I have been sitting and thinking on this for several days now, and I’ve realized this is something I feel strongly enough about that I need to express my thoughts and feelings publicly.

I am 100% pro-choice.  By that, I mean I am 100% pro-CHOICE, emphasis on the choice.  I firmly believe a woman should have the legal right, as well as access to all necessary supports and resources, to make her own decisions regarding a pregnancy she does or does not wish to carry.

I do not care what reason a woman may have for choosing to end a pregnancy.  I may or may not personally agree with her reasons, but that choice is hers to make – not mine.  If, and I really want to carefully couch this if, there is a real and valid concern about a woman’s ability to cognitively make this decision, then we as a society need to ensure the appropriate resources and treatments are available for her to enable her to be able to make the decision.

Conversely, if a woman CHOOSES to CONTINUE a pregnancy that others might think should be terminated, perhaps due to a terminal condition the fetus is suffering, that woman also deserves all of the resources and supports necessary to carry out that choice.  She should not feel pressure from society, and most certainly not from her providers, to end the pregnancy.  She should not be denied the compassionate care she requests to help her through what will be a very emotional experience.

What has spurred me to write this post?  Just this week I was made aware of a situation that has made me sick to me stomach with rage.  A woman carrying a child diagnosed with a terminal condition is experiencing pressure from her health care provider to terminate the pregnancy.

I am infuriated!  Women should have a right to not just medically competent care, but also compassionate care.  This woman is already going through one of the most heartbreaking experiences a mother can face.  She is making the choice to carry this child, knowing the outcome she must expect.  She deserves nothing but tenderness, compassion, and empathy in the months to come.  I am appalled, but sadly not really surprised, that a woman’s health provider would fail to offer this.

I do not want to paint all women’s health care providers with a broad brush.  There are many truly amazing providers, and not just in the midwife community.  However, I continue to hear too many first hand stories from women about experiences with their providers that I simply don’t hear about from men.  When it comes to maternal health care, women are far too often subjected to unnecessary procedures without receiving the proper information (if they receive any) for informed consent, there are also an alarming number of stories of women receiving procedures or treatments they explicitly rejected.

I want to revisit my own birth story.  In a previous post about women’s health care in the US I shared that when I was admitted to the hospital after my water had broken, but my contractions hadn’t yet started, the resident immediately requested that I begin Pitocin.  I refused, and within 2 hours with no induction medication my contractions had developed to such an intense duration and frequency that I and my daughter were in distress and medication was used to temporarily stop them so the doctors could get the situation under control.  Over the past year as part of a certification course to become a certified child birth educator I have done a lot of reading.  From that reading I have learned two things regarding my situation.  First, the resident was basing her request on the education she had received.  The general guideline is that if a woman presents with ruptured membranes but no contractions, you should begin induction.  Second, this is a problem because just as we cannot paint all providers with a broad brush, we cannot paint all women with a broad brush.  This recommendation must be evaluated along with a patient’s overall history.  If the resident had taken the time to notice that I had been on bed rest for 5 weeks due to pre-term labor and had been experiencing regular contractions throughout that time, she would have understood that I was not a good candidate for oxytocic induction medication.   I had a hyperactive uterus, if this had been combined with the use of Pitocin I would have been at significant increased risk for a ruptured uterus – and based on how my contractions progressed within a matter of hours without any medication I can’t help but believe that the risk for me would have been extremely high.

I know I will likely receive comments that the resident was just doing her job and following the guidelines she was taught.  And you know what, those comments are correct.  The root of the problem isn’t the resident, it’s the education and guidelines.  Compassion and patience must be an essential component to the training for our health care providers.

With compassion she would have taken a moment to talk with me, not at me, she would have had an opportunity to quickly learn the history of my pregnancy which she could have used to better inform her recommendations.

Next I will receive comments along the lines of “would you rather have compassion or be alive” or “would you rather have compassion or a healthy baby?”  My response to these comments would be that I want both.  Compassion and competent care are not mutually exclusive.  In fact, I will argue that you cannot have truly competent care without compassion.

I am very aware that there is a 2012 study indicating that patients reporting a higher rater of satisfaction with their providers have increased mortality rates.  However, the study indicates that this is likely due to physicians agreeing to provide services that may not truly be medically indicated at the request of a patient, and thus exposing the patient to the inherent risks of such procedures.  It also includes this statement which perfectly sums up what I mean when I say compassionate care, “In the ideal vision of patient-centered care, physicians deliver evidence-based care in accord with the preferences of informed patients, thereby improving satisfaction and health outcomes, while using health resources efficiently.35,38 However, patient-centered communication requires longer visits34,39 and may be challenging for many physicians to implement.40 ”

And right there, we see the real culprit.  Time.  Time is money in our society.  The time it takes to talk with  a mother about recommended interventions and risks of doing or not doing each one, the time it takes to talk with her about what she wants, the time it takes to find a plan of care that optimizes the use of evidence-based care and respect for her wishes, that is time that could be spent seeing other patients.  And, unfortunately due to a number of factors (student loans, malpractice premiums, etc.) providers are placed in a position to see as many patients as possible in as short a time as possible.

There is no easy solution to this problem.  In the US health care is a very large, and very profitably industry – for some.  Providers are placed in a very difficult position, especially maternal health providers.  The threat of litigation has led to a culture of providers actively making decisions to minimize their risk.  The sky rocketing malpractice premiums, again especially for maternal health providers, has created the need to see as many patients as possible to maximize revenue.

I wish I had an answer or solution to this problem.  The only suggestion I have to offer at this time is simply to use your voice when you face a situation such as the one the woman I mentioned earlier is facing.  Make it known that this type of care is unacceptable.  We deserve, and have to demand better.  If you use your voice, I will offer mine as a chorus.

 

 

 

 

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