Why Indeed

Tonight, as I began my reading, I couldn't help but think about the task that lay ahead of me. I believe that to be a good childbirth educator, you must be an activist to some degree. This is something I have never done and am cautious about becoming. I don't want to tell anyone that my way is the right way and their way is wrong. What I want to do is inform women of the evidence while being an agent of change in the current obstetrical system. I haven't quite figured out how I'll accomplish this goal.

The articles I read tonight were originally printed in Birth, entitled "Why do women go along with this stuff?" and are a two part roundtable discussion. While the articles focused on a variety of issues, I was most struck by the overwhelming task that is changing standard obstetrical practices and making them safe for all women. As proud Americans, we often think that we have the best medical care available and obstetrics should be no exception, but we're not the best in this instance. As of 2009, there are 44 countries with better infant mortality rates, including Cuba, European Union, Italy, Taiwan, Greece, Ireland, Canada, New Zealand, United Kingdom, Portugal, Australia, Netherlands, South Korea, Israel, Spain, Switzerland, Germany, Hong Kong, Japan, Sweden and Singapore (CIA World Factbook). Many of those countries use the midwifery model of care. I believe it would be in the best interest of most women that obstetricians begin to use this model of care for low-risk pregnancies and leave the high-technology, heavy-intervention care to those at high-risk.

This is a seemingly impossible task and with good reason. Penny Simkin says "[w]e must realize that each woman is a transient stakeholder in the maternity care system..." This is so true. Most women are pregnant for a short period of their lives and don't think much about the maternity system after they are done having children. Simkin also says that "[i]t is unlikely that a powerful consumer movement will materialize, because most consumers move on to other interests and obligations after completing their childbearing. (A few thankfully, remain involved, becoming birth activists, writers, doulas, childbirth educators, or care providers.)" It is very important to keep this in mind with the difficult task ahead. The total change may not happen, but if the effort is never made, we'll never know.

In the second article, Carol Sakala of Childbirth Connection says that "women don't know what they don't know." This seems like an obvious statement, but is the reason I am becoming a childbirth educator. I had no idea how much the typical information was driven by factors and agencies that ultimately don't have mom's and baby's best interest in mind. I could go on forever about it, but I won't do that now. The issue is how do we teach women what they need to know? How do we help them sort through the enormous amount of material out there and determine fact from fiction. I can't say it enough: I don't want to make decision for anyone else, but want to make sure that families have the correct information to make their own decisions.

I'm not sure where that leaves us for now. There's a lot of work to be done and a lot to think about. My next post will focus on some interesting observations I've made about my beliefs and actions while competing The Birth Survey.

References:
Kitzinger, S., Gree, J.M., Chalmers, B., Keirse, M.J., Lindstrom, K., & Hemminki, E. (2006). Roundtable discussion: Part 1 - Why do women go along with this stuff? Birth, 33 (2), 154-158

Klein, M.C., Sakala, C., Simkin, P., Davis-Floyd, R., Rooks, J., & Pincus, J. (2006). Roundtable discussion: Part 2 - Why do women go along with this stuff? Birth, 33 (3), 245-250.

CIA World Factbook. Viewed January 18, 2010.