When Nurses Perpetuate the Patriarchy

Wednesday, January 27, 2021

When Nurses Perpetuate the Patriarchy

All right. I had something planned for you, but then, after being in a birth I decided to bring something different to the table today.  It's just something that I walked away with a reminder of and I wanted to pass it along so if you are having your baby soon, hopefully you will remember this and you'll come back to this conversation and find that confidence to speak up. 

So what I want to share today about is how nurses can perpetuate the patriarchy of birth. And when I'm talking about the patriarchy of birth, I truly am talking about the medical system taking the power away from birthing people.  I think that there is a place where our medical system can be second tier, right? And that birthing person is the top tier. They're literally the top of the totem pole. They are number one on the pyramid. They are the peak, right? And the medical system, the medical staff, the doctor are below them. I truly believe this.  So, so deeply because I've seen it be practiced. I have seen practitioners who practice like that. And they're like, 'Hey, whatever you want to do!'. They really respect their place in the hierarchy. They really understand consent and they truly understand informed consent and informed refusal. They are happy to be respectful of reformed informed refusal. 

BUT, this is not the practice across the board.  So much so I really believe we have to stop the way that we are 'helping' people birth and we have to do do things differently. That means putting these birthing people on top of that pyramid at the top of that pole, totem pole, number one on the list- EVERY SINGLE TIME. This is your birth. Right?

I want to make very, very clear. Most nurses are so good. I really do believe that most nurses are amazing. I think very seldomly, are you going to encounter a nurse that is a bit of a sour Apple.  I don't believe you get those very often. However, here's what I will tell you again, we have to go back to their training.   We have to go back to what is being taught to these people. And they probably have no idea how it comes across to birthing people. They probably have no idea because this how they were taught to take care of people and help keep people safe in this way. 

So your job as the consumer to say, actually, that doesn't feel great. To say 'We're going to do this a little bit differently because I remember that I'm on top of the totem pole. This is my birth, and I'm getting to make the decisions here'. Right? 

So how do we do this? Let's just go through some examples. Anytime a nurse tells you flat out, 'No' or 'I wouldn't recommend that'-  I would encourage you to clarify. Are they saying no, because it's a safety issue or are they saying no, because that's their preference? Because if that's their preference, unfortunately that is not going to actually be a 'no' in our book. This is your birth. So if it is to keep me and that baby safe, of course, happy to listen to their advice.   However, if it's your preference that I stay on my back, I'm probably going to be moving, right?

If it's your preference that I don't eat something and you're saying that because that is the 'hospital policy', I am happy to inform you that the recommendations actually have been updated based on more current research than what seems to be the hospital policy.  You can say things like, 'I want to be honest and upfront with you, but I'm going to make this decision and you have a science to back it up.'

Even if you don't have the science to back you up, and this is your preference, this is your birth and your preferences should be abundantly clear.  Just because this person is the nurse, or just because this person has that higher education in medicine, or just because this person is your OB-  does it mean that they make the decisions for you? It's not how that works. This is shared decision-making.  We have to be mindful of that. Just because this person holds a certain degree or is a certain provider does not override informed consent. 

Sometimes providers will just be like all up in your vagina. They want to feel if you're making progress.  They probably do have a reason, but if you have no idea why I think that it should be clarified. I mean, nobody should be in your vagina without you understanding why.  I feel like if this provider has something that they need to go up in there for, they just need to clarify it with you. Then ultimately you also have the right to say, 'Yeah, totally. Go ahead.'

Positioning is often an area of control in the hospital.  Some providers prefer women to birth on their backs.  Most babies actually progress more favorably in side lying or being on hands and knees. Being on your back, it's not really the best position. I mean, women are still told not to sleep on their back in pregnancy. So why would we have you lay down during labor all these hours? It's very bizarre. Well it's not really bizarre. It's patriarchy, right? Like what's good for the goose is actually not good for the gander here. However it should be. Here is where we can see nurses perpetuating the patriarchy in a way that they probably don't even know. They don't realize that they're taking the control out of somebody. We've got to start challenging these patriarchal kind of ideas. 

Here's another example. When your baby is actually crowning your legs are going to naturally close so that your perineum can stretch open and close as needed as your baby is turtling out. Remember, you want to listen to that reflex. (This is going to be unmedicated. If you have an epidural, you are likely not going to feel this.) If you feel this, you want to give into it. It's a good reflux. We want your legs to closed, to protect that perineum. What do nurses do? They yank those knees back.  You can speak up here and say it is your preference to allow your legs to close.  You can ask the nurse or provider not to touch your legs.  You don't have to be super aggressive. You can be in control and just requires you stepping up and kind of speaking up.

You have that right to say, if there's no medical necessity necessity right now, can we wait? They're going to tell you if it's not okay that you can wait.  If you're coherent and you're safe and your baby is safe and there's a conversation being had that you're not looped into it...something is wrong with that picture. 

You have to be in control of these conversations and it starts with you being involved in the conversation.  That goes back to shared decision making and ultimately comes down to you, making sure you're in shared decision-making that you're involved in those conversations, that nothing happens to your body, that you don't first have a conversation about, right? It's important that you are in control of these conversations.  

I want you to know that your nurses are so important. They really do play a crucial role. And that's why it's so important to get a good nurse and  a nurse that you align with.  I don't think nurses intentionally perpetuate any of this patriarchal stuff.  I really do think it is the way that they're taught.  I think that these patriarchal ideas are just so ingrained in medicine and it's gonna really take us pointing these things out and saying, 'Actually, I'd like for things to be done a little bit differently'.   So these things are just important to me that you know them as a consumer of medical care of obstetrical care, women's healthcare.  

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