give it to me. I went toe to toe with him while the contractions were coming right on top of each other. They pass the stupid things out like candy, why on earth was he being so stubborn? I finally lied. He knew I was lying, but he caved. It’s kind of hard to dispute pain with a laboring woman. Ultimately, I was successful. I understood the severity of the situation, and I was willing to go to bat for my decision. I also successfully advocated for myself during the pushing stage. I knew there was something prohibiting my daughter from descending, and I asked for assistance. It turns out her head was crooked. I might have been able to do it myself in a few more hours, but I was exhausted. It was a relief to have them assist me with the vacuum, and have the pushing stage be over.
The problems arose when the medical staff chose not to provide information. I was surprised when I received my medical records to find that they had been giving me IV blood pressure medication during labor. It seemed so odd to me because they were very precise when giving me oral medication to tell me exactly what each pill was. They lined them up in the little paper cups. “This is your thyroid medicine. This is your allergy pill. This is the stool softener. This is…” You get the idea. Why is it okay to not tell a patient that you’re putting medicine in the IV if you have to tell them exactly what you’re giving them orally? Shouldn’t the same standard be applied? What about notifying patients before performing invasive procedures? The doctor chose not to tell me that the placenta was stuck. I was just the patient. Why would I need to know that there was a problem? He thought he could be a hero. I had a difficult pregnancy. I’d been plagued by complications. In some ways I can see where he thought he was “doing me a favor” by not having me face another one, but I probably wouldn’t be here today if he’d shared the information with me. Especially since his efforts failed, and in failing he exacerbated the situation. The rate of hemorrhaging increased because he tore the umbilical cord off the placenta, and we think this might have caused the uterine inversion. His attempt to manually remove the placenta caused so much pain because the epidural didn’t work that I couldn’t comprehend what was happening. I couldn’t advocate for myself through the pain because I couldn’t find my voice. Instead of screaming, I clammed up. My brain was compromised by the hemorrhaging. It was too busy keeping me alive to send the right signals to my mouth to form questions. It was like someone took hold of my throat, and wouldn’t let any air through it. Even when the doctor did try to explain what was going on, he spoke to the room in general while focusing on my hoo-ha. He didn’t try to get MY attention. He didn’t come up to my face, and speak to ME. There was no effort to have a nurse re-explaining it to me or my husband. There was no discussion of how to deal with the problem, he simply announced, “I need the surgical team.” I didn’t know why. I didn’t know the name of the procedure.
The secretiveness didn’t end there. When I came out of surgery after they re-installed my uterus, managed to remove the placenta, accomplished getting the uterus to contract back down which stopped the bleeding, and restored my blood pressure to a reasonable pressure, the first thing I asked was, “what happened?” I can understand my husband not being able to tell me. His fear was so great the he couldn’t comprehend the doctor any more than I could. He told me he’d get a nurse to explain it since the doctor had already left. The only thing she told me was, “you had a lot of bleeding”. They didn’t tell me what procedure they’d performed. They didn’t tell me why they’d performed it. They didn’t tell me how serious it was. They didn’t tell me it could happen again. I have to admit that while I attempted to advocate for myself at this time, I didn’t do a good job. I was so weak from the blood loss that I didn’t even think to ask all of the questions I should have, but they knew how severe the situation was. Why should the responsibility be placed on the patient to question them when they know how compromised the patient is? Should they really be able to fall back on the, “well you should have advocated for yourself” excuse? Where does the patients responsibility end and the medical community’s responsibility start?
I keep coming back to the need for good communication in order to be a successful advocate. There has to be a level of trust and honesty between the caregiver and the patient. The patient needs to answer questions honestly, listen to the recommendation, and ask questions if they don't understand or want more detail. However, the caregiver needs to do the SAME thing. They need to ask probing questions. They need to listen to the patient's verbal and non-verbal cues. They need to answer questions honestly. They need to explain why they're making this specific recommendation. They need to speak to their patient, and not the room in general. They need to recognize that their patients are autonomous, individual, and unique. They need to recognize that what works for patient number two won't work for patient number four. They need to realize that we each have different ways of analyzing risk, and they need to be honest about their doctoring philosophy. They need to be trustworthy.
Trust is difficult to build. It takes more than having a patient pee in a cup, get their blood pressure taken, measure a belly, and listen to a heartbeat. It comes from initiating difficult discussions. It comes from asking questions. It comes from giving honest answers. It comes from being open. It comes from not making assumptions. It requires open and honest communication. However, it helps everyone get through a difficult situation.
There was no good communication on the night of my daughter's birth, and this resulted in a failure on my part and their part for me to advocate for myself.
Friday, September 5, 2008
What's with the title?
30 minutes
That's the length of time it took my blood pressure to fall from 180 - 190 / 110 - 120 to 50 / 30.
That's the length of time it took for my uterus to turn inside out after my daughter was born.
That's the length of time it took for the hemorrhaging to take it's toll on me.
That's the length of time I was allowed to expel the placenta before the doctor shoved his hand elbow deep in my hooha and tried to manually extract it without a working epidural.
That's the length of time it took for my doctor to forget that I was a capable, autonomous, intelligent, and educated woman who should have been allowed to remain an active participant in my own healthcare choices.
Why do they forget this? It's such a simply concept. We hire them to be our guide. We ask them for advice. We expect them to explain our choices, and guide us to the appropriate decision. They aren't our parent. They aren't our boss. They aren't our god. Ultimately the choice should be ours. Why do they forget that in the heat of battle? They are a consultant, and their words should be listened to, evaluated, and a decision rendered by us.
Choice is a difficult topic. We should be allowed to choose caregiver and location. We should be given enough information during our appointments to feel comfortable with the choice we have made. We should be given honest answers about their childbirth philosophy, instead of finding out when we arrive at our birth location. Childbirth doesn't render us mute or stupid. It doesn't negate our decisions. We are expected to make choices about our children's healthcare once they're born, why can't we be allowed this same right before they arrive? After all, we have to live with the decisions that are made.
I acquiesced to many interventions I didn't want. I gave in to the induction because I couldn't consistently control my blood pressure. When I gave into that intervention, I knew that I was giving in to the Pitocin and the amniotomy. I was giving in to the continuous fetal monitoring. I was giving in to an IV. I was giving in to being, for all intents and purposes, strapped to the bed. When I agreed to the epidural, I gave in to the catheter. I gave in to pushing on my back. None of these things traumatized me. I made a choice.
In some ways, I made great choices. It turns out that a hospital is the safest place for ME to birth. Having an OB was another good choice I made. I chose a doctor who truly believes in vaginal deliveries. As long as we kept my blood pressure under 200, he kept letting me labor.
I advocated for myself by fighting with the anesthesiologist for the epidural. I advocated for myself by telling the nurse that the epidural wasn't working even if she didn't listen to me. I tried advocating for myself throughout my stay by asking questions, although given my compromised state I wasn't very competent or successful during my stay.
Trauma came later. It came when I was dismissed, belittled, trivialized, scorned, and ignored. It came when questions were not asked. It came when questions were not answered. It came in a thousand little insults. Patients aren't stupid. They know it's not normal to have 7 IV's in your hands after having a baby. They know it's not normal to spend the first 36 hours in bed without getting up to shower, change a diaper, or give a baby a bath. They know it's not normal to not care where there baby is, or wonder about their care. They know it's not normal to be too weak to get out of the sitz bath on their own. They know it's not normal to still have 5 IV's in their hands on the day they're discharged.
We know when you're lying to us. We know when you're concealing things. We are smarter than you think, and one of these days you'll get your comeuppance.
That's the length of time it took my blood pressure to fall from 180 - 190 / 110 - 120 to 50 / 30.
That's the length of time it took for my uterus to turn inside out after my daughter was born.
That's the length of time it took for the hemorrhaging to take it's toll on me.
That's the length of time I was allowed to expel the placenta before the doctor shoved his hand elbow deep in my hooha and tried to manually extract it without a working epidural.
That's the length of time it took for my doctor to forget that I was a capable, autonomous, intelligent, and educated woman who should have been allowed to remain an active participant in my own healthcare choices.
Why do they forget this? It's such a simply concept. We hire them to be our guide. We ask them for advice. We expect them to explain our choices, and guide us to the appropriate decision. They aren't our parent. They aren't our boss. They aren't our god. Ultimately the choice should be ours. Why do they forget that in the heat of battle? They are a consultant, and their words should be listened to, evaluated, and a decision rendered by us.
Choice is a difficult topic. We should be allowed to choose caregiver and location. We should be given enough information during our appointments to feel comfortable with the choice we have made. We should be given honest answers about their childbirth philosophy, instead of finding out when we arrive at our birth location. Childbirth doesn't render us mute or stupid. It doesn't negate our decisions. We are expected to make choices about our children's healthcare once they're born, why can't we be allowed this same right before they arrive? After all, we have to live with the decisions that are made.
I acquiesced to many interventions I didn't want. I gave in to the induction because I couldn't consistently control my blood pressure. When I gave into that intervention, I knew that I was giving in to the Pitocin and the amniotomy. I was giving in to the continuous fetal monitoring. I was giving in to an IV. I was giving in to being, for all intents and purposes, strapped to the bed. When I agreed to the epidural, I gave in to the catheter. I gave in to pushing on my back. None of these things traumatized me. I made a choice.
In some ways, I made great choices. It turns out that a hospital is the safest place for ME to birth. Having an OB was another good choice I made. I chose a doctor who truly believes in vaginal deliveries. As long as we kept my blood pressure under 200, he kept letting me labor.
I advocated for myself by fighting with the anesthesiologist for the epidural. I advocated for myself by telling the nurse that the epidural wasn't working even if she didn't listen to me. I tried advocating for myself throughout my stay by asking questions, although given my compromised state I wasn't very competent or successful during my stay.
Trauma came later. It came when I was dismissed, belittled, trivialized, scorned, and ignored. It came when questions were not asked. It came when questions were not answered. It came in a thousand little insults. Patients aren't stupid. They know it's not normal to have 7 IV's in your hands after having a baby. They know it's not normal to spend the first 36 hours in bed without getting up to shower, change a diaper, or give a baby a bath. They know it's not normal to not care where there baby is, or wonder about their care. They know it's not normal to be too weak to get out of the sitz bath on their own. They know it's not normal to still have 5 IV's in their hands on the day they're discharged.
We know when you're lying to us. We know when you're concealing things. We are smarter than you think, and one of these days you'll get your comeuppance.
Tuesday, September 2, 2008
Advocacy, smadvocacy
I've been trying to figure out where the trauma actually came from. I keep circling around in whenever I try to figure out and work through my feelings about advocacy. In nearly every birth story, I keep seeing that no matter what procedure was performed, induction, vaginal assisted deliveries, cesarean sections, episiotomies, or NICU stays, over and over again there's a comment about being unfairly treated. Is it possible that if we changed the way women were treated during labor that the procedures themselves wouldn't matter?
If doctors and midwives took advantage of their 12 prenatal office calls with each patient to discuss what their theory on birth was, and referred women who wanted a different experience to other providers, would that help? If they treated us with respect, and allowed us the opportunity to be true advocates for ourselves by making choices about our care would that help? I've talked to women who attempted home births with a midwife, who had midwifery care at a birth center, had midwifery care at a hospital, had a family practice doctor, or had an OB that suffered trauma. It doesn't seem to matter if your at home, or a hospital, or a birth center. It doesn't matter if it's a midwife or a doctor. You can have few interventions or many, and still be traumatized.
It seems like sometimes we focus on trying to control the procedures because we can't control the way we're treated. That seems to be one of the many problems. For a long time I wanted to blame the doctor for attempting to manually remove the placenta. It was concrete, and didn't take much effort to blame that procedure. After all, it was painful, scary, and horrific. However, that wasn't really the cause of the trauma. The real trauma, for me, came from being treated like an object, a future mal-practice suit, an imbecile, an over-demanding patient, a failure. If the doctor had asked permission and I had consented, I don't think I would have been traumatized. I wouldn't have enjoyed the experience. I might have had a few rough nights, but I wouldn't have been traumatized.
Maybe we should be advocating for true informed consent. Maybe we should be advocating for patients being treated with respect. Maybe we should advocate for patients being allowed the right to make their own choices. Maybe we should advocate for patients and doctors developing a relationship built on trust that would see us all through the ups and downs of birth.
I'm not talking about blind trust. I'm not talking about women believing that their doctor is a god - a know all, be all, decision-maker. I'm talking about having an open and honest relationship with their caregiver. I'm talking about having a caregiver that helps a women refine and build their birth plan at each pre-natal appointment. I'm talking about a relationship where if the doctor cannot provide the patient with an experience that they want they'll refer the patient to someone whose birth philosophy more clearly aligns with their patient. I'm talking about a relationship where the doctor actually educates their patients about birth, instead of leaving us to ferret it out of medical texts, baby books, home birth books, internet sites, or any other resource we can find.
I don't know, maybe it's off the wall. It's far easier to argue for no epidural, no pitocin, no episiotomy than it is to argue to be an equal partner in the relationship. It's easier to change procedures than it is to change attitudes, but it's the attitudes that caused my trauma.
If doctors and midwives took advantage of their 12 prenatal office calls with each patient to discuss what their theory on birth was, and referred women who wanted a different experience to other providers, would that help? If they treated us with respect, and allowed us the opportunity to be true advocates for ourselves by making choices about our care would that help? I've talked to women who attempted home births with a midwife, who had midwifery care at a birth center, had midwifery care at a hospital, had a family practice doctor, or had an OB that suffered trauma. It doesn't seem to matter if your at home, or a hospital, or a birth center. It doesn't matter if it's a midwife or a doctor. You can have few interventions or many, and still be traumatized.
It seems like sometimes we focus on trying to control the procedures because we can't control the way we're treated. That seems to be one of the many problems. For a long time I wanted to blame the doctor for attempting to manually remove the placenta. It was concrete, and didn't take much effort to blame that procedure. After all, it was painful, scary, and horrific. However, that wasn't really the cause of the trauma. The real trauma, for me, came from being treated like an object, a future mal-practice suit, an imbecile, an over-demanding patient, a failure. If the doctor had asked permission and I had consented, I don't think I would have been traumatized. I wouldn't have enjoyed the experience. I might have had a few rough nights, but I wouldn't have been traumatized.
Maybe we should be advocating for true informed consent. Maybe we should be advocating for patients being treated with respect. Maybe we should advocate for patients being allowed the right to make their own choices. Maybe we should advocate for patients and doctors developing a relationship built on trust that would see us all through the ups and downs of birth.
I'm not talking about blind trust. I'm not talking about women believing that their doctor is a god - a know all, be all, decision-maker. I'm talking about having an open and honest relationship with their caregiver. I'm talking about having a caregiver that helps a women refine and build their birth plan at each pre-natal appointment. I'm talking about a relationship where if the doctor cannot provide the patient with an experience that they want they'll refer the patient to someone whose birth philosophy more clearly aligns with their patient. I'm talking about a relationship where the doctor actually educates their patients about birth, instead of leaving us to ferret it out of medical texts, baby books, home birth books, internet sites, or any other resource we can find.
I don't know, maybe it's off the wall. It's far easier to argue for no epidural, no pitocin, no episiotomy than it is to argue to be an equal partner in the relationship. It's easier to change procedures than it is to change attitudes, but it's the attitudes that caused my trauma.
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