September 27, 2008

The Birth Partner

I actually had a hard time believing that I hadn't read this book before. It looked really familiar, but I realized as I delved into it that in fact, this was the first time I'd read this material.

The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth (2nd Edition) by Penny Simkin, P.T. is terrific. There's so much practical information packed into a very readable text! One thing I really like is the illustrations of different labor positions. I'm pretty familiar with them, but it is helpful to have pictures to look at with a mom instead of having to get into each one to demonstrate them all when time is short. There is a chart showing what medications are in which kinds of commonly offered anesthesia options, when these are usually administered in labor, and benefits and risks. Since I am not a medical professional, this is very helpful information for me when I ask "what kind of epidural are you offering my client?" and the doctor says "blah blah blah yadda yadda yadda " (i.e. names of medications I have no previous experience with.)

Probably the most interesting and challenging part of the book for me is the Pain Medications Preference Scale. This is a scale from 10 to -10: 10 means a mother would prefer not to feel any pain at all, getting anesthesia before labor begins. -10 means a mother would prefer to use of pain medications under any circumstances, even in the case of a cesarean birth. Both of these extremes being nearly impossible to put into practice, most women will fall somewhere in between. The Scale also shows what a birth partner needs to do to help a woman with this preference. The idea is for the mom and the birth partner to each identify their own preferences and support each other appropriately. That is the kicker for me. I know what my personal preference is and I know that many of the women I work with will have a different preference. So far I think I have done okay with that. I really don't feel any urge to judge any one's decision to (or not to) choose pharmaceutical pain relief when it is different than what I think I would decide for myself in a similar situation. But I find that I have sometimes reflexively justified a mother's choice as being one that I would make for myself in a similar situation. And although on the surface that may not cause a mother to feel judged or invalidated, on a deeper level, comparisons are odious. It doesn't matter what I would do if I were the mom. My judgement of that question is irrelevant to what is happening in the moment at a birth, and in the long run, I can see that it could be harmful to impose my judgement, offer my justification for her decision. It matters what I do do as one of her birth partners. My role is to validate her decision making process. What matters is for her to make a decision that is justified in her mind by her own values and preferences. It makes me so mad when a doctor or nurse says, "I would do this for myself/a family member, so it's the right thing to do." Just because it was right/would be right for you doesn't mean it's right for me. I don't want to say that - even subtly and subversively - to the women I am caring for.

The flip side of this is that Penny Simkin is one of the few birthy authors I have read who is really trying to be almost completely value neutral about the "big issues" in the birth world. In this book, at least, she is valuing caring support by a birth partner for a pregnant woman, but she is not expressing any kind of opinion herself about the birth industry and how it functions. While I think this is good in that it makes this book useful for a wider spectrum of people than many other books, I also think that I'm not sure value-neutral is where I want to or can be about the birth industry. Non-judgement of the people participating in the birth industry by having babies isn't the same as non-judgement of the system for me. I need to leave those judgments of the system aside when I enter the birthing space or even the educational space; but I (at least for now) think it's also important for me to recognize the judgements of the system I do hold as I lay them to the side when that's what's needed.

Okay, this one got long. Good stuff!

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