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Thursday
Jan062011

Is it distrust or is it just a different paradigm?

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By Jill

For reasons to be seen next week, this comment I left on Amie Newman’s post, Home Birth “Common Ground”?, is decent pre-intro to the Defending Ourselves against Defensive Medicine series beginning here next Monday.

 

“For women who wish to plan a birth at home, or at a birthing center, it’s not about a distrust of physicians so much as it is about a choice not to make it about physician-oriented care at all.” 

 

A wane in trust in the patient-physician relationship (and at a societal level) has been explored and documented for decades, much of it attributed to a veil being lifted about the heavy-handed (over)marketing of the efficacy of physicians in the last century, the “consumer” movement in general and patient awareness that there are many factors that motivate treatment decisions and this can foster a sense of suspicion and distrust. Oddly, I was just reading a 1996 JAMA article about managed care that discussed how awareness of gatekeeping and incentives bred animosity and frustration.

It is logical to assume that if a patient realizes that there are other forces driving “medical” decision making, they might look elsewhere for care in any specialty. I think you’re onto something, Amie, with your assessment that much of this has to do with realization that women are leaving physician-oriented pregnancy care for very rational, empirical reasons, much like when a patient is recommended the most aggressive treatment available in another scenario, such as back surgery, and decides that they would rather see how their body heals with physical therapy. Fortunately for patients, most physicians don’t seem to incur a narcissistic injury from this phenomenon and build an identity around it. In fact, most doctors that I talk to say about the same thing about home birth—it’s a woman’s right to do it, it scares me that someone would place distance between themselves and an operating theater, don’t do anything stupid and please don’t hold me responsible if you come in bleeding to death. Other than that, I don’t think most really pay it much mind, as it applies to such a tiny piece of the population. (Permalink to comment)

 

Thoughts? Criticism?

 

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Reader Comments (10)

For me, it was mostly about not taking part in physician oriented care, but partially because I don't completely trust them. I have been treated poorly in the past by medical professionals so I have reason not to trust them. On the other hand, after my UBAC last May I had to trust them to remove my stubborn placenta that would not come out on it's own. There is a time and a place for physician oriented care and there is a time to trust your body and the birth process. Knowing the difference is a valuable tool. If I could have a do-over for all of my births I would have them all at home unattended. :-)

January 6, 2011 | Unregistered CommenterJessica

For me, it was somewhat about distrust, but it was also choosing to do what I thought was best for me and my baby. Taking my birth home allowed us to birth in a way I believe would have been impossible in a hospital.

January 6, 2011 | Unregistered CommenterMama&Ellie

For me it is about retaining control over my body and the situation and not handing over the rights to my body (and mind and emotions) to a third person who may or maynot be having a good day and their personal ideals not matching with mine.
Oh, and yes, after last time, I don't trust medical professionals, in most cases.

January 7, 2011 | Unregistered CommenterAnne

The comments on that article are starting to make my head hurt.

I think that it is a different paradigm and comparing midwifery to obstetrics is apples to oranges, but as Illinois showed us yesterday, we are not really at a point in the United States where midwifery is just another menu item. I think, and this is bolstered by some numbers I read about parity and use of midwifery care, that women are indeed saying "I want something else," but it still carries with it the subtext of "because I don't trust that the OB will treat me in the way I should be treated, medically or psychologically." Until the hegemony of the obstetrical/biomedical/technocratic model is destabilized, most women are choosing "not-obstetrics."

I think it all comes back around to the first part of your comment - the more that women see that the decisions that doctors make are based on nonclinical factors (think of the outrage at that Angie's List ad about the doc that gave a cesarean so he could go play tennis, ad infinitum), the more they will feel empowered to make decisions based on their own nonclinical factors and assessment of the risks. At it's heart, I think it's about distrust.

January 7, 2011 | Registered CommenterCourtroom Mama

For me, it's a little bit of both. I had two physicians lie to my face (in different hospitals, in different States). I liked these men. They were nice people. I was completely caught off guard when they told me such blatant falsehoods. The first time, I thought it was just the one guy, and figured that once we moved, it would be different with the next doctor. It wasn't. I didn't feel like I could trust these people to guide me in my decisions during labor anymore. I wouldn't know if there really WAS something wrong, or if they just wanted to go home early that night. I didn't trust them anymore, so I looked outside that system.

As I learned about alternatives to obstetric care, I realized that there is this vast pool of knowledge that for some reason my OBs seemed to lack.

So yes, my obstetricians drove me away from the mainstream system, but as a result I found something I feel is better. And now, even if something happened to restore my trust in obstetrics, I would not return. Only if my life, or my baby's life depended on it (which is what obstetrics is supposed to be for anyway).

January 7, 2011 | Unregistered CommenterHeather

For me it's about patient autonomy, needlessly incongruent paradigms, and a healthy dose of mistrust.

January 7, 2011 | Unregistered Commenterlabortrials

Yup. I see distrust of medical providers as a huge factor in, for example, the MMR/autism vaccination scare. Many parents were desperate for information when that Lancet article came out, and were met with outrage, scorn, or derision for questioning any part of the vaccination schedule or whether any components of a vaccine had side effects. As it turned out, there was no connection, thank goodness, but now there has been a decrease in vaccinations by parents who decided that they could not believe what they were being told (and an increase in hucksters who preyed on them)-which has overall bad effects for everyone.

So long as doctors refuse to meet patients at their level of concern, whether it be a desire for peaceful birth or a worry about medical side-effects, they lose the chance to educate and push people away from needed care. Some women will have out of hospital births that really shouldn't. Some parents will risk their child getting whooping cough or measles. These are not good outcomes. But the answer is not demanding that patients give up all their rights to make their own medical decisions, either.

January 7, 2011 | Unregistered Commenteremjaybee

I chose homebirth after workign through 30 weeks with a hospital based practice. The care was decent, but after dismissing my concerns and not giving me the information I asked for on evidence based care, and lying to me about several health things (which I looked up and confronted them with) I chose to go to homebirth with a midwife, as my other option was unassisted.

This was reinforced when my second child was over 10 lbs and all the local physicians I know said that 'their' hospital would not have allowed me a vaginal birth with an infant that size, as obviously I was diabetic (nope, sorry). I had a 30 minute labor, as is normal in my family.

Hospital birth or out of hospital with the medical model (OB or midwife!) has its place. Just not for me. If in the future it was necessary, then I would carefully choose a practitioner what was respectful.

January 7, 2011 | Unregistered CommenterLadyg

Very thought provoking. I think it is fairly equal from both sides: the women who realize that obstetrical care is not patient-centered, and the women who flat out hate OBs and other hospital practitioners. I am the latter. I have nurtured a deep abiding mistrust of Men In White Coats since I was a child. Bizarre that I would then choose to give birth in a hospital for my first child, but I was seeing midwives, I thought I was safe. Alas, the Man In The White Coat came in to cut me anyway, and lie about it. I realized too late that the only way to stay safe from the Men In White Coats was to stay the hell away from where they work, period. I know this outlook receives a lot of scorn from people who don't understand what the hell the big deal is. But IMO, there is validity to each side - not just the consumer-choice aspect, but the complete lack of trust. If a woman has felt violated by any subset of people she is naturally going to be leery of them. It is a matter of self-preservation.

January 8, 2011 | Unregistered CommenterJill P.

@Emjaybee: Amen. Why can't we have a conversation about people's fears, suspicions and concerns about vaccinations without shouting them down as a bunch of anti-medicine crazypeople? I mean, that's seriously the level of discourse as it stands today, and the home birth-midwife conversation isn't much more intelligent (from the "mainstream" end). And yet everything we read about the state of American health care tells us that health care in this country is broken because we a) receive too many invasive, painful, and scary interventions and medications that b) do NOT improve outcomes/ overall health. And yet any specific questioning of the system or attempts to alter it is frequently met with derision, especially women responding to issues that affect them and their children. What's up with that? If you want women to birth in hospitals because you think home birth is dangerous or going unvaccinate is dangerous, the place to start is *listening* to people and their concerns and taking them seriously, rather than yelling at them that they are stupid/dangerous/uninformed/ insane/ selfish whatever.

January 8, 2011 | Unregistered CommenterErin
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