Medical Intervention …Uncovering my own opinions and bias.

Having opinions is not the problem, learning to recognising them for what they are - simply opinion - and being brutally honest about our own conscious and subconscious bias that lead to those opinions is the hard bit…

Recently, as part of a doula training assignment, I was asked to write down my beliefs and personal bias on the topic of medical intervention at births. This threw me a little bit at first - As a doula rule number one is to be professionally unbiased, providing my clients with an unbiased approach to birth and birth planning is a huge part of what I do. As a human being however, I have inevitably accumulated my own personal beliefs and bias - This is unavoidable, if you are going to partake in this crazy game we call ‘life’ you are going to have opinions. If you don’t well then you should probably get some - but that’s just my opinion.

Having opinions is not the problem, learning to recognising them for what they are - simply opinion - and being brutally honest about our own conscious and subconscious bias that lead to those opinions is the hard bit. But this is the hard work we must do if we wish to learn how to stand back from our own ‘stuff’ and remove personal bias from our professional personality. Recognising our own opinions and bias on any topic opens us up to a healthy dialog with ourselves, allowing us to alter our opinions and viewpoints as we continue to learn from our experiences. This is how we grow.

My decision to avoid all medical interventions for the birth of my own child came from a deep seated personal belief that birth - undisturbed by medical intervention was not just ‘possible’ but that it was ‘normal’. I trusted my own body and I trusted my baby completely to be able to birth unassisted by medical science. I was not at all open to the possibility of accepting medical assistance to ease my own discomfort in any way. I resisted the idea of anything or anyone taking away what I considered to be a right of passage and an experience which I wanted to be wholly present for. I understood that medical intervention could be lifesaving in an emergency situation but in my mind at that time, medical interventions were simply not compatible with a positive and spiritually fulfilling birth experience. I now know that this is not the case.

 I had built up such strong opinions about hospital birth in the months preceding the birth of my son that I arrived at the labour and delivery ward so adverse to the idea of intervention that I barely let anyone from the hospital near me - In fact I think I shouted at the nurse to ‘Get the hell away from me’ at one point - This was a reaction entirely prompted by fear and by my own bias that I’d build up against medical personnel and methods.

Despite being a relatively rational person most of the time, I honestly believed that hospital staff would willingly go against my birth wishes and intentionally and stick a needle in my thigh or a drip in my arm when I wasn't looking. I was also terrified that my voice wouldn’t be strong enough in a room full of medical staff wanting to do things their way. I went in fighting. Thank goodness I had a doula so she was able to effectively ‘sit me in the corner stool’ and convince me that no one was about to do anything against my wishes.

 

So what factors lead me to this point?.. Experiencing positive stories of unmedicated birth from friends and family. Experiencing horror stories of medically managed births from others. Living in an affluent society where good quality health care and generally good maternal health mean that childbirth is seldom a dangerous medical emergency. Having very unpleasant experiences with hospitals and morphine when I was admitted with a serious injury in my early twenties. Having a Father who’s attitude to pain is “suck it up.” (He is a professional badass stunt performer and I was forever being told to toughen up as a little girl.) Being a bit sceptical of Western medicine in general (thanks Mum). Reading literally all of the birth books while planning my birth preferences, to the point where my head was swimming! Learning about the growing C section rates and the horrifying side effects of epidurals. Growing up in the U.K. where midwifery care is standard practice and up to 30% of women give birth out of a hospital setting (1) meant that I had also got my hopes up hopes up for a home birth, only to discover this wasn’t an option when my husband and I emigrated to Canada. * I felt forced into a hospital birth instead of embracing the idea. - All of these things! All of these things - and probably more that I am not even aware of, influenced my opinions and bias on medical intervention during birth.

 

When I began to study as a labour and birth doula my opinions on interventions began to change as I developed a greater understanding of them. The more I study and the more birth stories I heard and also got to be a part of, the more I realised that when interventions are used for the welfare of both baby and the birthing person, with fully informed consent, then they are indeed a blessing and something to be hugely grateful for. When there is a medical and/or compassionate need then I say hurrah for modern medical science!

 

To give a couple of examples. I was recently attending the birth of a client who had stated very clearly in her birth preferences and in all our meetings together that the last thing she wanted was medical intervention. However, after her waters broke at 36 weeks and she experienced no dilation in the preceding 12 hours, she chose to take the route of an induction. This decision was made with fully informed consent and with the welfare of both mom and baby in mind. After the birth, the mother talked about how she felt like it was absolutely the right course of action and how comfortable she felt with the decision to opt for the intervention.

I witnessed a mother lose control of her labour to the point where she was in a great deal of distress and unmanageable amounts of pain - she had been labouring for almost 24 hours with natural comfort measures and a tone of support from loved ones. Unfortunately she was stuck at 6 cm dilation and seemed to be getting nowhere, she had not slept or eaten, she was exhausted. With fully informed consent the epidural was administered by friendly and compassionate hospital anesthesiologists who helped her sit still and explained everything they were doing to her and myself. I watched as she began to relax and regain control of her labour, she began talking more positively and was able to rest. She achieved full dilation while resting and birthed her baby vaginally as she had so longed to.

What is important about these examples is not what I thought of them, what is important is that the mother in question was comfortable and happy with the intervention - in her opinion they were necessary and correct and she was aware of all the possible benefits and side effects of the intervention. The opinion of the birthing person is always the one that counts.

 

It saddens me to think that a birthing person may choose an epidural when what they really want is a little support. It frustrates me that when I arrived at the hospital to birth my son, the first thing I was offered by the medical staff was morphine - rather than a glass of water or a rub on the back.

It does bother me that more and more mothers are choosing to disassociate from the experience of birth because they simply see the epidural as ‘normal’ (around 50% in Canada (2)) and are choosing it whilst being completely unaware of its side effects. It terrifies me that the rate of cesarean section rates in Canada continue to increase while hospital birth rates decline (3)These things worry me, not the medical interventions themselves.

A Cesarean birth may be an incredibly self empowering and beautiful event, an epidural may be exactly the right comfort measure and provide exactly the right kind of reassurance for some. A seemingly small intervention like an amniotomy (artificial rupture of membranes) or a vaginal exam may feel like a gross violation if conducted insensitively or without consent. A medical intervention is simply a procedure, what gives it its power,  is how it is carried it out, when it is carried out and why it is carried out. What is important is fully informed consent and the opinion that matters is always that of the birthing person. At the end of the day in my role as a birth doula it doesn’t matter what my personal opinion is on any particular subject, what matters is how my client feels about it, how it effects or triggers them.

Someone once asked me “So if your beliefs are different from your client, how can you operate with integrity?” The answer is that I believe in something bigger than opinion, I believe in informed consent and the right to personal choice above all else. If you hold a position of responsibility, if you act as a teacher or an educator, if you stand at the front of the room, if you do any of these things then of course have an opinion, be educated, be informed, be inquisitive - no one will want to hire you if your not - But be prepared to take a good long look at those opinions on a regular basis, understand if and how they differ from the facts, be open about your bias and above all be open to change and growth.

 * Home birth is covered by midwifery care in many parts of Canada - just not where we live unfortunately!

 

1)https://www.midwiferyjournal.com/article/S0266-6138(17)30403-5/pdf

 

2) https://apps.cihi.ca/mstrapp/asp/Main.aspx?evt=2048001&documentID=029DB170438205AEBCC75B8673CCE822&Server=apmstrextprd_i&Project=Quick+Stats&

3) https://www.cihi.ca/en/c-section-rates-continue-to-increase-while-birth-rates-decline