I had a few moments to sit down today and read through the latest Sunday Morning Medicine from Nursing Clio. I have to stress here that if you like history, medicine or want to gain insight into past and present gender issues, then you need to subscribe to Nursing Clio. I learn something new every time I read one of the essays featured there.
Two of them caught my eye today, probably because my daughter (Miss G’s mom) posted a picture of herself at 22 weeks pregnant. Miss G is, of course, smiling by her side. In the past I have not edited photo’s of my family, and while I don’t think the daughter would care if I showed her smiling face, I chose to focus on her expanding bump today.
Anyway, Nursing Clio had an article on making a knitted uterus. One of the best prenatal teaching tools ever. Give me a great knitted uterus and a pelvic model and childbirth would become real for my couples when I was teaching. Using the knitted uterus allowed an educator to really show what happens internally to the cervix during labor as it thins, shortens, and opens. Combine that with the pelvis and we could illustrate all the movements baby has to make to navigate out of moms body. In a pinch I have used a tennis ball (mimicking the babies head) and an athletic sock with a nice tightly woven calf cuff that serves pretty well as a cervix.
Then, Nursing Clio also included an article on vaginal cutting during childbirth, or episiotomy. That’s a word that used to, and perhaps still does, strike fear into pregnant women. I could go on a rant about this ‘little snip’ as it was often presented to a laboring women. Or mention that, usually in the midst of an amazingly strong contraction a male voice would mention that ‘this process could go a lot faster if we just made a small cut down here,’ and let’s not get started on the process by which women were placed flat on their backs, spread-eagle in stirrups pushing uphill against perineal tissues that had no hope of stretching so they got the notification that they ‘could have a small cut or risk tearing…’ Nothing like instilling fear to get a laboring women to agree to being medically managed for the ease of the physician.
On the evenings that I taught this topic, along with other medical interventions, it was a test of my performance skills to remain unbiased when presenting the how and why that managed interventions such as the episiotomy were commonly used during labor or birth. I used to have a nifty, and simple, visual aid centered on episiotomy which would usually debunk that idea that without that little snip the perineal tissues would tear, or better yet, rip wide open. It involved a plain piece of copy paper, a pair of scissors and some gentle tugging force. Intact copy paper never tore, but create that realistic little 1 inch snip with the scissor and with almost no force at all it was easy to create one of those wide open rips that only happen WITHOUT the episiotomy.
Of course, I am not generalizing that all physicians would use possibly coercive techniques. Many, many would never consider being anything but honest, would never consider trying to influence a women during stressful points in her labor, would never use fear-inducing words to achieve personal goals. Some physicians however, even in 2015, continue to practice in this manner.
I miss teaching. I miss striving for a balanced but honest presentation of the facts to the pregnant couples in my classes. I do not miss the procedural and administrative changes of teaching in hospitals that put constraints on my ability to be open and honest. I’m sure you have all heard, in some form or other, of the phrase, ‘teaching to the test.’ I common term in K-12 education whereby the specific goal is to teach only the essential elements found on state-wide competency exams. When I left childbirth education, we were being encouraged to teach to the procedure. To downplay choice and simply present what would be occurring in a hospital birth.
Birthing preferences seem to rise and fall with each new decade. You know how clothing styles come and go. It often seems as if birthing procedures, and the acceptance or denial of those procedures, come and go as well. I’ve been away from childbirth education long enough to be unsure of where we are socially right now, although I know that the C-section rate has climbed steadily and is close to triple the ‘ideal’ and has at least doubled in occurrence since my last official class.
My favorite couples to teach were always the ones who knew that they had both a right and a responsibility to question, to choose, to be informed, and to make reasonable decisions about their labor and birth. Not everyone wanted that. I suppose some still don’t. Knowing that many were uninterested in choice and responsibility could have made teaching the class simple because I could return to that idea the hospital pushed of ‘tell em what’s gonna happen and move on.’ Honestly though, I could never pull that off completely because I knew that I wasn’t doing the job that I believed in and needed to be done. In not educating them fully, by not encouraging them to have a voice, I couldn’t say that I had served them well.
These two articles today have taken me back almost 20 years and allowed me to touch base with ideals that are still important to me, and ideals that I feel should be important to women and their partners rather planning pregnancy, or in the midst of it like Miss G’s momma. Advocating for women, and empowering them to have a voice in this personal process was one of the most important aspects of my teaching.
I have to thank Nursing Clio for this timely post and for allowing me to remember a time when I truly felt as if I was making a difference for women.