One aspect of "choice" that needs to be considered is that even when
all the pros and cons are weighted carefully and a very "informed"
choice is made, there is no guarantee that the option chosen will
prove to be the best in the final analysis. Mistakes can still be
made and decisions thought to be the best can turn out to be the
worst. This may result in an unexpected outcomes, but is part of
life and often leads to rapid and useful learning.
However, often when a poor choice leads to a bad outcome, the blame
starts flying and scapegoats are sought (part of the grieving
process). It can often be the mother who is blamed (for example in a
home birth) or the doctor, if the birth takes place in hospital.
For example, if a woman decided, after being told all the advantages
and disadvantages of an induction and is counselled on likely
outcomes, then still choose this option then I belive she must be
supported in her decision. It still may turn out OK (Sally Tracy's
work showed that if a perfectly healthy mother chooses an induction
for no medical reason she has a 40% chance of coming through without
further intervention). If things do turn out unexpectedly and
complications arise, then this women needs support postnatally so
that she learns from the event. However, she may be blamed or left
feeling guilty or depressed without supportive counselling with no
opportunity to learn how her decision, even though taken carefully,
was in the event not the best one she could have made.
I am all for choice and better options being made available. I also
believe that women will try and make the best decisions they can
given a chance, and even though they may decide to do things
differently than we would, they have a right to make those
choices. Circumstances change too, and these may affect the decision
making process - labour can be much harder than anticipated and help
may be sought. This is where the options are really needed so that an
epidural is not the only option available, but baths, showers etc etc
are also at hand (and a lot of this will come down to midwifery
attitudes and skills).
This is a tricky area - "informed choice" is really a myth, as so
many vested interests come into play, but we must support women once
they have made a considered decision. To do less would be to
undermine her further and to miss the opportunity for learning, even
of some of those lessons are unpalatable at the time.
Not really expressing this well this morning.....
Regards
Andrea
At 03:29 PM 17/06/2006, you wrote:
Dear Sue and all
What an amazing thread!!
Choice is the key. The choices that are respected and funded are
those that prop up the medical monopoly of the big business of birth.
So all you wonderful midwives out there, start/keep saying
it. There are no rules or protocols for women, there is evidence
and advice and a duty of care for midwives but at the end of the day
a woman must be making the decision. It is not until we have a full
complement of choice from homebirth to elec c/s can we say that
women are really making a choice. Now it is choice within a vacuum
of medical dominance.
I heard an interesting thing re ADHD on the radio the other
day. The researcher said "if we only ask Drs we will only ever get
a medical response". Nothing new but nicely put. By continuing to
defer to medicos when the majority of us have no medical condition
we will never make lasting change.
I believe some midwifery stars were recently at a conference
espousing the benefits of managed 3rd stage and justified by saying
physiological could only ever be considered when things were totally
natural so there was no real point etc. Whilst I understand the
pragmatics of that comment and the reality of the current system. I
find this a real sell-out and on par with the CTG argument and many others.
Just because something is the majority does not mean it is
right. Sometimes all the fools are simply on the same side, rich
and very powerful ones I know.
Recently I was told midwives greeted my news of twins at home with
reasonable upset saying it was one thing to do it but I should have
done it quietly!! Oh dear. It would have been so much nicer to
have prem babies with respiratory distress (saved by Obstetrics) or
a "vaginal birth" in lithotomy with a forceps for twin 2.
Lets get real. Innocent until proven guilty and Healthy until proven sick!!
They key to change is in the unity. If enough midwives and women
said No more it would change very quickly.
When we disagree and are challenged let's ask ourselves where the
woman's rights are in our anger, upset et etc and let's continue to
shout it loudly to Obs 'cause they have no argument.
JC
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