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.