Birthing mother abused for refusing male nurse

[sakura184]

This kind of crap is why I opted for homebirths

pjmedia.com/parenting/colorado-doula-and-assault-survivor-investigated-by-dhs-for-refusing-male-nurse-during-birth/

I have read all 38 pages of this thread, and it was a doozy. There's definitely some quite concerning ideological bias going on and I'm not entirely sure that has been dealt with appropriately.

Sakura, you have expressed some really concerning views on the level that you trust midwives (who you feel are mostly women) compared to doctors (who you feel are mostly men).

One of your very early comments noted the "confidence" of midwives who work with high-risk women (breech, twins) in a home birth setting. These midwives are not confident, they are ideologically fuelled and at best are ignorant of the risks and at worst downright dangerous. In the UK a midwife who chose to attend a high-risk birth knowing it was high-risk would be working outside of her scope of practice (which is low-risk).

Ideology fuelled practitioners get around this with the loophole of "variation of normal". This as a phrase means absolutely nothing, because unless something is happening that is not caused by the person's body (i.e. a car accident) it will always be a "variation of normal". Cancer is a variation of normal cell development, sepsis is a variation of normal cell response. Breech presentation is a variation of normal pregnancy but that does not make it normal or low-risk or suitable to be managed the same way as a head-down presentation in a low-risk pregnancy.

The American midwives of whom you are so fond are unqualified when compared to the UK (or the Netherlands) and poorly trained, there are few if any safety standards or regulations governing their practice and barely any education requirements. They contribute to the societal view that birth is inherently safe and that women can birth without issues if only people stopped "meddling". This means that women are drawn to this idea and are then very "anti-medicalisation" and will often refuse medical care.

Doctors will often end up having to fix the situations that have gone south due to a woman birthing in an unsuitable environment where monitoring was not done to a high-enough standard and where the antenatal care is patchy or missing. They also have to deal with combative clients who think that the doctor is just trying to ruin their birth or traumatise them.

Often, but not always, birth trauma is a result of a woman having an ideal of what she wants the birth to be like and this can often be an incredibly narrow view that is not always based on the realities of her pregnancy or general health. This does somewhat explain why birth trauma is more common in hospital deliveries as that is likely where you'll end up if things go south in labour or after (or before if your midwife is doing their job and risking out appropriately).

Of course women (and men) should have a choice to request a same-sex HCP if they wish. Arguably in most cases in the UK there are significantly more female midwives in hospitals and in the community, so this is likely to be easily granted in planned situations.

If you arrive in an unplanned way at a tiny rural hospital having never expressed your wishes or attempted to hire a doctor for your care then you cannot expect to always have your wishes fulfilled.

Also, if you arrive in hospital and then refuse the tests and interventions offered so that staff can assess you and your baby so that they can treat you if needs be, then you need to expect some concern from staff about your rationality and whether your baby has been adequately safeguarded during the pregnancy.

From my own experience, which is just mine, men in the field of OB/GYN and male midwives seem to be less susceptible to the natural birth ideology and this could explain why some people have found their male care providers to be more understanding, empathetic, or helpful than the female midwives/doctors.

It's also interesting that you never mentioned the risks of vaginal birth. You talked of the benefits of vaginal birth and the risks of C-Section but those are not two-sides of the same coin, just one side of two coins.

My final point relates to the "cascade of interventions" while I don't deny that one thing can sometimes lead to another, it is impossible to say whether an intervention is unnecessary unless you have a way to go back in time and redo a situation with the alternate option. Interventions are deemed unnecessary when a baby is born healthy, but we would not wish to perform an intervention after a baby is unwell/dead as the goal of birth is a healthy/alive child. If the experience is pleasant for the woman that is excellent, but that is not the primary goal when the risks to the baby are so significant (day of birth is still the most risky day in a child's life). Also, 'pleasant' is going to look different for everyone, so it might be vaginal birth at home or it might be elective section in a hospital with a baby nursery and exclusive formula feeding. If a woman understands the risks then it should be up to her (at least until the baby is born and is its own person with rights independent of its parents).

Sakura - Red was saying it's not healthy.
It's not.
It's really not.
Some comments on here are sickening and it isn't any way to live.
Which is what people have been saying all along.
Red has some great points, you should try to listen as they're spot on and reasoned.

loopsdefruit

I really enjoyed your post. The only thing I would disagree with is,

it is impossible to say whether an intervention is unnecessary unless you have a way to go back in time and redo a situation with the alternate option.

I know quite a few women who have had unnecessary interventions, including myself - the reason I can say that is the need for the intervention never really existed in the first place, or things which ought to have been tried first, weren't.

"If you arrive in an unplanned way at a tiny rural hospital having never expressed your wishes or attempted to hire a doctor for your care then you cannot expect to always have your wishes fulfilled."

Maybe not "wishes fulfilled" - I'd agree with that. But surely you can expect your legal rights to be respected and upheld? She knew her rights, and she knew she had the right to refuse a cervix examination.

"Also, if you arrive in hospital and then refuse the tests and interventions offered so that staff can assess you and your baby so that they can treat you if needs be, then you need to expect some concern from staff about your rationality and whether your baby has been adequately safeguarded during the pregnancy."

This sounds exactly like the paternalistic "doctor knows best" attitudes that Birthrights UK advocate against. They help women know their legal rights when doctors want to accuse women of "not adequately safeguarding their baby" because they have refused interventions. They have helped many women who have come up against these attitudes in the UK.

I'm going to repeat an excerpt from the article Red posted last light:

In more than 20 years as a midwife, he has met women whose decisions have been considered inappropriate by other professionals, but he has “yet to meet one whose decision-making process wasn’t rational or sensible, with each having undertaken their own research and weighed up all the advice and guidance they have been given”.

“The skill is to accept that ultimately it is not the health professionals’ decision to own,” says Mehigan.

Also, this, form a case Birthrights intervened in, where a woman was threatened with a Social Service referral because she had refused interventions:

After Birthrights’ involvement in Laura’s case, Bedford hospital wrote to Prochaska confirming that “the woman has the right to what she chooses”. It offered an apology for the remark regarding a referral to social services, adding, “We would have no reason to do this unless we have proven concerns about the parenting, which we did not.”

The obstetrician has been referred for further learning.

Are you trying to suggest I "get over" my mistrust of men?

Absolutely not.

You have said you distrust all doctors because medicine is masculine.

Apart from the fact that all doctors are not male and yes there is a paternalistic bias in medicine it does not mean that all medicine is purely for the interests of men.

Of course its not.

I am also saying that criticism of the health care system is absolutely paramount and it should be scrutinised and challenged where there are abuses of power.

But that's a world of difference from some of the stuff you've posted on this thread. Which strikes me more as iatrophobia.

The fear you have is jumping off the screen and it's at levels which are not protecting you from harm and actually could led to harm because its manifesting as lashing out, sweeping generalisations and what appears to be extreme avoidance behaviour. That's very different to being distrustful of men.

The fear is controlling you and is making decisions for you. That's not being rational and actually making an accessment of risk in a situation. You aren't actually in control of your concerns.

I've been there, and what I'm seeing is something of a reflection of where I've been in the past.

I'm not saying to readjust those concerns. I'm saying you need to manage them and put them into context so they arent taking over and leaving you blind to people who genuinely are putting your interests first and do care about your well being as their priority.

If you are unable to recognise and identify those who are doing that, you do risk your health because you can't communicate effectively and you can't make informed decisions as your judgement is being affected by the degree of your anxiety as you can't assess a situation properly because you are effectively in perpetual fight or flight mode.

(I recommend the Chimp Paradox by Dr Steve Peters about the difference between your rational and emotional mind and how when one takes over and dominates the other it's not really very good - you work best when they work together and in harmony).

Some of your responses here are not about feminism at all - you are hiding behind that as a defence to justify the sheer levels of your anxiety. I don't agree with everything you say and your definition of what's feminist and what's not. That's not the point and it's fine to disagree. Fearing men has its justifications and really has its causes and I have no desire to minimise that in anyway (though I suspect you might perceive me as doing that). The trouble is it strikes me as at a level more indicative of untreated or undiagnosed trauma or an extreme paranoia or a phobia rather than merely an ideological belief. In conflating your concerns about men and your concerns about doctors, it's creating something more than the sum of its parts.

And as such could really be a barrier to you in future to getting care and coping with a situation you don't feel comfortable in. It's about being about to challenge and assert your concerns in a meaningful way which serves you best. Not removing your risk filter or telling you in a patronising fashion to 'get over it' cos you can't do that with anxiety. The best thing you can do is identify what's happening and then go from there.

I wish you well and hope you do see this post in the way its intensioned as being sympathetic and on your side.

I hope you do challenge yourself and do look into this with an open mind when this thread does come to an end (which it's close to).

Good luck and take care of yourself.

@loopsdefruit

Concern trolling a feminist who doesn't want men near her in birth. We've had that already. Women who say no to men are paranoid, unhealthy and living in fear

Oh come off it. Many parents cannot accept that their baby has no quality of life. I can see why they go to court to turn the machines off. They are the experts, if they think a child should be given a bit longer to hopefully improve then I understand that, just as I understand they know when a baby won’t get any better and keeping them on life support is cruel. I’m starting to think you just have an issue with anyone that a) may know more than you or b) in a position with more control.

You do realise that we learn through mistakes? Do you want every procedure to always be perfect? I’m confused. How do you expect us to learn anything if we don’t try anything? The first heart transplant and many others after failed because there were no rejection medications because they didn’t realise they were needed. Through trial and error they found what works, my daughter is alive because of that experimentation. To add to that, of course healthcare is male dominant, because women had no fucking rights for a long time.

Sakura, come back and read this thread in a week with a clear head and open mind when no one else can reply.

That's all I'm going to say further on the subject of fear and probably on this thread.

Perhaps I am wrong. But I couldn't not say what I believe I'm seeing, as its an important subject to me and think tackling fear and anxiety is really important.

In more than 20 years as a midwife, he has met women whose decisions have been considered inappropriate by other professionals, but he has “yet to meet one whose decision-making process wasn’t rational or sensible, with each having undertaken their own research and weighed up all the advice and guidance they have been given”.

I think however you will find that people who come into ERs quite often are in the midst of decision making processes that are non-rational and absolutely not sensible.

You can't assume that Goosefoot.

Sakura, I am not concerned FOR you. I am concerned BY your opinions and the harm that the ideology that you contribute to does to women and children.

Goose, thank you. I am curious to if you're referring to things like artificially rupturing membranes or induction to a "timescale" as I do agree that often these things seem to be unnecessary. Women aren't all the same and babies haven't got watches. Practice guidelines have to be created at a population level and are designed to prevent mortality and morbidity. A lot of interventions are preventative rather than reactive so arguable you could say that if you'd just waited you wouldn't have needed the intervention. I suppose it boils down to are we willing to prevent harm to one person (with these guidelines) but potentially cause harm to another (by implementing the same guidelines) although it is far more complex and much less of an even risk-benefit than 1:1.

I think here is where Sakura's point about having an HCP that you know and trust is really valid. A good working relationship and someone familiar with you and your pregnancy may be better able to trust their own judgement within the guidelines that are in place and only intervene if necessary (and with consent). A trusting relationship would also hopefully help the woman to trust the medical advice that the intervention is needed, improving outcomes. Studies absolutely support that having continuity of carer is incredibly helpful but sadly the system cannot support that at this time.

Zebra, I do not think that social services should be used as a threat. It damages working relationships between families and social workers and is also not the purpose of safeguarding. If you are taking the time to threaten a referral then you're obviously not that worried so shouldn't be making one.

My point was that the woman in the OP did not have to go to hospital. She wanted a wonderful home birth, one that the doctors apparently ruined. But the doctors did not go to her house and drag her to hospital, she voluntarily sought their help and then refused their care.

It is unfair that there was no female member of staff available to care for her, but she had made no arrangements prior to going into premature labour to ensure she had care from a doctor who was female and who she trusted (or a midwife depending on the law where she lived). If you are so incredibly scared about the possibility of a man caring for you (100% valid) then you need to try and reduce that risk to yourself. In America that means hiring an HCP with privileges at the local hospital so that in an emergency you can keep your care provider with you.

Should it be the responsibility of patients to source their own care? No. But America is a really messed up place for healthcare and that is the way it is. There are lots of campaigns to change this but until change happens that is the place that people live in.

It sounds from the article in the OP that this woman was refusing all the help offered and was incredibly ideologically focussed rather than making decisions in the best interests of the baby (or herself).

She absolutely should not have been touched without consent, but if she was planning on refusing everything then why even bother going in the first place? What was her goal?

Also Sakura, you didn't actually address any of my points...

The thing with pregnancy is that you KNOW birth is going to take place well in advance and can therefore look at the range of emergency scenarios that may happen and carefully consider which risks you are happier and willing to take. You have more potential to come to hospital better-informed than a person who has found themselves in A&E.

Here is a quite frankly fantastic ted talk on warrior vs scout mindset by something of a heroine of mine it’s only just under 12 minutes.

It’s about ideological biases (we all have!), and how to account for that. I hope someone finds it of value.

Sweet, 100% true! Unfortunately "informed" does not always mean accurately informed. Until the biases that favour natural birth are addressed and women are provided with accurate information about the risks and benefits of all the options (risks of vaginal birth, birth injury statistics, benefits of epidural etc...) as well as supported to find a care provider they trust who will then work with them through the entire process I don't believe we can say that women are completely informed.

I don't think this will ever happen, there is a financial incentive for natural birth (in the UK a vaginal birth is cheaper, in the US a home birth midwife is not going to get money if she keeps sending clients back to doctors when their risks are too high) and so the ideology that feeds the natural birth movement is encouraged.

The patient in the OP went to hospital because her waters broke at 33wks - so that the baby could go straight into NICU. Just because she presents to the hospital in a emergency does not mean she has either taken leave of her senses, or lost her right as a patient to refuse medical treatment.

A doctor can treat a patient in an emergency if they are incapacitated - but that would mean unconscious, or similar. It does not mean "not taking a doctor's advice re. treatments."

A patient who is verbally and clearly saying "no" to an intervention must be listened to - it's her right. Whether I think it's right, or v foolish, doesn't matter. It's up to the individual woman.

Zebras, yes, I know hence the: "She absolutely should not have been touched without consent".

But why did she not make any arrangements during the pregnancy to ensure that she would have appropriate care in an emergency? Then in the emergency why would she refuse the treatment offered (not just the VE) that would allow an assessment of her and her baby's health.

There is some clear adherence to ideology on her part that makes the veracity of the article questionable, however again she should absolutely not have been touched without her consent regardless whether the HCP was male or female.

She should have made better decisions during pregnancy to ensure she had adequate care that would have been there in an emergency, but she shouldn't have been touched without her consent.

But if she went there in an emergency and the hospital have no prior healthcare knowledge and can’t check the woman over or her baby, then why did she go to the hospital?

Fundamentally , what I feel has happened on this thread, is that my preference for a female HCP is giving people reason to question my decision making competence, my health, my sanity, my judgement.

I've had namalt, I've been told to get over my mistrust of medicine, when I've said I trust it fine, if it's carried out by women. So it's not really medicine I don't trust, but men.

I'm being told that this is wrong think. I've also been given lots of practical reasons why I couldn't possible have an all female unit ( funding, staffing shortages)

You haven’t been told any of that. Stop lying. It’s all there in writing.

Also, you keep chopping and changing what the thread is about when someone disagrees with you. Not everyone will think the same and each side will argue their points. You points are that any man that works in the medical field is doing so for power or abuse reasons. That’s simply not true. You can refuse a male all you like no one has said you can’t, but I don’t think they shouldn’t be allowed to work there. And if you fail to make your preferences knowns and in an emergency there is only a male, you only have yourself to blame really.

What about men that work in children’s hospitals? Are they all there for abuse because most sexual crimes against children are committed by men. Would you also never allow your child to be seen by a male? My daughter has so many specialists or staff members caring for her that are male. She’s had a few male nurses, male liasons etc are they all doing so to abuse her? They have kept my baby alive all these years and I’m so fucking greatdul and I’m so glad they weren’t banned from the profession because if they were, my child wouldn’t be here. There may not have been enough female only staff to care for her. Funny enough she has two cardiologists and one is male and the other female. The male diagnosed her and has done so much for her, he always interacts with her even though she couldn’t make a sound he would comfort her. In comparison the female is also great but less bedside manner I guess is a way to put it, she’s amazing though and cares for my daughter. Point is, we cannot ban men from certain areas of medicine because it would be detrimental for many people. You can always refuse a male though, that’s okay but don’t make that choice for everyone.

Sakura, you really haven't been told those things and I'm sorry that you feel that way. I think you do make some really valid points within some of the harmful NCB things that you say and I would 100% support your wish to have only female caregivers if they are available.

I think if you are in the UK that is probably pretty easily achieved (maybe not if you require a consultant but that would just depend on area, I think you could probably ask in advance and try and organise it).

A key thing to remember is as the role becomes more specialised the number of available practitioners on a shift (or on staff) reduces. So there are lots of (majority) female midwives, and slightly less doctors (of which some will be female) then less maternal foetal medicine specialists, specialist cardiac people etc... but you can explore this antenatally and hopefully ensure that wherever possible you can have your wishes met. This needs some pre-planning though...

I don’t think sakura184 is stupid or actually arguing in bad faith. She has a fair point underneath it all. Just she clearly has a completely pathological distrust of men. Which again isn’t entirely unreasonable given the state of the world.

I hope she finds some peace eventually.