Sunday, January 18, 2015

Virtue as the Mean

     About a week ago I found this article in the Washington Post. It is the experience of one woman, a self-described "physician, teacher, and health policy researcher" while having her baby in a hospital. She details the immense pressure she felt to have a high intervention birth and almost a cesarean section despite her wishes to have a low intervention birth. The big take away from the article, at least from my perspective, was the danger lay women face in the delivery room given the adversity this woman of medicine had to confront in her own labor. At one point she mentions consulting with several other M.D.s of various backgrounds in order to advocate for herself and her child. While I thought the article was an insightful and pointed statement about maternity wards, the larger cultural commentary came from the vary first comment that showed below the article itself. I normally avoid the comment section like the plague but happened to catch this one as it was the only comment at the time. I didn't feel like wading back through that trash to get a direct quote, so I will paraphrase. The commentator basically said "Shame on you" to the mother. She was doctor. Apparently she should have known better and advocated for herself more. If she felt pressured it was her own fault for letting herself get into that situation.
    This is not the first time I've heard this argument. It actually comes up quite a bit. Women share their stories of abuse and mistreatment during their births, and they are blamed. It is there fault for not being more prepared, more educated, more anticipatory of the events. It's their fault for relying on doctors. It's their fault for not taking responsibility in their own care. It's their fault, period. I find these arguments confusing for several reasons. One is because there seems to be very few other specialized fields where consumers are expected to have expertise. Most people who go to a mechanic can't build their own engine. Most people who go to a gourmet restaurant can't cook French cuisine. This is also a huge issue of privilege- assuming that someone who is already paying a professional to perform a service also has the time and resources to teach themselves the ins and outs of the field and be independently educated on the topic. Is assuming that someone trained in healthcare and beholden to the hippocratic oath will provide adequate care really that far of a leap?
     But another thing about this idea of "it's your fault for not educating and self-advocating" is that it's bullshit. Because women who do all those things above- who prepare and seek out education and information and participate in their care- aren't treated any better a lot of  the time. They are labeled as pushy. As non-compliant. Demanding. Relying on Dr. Google. Buying into psuedo-science. Believing everything they read on the internet. They are accused of being selfish and even worse, of not valuing their child's life and health. These women have been dropped as patients by their doctors and had CPS and police called on them. They have been dragged into the OR against their will. Laboring women have been put in handcuffs.
    Apparently, there is a delicate balance to be found for a laboring women. She should be educated, but not questioning. Responsible but yielding. She should stick up for herself, but not to the point of stepping on the toes of the almighty gods in white coats. It's not surprising then, that so many women fall short of the virtuous mean. For me personally, I will always recommend erring on the side of education and empowerment. However, I think there is an alternative.

   What if, just for shits and giggles, we entertain the idea that maybe, just maybe, the birthing women     aren't the problem?

   What if maternity care in the U.S. is intrinsically flawed?

   What if the entire healthcare system is set up to thrive on profit driven by disease and trauma?

   What if the field of obstetrics was never intended to cater to the masses?

   What if our view of womanhood and motherhood is deeply ingrained in the patriarchy?

   What if profit drives care more than science and research?

   What if convenience is more sought after than health?

   What if we knew that the U.S. funnels more money into maternity care than any other developed         nation but has the absolute worst results?

    Maybe that is where all of  these people should be pointing the blame. But instead we invent these "mommy wars" and blame some women for being too informed and blame others for being too compliant and once again place that ever-tantalizing image of the perfect (birthing) woman on a pedestal for everyone to collectively emulate. All the while, ignoring the real problem of a deeply entrenched system that as it exists now is set up to undermine evidenced-based care. Education and advocacy gives women a fighting chance. It is the kevlar that they wear when they walk into the war-zone of the current maternity care system. But it is not a guarantee that they will come out unscathed, anymore than blindly following someone across the battle field with your eyes shut and fingers crossed. What we need is a collective cease-fire. A real, open and honest peace talk about how we got to the place where battle was a useful metaphor for childbirth. But as long as women are spending all their time and energy attempting to find the balance between advocating for themselves and being polite, no one is addressing the core issues. No one is trying to fix the problem if we are all too busy arguing about how to adapt to it.


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