Sunday, September 30, 2007

Deep Thoughts

The twin story is coming, I promise! The dad is so busy, he wants the mom to read him the story while he works, and, well, she's had a few things to do. Those babies are doing so well, I tell ya. They were both almost back up to birthweight by 3 days. Awesome!

While you are waiting anxiously, Dear Readers, I want to ponder with you the issue of rights in healthcare.

I believe in the total individual right to autonomy in healthcare. I believe that parents have the absolute right of informed consent and refusal. I believe that even if it would cause harm to their babies, women have the right to bodily integrity (i.e. I don't believe in forced or coerced cesareans. Ever.) This is a hard thing for me as a pro-life mama. It has shown me that there are consequences that follow fetal rights and what can happen when the rights of the baby override the rights of the mother. This is a dichotomy that shakes me to my core. I have contributed to Right to Life since I was a teen, and I cut my net.teeth on newgroups debating vigorously my anti-abortion stance. However, this does mean that mother's rights to autonomy in their own pregnancy and birth can be pushed aside in the name of their baby. I do see now where the logical end of these things are.

So, with all that said, what are the rights of the caregivers? Do I not also have the right to informed refusal and/or consent? Can I not decide which births I am willing to attend, which are in my comfort zone, and which are within my skill set?

If I suspect twins, for example (heh), and the parents do not want an ultrasound, they have the absolute right to not have the ultrasound. However, I should have the right to say that unless I know certain circumstances are met, I have the right to not be forced to take responsibility for their care.

Now, what happens when it reaches 39 weeks? When a mother would most certainly be cut if she went into the hospital?

I have said I have a "new rule" that if I suspect twins or breech, the couple must get an ultrasound to confirm position, zygosity, etc., or I will kindly show them my door.

What is reasonable, Constant Readers? Where do the lines cross? Where do they parallel? And what happens when the midwife's right to remain in her comfort zone conflicts with the couple's right to refuse interventions?


Morag said...

I think that's totally reasonable!
I can't wait to hear the whole story. my whole class waits with bated breath!

Tiffany said...

The difference between chossing your place/type of birth and abortion is staggering.
Abortion is a MORAL are taking the life of another.
Birth choices are a personal issue that do not have moral implications.

And I think it is only wise to be cautious in choosing who your clients will be. You are ultimately the one responsible (legally) in their care, and so putting limits on what you feel comfortable with is only smart.
Also, the whole of the midwifery/homebirthing community (reputation, how other view them, etc) rests on the shoulders of midwives and the care they give (right or wrong, that is how it is in the USA) and so to provide optimal care requires discernment on their part and making wise decisions for the community as a whole.

kristina said...

This is an issue I'm dealing with as a doula - and I don't even make medical decisions in my role. So I totally get your dilemma. I guess I am starting to see it as two bubbles - the woman's bubble of comfort, and the provider's bubble of comfort. It helps if the provider and woman have large bubbles. If they can't find a place where they both overlap, the woman can find another provider's bubble. Then she still retains her rights to make the call on her own healthcare, and the provider has kept their own integrity (ethical, medical, legal) as well. The problem arises when it is an emergency situation and there is no time to look for another provider. I still don't know where I stand on that.

Emily said...

Yeah, that is a tough situation. In my mind, it's mostly b/c of the timing. It is totally acceptable and *responsible* to "risk out" a client for situations you're not equipped/experienced/comfortable with. Like to say breech is not in your comfort zone b/c you don't have the training or just flat aren't comfortable--I could totally appreciate and respect that.

But the thing that is unethical is to dump a client completely and not continue some sort of care until she has found a new person to fill that role. To at least hold her hand.

Anyway, I'm not a MW, but this is the care I would expect from one. A friend of a friend claims that her midwife dumped her right before her due date and wouldn't return any of her calls after that. She felt abandoned. I guess that "abandoned" feeling/situation is what I would want to avoid.

Anyway, my rambly two cents..... Following your heart and instincts is probably the best way to handle most situations anyway! :)


Dollymama said...

I think the answer is that everybody has choices. The pregnant couple can make the choice to do or not do as their caregiver recommends. The caregiver chooses whether or not to work with that couple based on the decisions made. The couple can then decide if it's worth it to them to not have the caregiver they want in order to avoid what the caregiver recommends. What I would say you don't want to have happen, is for either party to have to violate their own conscience.

In an emergency situation I would say that it is a moral issue to help someone that needs help if you have the ability to help them. But it's also valid to realize that sometimes people cause themselves to be in an "emergency" situation in order to get help from people that don't want it. Which stinks. But would be mighty hard to walk away.

Having had two necessary c-sections myself, I would say that although I would like to help women avoid c-sections, I would also not think it the end of the world if they ended up with one. I know that tons of natural birth advocates equate it with a complete tragedy, so I would probably enrage them with that statement. Sorry about that.

Housefairy said...

DO NOT abandon your clinets! I have personal and friend experience with this and it is extremely painful and damaging.

But I know you wouldnt do that. SO my advice would be to set up some ground rules early on in the relationship. you are free to tweak and change these as situations arise, but early and mid pregnancy is a good time to realy establish what you do and do not "do" and then, unapologetically, stick to it.

Any other service provider has rules and what they do and do not provide, accept, etc. You can, too!