Saturday, May 17, 2008

Experience redux

I have written many times before about the need for large amounts of experience to become qualified to care for women during childbirth. I have approvingly quoted both Kneelingwoman (Further thoughts on respecting birth) and Navelgazing Midwife (Why reality wins again) on the need for experience. Now Navelgazing Midwife has provided further thoughts that serve to emphasize this very important point, in her post Respectful Trust:
It always annoyed me when I, as a doula or childbirth educator, would be told, "You just haven't seen enough" when I believed complications were more created than something random. And yet, here I am, many years and many birth experiences later, saying that very thing to women-midwives and natural birth advocates alike who insist it is the provider that creates the difficulties and if left alone, birth would be perfect.

It's not true.

You know how sometimes you hear your mother's voice coming out of your mouth? Saying those phrases you swore you’d never say? It is like that.

"You just haven't seen enough." "The odds aren't great, but when you are that 1% it is 100% to you." "The important thing is a healthy mother, a healthy baby." I don't always say such phrases, at least that callously and angrily, but I sure do believe them.
In many ways, the gulf between direct entry midwives and obstetricians is not a reflection of different philosophies. It is merely a reflection of the fact that obstetricians have so much more experience than direct entry midwives. The only reason that DEMs can cling to philosophies that are so out of touch with reality is because they don't have much experience with reality.

Here's what experience has taught obstetricians, which most DEMs have not yet learned:

1. Death of either the baby or the mother is very common in childbirth.

2. Childbirth (like pregnancy itself) is not inherently perfect. Indeed it is inherently imperfect. Just like pregnancy has a built in miscarriage rate of 20%, childbirth has a built in rate of death and permanent injury.

3. Interventions dramatically reduce the chance of death and permanent injury.

4. Pretending ("trust birth", birth affirmations) accomplishes nothing. It may demonstrate fidelity to a particular philosophy, but it has NO impact on outcome.

5. "Intuition" is meaningless in the absence of large amounts of training.

6. Experience saves lives. More experience saves more lives.

7. Ignorance is not an acceptable strategy. Remaining ignorant of complications and how to manage them does not prevent complications.

8. You should always listen to, and take seriously, people who have more experience than you do. After you investigate their claims, you may not agree with their recommendations, but you will know more than you did before. Moreover, you will often find out that they are right and you are wrong.

I am not suprised that both Kneelingwoman and Navelgazing Midwife has come under so much pressure from other DEMs. The reason is simple. Other DEMs know that both Kneelingwoman and Navelgazing Midwife are correct. DEMs are woefully undereducated and inexperienced. DEMs feel threatened not just by the practical implications of their criticism, the fact that they need to make the requirements more stringent and therefore harder. They also feel threatened at the deepest level. They understand that more experience and more education will have the same effect on them as it has had on Kneelingwoman and Navelgazing Midwife; it will force them to give up on cherished beliefs because they will learn that those beliefs have no basis in reality.

It takes a tremendous amount of internal strength to acknowledge that you might have been wrong in the past. It takes much more strength to acknowledge that in the face of pressure from colleagues who are frightened by what you have learned. Although I disagree with Kneelingwomen and Navelgazing Midwife on many, many things, I have a great deal of respect for them as people who can endure painful realizations in order to put the needs of their patients ahead of their own. For me, that is one of the most admirable traits of a dedicated healthcare provider.

0 Old Comments: