Friday, 21 May 2010

Devolved Responsibility and the Medical Model

I was in the children's ward at the hospital earlier this week where my littlest girl had just had an operation. I overheard another mum talking to her daughter who had also been in surgery, and the language she used attracted my attention. She talked about what they were allowed to do and when they were allowed to go home. This is the kind of language I notice when clients use it and challenge them about whose decision this is to make. And here I was just a few feet from where my clients often make those decisions, listening to a mum use this language and I realised that I was resisting doing the same thing. I knew that the medical staff wanted my daughter to have a wee before she left and she was resisting this. When she asked if we could go home, I could have said "We're not allowed to go home until you've had a wee" but I chose to say "We're not going home until you've had a wee". Did it make much difference? Yes, I think it did.

If I said that we were not allowed to go home, then I would be saying that the decision about when we go was to be made by a doctor or a nurse, which is clearly not the case. If I chose to leave the hospital without this consent, no-one would be able to stop me. But I would have devolved the responsibility for this decision, at least in my daughter's mind, to the medical staff. It's not my fault we can't go home, it's the doctor/nurse's fault.

This made me think about something that has been on my mind for a while. My recent shift in teaching method has involved a deeper understanding of the effect of my words on my mind and the minds of those hearing them - Neuro-Linguistic Programming. I used to say that I wanted to have my second baby at home but I had to be induced, so I had her in hospital. This wasn't true, was it? I was strongly advised to be induced but in the end, it was my decision to make. How could I tell clients that all these decisions are theirs to make and then imply that I had no choice about my induction of labour? Well, this is all old news to me but this new experience in the children's ward helped me to realise why I chose those words. If I said "I wanted to have my baby at home but I chose to have an induction" it gives me the responsibilty for this possibly unnecessary and potentially harmful intervention.

So when a couple tell me their labour story and say they had to have a caesarean, are they deliberately avoiding responsibility for the decision they took, or did they not hear or understand what I had said about it being their decision to make? And how does this start to their parenting life affect their sense of personal power around their child? And what precedent does this set for the woman's future belief about her body's ability to give birth? And how much bearing does this have on our blame culture? If a woman feels that she 'had to' have forceps to birth her baby, how does she feel if her baby has bruises? Does she automatically blame the doctor as it was his/her decision? And what if the effect is more serious or longterm? How different would have be if the couple were empowered to make the decision for themselves? Would they be so quick to blame the doctor for any repurcussions?

So, I guess I am saying that in taking control of decisions away from the labouring woman, obstetricians have helped to bring about the litigation culture that causes them so much angst.