Empathetic Medicine

My daughter turned seven this past weekend. I wanted to post about her birthday, but I couldn’t figure out what I wanted to say. Thinking about my children’s birthdays is equivalent, for me, to thinking about their birth days. And my feelings about my daughter’s birth are still so complicated, it’s difficult to know what to say.

Then yesterday I was driving around without the kids in the car, a rare and precious thing in and of itself, and I heard a story on NPR about the Narrative Medicine program at Columbia University. In this optional program, medical residents read literature and write narratives from their patients’ perspectives to help them better understand where their patients are coming from. I really like the idea of fostering empathy in doctors, especially given the by-and-large un-empathetic treatment I’ve received from doctors.

One of the residents interviewed for the show talked about how she becomes so frustrated when a patient won’t accept her advice. She said that she was hoping that the class would help her to understand her patients better so she could better convince them that the advice she’s giving is the right advice for them.

That statement led me to thoughts about the interactions I had with doctors during my pregnancy and birth with my daughter and why it’s so difficult for me to feel heard by physicians.

My experiences with doctors during my first pregnancy and birth were rushed and filled with coercion and scare tactics, out-and-out misinformation and power struggles. I was experiencing a miracle, but they were experiencing a day at the office. I felt like an individual engaged in the incredible task of growing and nurturing a living human being, but the doctors saw me as a bundle of problems and potential problems that each had a clear-cut solution. I saw myself as the necessary part of a natural process, but the doctors saw me as an inconvenient interloper between them and the fetus in my belly.

My midwife, on the other hand, recognized and celebrated the miracle. When I went in to interview her, before I’d even decided for sure I wanted her to be my midwife, she offered to let me listen to my baby’s heartbeat on the doppler. With excitement and wonder in her voice and her eyes, she led me on an auditory tour of my belly. At the end of the visit, she hugged me and we celebrated this momentous occasion together. Contrast this with my first belly-listening session with my doctor, in which I got about ten seconds of the baby’s heartbeat before the doctor said she couldn’t stand the sound of that doppler and shut it off.

I had planned to have a home birth, but on the advice of my midwife, I had tandem care between my midwife and an OB, just in case we ended up at the hospital. I hated my OB. I hated the whole practice. As soon as I got my GBS test results back, I quit going. Even though it cost more, I preferred to go to my midwife for the last month of my prenatal care.

But I ended up at the hospital to give birth—pitocin, epidural, absence of informed consent, and all.

I’ve spent the past seven years trying to figure out how to frame that birth experience. There were so many very positive things about it, not the least of which were the healthy baby I birthed vaginally. There was the incredible L&D nurse who helped me maneuver the baby into a favorable presentation so that labor could finally progress. There was the opportunity to (gently) tell off my OB, who was intent upon performing a surgical delivery even when everything was finally moving along and baby and I were looking great. There was the power I felt as I pushed my baby out. There was the wonderful postpartum nurse who taught me how to co-sleep with my baby.

But there were so many other things that haunt me about my experience in the hospital and have left me with an anxious and pervasive sense of powerlessness and an almost pathological distrust of doctors and hospitals.

Let me be clear: I am not upset with myself for having an epidural or even for going to the hospital in the first place, even though I can think of things I could have done differently that might have kept me at home to birth. I am uncomfortable with the feeling of being funneled into a system in which the only options are the ones that someone else has pre-decided for me and in which I am irrelevant as an individual, thinking human being. It’s the objectification of my Self that I have so much trouble working past.

My primary memories of my daughter’s birth are fear, confusion, powerlessness, and loneliness. There were times when I didn’t know where my husband or any of my three doulas were. There were times I didn’t know where my baby was. I was stranded among strangers and unable to make myself understood.

I wonder if the residents in the Narrative Medicine program would be able to put themselves in my shoes and see why being treated with kindness, empathy, and compassion would have made so much difference. I wonder if they could understand that there is more than one way to reach a “healthy outcome” and that there isn’t one right answer to most of the questions that arise. I wonder if they would be able to recognize and share the miracle rather than taking it as their own.

That resident who wanted to understand her patients better so she could get them to accept her advice? She makes me doubt that any of this is possible.

If a doctor is listening only to try and get me to come around to her point of view, that’s not really empathy. On the contrary, it’s just another form of coercion. If a person—including a doctor—truly understood my perspective, she would accept that the choice she’s trying to make for me really isn’t the best choice for me. She would accept that I can make an informed decision that is contrary to her advice.

I had my second baby in a portable tub of water in my dining room. My primary memories of that birth are the feelings of profound connection between me and my body, my husband, my daughter, my son, and my sister, midwife, and doula who were also there. My midwife steadfastly refuses to take any credit for how well his birth went. She insists, rightly so, that her moms do all the work and she’s just privileged to be invited to a part of that miracle.

I so far haven’t met a doctor willing to step that far back. I know they must exist, but they seem to be a rare breed indeed.

Related Posts:

-My Son’s Birth Story, Part 1, Part 2, and Part 3