The concept of 'choice'

[Arcadia]

Following on from bg's thread about owning our choices, I have been thinking about our perceptions of choice and the extent we really choose to do things.

I am mainly thinking about systematic things that prevent an empowered decision, so that things that seem to be within our power are actually weighed one way or the other. The intervention rates at hospital spring to mind. How often do we hear of births not going to plan, and often it is because of the cascade of intervention that occurs. Yes it does often save lives, but how much of the interventions are actually wanted by the patients, and how much is scare tactics and procedure? Is it still a choice?

And then the issue of breastfeeding. Many women feel they do not have a choice, but if statistics are correct, over 80% want to breastfeed when the baby is born and yet a small amount succeed. Obviously something happens that prevents them achieving this goal, so is that really a choice to stop?

And so what do we do with this kind of information? Do we help people see they may be disenfranchised, or is it better to just accept and move forward?

To use the horse and water example. You can lead a horse to water, but you can't make it drink, but does the horse know there won't be another drink for a long time? Does it know it might be thirsty until it does drink?

[kateo]

I have been thinking about similar issues.
I have been thinking of "birth plans" and wondering if due to the "cascade of intervention" that having a birth plan may actually be a recipe for dissapointment.
The process of birth is soooo dynamic that perhaps to pretend we have chioce is immediately setting us up for failure.
My daughter died at 41 weeks inutero. There was nothing in my birthplan about how I would birth a dead baby. Ellen was born even so.
None of this was my choice. I birthed at a hospital that was not my choice with dr's that were not my choice giving birth to a precious child who was dead against my choice.
Birthplans are soooo often broken and unachieved that perhaps they should be done away with.
Are they really a reflection of our choice or a reflection of our unrealistic dreams?
At birth classes there was a "glossing over" of poor outcomes and encouragement of good outcomes.
If we do have birthplans should they beter reflect the reality ofwhat happens.
I am seeing a psychologist since the loss of my daughter and she mentioned the other day that she sees women who are struggling to cope with the fact their birth didn't go to plan.......I must say I felt like saying to them "get over it you have a live baby!" but at the same time perhaps they were set up for poor outcomes.......

[Fleur]

Choices....
In the thread you are talking about, I would consider it to be informed, concious choices. It's a bit harder to apply those things to an emergency CS due to distress for example.

So to try & think of where you might not have a choice....

I will use my BFing experience this time around...
Pie went from the delivery room to SCN & a drip. She was a slow feeder to start with & then I developed oedema. I was expressing to get my milk in from day one. By day 5 I was expressing to feed her as she simply could not attach to massively engorged breasts. It was fluid engorgement, so I couldn't just express a bit off.
Now here's where we get to a fork in the road....
I was given the option to stay in hospital with tube feeds, or go home with bottles & try to re-latch her to the breast when the fluid dispersed.
I was apprehensive about bottles because everything I had ever heard said not to do it, but I trusted the advice of the LC's who assured me they had an 80% success rate getting babies from bottle back to breast.
It didn't work. Long story short I am still expressing (weaning now).

So...my choice?

Certainly not my choice to develop oedema. Not my first choice to give her a bottle either, but I was acting on professional advice....
and yet in hindsight I still accept it as my decison, my choice to listen to them and to take their advice. The buck stops with me.

I agree that it's not always simple & clear cut, too often there is bad advice, the wrong advice, no advice at all... and women are left thinking 'I wouldn't have chosen this!'
It's why it's so important to be informed. You can't really make a choice without having some knowledge.

To answer your question, no it might not be a choice to end up with medicalised birth & a cascade of intervention. But if it were me (and it has been) I would still be owning it. Saying 'hey, that's how it was for me cause...'

I know it's not that simple I don't even know if I made sense :9

[thepixie]

Arcadia I have been thinking about Kate07's thread (as I can see you have too) quite a lot, and the mismatch between birth plans and birth realities. The conclusion I came to is that the reason why birth plans are often so wildly out of sync with what happens on the day is partly due to the dynamic nature of birth, but in a large measure also due to zero to no continuity of care for the majority of women during pregnancy. If birth plans were developed in genuine collaboration with the midwives and doctors who were going to be there on the day, then they could be informed by the realities of what happens in the birth centre or suite. What actually happens is that women do research which is by necessity general in nature, without the 'inside information' from care providers and facilities (because they just don't have adequate contact and care) and when they arrive they find that their birth plans are laughed at or ignored because they don't fit in with the ethos, policies or procedures of care providers or hospitals. So women think they have a choice, only to arrive on the day when they are no longer able to exercise it, and find that they don't.

The same goes for the cascade of intervention. To give him credit, my OB did actually use these words to me - he didn't explain it, as I was aware of the concept and in our 10min consultation there wasn't time for discussion.

Hooking up with Kate07's thread about consent to procedures during birth, if there was genuine continuity of care then a care provider would almost never need to give a detailed explanation of a proposed intervention to a labouring woman. Birth may be an emergency situation but it's hardly an unexpected one. Most pregnancies are nearly 10 months long - plenty of time to go through common complications, reasons for episiotomy, assisted delivery and c-section. The only complications or interventions which should need to be explained in detail are the truly bizarre and obscure. If there was proper continuity of care, the HCP would say - "do you remember when we discussed X? Well it's happening now - I need to do x, y and z, is that OK?" That would be a genuine choice, or proper informed consent, as opposed to what seems to happen now - CPs do what they think is best, and excuse the need for informed consent by saying "o it was an emergency, there wasn't time, she was so out of it she wouldn't have understood anyway."

As for BFing my opinion is probably not going to be popular, but I'm going to put it out there. I can't speak about private LCs but the ones I encountered in hospital were awful. They were obsessed with a specific dogma about BFing and felt it was their role to shove that down the throats of new mothers at the expense of actually helping them to BF. They were arrogant, inconsiderate, unhelpful, and downright rough with vulnerable new mothers and tiny babies. I have seen and heard about more women who were actually put off BFing by the LC's (also known as BFing or Nipple Nazis) at the hospital than were helped by it. I quickly learned to ask the midwife who was not a LC to help me as she simply came to my room, checked our attachment, and gave the help that was needed.

Anyway to come back from a long ramble, I have watched this series of threads develop and the thought behind each one was valid. However there is not a single answer for every situation. Sometimes we need to own our choices, and in other situations, for one reason or another, our initial choices lead to unintended consequences which were not what we wanted at all. In some situations our choices are completely taken away. Each of these is a different situation and will create a different emotional response both in ourselves and others. All we can do is learn from our experiences, and try to share what we can in the hope that if more information is out there, people can make truly informed choices and get the outcome they are hoping for.

[Arcadia]

Thanks for the replies. Pixie I gotta spread the love, but your post was right on the money. I think the whole idea of 'choice' in childbirth is a bit of a misnomer.

There are so many variables, it is impossible to plan for each one. I do not think women should just take what they get though, but as pixie suggested there needs to be closer collaboration between patient and care providers.

My sister is a care provider and seriously she us overworked enough without having to forge meaningful relationships with every patient, but I think this is inherently part if the problem. We have systematized health to such an extent there are major gaps between expectation and reality. Women in labour need special care, new mums need special care, and yet so often they are left feeling like they recieved substandard care. Some of this can be attributed to high expectations, but seriously some if it is just substandard care (like kate07's case).

If we just take the expectations angle, then I can see why people would question why we build these expectations in the first place? But the same could be said for any group fighting for their rights, somehow we feel things could be better, despite being systematically told they have to be this way. Feminists and civil rights activists spring to mind...both were told they 'needed' the shackles of their oppression, but somehow they fought against it, and no doubt there were those who found it easier just to accept the status quo and stay within their gendered\racialised roles. Does this mean change should not be sought, or expectations changed?

Part of agitating for our rights is the process of confronting the position of being oppressed, and I think bellybelly does this to people. It shows them that the stance if natural birth and breastfeeding is oppressed in general society (gee just look at the daily telegraph), but of course this means it appears to only advocate these things, which is not entirely true, but it makes it hard for many people to navigate their way through their own experiences in comparison to many here on BB.

Typing on phone with breastfeeding toddler, hope that makes sense...

[Lulu]

It's hard when everyone has different expectations.

How realistic are those expectations in the first place? With my first I assumed the ob would be there for longer than 5 minutes, I know now that isn't realistic but maybe because you are paying them a packet you expect it

Next time I thought I had continuity of care with the local dr and we discussed everything under the sun at our appts. When the time came no one bothered to call him in because someone had the idea he was on holidays ( he wasn't). I'd built a relationship with him and I would have felt a lot better had he been there as things weren't what I expected. All I had was a middy there stretched across three rooms and the chick next to me screamed louder, and my poor sister had to drag her out of the other room when I needed help.

You can't foresee that....

In any case after all this I decided on a Doula so I could be assured of continuity of care at the time I might need it most. The system isn't perfect so I made sure I had what I needed in case of busy nights/full moon/dr on "holidays" whatever.

I don't think the expectation of having a middy with you at all times in labour is unfair, but maybe not realistic at all. For me I think feeling unsupported can lead to fear/stress and plans out the window.

I always try to encourage someone to think about a Doula.....then I run the risk of them getting annoyed thinking I'm saying their husband won't be a good birth partner - but I will always pass on "there won't be someone with you all the time ok?"

[Fleur]

Anyway to come back from a long ramble, I have watched this series of threads develop and the thought behind each one was valid. However there is not a single answer for every situation. Sometimes we need to own our choices, and in other situations, for one reason or another, our initial choices lead to unintended consequences which were not what we wanted at all. In some situations our choices are completely taken away. Each of these is a different situation and will create a different emotional response both in ourselves and others. All we can do is learn from our experiences, and try to share what we can in the hope that if more information is out there, people can make truly informed choices and get the outcome they are hoping for.

that is so well said, and a really good point - you won't get one answer, because it's not ever just a one-size-fits-all situation or POV that people are coming from....

[thepixie]

Arcadia my love I this thread... Really enjoying the discussion. Obviously I would have preferred DD didn't need specialist care, but as she did, I was incredibly grateful to be there, and she was looked after beautifully.

BBL to post more shortly I'm on my phone and I can't express myself properly LOL

[onthefly]

I thought I'd accepted my choices (with regards to DS' birth) and made peace with things, but then I got pregnant again and realised that I hadnt'. Still trying to figure things out.
Anyway, I'd like to know too, when is a choice really a choice? Why do some things stay with us so long and do our heads in, when others we can just brush over.
We gave DS some formula when he was newborn based on dodgy advice from a midwife. But I never beat myself up over that.