April 24, 2003

Setting parents up for coercion during labour

Back to work today after the Easter break. Over the weekend I had a chance to catch up with one of my pregnant neighbours (there are 4 couples expecting babies soon in my small block of apartments) and I was able to answer the questions she had regarding her birth plan. She and her husband had completed the 7 week prenatal course at my local hospital (the Royal Prince Alfred Women's and Babies Unit) and she had some interesting feedback on the way that course had been conducted.

The educator had managed to alienate the fathers on the first week by making flippant comments such as "you guys won't be doing much - you'll just be there to observe", which angered this father, as he has every intention of being very much involved. Several couples did not return for the rest of the classes and I wondered if the educator followed up to find out why - perhaps her pitch was unappealing?

The main thrust of the course, according to my friends, was to prepare the parents for the hospital policies that will be applied to them when they come in during labour. It was stated that "you will have a 30 minute CTG trace done" and when they challenged the necessity of this, it was grudgingly acknowledged that this could be circumvented or done by hand using a sonicaid, but it was emphasised that "this was hospital policy". Other issues such as routine Vitamin K injection for the baby and routine oxytocics for third stage management were also stated as necessary policies. The whole tenor of the discussion (lecture?) was to set parents up for the procedures that would be applied to them. There was no real exploration of the issues nor information given that would enable parents to make an informed choice. If this couple had not continually asked questions and challenged the sweeping statements, the other participants would have had no idea there were other ways the birth could be managed.

Having spent a whole week listening te Mavis Kirkham during the Future Birth tour talking about "the rhetoric of choice and the reality of coercion" it was obvious that this was the practice here in Sydney, as it is in most parts of the western world. My friends could certainly relate to this statement when they recalled the program they had just attended. Needless to say, they have sought broader information elsewhere and have crafted a careful birth plan which they will be presenting to their private obstetrician and the midwives in the Birth Centre when the time comes.

I have assured them that the Birth Centre midwives will listen carefully to their desires and not perform any routine procedures ( I hope I am right!), and certainly not without clear permission. My neighbours found it ironical that if something is so important that it must be regarded as a necessary routine in the Labour Ward (such as an on-admission CTG trace) that it could be safely overlooked in the Birth Centre. This is indeed another wonderful example of the double standards that exist in maternity care!

I am continually amazed that hospital administrators, clinicians and educators fail to grasp the basics of risk management: good communication and full disclosure of all facts so that informed consent can be assured for clinical procedures. When they with hold information (especially deliberately) they leave themselves open legally and it must just be a matter of time before someone takes them on in a court of law, for acting against express wishes that resulted in an unwanted outcome. I say, roll on this day..... perhaps this will be the only way they will learn.

Meanwhile, my friends reported that there was one woman in this prenatal program that said not one word through the whole seven weeks, even when invited to speak. Finally, as part of the closing exercise, when each person was asked to give one word about how they were feeling about the program, she volunteered her word - "scarey". A sad indictment of this program and its inability to meet her needs.

Posted by andrea at April 24, 2003 07:45 AM

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Andrea,
The other night in SCN I had three mums BF their bubs and I was there assisting as required and getting into a conversation about Antenatal classes.
Mum 1 said she thought the ones at Wang Hospital were great! But they need to talk more about Painrelief as her Doctor in ANC did--- But she had made up her mind to keep mobile! She had Pethidine though she wished she hadn't!
No 2 had been at another hospital for her first bub in Melbourne and had a terrible scary time and now this one at Wang had been great but she wished they had mentioned before THE EPIDURAL- that Doctor she could have a Epidural almost immediately which the Dr recommended at her last visit and she did and "it just made it so easy"!!
The third a little Late teenager just blew them away by saying her midwife "talked her through and she had only gas at the last while after a wonderful spa"- She proudly said she knew each pain was positive and one pain down toward the bubs arrival-- and it was great!
I was very respectful of the others but praised her for her speaking out so positively about her labour--- The next night she came in while the midwife who was at her birth and I were having coffee and said thank you for making Birth so special for her.

The doctors coercion was "what influenced the first two ladies and broke their belief in what their body could do" while the teenager doubted the doctor "who was making money by being there"- her comment! Seeing he wasn't she was glad!!

Thought I would share this conversation with you.
Big Hug and take care,
Robyn Aulmann RM FACM Rutherglen Vic

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