There are many pressures on people involved in the pregnancy and childbirth. There is the pressure of ensuring optimum outcomes, of being objective and informed, of being appropriate and true to philosophy and ethics.
It often seems like a confrontation between disciplines, a them and us depending on your perspective. For the individual a view can be a confirmation or challenge to their value structure depending on the answer to the original enquiry.
On the whole, Obstetricians, doctors, midwives and women ALL want an outcome which optimally includes a physiologically, mentally and emotionally well infant, mother and family. It appears if you start off on that premise, that that it is a good working foundation on which to build. Unfortunately the avenues and navigations made on the journey to these optimal outcomes are thwart with subjective, political and emotionally charged biases and in this age of a wealth of information being provided without any substantiation it is an impossible task.
Obstetricians are often touted on one side as being the controlling self interested misogynistic discipline that focuses on control rather than the natural marvels of reproduction, whilst on the other side Obstetricians are the saviours of rational against absurdity, the purveyors of truth in a suspicious and superstitious world. On the opposite side of the coin midwives and doulas are perceived as being the stalwart bastions of all that is natural and empowering, the feminine struggling against the misogynistic control of patriarchal medicine whilst on the other hand being seen as being the unscientific, flowered up, rose tinted nature at all cost ignorant practitioners who rely on faith and trust. Women on the other hand are the flotsam and jetsam to be gathered collected and collated, whilst all the time celebrated as being the singular force in the decision making process. Unfortunately we ALL as health professionals encounter this in our working careers, witness it through our peers and experience it through ourselves and families.
Going back to the singular, on the whole truth, that we ALL want optimal holistic outcomes at the end of our care we should embrace all perspectives and empathies whilst being courageous to speak truth within the framework of respect. We should NEVER be scared of the word death as a reason to recommend an intervention, an extra observation etc. Whilst we embrace the overwhelming potential for uncomplicated "natural birth" and bathe in the miracles of childbirth we should always do so from an empowered position of being informed and trusted. We have to earn that right, which we do so by maintaining respect, inclusiveness and clarity of reasoning.
Drs. will collectively be more involved in complicated pregnancies and births, this is because their skill set is rightfully focused on when the natural journey through pregnancy takes a detour. With obstetric involvement does not come the surrender of the individuals views or rights, through trusted communication and consideration ALL parties will come to the decision and plan for care that embraces truth, understanding and acceptance of evaluated risks.
The provision of truthful, unbiased and accepted information is hard, it is organic and as such changes sometimes acutely, those promoting their own personal agendas on all sides can, subjectively use objective information to further their perspective. This is the crux of the dilemma, a dilemma that has both an easy and yet difficult solution, without surrender, trust and respect your client, doctor, midwife or woman. If it is not possible to do that, challenge yourself to why such a distrust exists and rectify it by asking questions, securing answers, restating opinions, challenging your own position and its origins, seeking objective information.
Recent events (Natural Childbirth Group Shuts down after stillbirth, Undiagnosed twins at home controversy, The alarming rise of Free-birth ) have shown how subjective views with political or philosophical agendas can promote inappropriate courses of actions/inactions and outcomes. As usually there are shocked and reactionary statements, criticisms and calls for actions. I lament the pressures on people to exist in a suspicious and paranoid care environment but ignoring its existence is to bury ones head.
Self analysis and reflection, openness, and the cultivation of productive, respectful relationships is the key to informed decision making. It's all communication really!
On a personal note, I love the challenges of my vocation. The people I meet have their hopes and dreams, their problems and challenges and we face them together as a team. Agendas are dropped as we work through options and solutions. There is no exclusionary aspect, the woman advises me of her preferences based on all considerations and recommendations. How privileged I am to be trusted by these women with their care, may I long deserve and receive such respect.
Petrina Duncan, Obstetrician, Gynaecologist, and mother. Writes about events, news issues and health issues.