Tuesday, September 29, 2009

Birth Plan Item #1: Leave My Cervix Inside My Body!

Last night I finished reading several articles in Midwifery Today about birth in the Ukraine. Apparently, it is a routine practice immediately postpartum to use two "shoe horn" shaped devices to pull the cervix out of the woman's body to examine. Yes, I think that warrants repeating--manually pulling out the cervix to look at! (no pain medications). This is so patently horrible and unnecessary that I had a visceral response to reading about it--my uterus hurt.

However, as I reflected on my reaction, I began to wonder if the practice is any more strange or disturbing that some U.S. maternity care routines? I still feel like cervix-pulling-out ranks pretty high on the horrible factor, but I also recognize that is is filtered through my cultural lens of what I'm used to--"normal" (i.e. culturally acceptable) birth practices in the U.S. (such as Pitocin injection immediately following most normal births regardless of indication and so on and so forth). We have any number of questionnable medical care practices in this country too, but because I'm used to them they register as "normal." Of course, this doesn't mean I approve of them or fail to notice that they are not evidence-based, but I accept them as possible occurrences and I'm certainly not surprised to read about them over and over again.

One of the articles was about birth in a Ukrainian "birth house" and the other was a composite of observations about birth in the Ukraine in general. Sometimes there is a tendency amongst midwifery supporters to romanticize birth and midwifery care in other countries and to vilify the U.S.--if you are a Ukrainian woman, this is clearly misplaced!

My first thought when reading the essays was, "Wow! The U.S. system isn't so terrible after all!" But then, I tried to imagine the U.S. birth culture seen through completely fresh eyes, as I had just viewed the cervix-pulling technique. How would facets of hospital birth care in the U.S. appear to me if I was just hearing about them for the first time? As gross human rights violations?

Though I cannot make it have the same raw emotional and physical shock to me as cervix-pulling-out, I can only imagine how an episiotomy might sound to my imaginary fresh eyes: "then the doctor took some scissors and cut through the skin and muscles at the base of the woman's vagina." Or, the same with the not uncommon addition of, "as she begged 'please don't cut me! No!'"

I also read with sadness and dismay about the emotional maltreatment of Ukrainian women in labor and how (in hospitals) they are frequently denied the companionship of their husbands. Is this really more awful than women being coerced into unnecessary cesareans or even more basic, being denied food and drink throughout their labors? No, not really, just less familiar.

While it is nice to recognize that there are things that women birthing in U.S. hospitals can be very grateful for, there is not an official continuum or hierarchy of "better" bad things to happen to birthing women regardless of country of residence. Humanized care is humanized care. Women worldwide deserve a safe environment, a respectful caregiver, continuous emotional support, physically responsive care, evidence-based medicine, and to have their cervixes and uteruses left inside their bodies.

CfM Blogger

P.S. In case anyone is interested, "cervices" or "cervixes" and "uteri" or "uteruses" are both acceptable plurals ;-)


Tiffany said...

I think I had the same reaction to the whole pulling the cervix thing out that you did - ugh! You make some very valid points about care in this coutnry versus caree in other countries. The grass isn't always 'greener' on the other side. But humanized care should be universal!

Anonymous said...

Thanks for reading and feeling. I cried for days and had insomnia. And you're right, after seeing home births, hospitals seem so . . . i have no word.

thanks again,

anne sokol
kiev, ukraine