Ehhh- ssay

I have an essay to write for uni this week (ideally this weekend) and it’s not difficult, it’s just outrageously fiddly, given that it’s only a pass/fail ethics essay on an Obstetric or Gynaecological thing we’ve seen during our term so far. I keep going “Right, now’s the time! Going to do this thing right now!” and then opening it, reading the guidelines and going “ugh… I seriously can’t be arsed with this”. (I mean, I will, but… ehhh…)

So! We need an “ethical dilemma” which we might plausibly have observed, for which 5 peer-reviewed references can be found. I wanted to write an essay on the ethics of midwives saying “you’re going really well, won’t be long now!” all the time to women who are pushing ineffectively, and in pain. I kind of feel like that’s unethical, inasmuch as if you’re in pain, and asking for help from a healthcare professional, the least they could do is say “I know you’re working really hard, but try doing it slightly differently and it will hurt less and work better.” When I say this, people tend to say “oh, but we want them to be supportive!” but I definitely think you can both help and be supportive. And if someone has a bunch of family members and only one qualified professional in the room, they pretty much have “unhelpful but optimistic” covered, and could really use actually meaningful assistance. A coach not a cheerleader, if you will. Especially since dragging the labour out is not terribly good for the baby, always.

So obviously I could easily write 800 to 1500 words about the ethics of that, no problem, but if you can find 5 scholarly references discussing that sort of thing you’re a better researcher than I.

I did manage to find a midwifery guideline from (I think?) the UK, which said that since one of the goals was to minimise interventions in birth, then we shouldn’t do things which increase the number of interventions. It listed some sensible things to do(you know, like letting women give birth in whatever damn posture and position they like, which we totally do these days), and some things we should avoid, such as checking that the baby is ok by listening to its heart rate or using what’s called a fetal heart rate trace or CTG, which is a sort of ultrasound thing they stick to the mother’s belly during riskier deliveries to make sure that the baby’s heart rate isn’t indicating that it’s in trouble. I just… I feel like I must be missing something. Right? Because to me, “Procedures that increase medical interventions to be avoided where possible e.g. continuous electronic fetal monitoring, epidural anaesthetic” inasmuch as a sentence that poorly constructed can convey anything, says “we are against interventions which are unnecessary [which is good] and therefore we shouldn’t do things which will cause us to intervene [wellll...] like check the baby and allow ourselves to find out that we need to do something[!!!]”. What? No! Fewer interventions is important because it is a step towards better wellbeing of mother & baby! It’s not an end in itself for which we should be sacrificing their wellbeing! Aaargh!

So maybe I can do an essay on whether it is ethical to perform or withhold CTG? I certainly feel like it wouldn’t be hard to find references saying that “if in doubt check” and “if the baby and mother need rescuing to save one or both of their lives then you can jolly well do it, and I don’t give a damn what your departmental target for 'natural' births is”, and obviously it wouldn’t be hard to hold forth about it to the tune of 1000 words. My only real concern is: is that even a dilemma? Like, it seems pretty obvious and clear-cut to me. I’m going to find it hard to present arguments against making sure the baby is ok in a non-invasive way, I’m thinking. Maybe if the birth was very hih risk and you needed to have the CTG on the whole time it would make it harder to have a water birth [which otherwise are totally do-able in the hospital Labour Ward, by the way]? I mean, if so, then there’s that. That would seriously be the first instance I’ve come across where “medicalization” meant that you couldn’t just give birth however you wanted in Hospital, if so. Can even I make a whole essay paragraph out of that? Implying that we should seriously weigh a lady’s right to aromatherapy and bath oils against the chance of her baby not surviving? I guess so?

Heh, maybe I should write an essay on the ethics of deciding you want to be listening to one particular song on really loud while you give birth, bringing that one 3 minute song on a CD, and then making the poor midwives listen to it on repeat for the whole 45 minutes you spend actively giving birth, because TV makes it look quicker? I guess that’s really more OH&S than ethics. The poor midwife spent the rest of the week with that song as an earworm. (I’d love to tell you which song it was, but by Thursday, when I was there, mentioning the name of the song was basically outlawed to prevent it getting stuck in everyone’s heads again).

The other thing of which is an option would be the lactation consultant who lectured us. She pretty much said that anyone who doesn’t breastfeed is a bad mother; that dads shouldn’t get to hug their babies because after conception, they’d done their bit and they should butt out of the sacred mother-child dyad and go, like, hunt or bread-win or something; that mothers should sleep with their babies despite the SIDS risk because if you aren’t going to breastfeed and everything properly then what’s even the point of your having a baby at all, it might as well get accidentally smothered; and that anyone experiencing problems with breastfeeding (low milk supply, baby bites chunk out of nipple [there was a picture of that, oh god], cracked nipples, mastitis etc.) only happen if you don’t breastfeed properly and are a bad mother, etc. Which was particularly awful because the lactation consultant / midwife / nurse (lady’s got herself all the qualifications remotely available, as you see) with whom I’ve worked in the past is eminently sane, and was all “what no” when I sanity-checked our lecture notes with her. So obviously I’m not suggesting that this whole bunch of people is inept, just that it seems like the only ones interested in giving us lectures are the ones with bees in their bonnet and occasionally also a few kangaroos loose in the top paddock, if you will.

I’m not sure that’d be a real essay topic either, though, especially since I have no idea who marks these. Plus; references? Although I bet there are papers weighing the benefits of breastfeeding with the harms of stigmatising bottle-feeding. Hmmm… maybe it’d be safer to fall back on old faithful well-researched things like pregnant women who smoke or take drugs, or indeed people who go up to strangers and abuse them for smoking while pregnant or with pram?

I wish we were allowed to submit ethics blog posts, rather than structured essays in which “Identification of Theme Objectives Addressed” is supposed to be its own subheading. That’s just embarrassing. I should just give them today’s post and say “see? I totally thought about it!”