Sunday, February 22, 2009

More on Midwifery and Gender

Well, we're two down (the little guy & I are both through the stomach bug) and two to go here and the suspense is high: are we through with Pukefest the Third, or is this day of non-sickness only an intermission? So, while I have the chance:

Interestingly, the comments and emails I've received on this blog and the family blog where I cross-posted the Private Practice entries have all been about gender and midwifery, not about the indignation I personally felt when seeing a "midwife" provide the kind of care Dell offered the laboring woman.

The gender issue seems a little like sleight of hand to me - here look: a male midwife!! Ignore the fact that Dell is not practicing actual midwifery. Since we've been in an ongoing old-school Star Wars movie marathon, the other comparison that comes to mind is the Jedi Mind Trick: we're post-gender here at Private Practice, look at sexy sensitive Dell delivering this baby!! Ignore the fact that Dell is performing a risky procedure without informed consent!

Let me clarify my feelings on the gender issue. I think men should be able to become midwives or ob/gyn doctors, just like women should be able to become midwives or ob/gyn doctors. Like I said previously, I wonder about the market for a male midwife. I think there is a significant overlap of "women who seek midwifery care because they perceive it to be more woman-centered" with "women who want a female care provider because they perceive her to be more woman-centered" (picture a Venn diagram here, if you would) and therefore, I would be curious as to how many women who fall into both of these categories might actively choose a male midwife. This is hard to debate because at least here in the United States, there are very, very few male midwives.

There's a much more important sleight of hand that women need to be aware of when they choose a care provider: the tendency to make assumptions about a care provider because she is a woman or he is a man OR because one is a midwife and one is a doctor. Get to know your provider! Neither gender nor training & credentials guarantee certain philosophies or care practices. If you can't get to know your provider, because you're seeing so many different partners in a practice or because (s)he doesn't bother to sit down during your appointments, that gives you some very valuable information.

Some men, as OBs, family practice doctors, or midwives provide excellent, evidence-based, woman-centered care. The country doctor in Lady's Hand, Lion's Heart (my review), Navelgazing Midwife's Dr. Wonderful, and Michel Odent come immediately to mind.

On the other hand, some women, as OBs, family practice doctors, or midwives, do not provide woman-centered care, instead relying on routines that are not evidence-based and can even be degrading.

Is it more shocking when a woman provides care like this? I don't know if it should be, but I've definitely heard, in tones of betrayal and disappointment, "well... I thought because she was a woman she'd __________________________." or "I thought because she was a midwife she'd __________________________."

A care provider's gender or training does not automatically guarantees a certain kind of care. There are certainly trends that midwifery care and OB care follow, but there are certainly midwives who tend to practice more from a medical model and OBs who tend to practice more from a midwifery model. Personally, I think gender offers even less certainty than training and credentials. Does this make me suspicious, or only a careful consumer?

How did you decide on a care provider? How much did the credential as midwife or OB or family practice doctor come into play? How much did gender matter to you? Did your care meet your expectations?

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
New Mothers Support Circle

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Anonymous Anonymous said...

When I was pregnant with Natalie, I did seek out a midwife but I had very little knowledge of the midwifery model of care and that some midwives (especially hospital midwives, although certainly not all!) practice within the medical model. And although red-flags went up with a couple midwives in the practice (I think there was 9, it was insane actually), the other midwives pushed the idea of a natural birth (birth is a marathon, birth hurts but you can do it, etc) but NEVER did they mean natural birth WITHOUT intervention - like pitocin, water-breaking, continuous monitoring, birthing on your back, frequent checks, etc etc! When they said natural birth, they meant a pain-medication free birth, certainly not women-centered/labor unfolding as it will care. It was all about them and their precious time. And while I was in labor, the midwife was only in the room to do checks, break my water, order the pitocin, prep me for an episiotomy (ouch!!) and watched Chris catch our baby (yay! at least we got to do that part of the plan!). BUT that's not how a midwife should practice!! They should call themselves something else because it's confusing. But it's EVEN MORE reason to get to know your careprovider and if red flags do go up, really explore them and know you have OPTIONS. Many options.
And gender did matter to me. I especially remember the male-midwife at the first prenatal appointment. He was rough with the internal exam and made a joke about being at the dentist (it's gross so I won't say it here, but I'll never forget how embarrassed I was!) and even the expectation that I can meet a complete stranger, take my clothes off and get an internal exam within 10 minutes is insane to me. My appointments were no longer than 15 minutes each. There was no listening, not much time to even ask questions. In and out, next patient waiting.

I am glad that my 2nd pregnancy was not full of embarrassing/non-listening/disrepectful memories of my care-providers. I found a real midwife, asked LOTS of questions about how they do things, how they handle emergencies (what is an emergency? - that's a question I definitely asked) and felt like not only did they listen to me but how I wanted things to go mattered to them. That's how it SHOULD be. I remember talking to my midwife for over an hour about the GD test, she took the time to listen and I felt actual care was being provided.

It was day and night between the providers and all under the name of midwife.

February 27, 2009 at 8:36 AM  

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