Responsiveness in the hospital community

The night I checked into the hospital to have my first child, I was cared for by a doctor I had never met. She was new to the OB/Gyn practice where I was a patient and I had never had an office visit with her. My optimism at the thought of having my child had led me to expect that when my time came, I would have one of the doctors I knew and by whom I would feel comforted.

Needless to say, I didn’t get what I expected. I had created a birth plan, a trend in 21st-century baby-having. I had expected that I might be able to have my son naturally and that I would be a part of the journey. The new doctor could barely contain her contempt at my having a birth plan. She probably saw me for what I was, someone who was going to need a C-section. Her responsiveness to me was negative and not directed in a relational way nurtured by compassion and companionship. We were not in a loop of mutual giving and receiving. Our communication was not dialogical except to the extent that she was thwarted by my birth plan.

L0000392 Woodcut: physician at patient’s bedside.
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk

Each time she said, “Well, if you didn’t have a birth plan, we’d be doing this…” it hurt my feelings and belittled me. Interestingly, the situation caused me to stand up for myself a bit, something that can be difficult for me. The birth plan gave me some power and set a boundary. I explained to the doctor that I wasn’t married to the birth plan, I just wanted to be part of the experience, I wanted to be in on the decisions and not just a body lying there at the mercy of the hospital. I wanted so much for it to be dialogical, that we would learn from each other and make the best decisions together. But dialogical negotiation was not in the cards. We negotiated a bit as I had to give permission for my birth plan to be tossed in the trash, one layer at a time.

After 30 hours of trying various methods to encourage my son to come, my optimism had to turn to hope, a deeper sense of well-being outside my expectations. In one crystalized historical moment suspended over several days, I had to live in survival mode, think about what was best for my baby and give up my expectations and plans for what my experience in the hospital would be like. Something in me knew that we would come out on the other side, and that was what mattered. And if we failed to make it out alive, I had tried my best to make the right decisions.

Fortunately for me and my son, I was not worried about him. I felt intuitively that he was fine, not in danger, and that we just had to get him here. When they finally rolled me down the hall to surgery, I was so desperately tired, thirsty and especially, hungry, that I didn’t know whether I had the strength to keep going. I became a body lying there waiting to have my baby “removed.” Recognizing that I felt in dire straits I remember thinking, “I’m going to have to process this when it’s over.” I had never had to cope in extreme survival mode before.

On the whole, I received good scientific care, but almost none of the responsive communicative actions from the hospital staff – doctors, nurses, lactation consultants and more – were particularly helpful or comforting. I still remember one nurse telling me that she Jokingly threatened my newborn that if he didn’t stop crying he would have to get his foot poked (as they do to check stats in babies) again! I was horrified. I didn’t have an experience of appropriate attentiveness. The staff did not seem to judge what would be the most caring response for me at any time. It was all a practical, scientific undertaking, based on the agenda of the various staff members: The doctor knew that she knew best, that baby nurse didn’t want to be bothered my son’s crying and the lactation consultant couldn’t stand the thought of any other method than breast feeding because she’d nursed seven children of her own.

Ironically, in the end, my “new” doctor ended up being such a good surgeon that I chose to have her deliver my second son in a planned C-section. When I was under what I would consider her will, our relationship was more cordial and she was more responsive to me as a person. I was also able to participate by learning more about C-sections and what to expect.

To close I must say that in other situations with my family, at this same hospital, we have received the most caring attentiveness I could imagine. We have been extremely blessed. Such contrasting experiences have shown me the importance of communication ethics in health care. We are all partners in these journeys, encouraging and nurturing each to health no matter the physical outcome. To miss the opportunity to encounter the other and work together through situations requiring care, is to miss a critical part on the human journey.

 

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