Wednesday, September 12, 2007

Autonomy

Autonomy.
Freedom to be able to move, make your own decisions.
How does autonomy play into the cesarean epidemic?
A homebirth midwife in many states is required to practice under a law which requires her to follow protocols established by the medical community standards, many times being excluded (Arizona) from seeing VBAC clients.
A CNM in a hospital setting is required to have her protocols reviewed by her "supervising" OB. In order to do so, she compromises on things that are expendable, many times excluding VBAC's from any care or making VBAC's do a variety of hoops such as continuous EFM (non-evidence based care), induction, refusal to allow a woman to continue past 40 or 41 weeks...the list goes on and on.
A Childbirth Educator has to watch what she says in order to keep her job because she might be encouraging women to ask questions, refuse interventions.
A doula is a private practitioner who can be removed from a hospital or banned from a particular practice's patients.
As Henci Goer reminded me this weekend, one particular individual at the NIH's meeting on Maternal Choice Cesarean stated that he was simply a good soldier doing his job, taking orders.

We are all taking orders from the American College of Obstetrics and Gynecology in a trickle down of morbidity and mortality that will touch generations to come. None of us have our hands clean in this debacle. This is not fear of malpractice, though that makes a nice excuse for obstetricians to bring to the table. "We don't want to get sued." Well, I'm not sure who believes this any longer and if they did... let us ask ourselves:
Are we simply taking orders? Are we the bystanders saying "Oh My God. That woman just died due to an elective induction." (the wife of a local arena football player) or "Her boggy uterus wouldn't come back, so she lost her uterus due to an ERCS." (a mom in New Jersey) or "my baby spent 3 weeks in the NICU for an unnecessary cesarean"...are we simply recounting the tales?
Are we standing in horror, unable to move? Are we the resistance?
Or are we the Germans....crawling back into our homes to hide in case that they next come for us?

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