Why We Broke Up With the Hospital (hint: she was a dirty cheat)
We’ve recently gone through a breakup. A sad one. The kind where you fight to keep your partner because you’re just so comfortable with him/her and life is so predictable but then you realize that the relationship is actually crushing your soul and it’s time to go. And then you find out all the things that have been going on behind the scenes and it makes you want to go all Lisa Left-Eye Lopez on his/her ass. But you’re a professional, so instead you just write a strongly worded letter of
breakup resignation and go home and watch Rom-Coms and eat chocolate on your couch under a pile of snotty tissues soaked in your tears.
Ok so fine, that’s dramatic, but for real…we broke up with our local hospital and it looked sort of like that. Let me back up.
I (Sam) had been working there teaching childbirth and infant care classes for the last five years. Claire had been doing the same for the past year and a half, and Kara for the past six months. A year after I began teaching classes there, I became the Coordinator of the OB Education program. Over the years we’d always had a bit of a struggle between what the “powers that be” wanted us to say to parents in our classes, and what we actually said. As the coordinator, I often fought these battles (very timidly, mind you, because I’m a recovering people-pleaser and I’m hell-bent on being liked) around tables with docs and managers and CFO’s. Everyone who taught classes there were certified childbirth educators and none of them were registered nurses, most were doulas. They’d belittle me and the rest of the instructors for not being medical professionals. I would remind them that we were certified to teach childbirth education and were providing objective, evidence-based information that is aligned with ACOG standards. They would roll their eyes. Rinse, repeat.
Here’s how the bureaucracy works in the hospital:
There are a few practices that are “owned” by the hospital, meaning that the doctors in those practices are actually hospital employees. The rest are private practices that have what they call “privileges” at the hospital. They are not owned by the hospital but they’re big practices that bring in a shit ton of money. So there’s power there. As hospital employees, we were technically not under the jurisdiction of said doctors. The OB Education program isn’t under the maternity center budget. It’s a completely different department with a totally separate budget. So we’re talking about two entirely different functions although we, as instructors, were often the first point of contact for prospective parents who would eventually be admitted to the maternity center. So let’s call it separate but entirely unequal.
So though these doctors were not the boss of us, and though we were sufficiently educated and certified in our field, and though we were loyal only to the women and families of our community, and though we were committed fully to teaching truthful, accurate, and evidence-based information…. It. All. Went. Wrong.
This past spring, I got a call from the practice manager of OB Ed. and the chief of Obstetrics at the hospital. They were concerned because the head doc of one of the largest OBGYN practices in Rochester (and the largest at our hospital) had taken a complaint all the way to senior management (the CEO) of the hospital. The complaint was based on two things that a patient of hers had reported: the patient was upset by the sight of a pair of forceps that her instructor showed her during class, and that she had found out that there were in fact, risks to getting an epidural and now she was “scared” to do so. This doctor wanted us out of our positions. Who ARE these doulas? Who do they think they are to prompt my patients to question me? This doctor was so thrown off by her patient questioning common interventions that she was willing to go to the top of the administrative food chain in order to take us out of the picture and thereby force ignorance on her patients. We were told to immediately cease showing intervention tools to class participants. That meant showing forceps, vacuums, amni-hooks, and other common tools was no longer allowed because it “upset people.” I’m sorry sir, does the sight of these medieval salad tongs unnerve you in a classroom setting? Boy then it’s gonna be tough when you see it coming at your wife’s vagina and wrapping around the skull of your unborn baby a few months from now. Good luck with that. If you give a doctor the okay to use forceps and you have never seen a pair, that is NOT informed consent.
Forced ignorance? Not really our thing.
No, doc. Your patient is not afraid. She is advocating for herself and she wants to discuss her questions with you, her provider, whom she trusts to keep herself and her baby safe. And if you perceive that advocacy as fear, that is not our problem and we will not keep her down from our end. We refuse to quiet women and we refuse to BE quiet women.
We were told we should not tell women that their nurse is busy and may not be with them in their labor room the entire time. Don’t say that girls, it’s bad optics. “Bad optics” are the actual words they used. Don’t make us look bad.
It is not our fault if the truth makes you look bad. People need to be prepared. If you don’t want to look bad then do better.
Don’t talk to people about the risks and benefits of an epidural. Tell them to ask their doctor. That is the only appropriate answer to questions about interventions, “ask your doctor.”
With all due respect sir, that is not an appropriate answer – not when people are paying a lot of money to have their questions answered by a certified professional with years of experience. I can actually answer that question.
The list goes on.
Let me be clear. The only thing we want for our clients and class participants is for them to learn to make INFORMED DECISIONS. For each person to know their options. To be aware of both the risks and benefits of each of those options. And then to go forward with that information and make the choice that feels right for HER damn self and HER baby and HER body and HER family. Because the battle cry of a doula is this: If you don’t KNOW your options, then you don’t HAVE any. You do NOT turn over the autonomy of your body simply because you walk through the doors of a hospital. YOU are still the boss of YOU. You don’t need anyone’s permission. You don’t need to be “allowed” to do anything. YOU have ownership over this experience. NOT. YOUR. DOCTOR.
*Exhale, Sam. I’m still getting riled over this breakup, sorry friends.*
So here’s what hospital management did when they had a choice to either side with TRUTH or MONEY. They turned over all childbirth classes to RN’s (without requiring them to obtain a childbirth educator’s certification) in order to appease the doctors who bring in money. But we could teach the other subjects if we wanted. Thanks, Hospital. It’s like they told us they were going to see other people but maybe sometimes we could still make out on a Friday night if they got drunk and missed us or something. So we gathered our dignity and stood our sacred ground and wrote letters of resignation.
Let me be clear on something else. These nurses are amazing. We know them and we adore them. This has nothing to do with them as people because the ones that are willing to teach these classes are the ones that deeply connect with and want what is best for their patients. It’s like looking at your ex’s new girlfriend and kind of not blaming him. But still, it smarts.
Here’s the bottom line: If you want to learn about hospital birth, take a childbirth class in a hospital. If you want to learn about normal, physiological birth, and still have all the options for medical interventions presented to you in a non-biased way, please take a class outside of a hospital. Here are some options in Rochester:
Women, the birth world needs a #metoo movement. Challenge your care providers. Ask them questions. If you don’t like their answers, GET A NEW ONE! So many fish in the sea! Dump his/her ass! Women and babies are dying. The maternal mortality rate in the United States is higher than any other developed country and labors are longer than ever! Things are not getting better, they’re getting worse. Break up if you need to. Wipe the mascara from your eyes, buy a flashy pair of flats for your swollen pregnant feet, put your big girl pants on and hit the pavement! And if you need a girlfriend to talk to, call us! We will bring the chocolate.
**P.S. Here’s a piece of information that may blow your mind. When people ask us for recommendations for a care provider for their birth in our area, we recommend either having a home birth with a midwife or choosing a family practice. Our favorite docs in town happen to be men because these are the individuals that we’ve witnessed treating women with the highest amount of respect. That’s something to chew on.
**P.P.S If you want us to name names, see us after class.