Sunday, December 30, 2007

Birth Messages II

A few posts back I said I'd write about my awful lesson in birth messages. I have started this post repeatedly and can't find a satisfactory way to tell it. In the interest of getting it "out," I'll just go with this one.

Several years ago I posted on this blog my account of a Cesarean birth I'd witnessed. I attended the birth as a doula. I was very upset about the birth and wrote candidly and angrily about it.

My anger was directed at the doctors who had, in my opinion, pushed the mother into an unnecessary C-section. These same caregivers then treated the surgical birth (again, in my assessment) very disrespectfully. I had wanted a different experience for my client. I tried to say this in my post. Because of my anger, I spoke in very harsh terms about this birth, ultimately comparing it to "a fuck." Not words I usually use, but they conveyed how vulgar I'd perceived this experience to be.

More than a year after I'd written the post, I ran into that client. We had a friendly chat. I was happy to see her and her child thriving. In telling her about my doula work I mentioned that I wrote about it in a blog and gave her the name of it.

Four months later I received certified mail from DONA saying I had had a grievance filed against me by a former client. I thought it must have been a mistake. I hadn't been at a birth in many months and couldn't think of a client with whom I'd had negative interactions. Even when I turned to page two, the official grievance letter filed by the client, and saw that it was the client from my story above, I couldn't imagine what I'd done to cause her to file a grievance. Hadn't I just seen her recently and gotten a hug from her?

Her letter told the story. That night she had gone home and found my blog -- this blog. She went through my archives to the time of her birth and read the posts leading up to and including the one detailing the birth of her child. She said she felt "horrified and betrayed" to have her birth defiled by such ugly words.

I, too, was horrified. I re-read my post through her eyes. I would have been shocked to read about the birth of one of my children told this way. Even if it had been a "bad birth," I would not have wanted anyone else to say so without my consent.

This posted a dilemma for me as a doula and a blogger:

To what degree am I able to blog about births?

The answer is not easy. DONA provides some direction. Its code of ethics and standards of practice instruct that we must keep confidentiality for our clients. Hence, I not only refrain from identifying clients' names, children's genders, occupations, home cities and hospitals of delivery, I also blog anonymously myself. This is all intended to keep someone from reading this blog and saying, "Hey! She must be writing about my sister-in-law!"

Still, applying those standards to my posts didn't really help. I had kept confidentiality by not revealing my client's identity or mine in any way. But I still had been deeply hurtful.

One could argue (and several friends did) that as long as I kept my client's identity secret, I could write whatever I wanted about her birth. After all, my experience as a doula was as important as hers as a mother. I am permitted to have my own reactions to births -- including anger -- and this is a forum for sharing those reactions. Another friend pointed out that a lot of non-fiction writing makes people angry, in large part because they do not like how they are portrayed. This disconnect is unavoidable and I am not under any obligation to mediate it.

While I agree with the truth of these viewpoints, they do not sit right in my doula heart. Just because one can do things that may ultimately be hurtful, does not mean one should do these things.

The best argument I can think of for writing about births, consequences be damned, is that advocacy involves telling the truth. I believe the birth system in America is messed up. I can provide first-hand accounts of how the status quo is not always in women's best interest. If those who witness birth wrongs don't talk about them, how will people know things need to change?

Yet even this argument ultimately pales to the sanctity I with which I want to approach birth. I ultimately decided that I will not post birth stories on this blog without the mother's approval. In effect it means I have stopped posting birth stories. I can't quite bring myself to say, "hey -- now that you've given birth, will you read my account of it and give me permission to put it on my blog?" It makes me feel less like a doula and more like a voyeur.

I miss sharing birth stories. Many of the stories I told were wonderful ones. Stories of strength, joy and satisfaction. I do no miss the voice in the back of my head saying, "what if she reads this? Will she know it's her? Will she be surprised you noticed X?"

The most recent International Doula included a piece on internet ethics. I was excited to see it, hoping we could begin to establish some norms for blogging in the birth community. But the example they used was a much easier one of someone referring to a client by first name and other identifying information in a chat room.

Please feel free to weigh in and also link to any relevant posts out there. I know many of you have been writing and thinking about this (as well as the disappearance of many great birth blogs including FP Mama and Red State Moron).

p.s. I long ago removed all old birth stories from the blog except a few for which I had don't bother trying to find the one above or any others.

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Anonymous Anonymous said...

I want to thank-you for having the courage to share your experience. I am sorry that this became a painful experience for your client and yourself.

I am curious, was there any attempt at a resolution between you and your client?

I understand what your friends are describing in terms of your right to reveal shared experiences. However, as a doula and a trainer I have to add that I maintain that our primary and first priority is the needs of our client.

Finding a safe place to discuss professional challenges is vital to addressing the stress and challenges of our work, yet we must do so in a way that risks no harm to our clients.

Clearly you must have felt your actions were appropriate otherwise I suspect you would have never directed your client to view your blog. Now that you have time to reflect it appears as if you are seeing the circumstance through a different lens, that of your client. I think it takes great humility and maturity to recognize when we have not handled a circumstance ideally.

I have loved reading your blog for years, I wanted to come to your defense as I read about your experience. I 'feel' as if I understand your intentions, I know you never intended to bring any harm to your client by blogging about your shared experience.

But I do understand why your client was upset. I appreciate your courage. I hope that your comments will inspire other professionals to more closely evaluate their use of blogs and the internet to process difficult births. Professionals need to access support for experiences like that which you described, but we are obligated to process these types of circumstances in a way that always protects the client's privacy.

Thanks for sharing.

12:16 AM  
Blogger reeciebird said...

This is a tough one. As a mother with a less than perfect birth, it was very helpful to hear my doula's perspective. She had many specific comments revealing positive aspects of my particular experience that I was unaware of. She was even the one to tell me I had oligohydramnios, which was confirmed when I read my records two years later. That objective, educated perspective is incredibly useful and healing.

And reading blogs, current and former, like Red State Moron (which led me to you!), SageFemme, Navelgazing Midwife, FP Mama and the many, many birth stories shared shaped my second, wished-for, worked-for dream birth. Those women, writers and subjects, fed my vision of how birth should be for me, and I couldn't have achieved it without them.

2:26 AM  
Blogger Kniterella said...

It is sad when you can't post for fear of hurting others (even more sad if you need to fear repercussion. The society we live in seems to lean toward the hurt and forget about the good that can be gained by sharing experience and information.

These things nudge me to consider what I write/say differently and the resulting message is sometimes off base from my original intention - so watered down that it seems better not to write at all.

Seems like a blog post is forming for me too...

10:33 AM  
Blogger Jennifer said...

It's been two and half years since my sons birth and I still can't bring myself to contact my doula and hear her perspective. I want to one day, and I am getting close to being ready, but I just can't do it yet. When I read my husbands account of the birth it was highly upsetting for me, even though we had talked about it several times before that, there was still new information that I had to process after reading his account. I can totally see how this would be very upsetting for a client to read, especially since it was a less then stellar experience. I think you have done the right thing by removing the entry and not writing about births on your public blog. I love reading about births, but I think they belong to the mother to tell. Or, if the mother gives permission for the story to be written. But I can see how awkward it would be to ask for this type of permission.

12:43 PM  
Blogger doulicia said...

Anonymous asked about attempts to reconcile. I called my client within minutes of getting the letter from DONA. I left a voice mail message saying I'd just learned of her tremendous upset and apologizing. I asked if we could meet or at least talk on the phone so she could say to me all the things she must want to. I even promised to keep quiet so she could just vent at me. Note that it had been four months between when she filed the grievance with DONA and when I was notified, a delay I hope DONA is trying to eliminate.

I did not receive a return call and by the next day -- after a very sleepless night -- decided to at least write my apology and send it to her. I did not hear back from that either.

DONA ultimately recommended, some six months after I responded to the grievance, that I write my client a letter of apology. This left me in an odd position, having already done it once, months earlier. But I finally did write her again, again asking for some sort of airing of her frustration with/anger at/hatred of me, if for no other reason than we may cross paths in the future and it could be awkward.

I sent that last letter in October, a full year after she initially read my blog. I have not heard from her since our encounter when I initially invited her to read it.

By now I am resigned to the fact that I have damaged our relationship beyond repair. It makes me sad every time I think of it. At the same time, I can understand her feelings. It's just tough all the way around.

7:33 PM  
Anonymous Kat said...

Great post, thanks for sharing! I belong to a neighborhood moms' yahoo group and noticed how incredibly personally women would take comments about birth (they weren't comments about their own birth, just my attempts at educating about better birth). The fact that my attempts to educate were often taken as personal attacks made me realize how delicate a topic birth is and made me very wary about posting birth stories on my blog without permission. I must admit that I am rather blunt about asking moms for their stories, I can't help myself, especially if I think it is a story that will really speak to other moms. I usually ask moms to share their stories with me when they are written up and ask them if I can post those stories on my blog. Often they agree, assuming they have the time to write up the story.

8:35 PM  
Blogger Morag said...

This is such a tricky one isn't it? I have a file of birth stories which I have written, recounting these women's births from my vantage point. In them I have occasionally railed at the bad, bad care I witnessed (and supported through and in spite of) which resulted in crappy outcomes. But those rarely, if ever make my blog, and if they do it's in the most abbreviated, mixed up way which disguises my clients, their caregivers and (recently) myself.

Kudos to you though for having the humility and love to be so ready to apologize and offer again and again yourself for her to vent her rage and disappointment. I remember a simply rockin' post by Navelgazing Midwife in which she spoke at length about the importance of birthworkers to stand in the fire of their client's anger if they have somehow have messed up. This too is such an important piece of birthwork. Trust that your apology hasn't disappeared into the ether. She got your messages, and read your letters. Her anger will linger but I think that ultimately your heartfelt regret will sit warmly with her. I know that my anger toward the caregivers who have wronged me in the past, would be much soothed for a simple acknowledgment of their mistakes, even though I have no interest in sharing a cup of tea with them.

The thought occurs to me also that your actions in expressing your anger at her treatment, may cause her to reevaluate her care, and may ultimately result in a different picture for her or someone else in her circle. As difficult as this has all been for all involved, I can only see this in a positive light.

Because as we all know, evil flourishes when good people remain silent.

I should also add that I'm no longer a doula, because I could no longer stand by and be a piece of allowing shitty care be painted as a "good birth". Bad care is just that. Bad care. I hate it when doulas (or anyone else, actually) are complicit with maintaining the "good birth" vibes for women, when in fact, dreadful, unnecessary and harmful care results in one more statistic rotating out of our hospitals.

Your blog is awesome and enlightening, not only for those of us who work with birthing women but also for those women navigating the maternity system here themselves. Somehow I hope you find a way to keep telling your truth, and sharing what you have seen. We clearly need to keep hearing it.

10:09 PM  
Blogger Kristina said...

I struggle with this on my blog, too. I am not anonymous, I live in a smaller town, I'm a new doula and therefore have been to only a handful of births, and doulas are few and far between so it would be easy to identify whom I was talking about.

I think Dr. Charles (no longer blogging) had it right. He wrote from personal experience, but all his work was fictional. His characters were collages - a mixture of his real clients and stuff from medicine in textbooks and the like, and were therefore unrecognizable. I hope someday to have attended enough births to write like that.

1:40 PM  
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5:30 PM  

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