#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.

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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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Lessons from giving birth: A letter to my friend Wendy

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Dear Wendy

 

When I was in labour with Olivia, you were there, and I hated you.  Don’t take it personally, I hated everyone.  I was in pain, and not having fun. I felt sick to my stomach, and shaky, and in pain, and those feelings mixed up together in a hot and cold mess of misery. The nausea shakes and pains came at me in disorderly unpredictable waves, I couldn’t brace myself against them.  At that point, I was mad at the world.

For a price, you can employ other people to do most unpleasant things in life.    You can pay someone to wash your windows, to scrub your toilet, to clean your stove.  Some things you can avoid doing entirely, a favourite technique of mine.  This makes sense because according to a quiz I took on the internet I’m an anxious avoidant on the attachment scale. My oven cleaning strategy illustrates this perfectly.  Normally, I just don’t clean my oven. Things merely burn off as they crust over and reach a critical mass.  Pregnancy and birth don’t work that way.  You can’t get a stand-in for the unpleasant parts.  

In my case though, the pain brought important lessons.   First, I’m really good at birth though no one could say I enjoy it.  I know women who do: I shake and vomit on the floor, like I’ve had too much too fast to drink at a party, like I’m having a bad acid trip.  The hangover part is missing though. Instead, I get this grand afterglow, the kind of buzz addicts everywhere search for endlessly.  The kind of feeling you might expect to have when you’ve died and actually gone to heaven.  Complete with angels.  One anyway:  a plump, pink and juicy freshly squeezed angel baby that plops out of your vagina.  It’s ridiculous, hysterical, and also true. 

The second lesson was this. I’m getting serious now.  When I had Olivia, there was a point where that intense feeling of hating you and everyone else because you all were enjoying your lives and not in pain—so unfair – there was a point where this feeling suddenly gave way and I realized something:  I was alone. With my baby yet to be born, I was alone.  With a room full of supporters, I was alone.   No one could birth the baby for me.  The labour was mine and mine alone.  It would continue inextricably as death follows life.  

The Jesuit priest Henry Nouwen wrote in his book The Wounded Healer that “the painful experience of loneliness is an invitation to transcend our limitations and look beyond the boundaries of our existence”.  He wasn’t kidding.   My painful experience of loneliness just happened to coincide with the pain of labour, but the transcending bit was exactly the same.  This was a gift, filled with promise. I looked at the boundaries of my existence and found the space it enclosed to be empty.

Nouwen writes that we spend our lives trying to fill this emptiness, to meet the right person who will complete us, to have a job that makes us feel powerful and special, to read a book that will have all of the answers.  Or we drink, or become addicted, or shop.  We are depressed, sad, anxious, unhappy.  It is all everyone else’s fault.   There I was, in a blue cotton hospital gown that did up the back, in a room full of people, alone with my pain. And like Nouwen said, I too have tried to fill this emptiness.

How many of us really ever come to know the mind of any other?  We read of suicides, of murders,  of murder-suicides,  the neighbours say during interviews on TV “I had no idea”.  I think it’s because we keep the worst of ourselves, the empty space we all have– mostly hidden from each other’s view.

 

There’s a quote that says that having a baby is to forever know what it’s like to have your heart walking outside your body.   This is true.  But it’s true when we have any meaningful relationship. Real relationships have real meaning only if we put ourselves on the line:  we let them have a piece of our heart to carry with them, to do with what they will.  We give away a lump of our own myocardium and we risk that others will not value or cherish it.  Sometimes they can’t even hang on to it; they let it die for lack of caring.   Meaningful life is a willingness to be vulnerable with our true unvarnished secret self, the self that approaches –but can never truly banish—the truth of our isolated existence.

 

 

Time has passed since that birth, but I remember it all so clearly and I always will. We had the same due date, you and I.  But I went into labour before you, so I came to your birth a few days later with my daughter, the first birth she has ever attended.   You sang in labour, like you always did.  Each note held, clear and beautiful, moving higher and higher up the scale.  You are a true soprano. I imagine you filled your empty space with song.  Your son is a musician now and my daughter is studying to be a midwife and I don’t know if that means anything.  

What I do know is this.  We all get here- one way or the other- from the body of a solitary woman (results may vary).   There is always blood.  There is almost always pain.  There are sometimes drugs; forceps, surgery, prematurity, inductions, stitches.  Sometimes, the pain is not understood or comprehensible.  Sometimes no one cares.  Sometimes it’s really ugly.  Sometimes it leaves scars.  Sometimes it’s nothing that fabulous or transcendental. Sometimes it’s ordinary, straightforward, routine.  But maybe birth could have something valuable to teach you about yourself.  

 

 

You can listen to my friend Wendy’s heart walking outside her body here: 

 

http://keenanreimerwatts.bandcamp.com/album/thoughtful-music-and-other-music

Or here on youtube: https://www.youtube.com/watch?v=95i20vcago8

On the penalties you pay for believing in women

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On the first day of my first obstetrics rotation as a medical student, I got to attend a birth.  I was assigned to shadow one of the staff obstetricians. We waltzed in unannounced to the room of a labouring woman, who was pushing, feebly, ineffectively, with her feet in stirrups, legs encased in drapes.  The doctor turned to me and rolling his eyes said, “At this rate, we could be here all day.  Nurse, get me a pair of forceps.” And then, for what seemed to be no reason at all, other than impatience, he pulled the baby out.    It was awful and I remember feeling terrible for everyone….the mother and her baby, the nurse who had to “obey” and for myself for having to bear witness to this thing. 

 What did I do with those feelings?  Did I report this behaviour to the proper authorities?  No, I certainly did not.  It was clear to me that this was how it was going to be, that shocking things like this were – shockingly – forbidden to be viewed as shocking at all.  The way everyone else around me was acting it seemed to be the expected norm.  The staff doctor was my boss, and he was at least in part responsible for my grade during that rotation.  I was in no position to complain.   

To be fair to the obstetrician, as a student, I didn’t understand everything that was going on.  It could have been that there was some other reason to deliver the baby that way that I didn’t fully appreciate.  Maybe the fetal heart rate tracing wasn’t optimal.  Still.  I’ve had many other experiences of the same kind in my training and beyond, enough to know that this kind of casual approach to violent events is commonplace.

By looking at me and speaking to me in that way, including me as a sort of a peer… “we could be here all day” ….. I was being asked to take sides.  It was as if I was being groomed for something.   Grooming can be quite flattering.  You don’t want to speak out because you are afraid of being humiliated.  This doesn’t change the fact that you are complying with the abuse of women. But you are complicit in an act of oppression for the same reasons everyone complies with oppression, because you are weighing the risks and the benefits of non-compliance.   You are performing complex calculations in your head, below the level of your cerebral cortex.  Who would have known the brainstem can do this kind of math? 

It’s a survival mechanism though.   We need to suppress this information from our conscious selves to function in this system.   We are helped to suppress our empathy in so many ways.  In the hospital setting we make the patient seem “other” than ourselves.  The patient gets a hospital gown and an arm bracelet to segregate and anonymize her. The patient I described in that story above didn’t even have a name.

We do these things in part because at times we have to do horrible things to people in the name of helping them….for example, most days I’m cutting into the flesh of women which could—perhaps even should– be repulsive and frightening but I have learned not to think about it in that way. It is easier to think you are cutting into a piece of some sort of material and not, you know, an actual woman.   

The problems happen sometimes when the patient seems too much like us.   As long as the patient comes from some sort of difference:  age or race or socioeconomic class, it’s okay*, but then, someone comes along and bam—-all of a sudden we have trouble.  For example, I once had a lot of problems staying out of grief with a dying woman who –though not related to me—happened to have the same last name, and children around the same age as mine.  (For the record, staying connected to her as she died was a transformative event in my medical life, which is to say, my actual life.)

And then there are the very scary things that happen.   Like when patients bleed to death and babies die.   After half a dozen or so of these sentinel events as they are called, we start maybe exhibiting some of the signs of post traumatic stress disorder.  We shut off even more.  We abuse patients, for better or worse, we are perpetrators.  We become that obstetrician that I followed on the first day of my obstetric rotation.

Not much is written about the perpetrators of violent crimes. They aren’t usually the ones seeking therapy.   I read a book recently called The Birth Wars by Mary-Rose MacColl, which highlights the terrible relationship – the war – between midwives and doctors in Australia where tragic outcomes for women and babies have become a sort of collateral damage.  She doesn’t offer us any solutions but it seemed to me, since she called it a war, we can maybe learn something from the studies of soldiers who have been in combat.  I think the comparison is apt because they are both perpetrators and victims.

Judith Herman, who wrote the book Trauma and Recovery about the survivors of violence, political terror and sexual abuse, writes that every soldier has a threshold of resilience that can be exceeded fairly quickly:  most “tours of duty” exceed this threshold.  And given a horrific enough event,   no one is immune from the consequences of traumatization.   Judith points out that the trauma of combat takes on greater force when the soldier can no longer rationalize it in terms of some higher value or meaning.   Doctors like me feel a little bit this way when we question the evidence behind our practice.

There is a solution.  Herman also writes about the healing power of connection.  And so it is the connection that provides the recovery. It is disconnection, in some cases perhaps a merciful act of the brain to minimize memory of horrific events, which becomes the problem.  

Therapists say that when we make connections, whether it is in our relationships or in our professional lives, we can talk about anything.  What they don’t seem to talk about is the cost of connection.   Each of us needs to weigh in that cost.   If you disconnect, it seems that you will probably pay later: depression, anxiety, PTSD.   With connection, you pay now:  anger at everyone who makes the system suck for women. Anger at yourself for not being able to change it.

For me, one of the penalties in believing in women is to live alone in a world of wounds.  The choice is to harden my shell, or to make believe that the consequences of intervention and obstetric “scare” are none of my business[i].   I can’t seem to do either one.

 

*******

I am in the operating room, about to do a caesarean section.  The baby is exceedingly premature.

A paediatrician stands waiting to take him away.   The baby is breathing on his own, and very vigorous, and so, I say to the mother, go on, reach up and touch him, it is really important; they may not let you hold him for a while.  She reaches up and grabs his little foot in her hand, and afterwards I am sewing up her skin she is still looking at her hand and marvelling at the warmth of him, and how wonderful his skin felt. “He was hot as, cuz he came from inside me, and his skin was so freaky, soft,” she is saying.   But the anaesthetic technician has just noticed her fingers are covered in blood and amniotic fluid.  Frowning at me over the top of the drape, he hastily puts on gloves, and gets a bunch of tissues to wipe it away.  

 

 


[i] Aldo Leopold described this wounding from the view of an ecologist living a world of exploitation of the land, in his book, A Sand County Almanac  Oxford University Press 1949

*(of course, this is NOT even remotely okay)

“The women aren’t here for us.”

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I was in a meeting after some horror show had played out in the birthing unit. It featured a ruptured uterus, a dead baby and multiple units of blood, and the STAFF were traumatized. We were planning a debriefing session: the venue, the time, the invitee list. One of the managers thought we were taking things a little too far. She said, “We have to remember, the women aren’t here for us”.

Are the women here for us? Not exactly. But care is not a one way street, and we need to talk about that.

I listened to Dan Ariely’s TED talk “Our buggy moral code.” Dan spent months; stretching into years, in the hospital after third degree burns affected most of his body. During that time he had to have many painful wound dressing changes. You may have heard that having burn wounds attended to is one of the most painful things imaginable. Dan said that the nurses would rip off the dressings quickly. And, they would start cleaning the most painful parts and work their way towards the least painful. They would rush through the work as quickly as possible. He would beg them to do it slower, give him a rest, save the worst parts for last, but they said “No, its better this way. It would be much more traumatic, if we did it the way you suggest”.

Once Dan got well he started doing research into whether what people believed about pain was true. He did a number of experiments using small electric shocks, plunging ice baths, vice grips on fingers, things like that. He rigorously measured the responses to the degree of pain his subjects experienced. Dan found that the average overall pain that people experienced was much reduced if things were taken slowly. His work revealed that many of the things that health care workers did to burn patients as a matter of their intuition were wrong and should be changed.

There are two powerful messages in Dan’s story. The first is the message that the patient is often right. We should listen to our patients much more than we do.

But I’d like to deal with the second message, made very clear went Dan went back to the hospital and spoke to the staff who looked after him. He explained his results to his favourite nurse. She said that there was one very important thing that Dan didn’t measure. He hadn’t looked at how the treatment made the nurses feel:

She said, “Of course, you know, it was very painful for you. But think about me as a nurse, taking, removing the bandages of somebody I liked, and had to do it repeatedly over a long period of time. Creating so much torture was not something that was good for me, too.”

In obstetrics we are the creators of torture. We often are witness to suffering, many times we, like the nurses who looked after Dan, are the ones inflicting it. We are regular bystanders, harbingers, creators of pain: we are victims of vicarious traumatisation and perpetrators of violent acts. It is true that sometimes we save lives in the process. But these uglier views of typical clinical events must be faced and examined carefully.

It is not good for staff to come to work and harm patients in the course of their care: intentionally or unintentionally. But the nurses did hurt Dan, they felt they had to, as part of their job. The pain they inflicted affected them so deeply they could not listen to what Dan was saying. Some part of their selves disengaged.

The day of the horror show, a mother was hurt and a baby died. I’m not getting into the fault of it. The thing is we were the audience and the cast of a tragedy. We need to review that play and not only to find out what scenes might have been better acted.

I think that when the manager said “the women aren’t here for us” she was extorting us to remember our non-starring role: the women aren’t here for our entertainment. She felt we should keep this professional distance, keep our emotions in check, toughen up and get back to work. The implication was there that if we didn’t, there was something wrong with us. But there is something more wrong when we don’t take the time to consider not only what happened, but how we feel about what happened.

There are times, I get called in to look at a tracing, or to give some advice, to births I have no other business being at, and when I get there, I realize that my services are not required. The woman is being supported, the midwife and family are there, and whatever they called me to do was a false alarm. Still, it is very hard to leave. I mean, it’s easy to leave a place where you are not wanted….but in this case, there’s a feeling of going out into the cold rain from a warm hearth, and you would like to linger, you would like to be invited to stay. But I don’t. That women wasn’t there for me. It’s enough for me to know that the warm hearth exists.

Instead, I’ve got a permanent invite to the parties that no one wants to attend. There’s a rush of adrenaline with all the drama of a five alarm fire. There’s a ruptured uterus, a dead baby and multiple units of blood. Like they say, it’s a crazy job but someone’s got to do it. Turns out that women want that someone to be a person who cares deeply about them.

Why Do Bad Maternity Systems happen to Good People?

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The truth is that just because there is a better way doesn’t mean that’s the way it’s done.  I had an “aha” moment about why crappy care prevails in health care—-in particular, why women are still being abused and traumatized when they come to hospital to give birth— when I listened to this podcast  on the “religious” CBC radio programme Tapestry.  In the podcast, Mary Hynes interviews Gretta Vosper, an ordained minister of the United Church of Canada. Gretta tells the story of a particularly bitter conflict which had emerged within her church community and the pain that conflict had caused her.  She questioned why it is that in so many church settings, the meanest voices seem to own the podium.  What is peculiar to our humanity that this happens so often?

The reason, Gretta said,  why the bullies often win is that they exploit a loophole in our human nature.  Most of us want to get along and not be confrontational, so even in a place like a church where you would think people are mandated—commanded even— to get along and have empathy with each other, the bullies are set up to win.  Even in a place like church.  One bad apple can and does spoil the whole bunch.   A cursory look elsewhere in human history confirms this.  Why don’t we speak up? Why don’t we call evil out wherever it happens?

If churches can at times be hotbeds of hatred, is it really a surprise that health care workplaces are so often such unhealthy places for both the sick and the people who care for them?  Is it really so strange that hospitals are the institution where vulnerable people go to be healed but all too often come out further wounded?  That working in health care feels like being cast into both roles of an abusive relationship?  We are perpetrators, and sometimes victims.  We should perhaps be more often surprised under the circumstances when we get things right.

Since health care workers are the workforce of hospitals as well as being  members of the caring profession you would be forgiven for assuming that hospitals should automatically be workplaces filled with kindness and empathy. Indeed, kind people are attracted to the health care field but kind behaviours are often suppressed.  Horizontal and vertical violence are rife.  There is a combustible mix of people with the “disease to please” and one or two power brokers ready to exploit that: taking advantage of the softer nature of others as increasingly a certain management model and style has set in.  Staff are overworked and underpaid as managers are rewarded and in some cases paid bonuses for balancing the budget on their backs.  We are told that the patient comes first, and we have to do more with less, we understand that—-and people are being stretched beyond their capacity.  If we don’t look after our staff at a very basic level, they can’t look after anyone.

Once, I was finishing a caesarean section late at night.  My house officer assistant and I were both very tired. When we went to apply steristrips before putting the final dressing on the wound, we were clumsy with fatigue, accidently pulling off the steristrips we were trying to put on, making them stick to each other, having to redo some, and dropping swabs and equipment on the floor.  We were moving in slow motion, and screwing up out of sheer exhaustion.  The scrub nurse was watching us, and suddenly, she got so frustrated and angry that she lost it. She snarled at us to get out of her way, slammed on the dressing, and proceeded to very roughly take down the sterile drapes.

When that nurse ripped off those drapes, the drain I had put in the woman’s abdomen pulled out partway and I had to take down the whole dressing in the recovery room and remove it. It wasn’t a big deal, but maybe it could have been.  There might have been some sort of consequence for the woman, the newly minted mother at the end of the drain.   Infection, a missed haemorrhage. Certainly it was unkind.  And it is a million little unkindnessnesses that stack up together and make us all victims of the bad maternity system: the patient, the nurse and me.  I was too exhausted and too afraid to tell this nurse that her bitchy behaviour had caused a problem for the patient, because, in one part, the confrontation was just going take too much energy for me to muster up.  The next time I’d see that nurse she might make trouble for me.  In another part it was also because this small seemingly insignificant example of crappy care is a lot more common than you’d think.

Maternity care in too many parts of the world is an assembly line of impersonal care, provided by wounded healers working in a broken system.  We must do something different than we are doing now.

PS. I wrote this after reading this excellent post of Sheena Byrom’s here (where you can also download her awesome presentation about maternity care in the UK).  In it she asks why we aren’t following the evidence and changing the maternity system for the better.  And it got me thinking.