Are you an Ungrateful Patient?

This week, the American Medical Association voted in favor of Resolution 710, an attempt to identify patients who are "abusive, hostile, or non-compliant."

I come from a family of medical doctors and nurses - my parents, my grandfathers on both sides, numerous cousins, and an extended family, all of whom could staff a large community hospital with all specialties. I appreciate doctors and the fact that, for many, practicing the healing science of medicine the way they dreamed of when they were students is simply not possible with our current system of medical malpractice and liability.

And so, if this resolution were about liability, I could probably understand it. In this litigious culture, it seems reasonable that doctors should have the ability to indicate simply that a patient has not complied with suggested care, and therefore the doctor is not responsible for the negative outcome that ensued.

But the introduction of the resolution is not about liability, and it certainly isn't about improving patient care or outcomes. The resolution is suggested because patients "are becoming more abusive and hostile toward physicians," and have "unreasonable expectations and demands," which includes "instantaneous cure," due to the "arrogance and/or the belief that they 'own' their physicians." The resolution further states that "the stress of dealing with ungrateful patients is adding to the stress of physicians, leading to decreased physician satisfaction." This isn't about an MD protecting him or herself from a malpractice lawsuit. This is about doctors made cranky because their patients are demanding to be collaborators in their own care. It is as simple as that.

But what's not simple are the implications. In maternity care, women who want to be supported in a low-intervention birth can indeed be identified as non-compliant, particularly when women have very little choice but to give birth in a hospital that sees childbirth as a medical malpractice suit waiting to happen. A healthy pregnant woman who wants to give birth safely and with minimal medical care is not asking for an "instantaneous cure." In fact, what she is asking for is time -- a whole lot of it -- so that her baby can descend into the pelvis as it is physiologically programmed to, and so that she can experience the sensations - yes, the pain! - of healthy, normal childbirth without the pressure of liability-based policies rushing her and quite possibly altering her body and her ability to give birth in a physiologically normal way ever again. I appreciate that doctors face malpractice threats that can indeed ruin their careers and their quality of life, if not their children's lives, but birthing women are a part of this same system, and we are fighting for our lives, too. We don't want to "own" our physicians, but we want recognition that we do own our own bodies, and that we cannot be subjected to unwanted medical procedures that are not based in sound evidence and do not increase the chance of a healthy outcome.

The implications go beyond maternity care. If an MD in any area of medicine identifies a non-compliant patient to a health insurance company, can that insurance company refuse coverage of a non-compliant patient?

Just who, in fact, does this resolution serve? Will it result in greater doctor-patient relationships? Will it create better "job satisfaction" for physicians? It will only create more sick people who are ineligible for care. And that will not increase anyone's satisfaction at all.

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Women Must Be Informed, Political Collaborators in Their Own Care

Dr. Tiller's clinic in Witchita, KS, one of the few in the country that provides late-term abortions, is closing. With his murder, in addition to wiping out the life of a husband and father, the anti-choice movement has taken away women's access to critical, necessary services. And while the current political make-up shows that the anti-choice movement cannot overturn Roe v. Wade, Dr. Tiller's death is a reminder that all it takes is a sniper to reduce our choices even further. And since OB-GYN's aren't racing to provide abortion services at the risk of their own lives, Dr. Tiller's practice may not ever be replaced.

When I'm not a doula, I work as an abortion counselor. Although most of the women I meet with are between 4 and 7 weeks pregnant, the clinic where I work provides abortion services up until the 23rd week of pregnancy, which is the legal limit of abortion care in the state of Massachusetts.

Your reaction may be visceral, no doubt. At 23 weeks, abortion can be extremely difficult to understand or justify, and it is not uncommon to shake your head and say "I have a real problem with that," even if you are pro-choice. It is tempting, if not comforting, to separate yourself from a woman who would make this choice by assuming that she must be a monster. And I'll be honest and say that once I sat down with a woman who seemingly had no feelings about having an abortion in her 23rd week of pregnancy. It chilled me, her apparent lack of feeling. But many more times than just once, I have sat down with couples who are heartbroken: a routine ultrasound in the 20th week discovers massive deformities; an amniocentesis details profound genetic abnormalities that at are incompatible with all but the briefest of life, and suffering is certain; a doppler at 22 weeks returns no heartbeat, reducing a wanted and cherished baby into a diagnosis of fetal demise. And sometimes, due to the time it takes to run tests, or to the human inconsistencies of those who administer those tests, or the varying reliability of technology, a pregnant woman in those situations can be beyond 23 weeks. And so what do we do in the state of Massachusetts? We tell her she can deliver her dead, deformed, or doomed baby in a labor and delivery unit of a hospital -- which is as monstrous as it sounds -- or we recommend she travel immediately to one of the few clinics in the United States that can terminate her pregnancy. And with the death of Dr. Tiller and the closing of his clinic, there is now one less place where a woman in this delicate and devastating situation can go for care that is humane and treats her with dignity.

And on the other end of pregnancy, women are also losing choices in childbirth. In my line of work, I hear many birth stories from women, and the majority of them have the same eerie arc: first, induction; second, confinement to a bed; third, bone-crushing pain; finally, forced pushing while lying on their backs. Statistically, more than 30% of those stories end in c-section, and these are in pregnancies that had been normal, low-risk, and healthy. It's also the basic formula for reality birth shows on cable TV, where birth is boiled down to a medical event that skirts death practically every time.

VBACs are becoming harder to access, despite evidence that indicates that VBAC is lower risk than repeat C-section. Providers, among both OB's and L&D nurses, have attended fewer and fewer low-risk, healthy childbirths that are purposefully unmedicated and without interventions. What results over time is that if a laboring woman wants a natural birth, she could go to a hospital and have no medical professionals with the experience or willingness to support her desires. Birth centers are losing funding, and homebirth is either criminalized or unregulated in half of the US. In the other half of the country, the standards of care that do govern it are so limiting that its practice is nearly impossible but for a few renegade midwives who are essentially providing care without the benefit of professional support in case of a true obstetric emergency. Healthy women who could experience the normal physiological process of birth are beholden to the artificial constructs of time, liability, and television drama. The art of childbirth, and the choices that encourage birth as a safe, non-medical event, are being lost.

Unless we have a vision that is greater than the arguments of pro-life vs. pro-choice, homebirth vs. hospital, natural birth vs. epidural, we will lose what is truly at stake at the heart of these issues: choices. The quality of women's health care is dependent upon choices and access to qualified care providers, and women must expect no less than to be informed, political collaborators in their own care.

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Your birth story is an important part of healthcare Reform

If you sought care from a Certified Professional Midwife during your pregnancy, or if you gave birth in an out-of-hospital setting, your story is symbolic of why maternity care reform is a critical part of health care reform.

Certified Professional Midwives decrease the c-section rate and provide women with individualized, nurturing care in their pregnancies, labor, and deliveries. Certified Professional Midwives are the ONLY birth professionals trained specifically in out-of-hospital birth.

The c-section rate is soaring, and women are losing choices in how they give birth. Please tell your birth story.