The things we say to women

Things said to women by obstetricians:

  • “Why not just have a caesarean?  You’ll be up and about 24 hours later” (implying that at the end of the 24 hours, recovery is complete)
  • “I have diabetes too, and I opted for a caesarean and I’m fine” (and therefore you will be, too)
  • “We can wait, if you like, but it’s much more risky to do an emergency caesarean than to do an elective caesarean” (said to a woman planning a VBAC.  The possibility of a normal birth was not entertained)
  • “Caesarean is shown to be a safe way to have a baby” (but is it the safest, and did this obstetrician discuss the risks of caesarean?)
  • “It’s perfectly safe to have an epidural and you’ll have more energy to push” (with no discussion of the consequences of epiduralised labour)
  • “We would be most relieved if you would just agree to having a caesarean” (said to a woman who planned a VBA3C in a major tertiary referral hospital.  It’s all about the hospital!)
  • “If you don’t have your baby by caesarean, your baby will die” (is this really true?)
  • “If you have a home birth, your baby will die” (is this really true?)
  • “Homebirth kills babies” (always??)
  • “You need to be induced today because your baby will die if it stays in there longer” (this was said to a woman who was 10 days past her due date.  All indications were that the baby was, at that time, healthy)
  • “I’ve just broken your waters and applied a clip to baby’s head” (done during a vaginal exam, without the woman’s knowledge or consent)
  • “When you have your next baby, you have to come back to me.  I did your repair this time and no-one else will know how to repair you next time”
  • “It’s good that we did this caesarean.  The baby was posterior so there was no way he could have been born normally”
  • “The only thing that matters at the end of the day is that the baby is healthy” (said to justify an emotionally traumatic birth)
  • “If you had gone with midwives, your baby would have died”
  • “Don’t go to the birth centre.  They leave women to labour for days there and then when they bring them around [to delivery suite] they’re always begging for an epidural”
  • “Some of the worst tears I’ve seen have been in women who have been delivered by midwives”

Things said to women by midwives:

  • “Babies die.  They die at home and they die in hospital” (This is true, but preventability is the unaddressed key.  How many of the homebirth deaths could have been prevented had those babies been born in hospital?)
  • “If you go to the hospital, they’ll force you to have monitoring and then it’s a slippery slope with all of the interventions they’ll force you to have” (without talking with the woman about strategies she can employ to communicate assertively with the hospital staff; without the offer to attend with her; and with no certainty at all that monitoring will lead to other interventions)
  • “Twins are simply a variation of normal.” (maybe, but they carry a higher risk than a singleton birth)
  • “If we transfer to the hospital, we’ll say that you’ve only been pushing for 2 hours” (instead of 6)
  • “Hospital birth is risky.  Homebirth is safe.”
  • “There are lots of risks in going to hospital that they don’t tell you about”
  • “Hospitals kill babies, and women too sometimes”
  • “Hospitals don't necessarily make a difference to the outcome”
  • “If we trust birth, trust our bodies and trust our babies, we will have a safe birth”
  • “Gestational diabetes has no implications for the baby apart from macrosomia”

None of the above statements is necessarily true, balanced or unbiased, but each statement has been said to a pregnant / birthing woman by a care provider who is in a position of trust.  Midwives have a go at obstetricians for saying what they say when it is not truthful, and obstetricians have a go at midwives for saying what we say when it is not truthful.  Each practitioner holds firmly to their own beliefs, for a whole range of reasons, and uses their position of trust to influence a woman’s decision in a way that is favourable to the practitioner.  If an obstetrician can successfully convince a woman to have a caesarean, s/he cannot be taken to task for failing to perform a caesarean in a timely manner.  If an obstetrician convinces a woman to seek obstetric, rather than midwifery care, s/he has more control over the outcome.  From the midwife’s perspective, the fewer women who transfer to the hospital, the less exposure for the midwife (from hospital authorities) and the more positively her services are viewed by women and homebirth forums.  Also, in the current system, a midwife must hand-over care of the woman if a transfer is needed.  Unethical?  Yes, maybe, and it happens from both sides of the fence.  The truth lies elsewhere, in a place where obstetricians respect the important role of the midwife in caring for all women, regardless of risk, and where midwives value the obstetrician’s important contribution to the care of women with risk factors.  Where each honours and respects the boundaries between midwifery and obstetrics and calls on each other regularly.  Where low-risk women are encouraged by doctors to start their care with a midwife and to consider birthing at home.  Where midwives consult with obstetricians without hesitation.  And where hospitals are friendly places to women and midwives.