Too Polite to Fight
Wednesday, March 3, 2010 at 1:12PM
Courtroom Mama is a lyrical genius.
I’m not sure if she remembers writing “maternal request or doctor behest” in an e-mail a year and a half ago, which I totally hoisted once or twice without due credit, but she’s identified a cousin of the “Too Posh to Push” archetype.
Her cousin, “Too Polite to Fight.”
Ms. Too Polite to Fight is a stereotypical manifestation of gender subordination. When faced with a recommendation of a cesarean, she feels uncomfortable questioning the doctor or midwife and sheepishly schedules the surgery.
On the Internet, Ms. Too Polite to Fight gets her share of shit from anonymous mobs of men and women who yell, “IF YOU HAD JUST EDUCATED YOURSELF, YOU WOULDN’T BE IN THIS PREDICAMENT!” and “WOMEN JUST NEED TO STAND UP FOR THEMSELVES AND SAY NO!”
Ms. Too Polite to Fight, it was your fault.
After all, it has nothing to do with institutionalized sexism or violence, the doctor/patient imbalance of power or the societal doubts about whether a pregnant women really is an autonomous individual and subsequent dehumanization of her. Or medicolegal factors or physician preferences and biases or hospital policy. Or the woman’s personal history of emotional abuse or her religious beliefs.
She was just too polite to fight.
And next time she can go to the same hospital and see the same doctor and everything will be different because this time she’s going to educate herself and fight for her rights.
Right?
Right?
Yeah, right. It’s just one piece of the puzzle.
Reader Comments (24)
And if you're not TPTF, you are "pushy" a "troublemaker" a "crazy hippie-granola type" or ultimately "a selfish mother who doesn't care if she KILLS HER BABY OMG !!11!!"
MotherBlaming: the sport of..well..everyone, pretty much.
Yep. It's all my fault. Everything.
Just ask my kids.
So, I'm a student nurse. And over the past two weeks I had the honor of doing my labor & delivery rotation in a local hospital - the one where the freestanding birth center does their transfers when needed. I had a hospital birth with my twins, who had TTTS, and the folks in my practice were so kind and totally humored our, 'what, are we interrupting your GOLF SCHEDULE?' (in february) attitude when they recommended early induction and worked very hard to ensure a good experience overall. In a teaching hospital, especially, I thought that was the bees' knees. I had a birth center birth with my oldest and my youngest was attended by a midwife in a hospital. So you can see that I haven't had a whole lot of direct experience with your basic, routine hospital baby birthin' - and quite frankly, I was scared shitless.
So my patient last night was so sweet. She had complications with her first pregnancy and after 3 hours of pushing endured both forceps and a vacuum extraction. That was over a decade ago, and here she was, sad to be overdue but okay with her induction that was already taking 2 days - cervadil in, cervadil out, cytotec orally, then pit/AROM all at once yesterday AM and she asked for an epi (and got it) at 2cm. I arrived at about 3 and she was 6cm and 75% effaced. She was uncomfortable but cheerful and she warmed up to me really quickly. I'm primarily a massage therapist, so I checked out her contractions on the monitor and I taught her mom how to squeeze and massage her ankles (so conveniently lined up with the uterus reflex) and pretty soon she was contracting regularly. She went into transition and became fully dilated before 6PM, which was when her favorite doctor was scheduled to leave - but the nurse assured us that he promised to see it through. We were all in high spirits, her boyfriend had gotten involved and was rubbing her belly and joking. I'm going to gloss over how many times fingers entered her vagina and how the 15-minute interval btw temperature checks...just...you know.
Although I guess I technically had the same kind of pushing experience with my twins, it seemed much more focused and emergent. (It was, I guess - my babies were in danger and hers was shouldering the pitocin beautifully.) I wasn't prepared for a nurse looking at a monitor and telling us when to grab her legs, and the counting to 10 while she held her breath and pushed. I felt for her between contractions because she kept asking if it didn't just make sense for her to get up as much as possible so gravity could help out. She was working so hard and the nurse checked a few times and said the baby was starting to descend. We could see changes in her belly. She was excited and scared.
You know where this is going, I'm sure. Why else would I be sharing it here?
At 7 was the changing of the nurse guard. We'd gotten out the baby warmer and all the equipment for delivery. We'd started to set everything up. The nurse who was leaving was optimistic, too. She mentioned in passing to the oncoming nurse that the patient had pushed for 3 hours with her first baby who was a 6lb. preemie @ 34 weeks, induced. The nurse paused and said, "oh." She took a couple more notes and left the room.
The doctor came back, looking pissed. At this point, it was close to 7:30. He checked her roughly and asked her how big her first baby was. "Six pounds, and you couldn't push her out? How do you think you're going to be able to push this one out? She's at least 8." The patient floundered, saying that the u/s the week before had said a little over 7. "You think all THIS is only seven pounds of baby?" he said as he jabbed her at the fundus. She started crying and said, "But I only gained 15 pounds! I did such a good job!" He said something about how she hadn't been working hard enough, hadn't been pushing hard enough, and then he snapped off his glove and left. By this point it was 7:30 and time for me to leave, so I squeezed the grandmother's hands and told the mom that I knew she was going to have such a wonderful time with her baby and then I walked past the room right across the hall where they were already setting up for her c-section.
I'm still horrified. I mean - I read about this stuff all the time. I hear it from people I know. I'd actually put out a little prayer to Baby Jesus in his hairy baby Jesus shirt not necessarily to help me figure out where I'm headed with all this back to school as a grownup nonsense, but more to just show me the things I needed to see. My facebook status last night was "Be careful what you ask for." I want to go find that doctor and follow him to the grocery store and kick him in the shins! And I just know...this was one mom, in one hospital, on one night. Ugh.
Hm. That was real long. Sorry about that. I sure needed to get it out, didn't I?
I think the trouble is that there is so much information out there designed to instill fear in the parents. Look at all the "reality" birth shows... is there one birth that doesn't have some cliffhanger emergency that needs rescuing? Look at the roughly 1/3 of all birthing mothers having cesarean births... presumably to save the baby in most cases, creating the impression that something must be dangerous about birth if 1 out of 3 birthing mothers have to have surgery to give birth. Look at movies and TV shows that turn birth into this horrendous and/or comical event.
I'm not saying that art doesn't reflect culture. I definitely think it does in this case, but it also reinforces the harmful and false idea that birth is inherently dangerous and women need to be "saved" from it.
And then there is the dead baby card that is played at some point in almost every hospital birth I've attended. "You don't want this pitocin to get things moving? Your baby could get an infection if your water is broken too long...", "You've pushed long enough, we need to use the vacuum or your baby won't be breathing when he comes out...", "I don't know what your endgame is, but I want a healthy baby..." I could go on and on and on... No matter how educated one is *before* the birth, once they are faced with the threat of death for their baby, they are no different than the parents who never stepped foot into a lamaze class or didn't open a childbirth book.
Education must be paired with empowerment in order to improve the birth experience. The system that I am a part of often does everything it can to take power away. I see how little education can matter in the end.
Yo, my science is tight.
Love the graphic. I'd love to make graphics representing all the mother-blaming tropes that get trotted out in discussions about birth -- I'd spit a couple more but I can't top "Too Polite to Fight"
You won the internet this week, CM.
foxy.kate - thanks for sharing that story. i can see why you needed to tell it. that mama was lucky to have you there.
I commented on the original post, but here it is again:
I wasn't trying to say that EVERY woman down here who has a c-section does so because she's a mint-julep-sipping-rich-white woman. However, there is a tendancy in the South, where I've had ALL 5 of my babies, including my last hospital VBA3C, to not make waves and not question authority. I'm not blaming women for their c-sections. I've just giving a guess as to ONE influencing aspect in what has become a horrible trend in medicine.
I just wanted to say thank you because thanks to the recent and ongoing discussion here and on the sister blogs (I don't know what to call them) I literally fired questions at my OB yesterday trying to bridge the gap and not put up that wall of silence between he and I when it comes to my care. I was definitely becoming TPTF. I want to feel like we are a team involved in my care. Keep up the great work women.
Foxy Kate, WOW. I shouldn't be surprised by these stories anymore, but it's still a kick in the crotch, every time.
Please help be part of the solution. :o)
Kate, I remember reading somewhere where one patient DID approach her OB when she ran into him in public, and proceeded to rip him a new one. He sulked away, tail between his legs, basically.
I don't want to "blame" anyone, but where do you draw the line? Should we expect our doctors to tell us all the information we need to hear about birth and our choices? Yes. Will they? No. So what's in between? At what point should we be responsible for ourselves and be our own advocate, because no one else will? I think many of us who are here, including myself, were in this situation, and some of us learned from our past experiences; some may not have. I know I am definitely NOT the same person with regards to birth that I was when I had my first child, because my experiences, both good and bad, changed me completely. AND I met some people who shaped my ideas, as well as educated myself about my own body and what it could do, and mostly what doctors would try to tell me it *couldn't* do.
I know so many women who fall into the TPTF category, because they think 'doctor knows best.' Until they meet a "bitch" like me who sounds anti-doctor and goes all crunchy granola on them LOL they will propagate that same TPTF mentality to others, and so the cycle continues. One woman I know just gave birth to her first at age 37, and basically said to me, "It was my first, I let them (the doctors) do whatever they wanted." Huh? Do we run the risk of sounding wacky, and inadvertently "blaming" women? Perhaps. As long as I got my point across and hopefully they realized that there IS a choice, then I guess I'm okay with that.
Too polite to fight...the beat brought back early 90's MC Hammer Too Legit to Quit to my head. I'm thinking some kind of made up lyrics to the Too Legit to Quit song that talk about how women *are* too legit to quit and all those other "too"s (TPTF, TPTP, etc.) are just unhelpful stereotypes. How about "NOT Too Polite to Fight" or something like that.
I'm thinking out loud here...it would have to be well written so it wouldn't sound preachy and woman judging...but I think it could probably be done. (Even when we don't intend to be woman-judging, it can easily come across that way.)
@ Bethany - I think most people understand your original comment wasn't meant to be woman judging, and I think The Derganed Housewife summed it up nicely. The problem is that women *have* to be "impolite" and fight, or end up bieng TPTF. Rock, hard place, moms. And Vanessa's quote summed it up nicely "The system that I am a part of often does everything it can to take power away. I see how little education can matter in the end." In a system like that, blaming the woman is just a way for cp's to keep from looking in the mirror (IMO).
Now comes the hard part...how to change what is...and in the meantime how to work with what is. I think conversations like this are a start...they keep us honest. But (this goes with a post last week), effecting change can at times seem overwhelming. Anyone with ideas that touch on influencing this culture of mama blame (and this goes to ALL choices made by mamas, not just birthing ones), I'd love to hear them.
This post feels so appropriate for my mood today. With my first child, born in 2005, I was definitely TPTF. The more I learned about birth and how I had been duped into a cesarean I didn't need, the more I beat myself up about it. Why didn't I stand up for myself? Why didn't I make another choice? Why wasn't I more educated? I then realized that I shouldn't have had to be the only one to stand up for myself. It was the doctor's fault. I was lied to and taken advantage of. Women trust their doctors. They go to school and do this everyday. They should know best, right? That is why I can't blame women for all the things that happen to them during birth.
I am now in a totally different place in my life and have planned a home birth for baby #3 (due any time now). But I know if I were placed in another hospital situation, I may just become to polite to fight once again. I am just not a person who can stand up in such a vulnerable position as giving birth. It truly scares me. I am praying that I won't need a hospital transfer.
Yesterday, my c-section wounds became fresh again. My sister-in-law, who is a registered nurse, gave birth to her first. In the times we discussed pregnancy and birth, she was adamant about how much she knew about it and that she wouldn't be bothered how she delivered as long as the baby was fine. This was frustrating to me, but I figured that she had studied and had experience and it was her choice.
She went in for an induction due to high blood pressure. Prostaglandin didn't work , and pit was not super effective. She then had an AROM and labor was finally getting started, though it was quite slow. An epidural was administered at 3 cm and labor slowed again. Pit was upped and she finally made it to 6 cm. By this time, the doctor was really impatient as she had been there for over 30 hours, but had only been in active labor for 9. She was fed some lies about how she had CPD and her big baby could get stuck, and that she could kill her baby, blah blah bah, if they didn't perform a c-section. She was in tears. She wanted to continue to try, but consented to surgery. By nature, she is much more outgoing than me and is educated, and yet was taken advantage of when she was at her most vulnerable.
My heart is broken for her. It makes me so angry I don't know what to say. Of course it is ideal for a woman to be educated and to advocate for herself, but even those who are armed and prepared are crushed under the system. It is not their fault, but yet people continue to blame mothers for the state of birth practices.
Kathryn,
It's sad and unfortunate for your sister in law. Yet I think, like so many of us, she learned the hard way, maybe? Even as a nurse she still became a "victim" of the system. Which is really frustrating. They even treat fellow OB's this way, which is why so many of them are having repeat c/s and ALSO home births.
Throughout most of my last pregnancy I smiled and nodded during many doctor's appointments, went home to process and then dealt with it on my own, I guess. But at one point one of the doctors in my practice tried to bully me into doing a c/s early, and I said to myself, I need to be the advocate that I encourage everyone else to be. My husband was supportive, the nurses were awesome - long story short, I had been admitted for observation and the doctor was trying to call me in my room, but the nurse wouldn't patch her in to me LOL (which made her even more rude). I was on the verge of wimping out, and literally had to tell myself, even as I was on the phone with her, to be calm, rational, and firm. It is a CONSTANT battle. One I have with myself even now, as I think about having another baby. Do I really want to do this to myself? I don't know anymore.
I do agree that some must learn the hard way. Her cavalier attitude beforehand made me think she would be in for a surprise, and I was right. It is really sad that someone like me was able to "call it" before it even happened. Once she mentioned induction, I just knew it would turn into a c-section. Despite her attitude, I still feel for her and her experience.
I think it is hard for me to stand up in the heat of the moment. I am very grateful for the nurse who stood up for me during the birth of my second child. I may have ended up with another cesarean without her. My husband is very supportive of me and is also rather passionate about birth, but neither of us are the type to confront it head on. We are closer now, but it still feels like a stretch.
I think one of the things that has made me feel so bitter about my experience is how it has affected the rest of my childbearing life. But then, I remember that I would likely not be in the place I am now without it either.
And can I just add how much this photo creeps me out? On display, for everyone to see, like an object. They treat freaking cadavers with more respect. It does remind me of the some of the photos of abandoned hospitals I've seen. It practically makes my skin crawl.
BTW, it looks like the original operating room is part of a museum in Great Britain.
http://www.timeout.com/london/museums-attractions/event/63978/old-operating-theatre-museum
The description says, "Built in 1821 for poor women...." The original obstetrical guinea pigs.
The thing that aggravates me more than anything is that women shouldn't HAVE to fight while they are in labor to be respected and heard. My sister's second birth was a long, drawn out battle during which several different doctors came in to tell her why she was so wrong for continuing with her birth wishes. I was there with her and saw how hard they pressed her and manipulated her. They even flat-out lied (my personal favorite quote from the highest "ranking" doctor was: "The longer a baby stays in during labor, the less likely it is to come out on its own." HUH?) But she stood her ground and had a healthy, unmedicated vaginal birth.
After that whole experience, I was just left thinking, "WHY, why, why would they even put her in that position in the first place?"
The Deranged Housewife, I'm so impressed with your Google skills!
Augusta, that's why when I hear the old "We can never know which cesareans were unnecessary in retrospect," I have to manually roll my eyes back to the front of my head.