Tuesday, May 4, 2010

Hypervigilance and Negligence

The more I doula (yes, I use the word "doula" as a verb with impunity), the more I see terrible imbalances in hospitals between hyper vigilance and negligence.

I'm not a clinician of any sort, and I appreciate the medical care that is given to my clients to help them have a safe birth. But some things don't look so safe, and it strikes me as very strange sometimes what is focused on, and what goes under the radar.

I have questions. If a woman's waters have been broken for a certain amount of time, infection becomes a huge concern for the hospital staff. Synto is started if labour doesn't start at what they deem is an appropriate time. I know there are other reasons besides infection women are told to go immediately to the hospital when their waters are broken, but the reason mainly told to the birthing women themselves is so the staff can monitor for and treat potential infection. But if a woman has to hang out in the hospital, which is crawling with germs, and be examined frequently (they say they won't do it a lot with broken waters but still do anyway a lot of the time), which pushes bacteria wombwards, how does this help her deal with potential infection? Not only that, but a couple hospitals here don't use sterile gloves for examining a woman with broken waters. Many staff members will come into the room, NOT wash their hands, rummage around in the little box with the regular examination gloves, and do vaginal exams with those. So their hands, which have goodness knows what germs on them, contact the gloves they wear for the exam as well as some other gloves in the box (which will contaminate the hands of those who HAVE washed). And then they examine the cervices of women whose waters are broken telling them how worried they are about infection. Hmmmm. Meanwhile, evidence shows labour stimulation can increase the rate of C-section....which increases the chance of infection.

I had a client recently whose waters broke with an exam, and she was told that in 4 hours, if she didn't birth, she'd be given an IV and Synto, etc. But hello, the water was thick with brown meconium, and was pouring out in great gushes. After all this talk of infection and interventions for the prevention of infection, I wonder why nobody thought to listen to the baby's heart after those waters released. As a doula, if I see meconium in the waters, I high tail it to the hospital. I have to, because I'm not in a position to monitor a baby. I understand that meconium is a potential sign of distress. So if it's a potential sign of distress, why would they have waited over an hour before monitoring the baby, favouring to focus on the evils of potential infection?

I have seen incredible hyper vigilance over a woman's pain with a pointed obsession to eradicate it, but lack of attention to the actual birth. I have heard doctors, even when their patients are fully dilated, strongly encourage them to take an epidural because the pain will only get worse (?????). Some are so focused on draping those sterile sheet jobbies all over the mom because birth is all dirty and we need to prevent infection (again) for her and her baby (?????), the baby practically falls on the floor because the actual WOMAN is receiving no attention when she's yelling THE BABY IS COMING! Or, they go and cut a woman's perinuem par routine, which can cause terrible pain and infection, in spite of all this talk about HAVING to do things to prevent infection. Or in all the fuss about pain and infection, the damn resuscitation equipment has not been checked to ensure it's working properly (and yes, I have been in situations where a baby needed this equipment and it wasn't immediately available because it hadn't been properly set up).

I have stories. Oh, I have stories. I don't tell most of them to protect the privacy of my clients. I also don't want the mistake of one person to colour a person's entire view of the hospital. I don't want to breed mistrust. But maybe this is why doulas are having issues in the hospital...not because we actually offend and antagonize the staff with even our most gentle questions, but because we are the witness in the room.

I'm feeling a little raw from a couple of RIDICULOUS things I have seen in hospitals this past week. I don't expect perfection from nurses and doctors, and many of the things that go on are not their fault...sometimes it's administration and understaffing or auxiliary staff issues. But it would be nice to be able to trust that the important things will be tended to immediately, the rare potentials will be inconspicuously prepared for but not obsessed over, said obsession leaving little room for presence for the here and now, and people saying things that make SENSE. I cannot tell you how tired I am of reasons being seemingly plucked out of the air to justify actions. I heard someone say to a client of mine who wanted to push on her side, the practitioner being very uncomfortable with this position, "well, um..it's not safe to push that way because the pressure of your arm against your inner thigh could cause an embolism." How's that for evidence based practice?! How's that for fear mongering? Even an honest, "I'm just not comfortable with this position due to a lack of experience with it,' would be acceptable rather than that garbage. I just don't get this system sometimes. Not at all. And nobody seems to be able to give consistent answers, and culpability can be iffy. But if I even take on a tone in my voice that is perceived as (though it isn't intended to be) snippy, I could potentially be black listed, laughted at, yelled at, insulted, and hated on sight. Doula work is beautiful, amazing, and wonderful....but it is not for the feint of heart.