Tuesday, April 21, 2009

freedom to make decisions

From time to time I receive emails from students, asking me to tell them about my midwifery practice. This week's student email had an attachment with about 20 questions under the heading 'Issues that affect midwifery practice'. Rather than spending a couple of hours completing this questionnaire, I have referred the inquirer to this blog, and others, where many of the questions have already been answered.

Today I have selected a question from the list:

"Do you believe pregnant women today have more freedom to make decisions about their birth than they have previously?"

My answer is No, and Yes.

Fence-sitting is probably not very helpful, but I will try to explore the question further. I don't want to sound like the old crone telling stories about the 'good old days' either.

I will link my comments to what I know now about:
1. the freedom that a pregnant woman has to make decisions today
2. the freedom I experienced about 30 years ago, when I was the pregnant woman
3. the freedom my mother, who was also a midwife, told me of her experience about 60 years ago, when she was the pregnant woman.

I say 'No' - that women today do not have more freedom to make decisions about their birth than we had either 30, or 60 years ago (or further back in time, for that matter). Today's mothers face information overload; so many choices that they can easily lose sight of the fact that bearing a child is as normal as life gets.

Many women today are captive to fashion and custom that are driven by capitalistic and humanistic ideologies that have developed in recent generations. There are so many products and gadgets and services that go with the baby business that the reality of the miracle of precious new life can easily be missed.

Today's mother is uncritical as she welcomes technology that invades the privacy of the womb, giving proof of a heart beat in the early weeks, and progressing on to amazing 3D pictures of an unborn child; and answer the question, is it pink or blue? She does not ask for proof that this is safe for the child, or for the next generation. She is encouraged to justify the experience as an opportunity for bonding.

Yet a darkness falls on her life when some small item, called an anomaly, is 'discovered' on the flickering screen. The longed-for child becomes a condition that has to be managed. Dreadful decisions have to be made.

Thirty years ago ultrasound was new technology, available to only a few. Sixty years ago it was beyond imagining. The mother carried her child in the secret place, and experienced meeting her child and discovering its features all in good time.

Thirty years ago the midwife learned to use the Pinnard stethoscope, and the labouring woman was 'managed' lying on a bed. For the birth the woman was often placed in the 'left lateral', the teaching position. The midwife, and a group of students, stood on the right side of the bed, watching and managing the (sterile - no touch) business of birthing, while another midwife stood on the left side of the bed and administered the gas.

Sixty years ago the movements in the womb, felt by the mother, were the primary indicators of wellbeing. A baby whose movement had ceased was stillborn. Still before birth, as well as still after birth.


AND I say 'Yes', women are more free today than in previous generations, to make decisions about their births, because today we try to protect human rights such as autonomy in decision making. Today noone can touch you, or take your pulse without your permission. Anyone expressing that idea 30 years ago would have been quickly put in their place. I felt extremely anxious in 1980, as a pregnant woman booked to give birth to my fourth child at the Royal Women's Hospital Family Birth Centre, when I declared to Dr John Neil that I did not wish to have a glucose tolerance test. He rubbed his chin and said "Well we do let birth centre patients have some say in these things", and generously gave his OK.

My generation of mothers fought for, and won the right to have our husbands at our side in the labour ward, while our parents had been separated at the fathers waiting room. Today I wonder if we have progressed. Although midwives today have learned to operate sophisticated pumps and monitors and beds that are like transformers, many have lost the skill that my mother had 60 years ago, being 'with woman'.

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