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Wednesday
Mar172010

Good Little Girls

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Guest post by Angela Quinn

We are conditioned from the time we are young girls to placate, to assuage conflict, and to defer to authority.  We are social beings.  No one likes the bossy girl on the playground, and bitches don’t get asked to the school dance.  How many nights of sleep have we lost wondering how to smooth things over with an offended colleague or why a certain friend seems to be giving us the cold shoulder?  It doesn’t make sense, but we feel a sense of rejection when the girl at the coffee counter is unnecessarily rude or a random stranger gives us a dirty look.  We say, “I’m sorry” almost compulsively, even when someone else bumps into us.  Though our parents may have raised us to be strong, independent women on the outside, many of us still grow up with an almost pathological need to be liked, accepted, and respected by everyone around us.

So, when it comes time to ask our obstetricians the really important questions, we hold back instead of pressing forward.  After all, who wants to be that patient, the “troublemaker?”  We wouldn’t want to put him on the spot, make her uncomfortable, or, God forbid, be annoying.  Even when the things we are told do not resonate with our sensibilities, with our intellect, and with the very moral fiber of our being, we do not question.  We leave the office dissatisfied, with unresolved issues and nagging doubts.  But we do not argue.  After all, we are good little girls.

We listen and we smile and nod for 9 months.  We do not rock the boat.  We shush the little voice in our head that keeps asking why…or why not?  So, after months, years, a lifetime of obeying and acquiescing, bowing to authority, why should it suddenly be any different while we are in labor.  Inside we may be screaming, DON’T DO THAT TO ME!  But we don’t say it out loud.  Instead our conditioning takes over.  But what if my doctor gets mad at me?…Could he just walk away and refuse to be my doctor, even now?…Will she ever speak to me again?… Those nurses are going to hate me…It’s easier to just go along with it…And, of course, I wouldn’t want him to think I don’t trust him!  

What if, instead, we took a stand?  What if we armed ourselves with information before ever stepping foot in the hospital and knew which “rules” (which are rarely written policies and are usually de facto practices) we were prepared to follow and which we intended to flaunt.  What if we acted like consumers, like people who are paying for services that we choose from providers who should be grateful for our business, rather than acting like we are privileged to be accepted by them? 

Armed with evidence, what if we pulled out healthy, nutrient-rich food to fuel the marathon of labor we were about to run and (gasp!) just ate when we were hungry?  And looked anyone in the eye who said that it’s not allowed and asked if they were prepared to forcibly remove a woman in active labor from the hospital?  What if we stared down every OB, scalpel in hand, prepared to do an episiotomy “just in case,” and threatened that his cutting us without our consent would be considered assault?  What if we refused to sign informed consent forms that appear to strip away our rights to make decisions about our care, and challenged the hospital to deny us any care because we refused to sign a form?  What if we checked in to the hospital in labor, even pushing, and didn’t request permission to continue to labor, but made a firm statement to all that we will VBAC our babies, and we (and our lawyers) dare you to perform a surgical procedure on us without our consent. 

We deserve evidence-based care given to us by providers that have our best interests at heart. We are the ones who will have to live with the consequences of what happens to us during our birthing process.  We will have to carry the mental and physical scars of these experiences for the rest of our lives, not the OBs, not the nurses, not the hospital administrators.  We are the ones who will, almost desperately and for years afterwards, search out willing listeners to hear our “birth story,” a story that may be filled with what-ifs and maybe-next-times and regret and confusion. 

What if we cared less about being good little girls, and gave our bodies, our minds, ourselves the respect we deserve?  What if?

Angela is a soon-to-be mother of 4.  She had an unnecesarean with her first, a VBAC with her twins, and is planning an HBAC for her 4th. She is a La Leche League leader, an ICAN member, and is constantly fighting her own urges to always be that good little girl.     

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Reader Comments (39)

Yes! This is exactly what needs to happen! It is imperative that the birthing mother/care-provider relationship be a two sided, trusting relationship. Many OB's sure don't seem to mind saying horribly rude and insulting things to birthing mothers...the good girls need to rise up and remember that rocking the boat is the only way to be a good mother and a good advocate for their family in this medical climate!

March 17, 2010 | Unregistered Commenterjustine

Terrific post! I actually intend to do just that, to be a "troublemaker" if warranted. I'm planning a VBAC and had my previous babies past 40 weeks, with my only spontaneous labor and vaginal delivery at 41 weeks. My practice has an arbitrary 41-week "cut-off" for VBACs. If I am healthy and the baby is healthy, no one is performing an elective Cesarean section on this ideal VBAC candidate at 41 weeks instead of letting me wait literally a day or two for spontaneous labor to start. I refused an elective induction and delayed a breech Cesarean section in the past, even though it required moments that were very uncomfortable to me and medical staff being annoyed at me for my massive inconveniencing of them, but I do not regret it. They gave me advice based on convenience and not safety, and I chose not to take it.

This is my favorite quote of yours:

"We will have to carry the mental and physical scars of these experiences for the rest of our lives, not the OBs, not the nurses, not the hospital administrators."

March 17, 2010 | Unregistered CommenterSoon to be mom of 3

I agree wholeheartedly!!! I have no problems with my girls (and boy) being taught to be peaceable with all humans. But when it comes to your health, their system is a business system not a health system. Treat it for what it is! Fortunately, my daughters and I are homebirthers and so will my granddaughters be.

I love your articles. Keep up the fight!

March 17, 2010 | Unregistered CommenterMichelle

Nice piece of inspiration for first thing in the a.m.! And amen.

March 17, 2010 | Unregistered Commenteremjaybee

Amazing statement! I refuse to ever let them touch me again! I had a c-section seven months ago. I still have nightmares and it brings me to tears when I think about it. It was even more devastating because I had planned to have a home birth. I almost refused to go but my midwife insisted because I was overdue. I wouldn't have needed one if they would have left me alone. I wasn't even allowed to get out of bed and I hadn't eaten for over 18 hours when I arrived because of stress but no they didn't let me have anything so I became too weak to finish. We need to stand up and make our voices heard! No more smiling and nodding. Rip up that little piece of paper that makes you a victim and throw the pen in their faces!

March 17, 2010 | Unregistered CommenterMandy Bridges

I wholeheartedly agree with all of the above... I also think that we need to show our strength in making sure that we have a strong advocate with us at the birth, who will reinforce our wishes - be that our partner and/or a Doula... because no matter the amount of education and preparation leading up to the day, there may be times during the birth process where all we want to do is scream "NO NO NO" but we can only concentrate on the contractions...

March 17, 2010 | Unregistered CommenterJennifer

Your experiences will help those of us who want to have children in the future...thank you for sharing!

March 17, 2010 | Unregistered CommenterJoy

My experience in behaving politely but assertively as a pregnant female patient is that your chart is labeled negatively, your doctor doesn't feel s/he can "trust" you - even if the most you've done to worry him is ask why he wants to do a 38 week cervical check during a normal, low-risk pregnancy - and he refuses to attend your homebirth because you simply asking the question makes him uncomfortable. Which is why you subsequently arrive at the hospital to meet said doctor ready to push, so he doesn't have the opportunity to play out all his assumptions of how your birth will go simply because you said something other than "Yes" or "Okay."

It's all well and good to say "Act like an informed consumer! Demand answers! Assert your knowledge! Ask questions! Show that you have preferences!" - but the reality for most patients is that this will result in backlash from the healthcare provider, sometimes to the point of actual punishment during labor. Should it be that way? Of course not. But a few empowered women asserting themselves is not going to change a system with this ingrained level of misogyny and lack of respect for women.

I thought I had found the right provider the first time - a family practice doctor who had been attending home births for over 20 years. I discovered he held many of the same attitudes regarding pregnant patients as other doctors, just a different birth philosophy (i.e., natural is better - but you better do it my way). It turned out I had to find a homebirth midwife before I found a healthcare provider who didn't take offense at dealing with an informed, educated patient who wanted to discuss care rather than have it dictated to her. And I know well that homebirth midwives aren't a panacea, either - there are midwives, including some I've met and/or interviewed, who clearly also subscribe so strongly to their own practice preferences that they do not respect a woman's informed birth choices.

Although the "informed, educated, assertive" patient works occasionally, in many hospitals and with many OBs and even midwives, it results in retaliation. It can be used as justification for a hospital obtaining a court order for dictated maternity/birth care (or the threat of the same), and/or can result in the involvement of child protective services once the baby is born. It can result in doctors and nurses who are actively unhelpful or even hostile; who refuse to follow birth plans or toss them in the garbage; who pull the "dead baby card," among other things. Birthing is a sensitive time and it is not an experience wherein a woman should have to advocate for herself against medical staff - in fact, many women are incapable of doing so during labor due to the strong suggestibility that overcomes many laboring women.

As a collective, women need to object to the workings of the current system, fight its inherent paternalism/sexism/misogyny, and advocate for greater respect and rights for birthing women to change the overall culture and atmosphere of maternity care. But on an individual basis, this is often a hopeless task that backfires for that individual. Instead, individual women need to very carefully select a healthcare provider who will respect her autonomy and wishes without argument or undue assertiveness, who makes her feel that her opinion and informed consent is an important and necessary part of her care, and who treats her accordingly during labor by providing information, asking questions, and giving appropriate guidance without coercive tactics.

You said:

"We deserve evidence-based care given to us by providers that have our best interests at heart. We are the ones who will have to live with the consequences of what happens to us during our birthing process. We will have to carry the mental and physical scars of these experiences for the rest of our lives, not the OBs, not the nurses, not the hospital administrators. We are the ones who will, almost desperately and for years afterwards, search out willing listeners to hear our “birth story,” a story that may be filled with what-ifs and maybe-next-times and regret and confusion. "

I think it is completely inappropriate to put the responsibility for this outcome wholly (or so substantially) on the laboring woman. Women should be educated and informed, but they should also be able to expect evidence-based care from whomever they see for prenatal and birth care. It is unjust to blame a woman for a difficult birth experience on her alone, especially when many women attempt to procure supportive care and end up discovering too late that their birth care providers are not all they claimed to be. Trust me, showing up ready to push was not a good experience and it was not how I wanted that birth to go, and there was absolutely no reason for it to happen that way except the fact that I was duped by my healthcare provider into believing he was respectful and supportive when in reality his own practice preferences and prejudices were far more compelling to him than respect for my autonomy. There was no way I could predict that this provider, when I said the stitches he was doing to repair my 2nd degree tear hurt and I could feel them and needed more local, would respond "That's just pressure." The treatment I received was unexpected and inappropriate and it wasn't until 37 weeks that I realized I had a problem - too late to procure a midwife or more supportive care before I went into labor at 38 weeks. After repeated protestations I was given more local, but then the doctor proceeded to continue stitching before it had time to take effect. There is only so much you can do when you've just given birth, people are holding your legs and you're saying what *should* be effective. My experience is in no way unique; and I was seeing a healthcare provider who was considered one of the very best options on the natural birth community.

The problem does not lie with women being too passive, particularly when labor induces suggestibility and passivity on many women. Expecting individual women to buck the system during labor is unrealistic, victim-blaming and, in many cases, actually detrimental to obtaining decent and respectful care. Of course it shouldn't be that way - but the reality for many women is that it is, and we need a massive cultural shift, not the unheard cries of individuals followed by laying the responsibility for the failure of those cries to be effective at the feet of the women who cried out - or didn't cry out, because they were unable to speak or advocate for themselves during the vulnerable state of labor.

March 17, 2010 | Unregistered CommenterAnon

Anon, I would say that's one of the answers to "what if?" If it's not received well, it can be disastrous. Nevertheless, I liked going on the "what if" journey.

March 17, 2010 | Registered CommenterJill

Boy, this blog is giving me a lot to think about as I prepare for the birth of our second child (I'm 12 wks right now). The first one was induced at 38 weeks for bad preeclampsia, and my doctor was awesome, but the delivery itself was beyond painful (my epidural [given to help lower my blood pressure] conked out at 6 cm) and terrifying. Now he's not doing OB any more, so I'm supposed to meet the high-risk OB Monday.

I agree with anon above, that's it's unfair to put all the pressure on women to stand up to doctors. As I wrote at length on another post, I've been on the receiving end of some horrible behavior. Arguing, though, has usually landed me being labeled "noncompliant", "argumentative", or something insulting about my mental health. It's very hard for someone with PTSD to be taken seriously by a doctor. My husband has to come with me to all important appointments to provide what we call "the appeal to irrelevant authority". So I can gripe and refuse and complain all I want, but it's dismissed as just the ramblings of a crazy woman. When he talks, though, they listen. It's unbelievable frustrating because I actually have 2 years of grad school in neuroscience under my belt, whereas my husband is an engineer! Which of us do you think knows more about my body? What would a woman without such an awesome partner be able to do in my shoes? Once you're saddled with that psych diagnosis (and many of us are), you lose all credibility. I've taken to snapping, "Just because my cortisol levels are affecting my hippocampus doesn't mean I'm an idiot."

March 17, 2010 | Unregistered CommenterAlice
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