Getting Qualified Care: Titles and Education

This is part of a series called Getting Qualified Care, where we examine the anti natural birther movement of storming the internet to dispel what participants within feel are lies and misinformation about birth. We are discussing just what constitutes quality care from qualified providers, the subtext being “who gets to decide this” — mainly, would you allow other individuals from a movement with their own set of biases choose for you what your standard of care should be?

What makes one “qualified”? Is it a prestigious educational background?

 Maybe it’s a rank or a title, like “Doctor”.

Amy is Harvard educated AND a doctor. Impressive.

Amy informs someone that college and medical background means you cannot disagree with them and possibly know what you're talking about. Interesting. Only a fool would disagree with a doctor!

Here is Amy telling us a Doctor is wrong.

Here is Amy telling us a Doctor is wrong.

Here is Amy telling us a Doctor is wrong.

Here is Amy beginning to tell us that yet another Doctor is wrong.

Don't want to ruin it for you, but, another wrong Doctor, according to Amy.

I could go on, but I think you get the point– Dr. Amy, 5, Other Doctors, 0.

It can’t be the Doctor credential and the years of medical training and background that is making people credible or qualified. Then again, I guess any glance at My OB Said What?! could have shown us that:

Just one example of real-life anecdotes submitted to popular website My OB Said What.

All doctors come to the table and present their “evidence”. How do you know who is telling the truth, especially in a world where we’ve considered that doctors are capable of being flawed?

Maybe it’s in the licensing of that title, to validate it.

Most of the “Fed Uppers” are on a(n in)quest to end midwifery that does not belong to the CNM (certified nurse midwife) category. They believe that all other forms of midwife (usually designated as CPM, or certified professional midwife) are a joke and disservice to women. It needs to be noted here that a lot of this stems from personal bias and bad experiences or trauma the women have faced with natural birth. Differing regions (particularly in the States) have varied regulation in terms of education and practice standards, but in general, much training and years of education are required for one to become a licensed midwife of any title. Yet, one of the main purposes this group claims to promote is eradication of what they deem less qualified midwifery in favor solely of the CNM model. Unfortunately, CNM’s largely practice in birthing centers and in hospitals. What I see as the real goal in mind is the eradication of home birth.

Is a midwife more qualified just for having gone to nursing school beforehand? Is a midwife more qualified for taking a more medical approach to birth? If no other midwife licensing is allowed or considered “qualified”, will that ensure everyone has more qualified care, or will it eliminate options and force women to choose between clinical birth and freebirth? Who gets to decide what kind of care a woman must receive, if not the woman herself? Who gets to mandate which one and only kind of education is valid and acceptable? What if midwifery as we know it became illegal?

Maybe it’s in the current state of practice.

Some argue that a midwife who refuses to renew her license recently is no longer a midwife and shouldn’t be allowed to practice. It doesn’t matter that her skills are still fresh in her memory, and that her choice to not renew is believed to be a political statement against mandating with whom and where women may give birth. To add controversy, suppose this midwife was unafraid of taking cases labeled “high risk” in order to give women more options for their labor, understanding the high risk cases could potentially result in a loss whether or not she presided over the care? If you knew a tragedy could be inevitable regardless, would you choose to stand by your patient, or would you CYA?

Others would argue that an out-of-practice OB/GYN who’s been retired for almost 20 years now, although still given the title “Dr.”, is no longer up to date enough to be giving accurate medical advice, opinions, nor to be weighing in on birth today and facts presented by others who are more current and active in the field. Indeed, birth has changed a lot since the 1990’s. For better or for worse, the skills, policies, drugs, and technology would be greatly different. A doctor who stopped practicing back then, in this fast-paced profession, would undoubtedly be considered old school or maybe obsolete to the hospital crowd.

Being fair, we could say that neither one has “lost” their skill set. Are either of them any less of a doctor or a midwife? Only in technicality. In our own minds, it’s up to our own judgment to ascertain this wisely. Who would you rather have– the latter, or the former– look after you? What would seem more “qualified” to you?

I think education is nice, licenses, degrees, and titles are all very nice… but at the end of the day, it isn’t any one thing that promises to provide you with “qualified care”. Everyone is equally capable of incompetence. Truly understanding this leads to resigned acceptance of freedom to choose the care you think is best, without harsh judgment or scorn.

How Birth Method is Never a “Choice”

CHOOSING

One side of a ridge is cold and foggy,

The other is hot and dry.

Just by choosing where you stand,

You alter your destiny.

Every choice you make changes you.

No matter how minor or how great, you must make choices each and every minute that passes. The irony of life is that it is a one-way journey. You cannot go back, you cannot make comparisons by trying one way and then another. There are no double-blind studies when it comes to your own life. Therefore, only wisdom will suffice to guide you.

via 365 TAO – No. 200.

I know you’ve been there– listening to your friends or acquaintances talk about pregnancy and birth, biting your tongue a little… speaking up when you can, sharing an article here and there. I hear people tell my friends not to let their babies come to term or get “too big”. I hear people tell my friends about “natural” induction methods that may or may not give them painful diarrhea. Disagreement or clarification can easily be viewed as a disrespect to one’s choices in birth. Everyone likes freedom, and everyone should be entitled to make the choices which are most right for them, right? So why am I disputing “birth choices”? Just what is a “birth choice”? Some women go to the hospital, some birth at home. Some choose docs, some midwives, some no one at all. Some get elective c-sections, some go totally natural. Are these choices?

I propose that it usually is not. Having a choice implies that there are multiple, potentially equal options. I no longer believe this is true, as undiplomatic of me as this sounds. This isn’t like choosing chocolate or vanilla, or preferring to wear a red shirt to a blue one. It isn’t tomayto, tomahto, preferences are swell! If only it were that simple.

You can almost predict what is going to happen to whom just based on conversations. One friend will try for a natural birth in a hospital and thinks this is achievable, avoiding all inductions and interventions. Another thinks that using a midwife will be the key to having all her wishes respected, and that she calls the shots. One thinks that she will only be induced “if necessary”. One seems just fine scheduling her repeat C-section a few weeks early. The list goes on, and you can almost tell exactly what is going to happen to whom, based on their “choice”, their personality, and their location. This one will get a C-section for “failure to progress”. This one will endure a hard labor in a medical environment because their husband wants her to. This one will take the drugs and intervention, but beat herself up over it. And, all may put on a happy face while holding their babies… and the next time they get pregnant, they will do it all over again like nothing is wrong, even if inside things didn’t feel right to them. Many, many women are pushing it all way down and suffering in silence, thinking their births were just “normal”. Hey, “normal” doesn’t make it right.

Take heart– We almost ALWAYS go into it naive. It doesn’t matter how smart or educated or caring you are. Don’t be offended if I insinuate you are or ever have been naive. I was naive. We have ideas that don’t ever get challenged until its our turn at bat, and then we are shocked into compliance. It’s fun.

I know it’s not Song Saturday, but I can’t help but think of and include this:

We always have a choice… Or at least I think we do. We can always use our voice– I thought this to be true … it’s not always that clear. I’d love to give my self away, But I find it hard to trust. I’ve got no map to find my way Amongst these clouds of dust.

Choices without information aren’t actually choices. I see the illusion of “choice” as the problem, rather than our ability to observe and predict what will “go wrong” in each other’s labors. The illusion of choice and the fight about it is dividing us, when the goal ever only was and should be to extend a hand to rescue each other. I don’t feel women really have a choice if they weren’t aware of their options when they decided. I don’t feel women really have a choice when they are aware of the options, but those are marred with common misconceptions and never get further explored. If your information has been filtered or controlled (and you didn’t even know it), or if you don’t seek to know more all on your own, how much of a choice did you really have? Most people think that homebirth is dangerous, and that birth in the hospital is always safest. What would you say if I told you that the reverse is true? What if I pointed you to information that blew your mind, and made you question every little thing you were ever told about pregnancy and childbirth? What if I could prevent a lifetime of regret, or a day of trauma?

There I go, sounding like a “UC Evangelist” again. I can see why the comparison would be made there. Both are zealous, both want desperately to save people. I like to think that’s where our similarities end. 🙂 I have heard “you’ve got to let people find their own way, Elizabeth”— which is very Tao of them, only I can’t get the memory of feeling like I was dying an excruciating death out of my head. Another Taoism– not regretting the past. A folly for sure of mine, birth regret! What can be done about the past? Why waste time regretting anything, particularly if it made you who you are today? But my motivation for helping people lies in not ever wanting anyone to have to learn the hard way these lessons I have learned. Sure, “choices” made me who I am today, and yes I am awake, alive, teaching, and happy. However, the severity of these things is not something I would wish on my worst enemy. You don’t have to make the “choices” I made. There has got to be another way to reach spiritual and physical truths other than that. And I seek to end suffering.

So, here I am, shouting out, hoping someone is listening…

It is with heavy hearts that we tread lightly with our friends on topics like “birth choice”. We feel such a sense of responsibility to inform people. We so want to shake them and tell them all the “nevers”, dispel the lies… but they do have a choice to walk their paths. Even if that choice hurts them. If we step on toes, we will likely be disbelieved anyway, and possibly lose friends over it. That wouldn’t help them, either, would it?  The conclusions will be any of the following:  a) you are just fanatical, b) my birth will be different, c) I just have different needs than you, d) I am better and stronger than you and thus will not be affected. Even if any or all of these are the case, it doesn’t actually promise one a better birth or mean the “fanatic” is actually wrong. So, what?

Some people will live their whole lives in denial. Most women will wear smiles and tell you nothing was wrong with their births. I think it’s a lot to process, and most people aren’t comfortable with living life in a way that forces them to face inconvenient truths.

I’m treading carefully as I can with people I know or love. I think that pregnant people get SO much advice, and everybody’s got an opinion, and most of them are damn strong ones… but, coming from my own personal place of pain, of course it kills me to see anyone go through what I went through, or worse. I just don’t know if most people are ready to hear this or not. If they are ready, conversing will flow easily. If not, I step carefully to let them be the directors of their own destiny, dropping little hints of enlightenment where I can along the way.

But for the most part, I preach to the converted or those who stand on the edge, readying themselves to jump in. 🙂 Here’s to hoping we are all creating less pain in the world!

My past choices were never choices. The only birth choice I made was THE only real choice for me, and that was to be free. It was something I had to do, and the only singular thing, so maybe that wasn’t even really a “choice”, either. See what I mean? It seems to me that birth method is never really, actually, honestly a “choice”.