The Birth Whisperer (and just about everyplace else in the birthosphere) has published a sign posted in the Aspen Women’s Center in Utah, USA.
Description: A teal sign on an office wall, reading:
Because the physicians at Aspen Women’s Center care about the quality of their patient’s[sic] deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in: a “Birth Contract”, a Doulah[sic] Assisted, or a Bradley Method of delivery.
For those patients who are interested in such methods, please notify the nurse so that we may arrange transfer of your care.
What struck me first about this sign was, somehow, not the illegality of refusing the presence of a doula at a birth and refusing informed consent for obstetric procedures, but the massive, glaring, deliberate omission of the woman in that opening clause.
These doctors are not concerned with women. These doctors are not concerned with women’s welfare. These doctors are not concerned with women’s health. These doctors see “delivery” (not “birth”, note) as a transaction between fetus and doctor, in which a woman is no more than an annoying, obstructive, hostile incubator. These doctors insist, explicitly, upon their dominion over women’s bodies.
They demand that their power be absolute – to the point of forbidding women to educate themselves, to the point of isolating women from sources of support, to the point of refusing women the right to decline them free access to their vaginas. This is the very definition of “abuse”.
Sadly, as so many have noted, all they’re doing is making it explicit. They’re not the only doctors with this attitude, with these rules. The only difference between them and many others is that they declare their hatred for you up front, instead of springing it on you later.
Categories: gender & feminism, violence
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Quicklink of the Day #2: #DestroyTheJoint excludes voices of women with disabilities 
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Hoyden About Town 
Ineloquent I know, but all I can find to say is ugh.
Not concerned with women’s health? Er, you sure about that?
Those doctors might be paternalistic misogynists. They might also be dedicated and caring professionals who treat the women in their care with utmost respect and regard.
The issue is responsibility for treatment vs autonomy of the patient. The conflicting attitudes could be described as “every birth is unique” vs “there is a step-by- step procedure that should be followed”. The question is, do doctors have the right to dictate treatment and procedures to their patients?
Ideally, any woman walking up to the door of that clinic reads the sign and says “OK” or “Not for me”: and the woman who says “Not for me” walks to the clinic around the corner which will offer her the care she is comfortable with. The problem is, there probably isn’t such a clinic within easy access and she may very well end up feeling done over and helpless in the bowels of a huge medical machine.
That is the outcome we must eliminate. It is probably a good idea to discuss it without sweeping generalisations.
WTF?! Reminds me very much of Catholic hospitals against abortion and pharmacists refusing to dispense birth control.
I think it’s a question of professional beliefs rather than moral. How something is done affects both the doctor and the patient at the time. A doctor who says “I like episeotomies” (sp?)is a bit different to one saying “because of my personal views, I am denying you medical treatment.”
Both cause the same injustice when people don’t have access to other service providers.
Any doctor who prioritizes the health of the unborn vs. the health of the mother is by definition a “paternalistic misogynist.”
The pro-lifer concerned for a woman’s health is the exception rather than the rule. And male ob-gyns are just a really bad idea. Way too much potential for abuse there.
It’s not that it’s about them making it explicit that they will provide as the health care professional for the best outcome for the woman, it’s that the woman doesn’t even exist. It’s like asserting that they will do whatever it takes for the fetus, even at the expense of the mother.
I know that it’s easy to argue that women will read this and then leave if they do not agree with those policies, but it’s not true. most women don’t know enough about these issues to know that a birth contract, a doula, and the bradley method are all things that are beneficial for them as autonomous individuals. by using words like that instead of saying that they won’t allow a personal advocate, they won’t work with you ahead of time to determine what methods you’d like you to use, and they won’t allow the father or partner to be an active participant and supporter in the birth they are relying on women not doing research into any of these things and being ignorant about their own pregnancy. unfortunately, in this world of multiple demands being placed on pregnant women, it’s extremely likely that whatever doctor the woman visits will end up being her sole provider of information about her pregnancy and future delivery.
so sure, an educated woman can go somewhere else if they do not like the methods that this clinic uses, but most won’t know better. not to mention, there isn’t usually another clinic ‘around the corner’. there are VERY FEW clinics for pregnant women.
I don’t see why a woman should be obliged to go to another clinic to suit the doctor’s preference at all, that is entirely unacceptable to me. All patients should be respected as autonomous individuals.
Doctors do NOT have a right to dictate treatments, they are expected to advise patients and perform procedures with patients informed consent. That the doctors here see fit to override something as simple as a birthplan, because they don’t even want to be bothered with their patient’s preferences *at all* in regard to treatment, makes it pretty evident that respect for the patient is not a priority.
It’s not a matter of finding another service provider, all service providers are obligated to give medical treatment with respect for their patients wishes. If you want to be a hospital despot, you don’t belong in a caring profession.
what happened to “the customer is always right” ?
If only all doctors would so clearly state their beliefs. It sure would save me a lot of time if I knew my obgyn was sexist, “pro-life”, anti-contraception, or any other of a million things. It would save a lot of copays too. I would love to interview my doctors before I make an appointment. It’s sort of nice to see such blatant sexism on display. How many patients have transferred? More importantly, are there many other choices in town? In some towns, women may have no other options.
By the way, do they charge for an office visit if they transfer you?
” They might also be dedicated and caring professionals who treat the women in their care with utmost respect and regard.”
I don’t think you can be treating someone with utmost respect and regard while denying their right to make autonomous decisions about their own treatment. If you respect them, then you think they have a right to make decisions about who they want at their birth, how they want to birth, interventions they do or don’t want. Otherwise, if you’re saying you think you’re in a better position to make those decisions, you’re basically saying you don’t respect them as an autonomous individual capable of making an informed choice, you don’t respect their preferences, and if they don’t like it? Screw them, they can go see another doctor – if they can access one.
A doula is only there to support the birthing woman – the fact that a doctor would be hostile to this should be ringing all sorts of alarm bells. They clearly feel it threatens their authority/power in some way, and since birth should be centred on the woman and not on the power of the doctor, this alone should be enough to make someone think twice before trusting them.
As the post – and others – have said though, they’re making it explicit. At least they’re not saying “My dear, you can have the baby swinging from a chandelier if that’s what you want”, and then leaving a trail of disappointed women who believed they were getting a natural birth the way they wanted it, but instead got the full gamut of interventions, in their wake.
For fuck’s sake, wilfully-ignorant commenters whose comments I really can’t be bothered letting through because they’re way, way, way off our comments policy: educate yourself before running off at the mouth about SCIENCE!!1! You don’t even need to do much work: just click on the Similar Posts links for a start, then follow further links from there.
If I ever saw a sign like that, not only would I walk out and warn everyone I know about that surgery, I would try to file a formal complaint with a higher power. If they are so clearly disregarding their patients like this… It makes me think they are more likely to push unnecessary interventions and C-Sections. Even if I wasn’t giving birth, I’d stay away from any clinic with a sign like that. Ugh. Too much bad. I hope the women in the area have access to another clinic and the resources to learn about the dangers this sort of mindset can cause.
Lauredhel:
Argh at those comments! This has nothing to do with “Science” or proposed benefits of whatever method, and everything to do with respecting the autonomy of the patients.
If I’m having treatment for cancer, I can’t demand the doctor treat me with homeopathic remedies. If I want homeopathic remedies, I go to a doctor of alternative medicine. If I want my child educated in a Steiner school, I go to one. I don’t go to the local school and demand they start teaching using the Steiner method.
If we want to start snarking on people who devalue women as people once they have a baby, we’d have to include midwives who think a new mother should be attached to a breast pump for eight hours a day.
No-one here has talked to the doctor who put up that sign, and so none of us can say definitively what motivated it. I am in favour of analysing language for subtext, but not of deriding a whole body of professionals dedicated to the care of others. We all know of crap doctors, we all know great ones. The issue is reducing unnecessary medical interventions in birth. Part of the problem is lack of hospital beds, and lack of funding for hospitals.
But if you were receiving treatment for cancer, you’d
(a) expect your doctor to be treating you based on the available EVIDENCE and
(b) not deny you treatment if you chose to seek other options AS WELL as their care.
It’s not like the examples you’ve given.
It’s like an oncologist saying “If you choose to drink peppermint tea to help with your nausea, I’m not willing to treat you, FIND ANOTHER DOCTOR”.
It’s like your local school saying “If you let your child play with Steiner toys at home, we’re not willing to teach her, FIND ANOTHER SCHOOL”.
No-one is deriding an entire profession – unfortunately, the evidence is that in most hospitals, and by most doctors, birthing women are not treated as autonomous human beings, capable of making informed choices about their treatment. That’s not to say there aren’t some good doctors, and it’s not to say there aren’t some bad midwives. But as “no good doctors” is not what anyone’s arguing, you trying to use it as an argument against the points being made here is just setting up a straw man.
Eilish, you’re speaking complete nonsense. Putting aside the fact that women are autonomous humans for a moment and should be treated that way, doula care IS evidence-based practice. Denial of doula care leads to longer labours, higher pain levels, and higher surgical delivery rates. Click on “Similar Posts” before you say anything more and look like more and more of an ignorant ass. I’ve written screeds and screeds and screeds of evidence-based posts looking at the science, and lack of it, behind obstetric interventions. It’s all there for the taking.
And no irrelevant straw-midwives, please.
And lack of hospital beds? Promote and fund normal birth and homebirth. Which is the exact opposite of what is happening in this sign, and with medicalised obstetric practice right now.
eilish, before you come back and respond to these comments, you should probably do some reading.
Read about the role of a Doula
Read about the Bradley Method and what it involves
Read about “birth contracts” (generally called birth plans) and what they entail
And then tell me why exactly doctors should have the right to deny these services?
Rebekka, no, it isn’t. PharoahKatt, I have read the links.
I was responding to the implication made by several posters that the doctor who posted that sign must be a paternalistic misogynist, and that doctors are kind of like furniture salespeople who should offer you the colour you want.
I reiterate: we don’t actually know what the doctor thinks and maybe we should consider before calling people names and making Baby Jesus cry. As professionals, doctors use the practices they think best. They may not be the best, but that doctor has to use the method s/he thinks right. What we want is for doctors to be open to change in their views, in order to better serve the people in their care. It’s an especially important issue for women, for reasons we all already know.
Lauredhel, I’m not suggesting midwifery isn’t evidence based, and I’m not arguing that it isn’t a good practice. I’m pointing out a different view on why hospitals don’t favour labours that go on for several days. I’ve seen you jump to the conclusion that anyone who doesn’t agree with you is a troll, so I’m not real surprised you are introducing straw men and ignorant donkeys to the discussion, but if you jump all over anyone who doesn’t agree with your choice of terminology, Hoydens will die out. And we can’t have that. The world needs Hoydens. The question of funding is vitally important, as is getting doctors to accept midwifery.
The Royal Women’s Hospital in my state has a birthing unit on the top floor. It’s an ideal situation. The woman gets autonomy, and if it goes pear-shaped there’s no worry about a race to the hospital. It’s generally booked solid. My friend gave birth there. She had a thirty six hour labour.
My s-i-l gave birth four months ago. That night so many women were in labour, there were women on trolleys in the corridor because all the birthing suites were full. Anyone wanting to let their labour run its natural course would have been very disappointed: but it wasn’t because the doctors and nurses were being uncaring shitheads.
Just think how many of those women could have been safely birthing in the comfort of their own home rather than on a trolley in a corridor if homebirth midwives could get indemnity cover.
eilish:
There is a reason that people are calling this specifit Ob a misogynist; sie is acting in a misogynistic way. Ok, you’ve read the links. So you know what all these practices are. Let’s have a look at what this doctor is saying.
I will not allow you to have a supportive birth coach with you to talk you through the birth, assist your breathing, and make you feel comfortable.
I will not allow you to have a preference for which interventions, if any, you want. I will not allow you to birth in the position which is most comfortable to you. I will not allow you to be as mobile as you want to be.
I will not alllow you to attend classes ahead of time that teach breathing methods and natural pain relief techniques. Should you attend these classs, I will not allow you to put these techniques into practice.
Do you see now why we’re getting so angry at this?
@Mindy, not to mention, it’s interesting that these women were lying down on trolleys, given the very good evidence that staying upright and moving around facilitates labour.
I wonder why they weren’t wandering the hospital corridors instead of lying on trolleys.
Oh, that’s right, hospitals and OBs don’t actually treat women based on the evidence, and don’t want them making autonomous decisions. Strap them to the bed and cut them, I say.
Oh, and @eilish, “no it isn’t” is a pretty facile argument.
Rebekka: but much quicker than making rude remarks about the gaping chasms in your really poor argument. And politer, too.
PharoahKatt, I totally understand the rage, and I’m in favour of rage, because that’s the way we get things done most of the time. That doctor is dismissing midwivery in exactly the way we don’t want. Clearly a person who needs to read the “Safe Motherhood” link with the important bits underlined.
But there are two conflicting needs here: the need of women to give birth without unnecessary fear and trauma; and the need of doctors and nurses to make sure nobody dies.
We need to continue directing the rage so that the unacceptable system is changed. Widespread discussion about signs like the one that started this thread, are going to lead to signs saying “Have a doula with that baby”. My concern about using sweeping generalisations to express our rage enables the opposition to dismiss us.
A nurse joined in the thread on the ‘Birth Whisperer’ and tried to make the time/beds argument and was overwhelmingly piled-on. She bailed out of the thread. They had a chance to make a solid case to someone in the system and that was a lost opportunity.
“the need of doctors and nurses to make sure nobody dies.” Oh please. A woman and baby are more likely to die in hospital, so if this is their reasoning then the doct0rs and nurses are in trouble because they are failing. A woman is more at risk having a caesar than a natural birth, yet the well being of the mother isn’t even a factor in that doctor’s sign.
@ eilish – it’s not “impolite” to point out the holes in someone’s argument – I’m open to being corrected if I’m wrong.
But just saying “you’re wrong”, or “there are gaping holes in your argument” isn’t going to convince me, or anyone else, that there is actually anything wrong with my argument. In fact, quite the opposite; it makes it look as though you have no argument against it, and are in denial.
If that’s not the case, by all means point out those “gaping holes”. I won’t be offended.
And one of the evidence-based ways to achieve this is by one-to-one doula support, which I have just posted an enormous amount of evidence on. Not midwives, doulas. Again, go away until you know something about what you’re talking about.
Fundamental principle of human rights: Women get to choose who does what to their bodies, who shoves their hands and instruments inside them and when. Women also get to choose what education they seek from third parties. This doctor seeks to deny women these rights just because they’re pregnant or in labour. There is no possible non-misogynistic framework in which this makes sense. Yes, that’s an absolutist statement. That’s because this is a fundamental principle.
Accidentally watched Medical Emergency last night. One of the ‘medical emergencies’? A woman, having her third child in natural labour with contractions about a minute apart in an ambulance racing to hospital. BP normal, mother coping well, everything normal. But it was a medical emergency!
They got to hospital before the baby arrived. Took mum to the labour ward. Mum asked not to be moved off the stretcher and was ignored (baby’s head was half out and she could feel it). She was telling them she wanted to push. They moved her onto the labour bed, one push and baby was out. Phew, one medical emergency avoided! What crap. Being a totally normal birth mum and baby went home the next day.
(not responding to eilish at this time due to comment policy)
Mindy: There seems to be a disturbing trend of not listening to women when they’re giving birth. I’m reminded of the woman who lost custody of her baby after refusing a C-Section. Apparently birth makes you less of a human now? Oh wait, I forgot, women aren’t humans anyway. Only white straight cis TAB neurotypical men are humans -_-
It’s not so much a disturbing trend as the entire history of birth since men started trying to take it over in, oh, the late middle ages.
Rebekka: Yes, of course. Part of the ages old practice of controlling women by claiming power and ownership over their bodies. It goes hand in hand with slut shaming and criminalising abortion.
I still prefer when places are open about the fact that they will treat me unfairly. Hopefully there is another clinic nearby that can cater to pregnant women’s needs?
it was the UT piece that then lead me to not be surprised. sorry if you know this (i’ve just happened in on your blog) but this is UT, where the majority religion, and thus the majority of the people who govern the state, doesn’t believe that women get to have a real say in anything besides raising families. women are 2nd class citizens to a lot of people in this state. *sigh* i bet all the OB’s in that practice are men, white ones, and of the majority religion. yes, utah is very very very weird.
eilish – couple of things you need to hear. 1. Don’t compare childbirth to cancer- it’s NOT a disease. And 2. Before men got it into their heads that they needed to undermine women’s capacity for giving life, in order to control it, we were doing fine at supporting each other to give birth. We knew what we were doing and it was considered to be well within the bounds of female competence. When childbirth became medicalised it was to the deliberate exclusion of women, because men needed to control everything including the means of reproduction – that was when we ceased to be human in men’s eyes. The sign in the OP is much more than the denial of women’s human rights, it’s a deliberate attempt to obstruct women from unity and solidarity.
Brooke- women are second class citizens everywhere.
Yeah, but in Utah and the red states, treating women as second-class occurs daily
brooke and Politicalguineapig: I realise it’s reassuring to pretend that this is something that happens Somewhere Else, to Those Other People, but this attitude is not even slightly Utah-specific, nor is it specific to certain states of one particular country.
Yeah, I know that. Still, I wish the red state politicos would get a big fat helping of the clue by-four or wither away like the useless political appendixes that they are.
Utah as a state is quite pretty, but my god, the people there. (Apoligies in advance to any rational Utahans, if such creatures exist.)
Then I request that you stay on-topic in this thread. You can start your own blog at http://www.wordpress.com if you have more to say on other subjects.
On a related note, this OB’s “birth plan” – argh: (found via Stand & Deliver)