What you can do…

Previously, I blogged about the lawsuit brought by Catherine Skol against the doctor who attended her birth, alleging that he mistreated her in a variety of ways. But while I think this story deserves to be told, and women especially need to understand that this sort of treatment might possibly happen (although I believe and strongly hope that it would be rare and therefore not likely to happen to them), my larger concern is keeping it from happening. As I was reading the allegations in the lawsuit, I was picturing what the scene may have looked like, and I began wondering what she or someone else might have done to stop her “care” provider from treating her like that.

One homebirth midwife’s blog I read recently talked about birth plans, and she encouraged women not to put things in their plans that they can control, such as requesting that they be allowed to wear their own clothes instead of hospital gowns, or requesting that vaginal exams be kept to a minimum. This midwife said, “Want to wear your own clothes? Just keep ’em on! Don’t want a vaginal exam? Keep your legs closed!” And that’s true. But it’s easy to say and many times hard to follow through with. I can’t tell you how many stories I’ve read of doulas (either professional or just friends attending another friend’s birth) who reported that, in the period leading up to labor, the woman was most adamant about having X, Y, or Z, while refusing A, B, and C, and that she wouldn’t cave to pressure, no matter how much — “it is gonna be my way or the highway” kind of talk. And then the doula gets the call that the woman thinks she just started labor and is going to the hospital (when she had previously said she would stay at home as long as possible), and by the time the doula got to the hospital, the woman was in bed with continuous monitoring, an IV in her arm and an epidural in her back — all of which she had in no uncertain terms said she would not have.

And that’s fine — it’s her choice, and she can change her mind all she wants. But it’s one thing to change your mind, and another to have it forcibly changed for you. And speaking from my own experience, in labor, I became very willing to do whatever anyone suggested. It may have been because I trusted my midwife and felt so comfortable with what she was telling me; or I might have just as easily followed anybody else. For me, it keeps me “on the strait and narrow” when it comes to selecting my birth attendant(s), to make sure that whoever I get will be comfortable with my wishes and protect my birth plan and desires and wishes unless these plans truly need to change.

Catherine Skol, the woman who brought the lawsuit, did have a doctor she trusted, but he was on vacation when she went into labor. The doctor named in the lawsuit was his back-up. This situation (the possibility of having an unknown doctor or perhaps somebody you know you don’t like) has led many women to choosing an unnecessary induction or even a C-section with the doctor of their choice than to take a gamble on someone else. Other women have chosen a very small practice (even one or two midwives or doctors), so that they can know both or all of the people who may possibly be in attendance at their birth. But it could be that even the best-laid plans go awry, and you may end up with somebody you don’t know at all. Hopefully, they will be just as nice and respectful as your chosen birth attendant, but what if he or she is not? What can you do?

I read several different L&D nurses’ blogs, so I left a comment about this case, and asked them what someone could do if they are faced with such a situation (hopefully never as bad!). Obviously, one thing a woman could technically do if, as in the case of Mrs. Skol, she was placed in stirrups in a painful position and/or told to push before being fully dilated, is just simply not to comply. But, again, it’s easier said than done — especially when the doctor is being verbally aggressive, telling you things like “shut up and push”, repeatedly saying that you will hemorrhage, and implying that your baby is going to die (and she had had a stillbirth years before, so that especially scared her). Her husband might have been an advocate for her — except he may have been as cowed by the doctor as the woman was; or he may just not have realized how awful the treatment was.

Here is a link to one of the nurses’ blogs I mentioned. She responds in some length to the questions I asked, so rather than try to summarize, I’ll just let you go over and read the full thing yourself.

Another blogger said this, “You can bet I would have been getting my charge nurse, nursing supervisor, and the head of OB involved if I faced this type of situation. I certainly would not have kow-towed to the OB and his arrogant, rude, abusive behavior.” [The idea of pulling my foot out of the stirrups — if I even let myself be put in that situation in the first place — and kicking the doctor in the face occurred to me, too.]

A lot of the things you can do are also going to be just your general “educate yourself” (and educate those who you will be bringing with you) and “stand up for yourself” (or have your labor support people stand up for you). I assume that since none of the nurses and the other doctor in the room were co-defendants with this Dr. Pierce, that Mrs. Skol did not find that they contributed to her maltreatment in any way, and were perhaps even trying to stand up for her. You have the right to ask for a new doctor and/or a new nurse. Unfortunately, the way some hospitals are set up, you may just not be able to get a change, or it might not happen in time for the birth. Large hospitals may have more than one doctor on the premises at all times, and a switch can perhaps take place almost immediately; smaller hospitals may have no doctors on the premises except to attend the actual birth, and may have to wake up another doctor and beg him to come in before you can have a different doctor. Obviously, there will be more than one nurse in the hospital, but some of the blogs I’ve been reading lately have been full of the more technical aspects of L&D nursing life — how women are assigned to which nurses, what their jobs are while the women are in labor or giving birth, how many nurses are in attendance during a C-section, etc., and it may be that if you ask for a change of nurse that it might take some time — simply because all the nurses on the floor already have their hands full, and it’s not just as simple as walking from one room to another to switch nurses. (Lovely paperwork!) But it certainly won’t hurt to ask.

If you have the opportunity to take a non-hospital-based childbirth education course, do it! You will learn what “normal” is and will probably get tools on how to advocate for yourself. This sort of treatment shouldn’t happen to anyone, but if you know what is normal and what is bad behavior, and if you know what to ask for and how to ask, you will reduce your chances of this sort of thing happening to you. Talk to your midwife or doctor, as well as the hospital staff before you go into labor, to try to know as well as possible what you can expect when you go to the hospital to give birth. Find out what they are inflexible on; find out what they would like but won’t insist upon. If you don’t like what you hear, the earlier you decide your course of action, the better. You can change hospitals and/or doctors, or even switch to a birth center or home birth; but many people are unwilling to take on new clients who are already at or very near term. You can also change your preferences (“I’d really rather wear my own clothes, but, y’know what, I’d just rather not fight it”). Knowing what is likely to happen will probably make you more comfortable as you head into labor — at least, I’m extremely uncomfortable when facing new situations, and always prefer to find out as much as possible beforehand. Also, if your hospital says that their protocol requires you to have or do X, Y, or Z, you may be able to get out of that by having your doctor write in your birth plan that he is authorizing a change of protocol for you.

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