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Lost Causes and Compasionate Care


This week, a friend who is a student health professional told me a story that reminded me of something that happened to me when I was myself a student nurse.

My friend’s story concerned an antenatal clinic to which she had been sent for an afternoon to sit in on appointments for women with complex problems. The consultant running the clinic was very senior and close to retirement. He was, in fact, far more interested in discussing his retirement plans with my friend than care plan for the women who were coming to see him. One of these women was documented as abusing alcohol; she had a mental health problem and was seriously over-weight. She had come to her appointment with her sister. Following the meeting, at which the consultant had directed his questions and comments to the sister rather than the pregnant woman, he remarked to my friend, ‘There’s not much you can do for someone like that. She’s a lost cause’.

There are so many layers to this particular ethical onion that it’s hard to know where to begin. However, I think the best commentary possible comes from a chapter in a book I have been reading – just published – about compassion in maternity services. The book, edited by Soo Downe and Sheena Byrom, includes some very honest accounts by midwives and doctors of their own practice and the practice of colleagues. A New Zealand obstetrician discusses how her feelings about and approach to ‘women with rotten teeth who eat too much junk food’ had changed fundamentally when she herself became a mother. As she travelled that apocalyptic journey from pregnancy to new motherhood, she realised that, ‘these women become mothers too’, that all women who have a baby share an experience so profound and life-changing that it dwarfs any peripheral characteristics relating to appearance or life style.

The book is a wonderful one and I recommend it to you (‘The Roar behind the Silence’, published by Pinter & Martin). As I reflected on its stories of prejudiced practice, stereotyping and the unreflecting dismissal of some women’s experience, as well as wonderful stories of courageous practice, I thought (very uneasily) about the incident which I had witnessed 35 years ago. I was doing my theatre placement and a woman was brought in for a caesarean section. She already had six children by several men, and looked unkempt, doubtless beaten down by a pretty hard life. She was placed naked on the operating table (to this day, I do not know why she was not wearing a hospital gown) and left exposed while staff moved around her, completely unconcerned, preparing for the surgery. One of the midwives suggested tentatively to the anaesthetist, ‘Shall I get a sheet for this lady?’ to which the anaesthetist replied, ‘That ain’t no lady’.

The late Sheila Kitzinger spoke constantly about the need to have strong women to create a sensitive maternity service. Murray Enkin, co-editor of ‘Essential Care in Pregnancy and Childbirth’ recognised that it is only by developing a critical mass of consumers that practice which is not compassionate and not even evidence-based, can be challenged. Educating women about their bodies, their births and their rights is a vital element in ensuring that that critical mass becomes a reality.

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