How doctors think: understanding the practice of obstetrics.

"Giving birth is about making mothers: strong, confident, capable mothers". 

http://www.barbarakatzrothman.com/

The truth of that quote inspires me, stirs my heart.

Giving birth is about making mothers. Midwifery is about supporting women through that process.

Obstetrics is about managing the delivery of babies.

Obstetrics is about managing and controlling the end result of a baby, and delivering it to a mother.

The difference in philosophies and practice are clear from these stark definitions.

Being managed weakens women and makes their transition to motherhood harder. I don't work in the hospital but I learn about obstetrics and the way it works every day. Women tell me their stories. 

How women tell me their stories is significant. A common primary theme is self blame, typical of any victim mentality. "I should have known" "I shouldn't have accepted..." "I believed him when he said..." "I shouldn't have gotten the epidural". Call those stories to truth! Women are being manipulated, controlled, abused by obstetrics. 

Rachel's first baby was born by C section.

"Tell me the story of how that happened" I say.

" I went in for my prenatal visit at 39 weeks. I was uncomfortable and my doctor said: "Your baby is ready to come out now. He's getting big. You are a small woman and you are already 2 centimeters dilated. Let's get this show on the road."

Dr Getthebabyout has set Rachel up. He has watched her weight gain anxiously, telling her every visit that the baby is getting big (perhaps 'confirming' this with an ultrasound). Dr Getthebabyout has put his long thick fingers up inside her vagina every week from 36 weeks, 'checking her cervix'. With that invasion of her body, he has increased her submission, and added to the impression of his omnipotence by implying that it provides him with knowledge about when the baby is ready to be born, or rather when Rachel's body is ripe for his management. He adds to Rachel's first time mother anxiety. Instead of encouraging trust in the the process of birthing and becoming a mother, he increases her anxiety with his own. (Perhaps "We need to keep an eye on that blood pressure" or "I don't think your baby has enough fluid"). Any excuse will do but when all else fails, the baby's size is a good one for inciting fear.

So Dr Gettthebabyout consults his calendar: "I'll be out of town next week, so how about this weekend?" (What a give-away. He wants your money so to make sure he doesn't let Dr Trustme get the fee while he is in Jamaica, he will make sure you have your baby on Saturday afternoon) (Not Saturday evening because he has a dinner party and he has to sleep Saturday night so that he is fresh for Jamaica).

Rachel is a smart woman with a responsible job. She does not let her staff at work walk over her. She does not let her boss push her around. But when it comes to giving birth she is vulnerable. She is new at this and the stakes have never been higher. They are love itself. Her baby whom she nurtures, senses and grows inside of her, is the stakes. 

So Rachel agrees to an induction. The pitocin is turned on at 7 a.m. After brunch with the family, Dr Getthebabyout comes into the hospital at 1 p.m. Rachel is 4 cm dilated so he gets out his plastic crochet hook. "I broke your water so we can move things along" he tells Rachel after he has done it. Rachel is irritated. She had read that leaving the bag of water intact might be a good idea. But what can she do? She has never been more vulnerable in her life. She is on her back, tied to the hospital machine-bed with the belts required for the fetal and uterine monitors as well as to the IV pump by means of a line in her arm. She has a band on her wrist and wears a hospital property gown slit open at the back. She has been forced into total submission. Before he goes home to pack his bag for Jamaica, Dr Getthebabyout places internal monitors deep inside Rachel's body and into her baby's scalp. The invasion continues.

The contractions are strengthening. Rachel's husband, Mark, tries to help Rachel to use her breath to stay relaxed, just like they learned in childbirth class. But it's not working very well. The equipment is in the way, and he is not very sure of himself in this hospital environment with its medical ways and bleeping machines. Mark can't help being submissive to Dr Getthebabyout's scheme too. The efficient and smiling young nurse, Anna, pops into the room again to tinker with the machines. She sees Rachel and Mark struggling to cope and says what she knows to say best: "Would you like an epidural?" Mark emerges from his submission. He knows that his job is to advocate for Rachel. He knows she doesn't want an epidural and he says "No thank you. We want to go natural" (surrounded by machines and in the belly of the obstetric beast, the paradox of that statement is lost on him). "OK" says Anna. She knows how obstetrics work. "Just let me know if you change your minds." Anna smiles and leaves.

Dr Getthebabyout has called the nurses' station, asking Anna what Rachel's cervix is at.(Remember he needs things to move along. The dinner party will be at the Gotitalls' house and should be a pretty glitzy affair). So Anna comes bouncing into the room again, checks the machines briefly then takes out a glove and states "I need to check your cervix to see how things are moving along". Rachel submits. She is 5 cms dilated. Anna reports back to Dr Getthebabyout who tells her to "turn up the pit". As Anna presses the buttons on the IV pump to turn up the pitocin as she has been told, she mentions in passing that Dr Numbit, the anesthesiologist is about to go into surgery so it's the last chance to get an epidural for a while.

After a smiling and efficient Dr Numbit placed her epidural, Rachel felt a mixture of relief and disappointment. She was just falling asleep when ........   bleep bleeep bleeeep BLEEEP went the machine by her side. Alarm and medical teams were immediately all around. The bleeping was Rachel's baby. He was shouting "Help, what's happening?" from deep inside of her and that's what she felt too. "Help, what's happening?". The save-the-baby team was at hand watching the machine and putting medicine in her IV (the epidural had reduced her blood pressure which had caused her baby's heart to slow)..... "Oh no....." said Rachel and Mark.  "No worries" said the team "This medicine will raise your blood pressure that was lowered too much by your epidural and the baby's heart rate will recover" and they inserted a needle into the IV tubing. The save-the-baby team stood around the machine. Rachel and Mark held their breath. They watched. They listened to the rather slow, not recovering too well blip of Rachel's baby's heart, and watched the printout develop. "Call Dr Getthebabyout" said the young man (a doctor?) who Rachel and Mark hadn't met before, "And get the operating room ready for a C section".

That's how Rachel's first baby came out and that's how Dr Getthebabyout made it to the dinner party, with plenty of time to pack for Jamaica too. One more family of victims to obstetric management.

And Rachel blamed herself!