1 down, or is it 2, or is it more?
I have been pondering on the power dynamics of a healthy young woman with a low risk pregnancy choosing an obstetrician and a private hospital for her pregnancy and birth. On average, women see the ob 12 times during their pregnancy (compare this to the WHO recommendation of 2-4 times). The woman then turns up at a hospital when she may or may not be in labour, submits to a (what looks like an excruciatingly painful) vaginal exam only to be told that she’s not in labour, and is sent away. Or, is "offered" an induction seeing as she’s there already. The gels are placed, contractions may start a few hours later, membranes are ruptured when the ob is in checking on their other patients, contractions pick up, the woman is VE’d again and told she is only at 3-4cm and the enthusiasm goes out of her. Syntocin is administered and either it hurts a whole lot more to have the contractions sped up (so an epidural in done), or the baby doesn’t deal with it, and off they go for a c-section. All the while it seems like birth is a horrendously dangerous thing and the ob is the only one who knows how to do it safely. There is an aura of fear and tension in the birthing suite, and little privacy, and a lot of paperwork.
Informed consent? I think not. Not for anything prenatally, interpartum or post natally. Women-centred care? Nope. Power in the hands of the patient? Nope. Good outcomes because they have an alive and healthy baby? Perhaps - even if she also have a large abdominal wound.
Who am I to question this? Who am I to ask questions of my elders/seniors on practices they learnt before I was born? Who am I to say that this model of care goes against everything I’ve been taught about evidence based, women centred care?
