This blog is a bit off topic but has been on my mind ever since the bruhaha on the neighborhood moms mail group to which I belong. The scandal began when I posted this post on my local mail group and a mom who seemingly interpreted this post as an attack against epidural-users slammed me publicly on the site. I had mixed feelings about starting a blog. I was afraid of trolls and wasn't sure if I wanted to deal with people leaving attack comments on my blog. I didn't want my posts being mis-interpreted. My good friend and fellow blogger helped me get over my fear (I need to toughen up, I know!) but lately I've been thinking a lot about virtual communities and the hostility and miscommunication they often engender.
I was reading the bloggers code of conduct, and wishing that all virtual communities would make some attempt at following these rules, specifically this one: We won't say anything online that we wouldn't say in person. Interestingly enough the proposal of this code of ethics drew waves of protests from parts of the blogging community. The virtual group I visit most frequently is not just a virtual group, we are all parents and live in the same neighborhood. And yet our group has a hard time following the bloggers code of conduct, particularly the suggestion not to say anything online that we wouldn't say in person. What is it about the online medium that provokes us to respond with rapid-fire remarks, often not policing our content, misinterpreting another's words without first asking the author for clarification or emailing off-line? Members of my virtual community often have little excuse for their attacks. Many times the attackers know the posters and an email off-line would be the better approach (again, the suggested path via the bloggers code of conduct). Certainly I have learned much from the discourse of my virtual/real community, primarily, to reflect carefully on what I post (a good lesson for me who has been too quick to post in the past). On the web, however, it is much easier to misinterpret another person's blog. We don't know that person and, unless we have been diligently following their blog, it is hard to understand the context within which they write. We might have missed a previous post that might be critical to understanding a future post.
I felt that Navelgazing Midiwife, whom I love, misinterpreted my post "Why Are Moms so Threatened" on her recent blog entry. This post was a direct response to the attack I received in my online community to the post Doctors have much to learn from Midwives when it comes to induction, which was inspired by the difference between how the midwives handled the mom I was working with who was past her due date and how the doctors of neighborhood moms had handled the "problem" of a mom going past 40 weeks. On the one hand (with the midwives), there was a wait and see scenario that didn't involve talk of induction until the mom was 41 weeks (and induction was not a given until 42 weeks) on the other hand the doctors mentioned the moms might have a big baby because they were past their due date and, in one case, told the mom horror stories of shoulder dystocia when the mom questioned the need to induce. Navelgazing's midwife's post on my entries seem to suggest that I believe all babies must fit through the pelvis (I most certainly don't, although the percentage that won't is small indeed) and completely misunderstood my use of the term "big baby" (perhaps I should be more clear about my use of the term, I will clarify this in my post). The lesson is, I suppose, that I need to be more clear in my posts and to remember there is a lot of background information that my readers don't have and that I sometimes assume they have. But for the record, and for my readers, I would like to clear up some of the misinterpretations of my posts.
Navelgazing midwife asks me to respond to the following scenario:
"You're the midwife and you have a woman pushing for a couple of hours
and you do a vaginal exam, having the woman push through two or three
contractions... you don't feel any forward movement. What do you say?
"Great! Things are progressing nicely!" Do you not say anything at all?
Or do you look at mom and tell her there is no progress and you should
probably think of the next course of action."
My response "I agree that sometimes the baby just won't fit and know that in the
future a mom might be mad at me because of a hospital transfer I felt
was necessary but which disrupted the moms plans for homebirth. I've
been thinking a lot about control lately and how we "natural" birthing
types can be as guilty of it as the medical community. While we might
not always like to admit it, the reality is that of course some babies
don't fit" shocks Navelgazing Midwife. Her response "Blinking, I wondered why she couldn’t develop a relationship with her
client that fostered a belief in each other… one where if the midwife
said, “There isn’t forward progress. We need to go in,” the client
would say, “Let’s go.” One where no one is angry with anyone else."
The scenario described by Navelgazing Midwife is of course the ideal. There is a reason I spoke of the scenario where the mom is angry at the midwife rather then one in which the midwife is trusted. Here is the background information I did not supply: my midwife is currently under attack by two moms who are very angry with her care of them (yes, you can definitely argue she should not have taken them on and I understand Navelgazing's midwife fear of certain clients after my midwife's experience), so that is what is on my mind at the moment. On another day/moment I might have given a different answer.
As an aside, while I believe that you must fully trust your caregiver, the trust must be earned and moms must honestly assess whether or not they can trust their current care provider/practice to fully support your birth choices (the glaring example being docs who "say" they support VBACs but have a successful VBAC rate around 1%). It isn't easy to question your caregiver, I know, I was there. While I am usually very good a pursuing what I want, when pregnant with my second, it was a friend who said "Kat, I am hearing you say you want a VBAC but the actions of your care providers and your desires for the birth suggest you will have a hard time having a VBAC in a hospital." I switched to a CPM at about 7 months thanks to a friend who gently but persistently encouraged me to listen to my heart/follow my instincts. And that is what I hope to encourage moms to do, not to give their trust blindly to a caregiver (who because of the large practices in the area, will probably not even attend their birth) but to seek out information, follow their heart, and find a caregiver/practice who will support them.
Finally, Navelgazing Midwife writes "In ignorance, for there is no other way to say it but this, Kat says
that whenever a doctor or midwife speaks about induction because the
baby is getting large, that that is a threat." I feel that I must have miscommunicated here. In the post in question, I was referring to the phenomenon I have observed lately of doctors routinely offering induction as a way of preventing the complications, such as shoulder dystocia, associated with truly big babies. I wrote:
"When an "expert" declares you need to induce because you are going to
have a big baby he/she is making a threat, not a suggestion. The
threat is, if you don't induce, your baby will "be too big" and you may
"tear", "baby may get stuck," etc. (this is what the doctors say to
their clients, in reality there is nothing wrong with having a big
baby). "
I am referring specifically to doctors who suggest that induction is the solution to the big baby "problem," something that Henci Goer has found to be false. If there was an error in my post, it was that I could have eliminated the phrase, "there is nothing wrong with having a big baby." I didn't mean to imply that there aren't complications associated with a big baby but rather to send mom the message that their pelvises are indeed ample and in most cases, their baby will indeed fit (see Pelvises I have known and Loved*). I think it completely unnecessary to scare clients with the threat of
having a big baby and wrote rather passionately on the subject because
I've heard too many stories lately from moms who have felt pressure to
induce in order to avoid a "big baby." None-the-less, so as not to imply that I think ALL babies will fit (is anything ever absolute?), I updated my post to read "induction will not reduce the complications associated with a big baby" and included a link to an article by Henci Goer on the subject.
I was encouraged that at the last birth I attended, the midwives made no mention of a big baby, even though we all thought that was exactly what we were going to have. There was a point in the pushing phase where the midwives seemed to be a bit concerned about the shoulders but thankfully all went well.
Thanks Navelgazing Midwife for encouraging a lot of reflection. I will try to be more clear in my posts and be careful of assuming background information. Please ask me for clarifications readers when/where they are needed. I am a student and have much to learn. And thanks to my kids who were very, very patient as I was blogging today. I owe you EXTRA quality time tomorrow! You really are wonderful little beings.
•Thanks to Pregnancy Birth and Babies for leading me to this article.
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