Midwife question: To mislead, or not to mislead?

3 July 2009 at 9:25 am 2 comments

I was recently reading The Blue Cotton Gown: A Midwife’s Memoir by Patricia Harman, a CNM, and this issue came up. Harman mentions in passing some of the things she says to patients (she doesn’t call these women “clients” like most DEMs/CPMs do, by the way) that seem to mislead them, or to misrepresent things, or just to present made-up information. Harman’s intentions are good–she wants to comfort her patients, she wants to relax them, and she wants to do what’s in their best interests–but I was troubled by her methods. 

Here are some examples from her book:

When telling a patient she has herpes:

“I know you’re upset, but this isn’t the end of the world.” Shiana squints like she doesn’t believe me. “No, really. I see two or three women a week with herpes.” This is a lie, but sometimes I exaggerate to make the patients feel better. Really it’s more like two or three cases a month. (90)

When coaching a woman in labor:

She lets out a wail and starts shaking. So much for childbirth breathing. “Get a grip, Laura,” I tell her. “Yelling is not gonna help, and it scares the baby.” I don’t know where I came up with that line, but it works. I’ve used it a hundred times with women in labor since then. She shuts up. (86)

When doing a gyn exam on a woman who complains of vaginal dryness:

“The average woman needs about twenty minutes of very direct, steady, gentle stimulation of her clitoris to have an orgasm.” I’m not sure where I came up with the twenty minutes, but it’s my standard recitation. “Some more, some less. And it needs to be steady, not this way and that, changing every few minutes.” I figure this covers everyone, and if a woman really gets twenty minutes, she’s lucky. If she has an orgasm in ten, she’ll just think she’s highly sexed. (29)

So, what do you think? Is this technique excusable on the part of a midwife? Sometimes, always, never? Is it just dishonesty and paternalism (maternalism?) in another guise? 

–Christina

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2 Comments Add your own

  • 1. bubbasmama  |  3 July 2009 at 7:03 pm

    i just… i guess i would always rather be told the truth? well because if i realized that something wasn’t true (the yelling scaring the baby, for example), then i would start to doubt everything else my midwife ever told me. and would feel so unrespected, too, like she thought i couldn’t handle the truth. yea, i’m not comfortable with it, even though i know she’s just trying to be comforting, i don’t think that’s the kind of MW relationship that i would be looking for, personally.

    Reply
    • 2. christinamichaud  |  6 July 2009 at 7:45 am

      Yes, I agree–I would also not be able to trust everything else she said! But I guess the fine line for me is the line of _not_ saying things–like when I was in labor, apparently my midwife was discussing with her apprentice the fact that the baby’s heartbeat wasn’t recovering well after contractions, and they said they’d let me try different positions but consider the idea of transferring to the hospital if that didn’t help. Well, I say “apparently” because I had _no_ idea she was saying this, or even that the baby’s heartbeat wasn’t perfect at any point. To me she just said something very mild and calm, like, “Christina, we want to get your baby more comfortable. Why don’t you get on your knees” etc. . . . My point is that there certainly was more information she _could_ have shared with me, but I don’t think I needed it at the time, and total honesty/sharing would remove the chance for that kind of judgment on her part.

      Reply

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