Credit: Rae Z/A on Flickr, under Creative Commons
(WOMENSENEWS)–What do I believe?
I believe that my nurse-midwife Deirdre is an excellent practitioner. I believe her hundreds of successful deliveries and the intense loyalty of her clientele demonstrate that she provides an important service. I believe her practice of non-invasive birthing for low-risk pregnancies contributes to a necessary movement toward more sensitive forms of reproductive health care.
I believe that after decades of successful practice and no bad outcomes, Deirdre made the wrong judgment call in not referring me to a doctor once I was a week postdate. I believe that judgment call resulted in Thor’s death.
I believe the likelihood of her making the wrong judgment call was heightened by the fact that she felt under siege. I believe the warfare between the medical profession and out-of-hospital midwives made her reluctant to refer a low-risk pregnancy with no sign of trouble to a doctor. Though I believe her most fundamental reason for not referring me to a doctor was much simpler: in her evaluation, it wasn’t medically necessary.
I believe the likelihood of Deirdre’s making a mistake was heightened by her professional isolation. I believe that isolation reduced the opportunity for informal, day-to-day talk with colleagues to remind her of risk factors that rarely come into play but which can be critical, like the dramatically higher incidence of stillbirth for women over 40 starting at 41 weeks’ gestation.
I believe that my midwives in Berlin, where I’d had my son Adam, practicing as a group and without feelings of defensiveness since local obstetricians collaborated with them, would have been more likely to refer me to a doctor.
I believe Deirdre has revised some of her practices as a result of Thor’s death. I believe she remains professionally isolated, and that this isolation creates unnecessary risks for her clients.
I believe that studies showing roughly 100,000 preventable deaths every year due to infections introduced in hospitals demonstrate that unnecessary deaths occur in hospitals on a massive scale. I believe that studies showing tens or hundreds of thousands of additional preventable hospital deaths due to other factors confirm that such deaths are part of normal hospital operations.
I believe some hospitals are addressing preventable deaths. I believe others are resistant to change.
I believe that the likelihood of unnecessary death for any one patient entering the hospital system is minimal. And so I do not believe that Thor would have died had I been receiving hospital care.
I believe Thor is the statistic for unnecessary death in an out-of-hospital setting.
I believe someone else’s child is the statistic for unnecessary death in a hospital setting.
I believe that a single unnecessary death during home birth prompts calls for abolition of out-of-hospital midwifery. I believe that hundreds of thousands of unnecessary deaths in hospitals prompt suggestions for voluntary reform. I believe the difference lies in the imbalance of power between hospitals and midwives, not the comparative level of risk of home birth versus hospital care.
I believe the medical system is in urgent need of reform. I believe that part of that reform must be to reward preventative and non-invasive care as bountifully as high tech, specialized care is rewarded. I believe that part of that reform must be to require that hospitals introduce procedures to dramatically reduce preventable deaths and injuries. I believe that part of that reform must be to choose protocols of treatment according to the medical evidence regarding the best interest of the patient, not anticipation of a lawsuit. I believe that part of that reform must be to integrate out-of-hospital midwives into the profession rather than marginalizing them from it.
I believe that instead of instituting reform, the medical system will continue to play, and be subject to, politics.
I believe that Thor died of politics.
I believe that Thor died in excruciating pain. His brain, deprived of oxygen, each cell suffocating, withering into itself, crumpling, collapsing, but still struggling, alerting the nerves that something was terribly wrong. The nerves suddenly plunged into burning acid, receiving the frantic message, sending that information in a useless loop back to the very brain that was under siege. The brain screaming in increasing desperation to the lungs that they should try something, anything. The lungs naively expanding, opening, to pull in relief, to pull in the cool air whose oxygen molecules it will quickly transmit to the bluish blood, re-reddening it, re-energizing it, so the blood can rush to the brain, restore it. The lungs instead getting meconium-filled amniotic fluid, choking the blood by transmitting precisely nothing, the blood by now dead but still pumped by the heart that hasn’t yet learned that it is all over, the heart sending the useless blood to the brain cells now wrung dry as they complete the act of withering, crumpling, collapsing, because there is no knight on a white horse, the nerves don’t send one, the lungs don’t send one, the heart doesn’t send one, the blood doesn’t send one, Mama doesn’t send one, Daddy doesn’t send one, midwife doesn’t send one. There is only the crush of suffocation, the realization that there is no help, the weakness too weak to despair, and then darkness.
Elizabeth Heineman is a professor at the University of Iowa, where she teaches classes on European history, gender and sexuality and the history of human rights.
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