Tuesday, October 16, 2007

excerpts from Woman in Residence

Here is an excerpt from Dr. Michelle Harrison's book Woman in Residence. She is family doctor who did residency training in OB/GYN; this book describes her experiences as a resident.
Imagine dancers on a stage. Once, doing a pirouette, a woman sustained a cervical fracture as a result of a fall; she is now paralyzed. We try to make the stage safer, to have the dancers better prepared. But can a dancer wear a collar around her neck, just in case she falls? The presence of the collar will inhibit her free motion. We cannot say to her, "This will be entirely natural except for the brace on your neck, just in case." It cannot be "as if" it is not there, because we know that creative movement and creative expression cannot exist with those constraints. The dancer cannot dance with the brace on. In the same way, the birthing woman cannot "dance" with a brace on. The straps around her abdomen, the wires coming from her vagina, change her birth.

The birthing woman plays in an orchestra of her body, her soul, her baby, her loved ones, her past and her future. And we do not know who leads the orchestra.

Doctors cannot lead the orchestra, because they are not within the process. Unable to hear the music, trained only in modalities of power and control, they can only interfere with the music being played.

What should they be able to do? They should stand ready to help the player in trouble to get back into rhythm. Instead, they take over. Instead of supporting the mother, they say, "Okay, you have failed. It's our piece now."

How do you get a 30 percent Cesarean rate? You orchestrate it. You write a piece in which the third movement is a Cesarean, then build the first two with that in mind. You write in a different language; you write in terms of centimeters of dilation, external fetal monitor, internal fetal monitor, pH, scalp electrodes, Cesarean birth experience, arrest of labor, protracted labor, fetal distress, episiotomy, prolapse, cephalopelvic disproportion, ultrasound waves, amniocentesis, "premium baby," post-mature (when the baby stays too long in the uterus), "maternal environment" (formerly known as mother). Those are the words, the notes, while the piece is played to the rhythm of fear.
Here is another excerpt:
Often I don’t like the women I've delivered. I don’t like them for their submissiveness. When I make rounds in the morning I ask, “When are you going home?” They answer, “I don’t know when my doctor will let me.” They have let themselves be imprisoned. For me, the submissiveness of one woman becomes my own, as though we were all one organism. . . . I used to have fantasies at Doctor’s Hospital about women in a state of revolution. I saw them getting up out of their beds and refusing the knife, refusing to be tied down, refusing to submit—whether they are in childbirth or when they were forty and having a hysterectomy for a uterus no longer considered useful. Women’s health care will not improve until women reject the present system and begin instead to develop less destructive means of creating and maintaining a state of wellness.

10 comments:

  1. You find such inspiring quotes. I love coming here(which I do several times a day) to see what you have found lately. This one was wonderful. What a great analogy for birth!

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  2. Wow, amazing. I have to read the book.

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  3. That's a truly amazing analogy. I agree with Kelley, you always find the greatest quotes!

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  4. How depressing. I hope this woman's perspective rubs off on her peers...I especially love the submissive part...thanks for sharing.

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  5. i never before thought of any of it in terms of submission.

    Recent events in my daughter's life have really put this hand in hand though and now the mantra is, no vulva, no vagina, no opinion.

    this was really great, Rixa. I had to come back and re read it.

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  6. I love the part about getting up off the tables and refusing the knife. It's a very powerful book. (And copies start at $.01 on Amazon so it's inexpensive too!)

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  7. This is a great excerpt!

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  8. I really liked reading this book years ago. Thanks for reminding me about it again!

    30% cesarean rate...*sigh* Our local hospital is much higher than that.

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  9. Passivity in healthcare doesn't just exist in birth; women and perhaps men too are used to seeing doctors when we are in pain, or needing help from them, and thus not dealing from a position of strength. Doctors hold the power in most dr./patient interactions; they know what your test results say, they know what your symptoms mean, they know what needs to be done, and you don't.

    And unscrupulous doctors take advantage of that. Moving birth into the hospital had the side effect of making the laboring mom a patient, and thus, the less-powerful actor.

    I remember feeling that way, feeling afraid and needing to be rescued from the unknown, then after my c/section, slowly coming to understand that my dr. did not, in fact, know more than me in that area; that the medical profession in general is profoundly ignorant about what birth is, despite their bluster, and they use c/secs as a crutch rather than trying to overcome their ignorance.

    I think that's what it's taken for a lot of women; which is profoundly sad. But really, I just did NOT want to believe that the medical system was so useless to help me, and would even hurt me. That's a hard thing to accept, when you're used to relying on doctors as the good guys.

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