#notallobstetricians

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In Tolkein’s classic Lord of the Rings, Arwen Evenstar gives up her immortality for the love of a mortal man, Aragorn. Arwen’s father is against the match. He’s got nothing against Aragorn, it’s just that he understands the full weight of her choice. But Arwen won’t be dissuaded. We often do things that are crazy in the state of temporary insanity induced by love. Like having children. It’d make a great story if I could say that’s why I did obstetrics too. For the love of it. But looking back, it might have been for hate.

My son Colin, the philosopher, tells me that our decisions go back to the big bang if we go back far enough. By this he means that there’s a certain inevitability to our choices. That if we look backwards at our lives, everything that happens nudges us in a certain direction, and we find ourselves falling down a particular pathway under the influence of these unseen forces. That hateful obstetrician who I met the day I attended my first ever birth might have tripped me up a little, but I might have been heading in that direction too.

I like to think that the reason I became an obstetrician was that when I saw that doctor pull that baby out with forceps for no apparent reason, it made me think that I could do better. That I could cancel out some of the abuses that I saw were happening to women. The trouble is that some of those things I did to cancel out the wrongs have been acts of responsible subversion. Because they maintain the status quo, responsible subversion is somewhat irresponsible. And also, since people don’t know about my good deeds, one day history might judge me in the same light as those evil obstetricians. History might think I was one of them. But history lies sometimes. Like, just because I once owned a gold lame pantsuit, it doesn’t mean I was a disco queen. Disco music gave me a migraine in my ear.

I’ve written about Mary Rose McCall’s book The Birth Wars before. In it, she compares the philosophical disagreements between midwives and obstetricians (birth as natural: birth as dangerous) to a war in which women and babies are the collateral damage. I’m aware that one day my grandchildren might well ask me what side of the war I was on. If you read the obstetric history books it would appear that all my predecessors were monsters and maybe they were but more likely they were just human beings trying to do the best they could with the material they had to work with: the lowest human life forms on the planet –mothers and babies. Who knows, maybe Joseph Delee himself, he of forceps = gentle / vagina = skull-crusher fame may have been a closet feminist.

The poet and philosopher Criss Jami wrote “When good people consider you the bad guy, you develop a heart to help the bad ones. You try understand them.” And he’s right. In trying to understand the field of obstetrics we must consider the patriarchy, and the fact that birth must not go quietly into the service of those dark knights.

In the world of obstetrics, there are too many bad guys. #notallobstetricians, that’s for sure, but far too many. The sad explanation is that we do not value motherhood, which is a nice way of saying that our culture (still) hates women. I know many people won’t believe that: they will say they love women, but they only love good women, thin women, beautiful young women, they don’t love women on welfare, women who smoke and who eat junk food, women with rotten teeth and rolls of fat, women who have had too many babies to too many different men.
When I had my first baby one of the first things I felt was a deep connection to all of the other women who had babies before me. This feeling surprised me. I think part of the reason it surprised me was, in truth, that I had been a snob. Before I became a mother myself I hadn’t appreciated the profundity of the act. After all, even stupid women become mothers. Women with rotten teeth, and rolls of fat, who eat too much junk food. These women are often, too often, some might say, mothers too. If ordinary, regular women could do this thing– become mothers— like I just had, then perhaps there was more to them then met the eye. Maybe there were other things I’d overlooked. It wouldn’t be the first time I’d judged someone harshly and then come to find things out about them that shattered my image not only of them but also of myself as a fair minded and reasonable person.

What all women have in common is that they when they become mothers they deserve the best of care. Let that sink in. That woman with the tattoos and badly dyed hair who got addicted and had a baby with a gang member deserves the best of care. Yes, we have a duty to protect the baby from abuse from her own flawed mother. But the best way of doing that is to make the world a better place so that good mothering can emerge from flawed women.  
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The Lord of the Rings trilogy has a long appendix, so maybe you haven’t read it. In it we find out what happens to Arwen in the end. As it gets closer to that day of reckoning, when Aragorn ages and eventually dies, Arwen comes to regret her decision. The reality of a mortal life is before her. It is in the end, looking back, where choices can be regretted. When we suffer, ourselves, for taking what stances we took in our lives. Where what seems like a good idea at the time doesn’t seem like such a great idea after all. Part of this is just what always happens when we have lived a while in the actual life we chose, with all of its disappointments. The road we didn’t take often seems so much better, because it’s always a fantasy. We don’t imagine alternative careers to be boring, alternative spouses to be abusive, alternative children that won’t brush their teeth when asked.

Imagine Arwen sitting at the coffee table with her best friend. There are things even best friends don’t talk about, for example, their choice of partner, especially when it’s a done deal like that. My dearest friends have ended up with some surprising choices. I know left wing beauties married to right wing uglies; down-to-earth earth mothers hitched to conservative snobs; friends who divorced weirdos and remarried idiots. You can’t account for it other than thinking that Cupid is pretty random. We might not comment but we certainly think it, what they hell did she see in him and she could have done so much better. Behind her back Arwen’s friends might have said that Aragorn was pretty hot in the day and a King and all, but seriously, I’m sure she coulda had any pick of the elves AND kept her immortality. To paraphrase my grandmother, “it’s just as easy to marry a mortal man as it is to marry an immortal one”.

We tell ourselves it’s for just and worthy cause, this diminishment of power. But there is no reward for love in the patriarchy. Most women become lesser beings there, in the service of men. We tell ourselves its okay, we’ve done it for a noble cause: because we love them. And we are punished, because they—the ones that write the rules that govern how women are abused and oppressed —-they hate us most of all.

***************

I am leaving the hospital after a difficult night which stretched well into the next day. A colleague has called in sick, and I have stayed far beyond the rest of my shift. When I get to my car, I realize that in my haste to arrive in a crushing emergency, I have parked in the space reserved for the paediatrician on call. My driver’s side window is plastered with a sticker warning me that I will be towed if this transgression ever happens again. The sticker obstructs my vision and I can’t remove it. I cheer myself up by indulging in a fantasy about what happens if I am killed in a car accident on my way home. The CEO of the hospital attends my funeral, the jerk who is a member of the hospital board, and wait, here is a particular manager who has previously made my life miserable; they all say how great I was. It makes at least page three of the Times. The dream sequence fades into nightmare when a man approaches. I think he’s going to offer me sympathy for a moment; he is looking at the sticker, so I get a shock, because he’s nasty. He strides towards me menacingly. How dare I park in this spot, he (An Important Man!) had An Important Meeting!! in the morning and was Running Late!!! I try to explain about the emergency c section that turned into a postpartum haemorrhage and the foetal distress that followed in the room next door, and the same time and to top it off there was a woman with an intrauterine death who I have just left and how one thing lead to the other and that I didn’t mean it, I try to engender some sympathy, you see, while I appreciate the importance of the meeting there were lives truly at stake, except for that woman with the dead baby which wasn’t an physical emergency but it was an emotional one, but I realize he doesn’t care. All I manage to say, hanging my head, is that I was on call. He knows what it’s like to be on call, he’s done it himself for years, as he (raising his voice)—- don’t I know—, is a Consultant Paediatrician. It doesn’t dawn on me until later when I am at home, that, because of my crappy car, and my crappy clothes, and maybe the mascara tracks on my face from the dead baby, he treats me that way because he doesn’t see me as a peer.

He thinks I am a midwife.

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24 thoughts on “#notallobstetricians

  1. First of all sending a huge, enveloping, solid hug to you right now for all that has happened. Those “shifts” are grueling, and all the harder when you serve women and families with passion and love, as you do. Secondly I’d love to put an ‘ours’ or a ‘shared with joy for all on call and going above and beyond the call of duty people’ sign on ‘his’ car park space! Thirdly you soooooo get it Alison, that this time my hug is for you, my sister.♡♡♡♡.

  2. Jennie Valgre

    This post is amazing. You are amazing. We are lucky to have doctor’s of your calibre and it always reminds me that where there is one, there are others. Thank you

  3. love the post, but does thinking you were not a peer, thinking you were a (lowly) midwife excuse his behavior? Welcome to the world of midwives who have to (shudder) occasionally cross paths with doctors—its dehumanizing!

    • 2beBorn, yes, this is one of the points of my piece. Awful. The thought that he mistook me for a midwife AND the way he treated me because of that was misogyny of the first order and as you have stated #yesallmidwives. I am painfully aware.

  4. Annie Frogley

    Wisdom, insight, empathy, skill, courage. You are an amazing woman Alison, and the women of Waikato and the midwives of NZ are fortunate to have you on their side. As for that ‘Consultant’ – he needs to learn some manners! (She says – toning down what ACTUALLY comes to mind!)
    I relish the thought of his discomfort when he meets you one day and realises his mistake!

  5. Sharn

    Much love and thanks. I have tears rolling down my cheeks reading this. Experiencing an area of the country where their are no registrars only consultants during office hours means making the 3am call to the person a scary thing. Where you are likely fobbed off for your inability to make an obstetric opinion leading to….”well of the trace has ‘unreassuring factors’ you might as well meet me in theatre if im coming in…. ”
    decision made site un seen. I use the term ‘site’ as the woman is clearly lost in this. Trying to convince a woman that because we are meeting the doctor in theatre does not mean their is the need of c/s or instrumental however you know that the ‘punishment’ for daring to need an obstetric opinion means that this is likely the fate. However thisbis only one area of the country. Returning back to your area of work Allison, I have since passed a tissue to a registra and comforted each other after giving care to someone in much need of love, kindness, and faith…. your attitude is filtering through. And it is a blessing. Arohanui

  6. Dear Arwen, I mean Alison!
    Thank you so much again and always for your truth and your courage to share it. Blessed are the folk who have the opportunity to be cared for by you!
    And, heres’ to the new paradigm, may it be here now!
    Best wishes and love,
    Jane Hardwicke Collings
    Australia
    xxx

  7. tashd1309

    Thank you for a wonderful and insightful post. I don’t suppose you would move to Australia would you?! Some of your colleagues here could do with some of your wisdom (many but #notallobstetricians).

  8. Susan crowther

    Hi Alison. Good to connect at #NZCOM14. Having read this also I now know and feel we connect across an invisible divide of sameness. Childbirth is so deeply and profoundly overflowing with spiritual, existential and sacred meaningfulness that not to be touched is the greatest of sadness.

    I remember many years ago in the UK entering the staff hospital carpark. The ticket man would not let me in as it was nearly full. The paed behind said she is a consultant let her in. He let me in ‘I was a consultant midwife’. I expect I would not have been let in if I had explained my full title!

    I eagerly wait getting to know you more.
    Susan crowther

  9. So beautifully crafted. Thank you.
    I think the hatred you speak of arises from fear and distrust. These doctors don’t believe that birth works, and that women’s bodies are unpredictable and not to be trusted. In Australia, in the large public hospitals where our young doctors are trained, normal physiological birth remains under the care of midwives. The doctors generally do not get a look-in. However, when either the woman or child strays from the normal clinical path, a doctor is called in. This means that 100% of the births they see require them to rescue either woman or child.
    Proof that birth is a narrowly averted tragedy. These young terrified residents are sleep-deprived and highly adrenalised. Not a place or time to learn about the miracle of birth, to honour the strength and capacity of women, or to believe that it can actually work.

  10. Judith Gruichich

    As a 76 year old “nana” with 6 children and 16 grandchildren, I cannot begin to tell you how far things have progressed since my birth giving days. I know very well it is still a struggle, but please believe dear ones you are all making a difference. My beautiful daughter is a midwife. I am very proud of her and can’t think of a more noble profession.

  11. Dinie

    Alison. Your writings sing to my soul. What you do and sometimes choose not to do does make a difference. I worked with a woman whose first baby decided to come at 34 weeks, She was strong and amazing but in the second stage the baby showed signs of distress. The obstetrician did a forceps and the woman had a third degree tear. Following this she had issues with incontinence. She had been advised not to have further vaginal births due to the incontinence and consulted in the second pregnancy. No discussion on avoiding forceps – it was avoiding vaginal birth. This baby decided to be breech and of course breech as well as everything else the woman reluctantly decided to elect for a section. And I mean reluctantly! I had provided, and she had sought, information on breech birth…. Sorry vaginal breech birth. Section booked for the Monday and she started labouring the Saturday before. When I called birthing unit and they told me you were the locum I thought all the planets had aligned for this woman. You gave her balanced information and her labour was progressing so rapidly she birthed her baby on her knees with you watching in the background. That woman went on to have her third baby at home and is awaiting repair for the damage caused in the first birth. She left her birthing experiences on such a buzz it was awesome to be involved.
    I know I said what you choose to do and choose not to do. The power has not only been taken from women but many women just give it away as though their choice about their own experience has no value.

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