Nursing, midwifery, and patient/practitioner relations

[AnthroGirl]

Good morning all,

After months of lurking and reading hundreds of pages of posts I have decided to come out of the woodwork. I will start by saying that I love this website! I have learned more from the men and women posting on these discussion boards than I have in many, many years of formal education! Now to the meat of this post...

I have kind of a bizarre social location, I am a PhD student in medical anthropology and I am an expectant mother (my second, due somewhere around the 1st week of May). It is the latter that drew me here, but the former that has led me to register and post. I am in the process of building a research question/proposal for my dissertation research which I want to be useful. My interests lie in the relationship between pregnant and laboring women, their physicians, nurses, midwives, and other health care practitioners. I am curious about decision making and informed consent; IE how (and why or why not) do women decide to undergo prenatal diagnostics? How do women negotiate the administrative and bureaucratic maze of hospital births? How might help (or hinder, although this is less common) women through this time?

These are just a few areas of interest, but as an anthropologist, I think that the most important aspect of my research is that it is useful and practical in the real world. I want to determine what kinds of questions need to be asked that will benefit not just expectant women, but physicians, nurses, midwives, administrators, and policy-makers (not that I'm overly optimistic!). Basically, without input from the communities that I wish to learn from, my questions are pointless. So, finally, hence the post...

From reading many pages of allnurses (I even went back 1998, wow have things changed!) I have started to get a bit of a feel for the complicated relationships between docs, nurses, women, administrators, and the like, but I am also interested in chatting with some nurses and others that may be hanging about on this site to get a more personal feel for what people think needs work.

So please, please, I'm begging feel free to fire input my way! I have had a dialogue with other academics who feel that women should be the main topic in this research, but I think that misses out on the complexity of the process of pregnancy and childbirth, and to an even greater degree the social aspect of women's health in general. So again, any input is greatly appreciated, and if at all suspicious of my credentials, please let me know and I will fill in any gaps!

Thanks,

anthrogirl

[mommy2boysaz]

Very interesting thread! I am a student in a CNM program and have worked OB for 11 years with mostly docs, but also with 2 midwives (all in a hospital).

This is such a complex issue. I think most women that choose homebirth do so based on a bad hospital experience in the past. I have witnessed doctors "stretch the truth" about a woman's progress in labor (or lack of), or even that the baby is "not tolerating" labor, just so he could section her and get home to dinner. Not unusual. I've heard of a doc telling a woman after doing a lady partsl exam that her membranes had ruptured so now we have to induce with Pit., when the membranes were NOT ruptured and the cervix was closed. Women are powerless in these situations! They believe what they are told. What else can they do? Now, women are saying that they don't want all the interventions, so they decide to go it alone at home because CNMs can't get the backing of physicians to practice homebirths. Docs don't want to lose all that money...

Study after study has shown that midwife attended births fare better than doctor assisted births, yet the insurance companies would still rather pay for elective inductions, Cesareans, and epidurals, in order to keep the medical establishment happy, than lower costs and have healthier outcomes.

Oh, and reasons for elective inductions and cesareans? 80% doctor convenience, 19% patient convenience.

I think this is a sign of our times: I want what I want, when I want it. One doctor I worked with was quite proud of the fact that he hadn't needed to come in at night to do a delivery in many months. He induced everyone at 37-38 weeks in the early AM, Mon-Fri. Delivered one way or another by 4pm!

I'm not trying to come off like I worked with all horrible doctors. They truly weren't. I think their actions are very typical of most Ob-Gyns today. They're tired and afraid of litigation and the patients are usually only too happy to get the discomforts of pregnancy over with a couple of weeks early. It's just accepted practice.

I truly do not understand why it's accepted and covered by insurance companies and Medicaid, though. The costs are just astronomical compared to a natural, spontaneous birth, and it's all unneccessary!

Well, just my !

[AnthroGirl]

First off, let me send out a heartfelt thank-you to everyone who has gotten involved in this thread. Your input is so thoughtful and interesting. Second, let me say that I am learning so much both about how some nurses may be feeling, but also that some of the same sentiments coming out of the midwifery and social science literature are shared in the medical field. When I originally brought some of these issues up with my OB (outside of the research setting, in theory, but one is always learning) she was actually ashamed of the c/s and induction rates at her hospital.

There are a couple of aspects that I think may be fruitful to come out of this discussion. One of which is something that SiennaGreen and others have mentioned. It is the fear aspect of childbirth that is often instilled throughout the prenatal period. I was speaking with my Massage therapist/Doula about this the other day. There is a fear that has been built around the pain and processes of birth which seems to be instilled in women. Even if it is not actual fear of complication, or pain, it is the fear of losing control. Women are told that they need to be a part of their labor and that they need to allow (or aid) their physicians in maintaining control of the timing and progression of their labors. they are also told that they cannot do this without help, because they are incapable of handling the pain. Sadly, women are taught that they will probably not be able 'handle' most of their labor, so it should be managed, augmented, and pain free. There is a great article called "Giving birth like a girl" written by Karin A. Martin that examines how women feel they are expected to behave throughout labor and birth which highlights how they think they must be nice and sweet and polite.

The other theme that is important throughout this thread is that of convenience. It seems that we recognize the inductions and c/s that are scheduled for the sake of scheduling, but outside of an intimate setting like this, there is no such thing as a social induction or c/s. Docs will swear that they are all medically necessary. I have lost count of women who are induced or sectioned at 38 or 39 weeks (or on their due date) because their baby is ENORMOUS and of average size. We know that this is happening, and obviously, from increasing intervention rates and the threads even on this site, women know this is happening, perhaps the questions are not what is going on, but how and why?

Here is a question to ponder: What is it about the relationships and interactions between women, caregivers, and bureaucracies (ie administrators and insurance companies etc) that perpetuate and increase practices that are not beneficial medically, socially, financially, or emotionally? How and why do these practices continue at their(increasing) rates? What roles do the women play in the maintenence of these interventions? Docs? Nurses? Hospital policy makers? ect?

I think we may be on to something!!!