But do it well...do it honestly...and allow for the inevitable misunderstandings.
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
Showing posts with label Collaboration. Show all posts
Showing posts with label Collaboration. Show all posts
Tuesday, August 19, 2008
Saturday, July 26, 2008
A Letter To My Beloved Midwife Friends
My Dears K, N, A, and T....
I love you guys...you know I do. I can't thank you enough for being there when I get saturated with medically managed, high risk births, and you spend entire afternoons with me reminding me "how it's done" when things are blissfully normal, helping me regain my perspective; but sadly, things are not always normal, even during some of the births you attend, and you have to transfer.
I was so pleased that you had found an M.D. to back you up....not an easy (heck, pretty much impossible) thing to do in this overly conservative area; but now that backup is being taken away.
And why?
Now, I'm getting this information second hand (it might even be third hand), but I trust the source I got it from implicitly, although I'm allowing for a margin of error in the sending vs. receiving of the communication that it took to trickle down to me; but it seems that Dr. H.'s partners are frustrated that their decisions were being second guessed when you would arrive the hospital with your client, and they were on call instead of him. An example that was given to me went something like this; when the Docs expected continuous monitoring, they got comments like "But Dr. H. says we don't have to have that"...and similar stories.
Oh my treasured friends! You know better than this! As incredibly knowledgeable and skilled as you are, once you and your client decide to transfer, you are no longer on your own turf. By definition, the pregnancy of the woman you are caring for has now become high (well, at least higher) risk, which takes you out of the care provider position, and places you into the support position. I know I'm not telling you anything new; but perhaps because Dr.H. has been so easy going and laid back when you came in, you assumed that his partners would be as well.
Not so. In my albeit distant and limited experience with all three of these physicians, they each have their own style of managing their patients. As with any practice, if a woman in labor comes in and her own physician is not the one on call, some compromises are going to have to be made if the other physician has not been consulted on the birth plans. At the very least there is going to have to be, if there is the time for it, some gentle discussion of whether or not she is comfortable providing care the way you assumed Dr. H. would. Keep in mind that you can't really be certain what decision's Dr. H. might have made...depending on the reason for your transfer, he might have insisted on continuous monitoring as well.
I can't speak for any of these physicians, any more than I can speak for any of you; and although I am well aware that our area is full of intervention-happy Docs who would just as soon have you prosecuted as look at you, I don't believe that every doctor out there is out to deny a pregnant or laboring woman her right to make well-informed decisions about her own body, her own baby, and her own birthing; but I do believe that every doctor has a right to practice in a way in which he or she is most comfortable...in a way that does not compromise their values, and that protects them from a lawsuit that could jeopardize their license, their practice, their family, and their employees and their families.
This is only fair.
If we want the medical community to respect us as collaborators, then we have to collaborate. We would not want them coming into a client's home and insisting on lithotomy position for the birth, or forbidding any food or drink in labor; in kind, we should not be insisting that they practice in a way that compromises their comfort level when a client is transferred into their care. Some compromises are going to have to be made, and the client needs to be made aware of this.
I know that, once a client is transferred, you feel very protective of her...that you want to advocate for her; but in truth, the legalities in this situation are that only a client (or her family) can advocate for herself. The fact that a transfer has taken place, in and of itself, is a clear indication that the client's hopes and expectations for her birth are not going to be completely met. It's a sad reality that we can't always have what we want, no matter how hard we try. Remember that old adage...how do you make God (the Universe, etc.) laugh? Plan something.
Life is unpredictable; the beginning life, as you all have experienced over and over, is equally unpredictable. Given the love and support of her treasured midwives, a client encountering a disappointment in her birth experience can be helped to feel the joy and beauty of her baby's birth, no matter how that birth is accomplished. True, the personnel of the hospital you transfer to may not be as supportive as we would like them to be; but that comes as no surprise to any of us; we know what kind of environment you are likely to encounter once the decision to transfer is made. Of course things could be done better than they are currently being done...but we aren't going to be able to achieve change with the one birth that is currently in question. It will take dozens and dozens of delicately handled transfers for the medical community at large to even begin to trust, respect, and cooperate with you. It's just the unfortunate reality that we have to accept right now.
Maybe it's not too late. This was a wonderful opportunity for collaboration; given Dr. H.'s respect in the community at large, once it became known that he was willing to back you up, maybe others would be willing to open their minds to the possibility (although I remember the situation with Dr.S. from years ago, and my hope is diminished somewhat). Maybe a well-written letter of apology and compromise, along with a request to meet and discuss the situation might change things for the better.
I can hope, can't I?
Blessings and Love,
K.
I love you guys...you know I do. I can't thank you enough for being there when I get saturated with medically managed, high risk births, and you spend entire afternoons with me reminding me "how it's done" when things are blissfully normal, helping me regain my perspective; but sadly, things are not always normal, even during some of the births you attend, and you have to transfer.
I was so pleased that you had found an M.D. to back you up....not an easy (heck, pretty much impossible) thing to do in this overly conservative area; but now that backup is being taken away.
And why?
Now, I'm getting this information second hand (it might even be third hand), but I trust the source I got it from implicitly, although I'm allowing for a margin of error in the sending vs. receiving of the communication that it took to trickle down to me; but it seems that Dr. H.'s partners are frustrated that their decisions were being second guessed when you would arrive the hospital with your client, and they were on call instead of him. An example that was given to me went something like this; when the Docs expected continuous monitoring, they got comments like "But Dr. H. says we don't have to have that"...and similar stories.
Oh my treasured friends! You know better than this! As incredibly knowledgeable and skilled as you are, once you and your client decide to transfer, you are no longer on your own turf. By definition, the pregnancy of the woman you are caring for has now become high (well, at least higher) risk, which takes you out of the care provider position, and places you into the support position. I know I'm not telling you anything new; but perhaps because Dr.H. has been so easy going and laid back when you came in, you assumed that his partners would be as well.
Not so. In my albeit distant and limited experience with all three of these physicians, they each have their own style of managing their patients. As with any practice, if a woman in labor comes in and her own physician is not the one on call, some compromises are going to have to be made if the other physician has not been consulted on the birth plans. At the very least there is going to have to be, if there is the time for it, some gentle discussion of whether or not she is comfortable providing care the way you assumed Dr. H. would. Keep in mind that you can't really be certain what decision's Dr. H. might have made...depending on the reason for your transfer, he might have insisted on continuous monitoring as well.
I can't speak for any of these physicians, any more than I can speak for any of you; and although I am well aware that our area is full of intervention-happy Docs who would just as soon have you prosecuted as look at you, I don't believe that every doctor out there is out to deny a pregnant or laboring woman her right to make well-informed decisions about her own body, her own baby, and her own birthing; but I do believe that every doctor has a right to practice in a way in which he or she is most comfortable...in a way that does not compromise their values, and that protects them from a lawsuit that could jeopardize their license, their practice, their family, and their employees and their families.
This is only fair.
If we want the medical community to respect us as collaborators, then we have to collaborate. We would not want them coming into a client's home and insisting on lithotomy position for the birth, or forbidding any food or drink in labor; in kind, we should not be insisting that they practice in a way that compromises their comfort level when a client is transferred into their care. Some compromises are going to have to be made, and the client needs to be made aware of this.
I know that, once a client is transferred, you feel very protective of her...that you want to advocate for her; but in truth, the legalities in this situation are that only a client (or her family) can advocate for herself. The fact that a transfer has taken place, in and of itself, is a clear indication that the client's hopes and expectations for her birth are not going to be completely met. It's a sad reality that we can't always have what we want, no matter how hard we try. Remember that old adage...how do you make God (the Universe, etc.) laugh? Plan something.
Life is unpredictable; the beginning life, as you all have experienced over and over, is equally unpredictable. Given the love and support of her treasured midwives, a client encountering a disappointment in her birth experience can be helped to feel the joy and beauty of her baby's birth, no matter how that birth is accomplished. True, the personnel of the hospital you transfer to may not be as supportive as we would like them to be; but that comes as no surprise to any of us; we know what kind of environment you are likely to encounter once the decision to transfer is made. Of course things could be done better than they are currently being done...but we aren't going to be able to achieve change with the one birth that is currently in question. It will take dozens and dozens of delicately handled transfers for the medical community at large to even begin to trust, respect, and cooperate with you. It's just the unfortunate reality that we have to accept right now.
Maybe it's not too late. This was a wonderful opportunity for collaboration; given Dr. H.'s respect in the community at large, once it became known that he was willing to back you up, maybe others would be willing to open their minds to the possibility (although I remember the situation with Dr.S. from years ago, and my hope is diminished somewhat). Maybe a well-written letter of apology and compromise, along with a request to meet and discuss the situation might change things for the better.
I can hope, can't I?
Blessings and Love,
K.
Subscribe to:
Posts (Atom)