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From Doulas to Doctors, Women Are Still Dismissed

Three of my cases this year have focused on trauma created by the failure of doctors to listen to, and communicate with, women in situations of fear and distress.
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Effective communication isn't easy because it's always a unique balance between the speaker and listener. When my daughter was seven she had an argument with a friend she felt hadn't understood her, and she was very upset. When we were talking about it, I asked if she'd said exactly what she meant to say to her friend. She looked at me, totally irritated at this point, and said, "YES. I WAS VERY PACIFIC!"

The infant researcher Daniel Stern says that, in some ways, it's when we find language that we lose it. A well-cared for baby moves from a reality in which her needs are met almost magically without language, to her toddler reality in which her verbal request for that third cookie is confusingly met with a "no." If we imposed adult language on the toddler's thoughts at that point, she might be thinking, "Excuse me, you must not have understood my desire for that cookie. The entire time we've known each other, every time I needed milk from you it was forthcoming. I used to love milk; now I love cookies. What is the problem?"

As adults we use language we hope conveys exactly what we mean, but sometimes, just like the toddler, even when we think we've been clear the listener doesn't get it. In our personal lives poor communication, misunderstandings, and an inability to have a meeting of the mind are one thing. But there is another failure in communication that has to do with a professional predisposition to not listen, especially to women, and it's been a disturbing issue in my practice recently.

Three of my cases this year have focused on trauma created by the failure of doctors and professional caretakers to listen to, and communicate with, women in situations of fear and distress. How can it be that in 2007 women are still dismissed in this way?

I don't hear these stories from men. In my experience, men also have issues with doctors and other professional caretakers but they seem to have more to do with being doctor averse or avoidant. While doctors of both genders can be dismissive in general, I do believe there's a special layer of dismissal for women.

A woman says to her male doctor, "Since the surgery I have pain right here." The doctor says, "That's not possible." Almost a year and at least $5,000 worth of medical expenses later, she's proven right. A woman says to her female doula, "There's something wrong with the labor, I need to go to the hospital right now." The doula repeatedly tells her she should just hang in there, it's not time yet, which proves to be a bad error in judgment. A woman laboring in the hospital is alarmed by the quality of her contractions and tells the doctors and nurses. They ignore her, only to realize hours later she's been on the wrong dosage of medication the entire time.

Coincidentally, within one year, two of my pregnant clients had the same delivery complication -- the umbilical cord wasn't long enough to allow the baby to exit. One mother's description of her symptoms, and her request for information on what was happening, were summarily disregarded by the doctor and nurses. By contrast, the other mother was treated with professional regard and kept informed as to what was happening, even as the crisis was unfolding. The first mother suffered the complication itself, and then had to endure the long and unnecessary trauma created by the very people who were supposed to be there to help her. The second mother suffered only the complication, which was far shorter in duration due to the attention the doctor paid to her situation, and she looks back on her experience with gratitude for that medical team. She didn't feel traumatized.

The client whose surgery adversely affected her health is heroic in her daily efforts to try and find relief. Some doctors have collaborated with her, but it's an exhaustive and expensive pursuit, and many times she's had to justify her symptoms to practitioners whose self-importance makes listening to women a dispensable chore.

Progress in taking women seriously has been made, and there are great stories out there about compassionate doctors -- mine included. But what follows are two narratives from the childbirth questionnaire in my Women's Realities Study. One of these women gave birth in 1965, the other in 2006. Can you tell which is which?

1. "I thought it was barbaric...It showed me, more than anything, the difference in how men and women are treated by the medical profession. Interns were coming in sticking their hands up my butt. The nurse said, "You can't have a baby without having some pain," as if I was weak and a bother. On the table they gave me a shot. I asked what it was for. They said, 'to stop your milk.' Nobody asked me if I wanted to breastfeed or not. [The most surprising thing about childbirth was] the crassness of the doctors, the lack of concern for me. [What do I wish had gone differently?] Support. Giving me information about what was happening. Making me feel like a human being, not an animal. [If men gave birth instead of women there would be] no pain. Praise instead of insults. Information. Choices."

2. [What word best describes my experience of childbirth?] Traumatizing. I hated it...I was tied down on a table, shaking uncontrollably, totally in the dark as to what was happening to me...All the while, since the danger had passed, the doctors and nurses were just chatting away like I wasn't even there, tossing my organs around and sewing me up. I hated them so much in that moment. I didn't feel like a person, let alone a mother...I'm still feeling terrible about the experience...largely because of how I felt about the callous attitude of my caregivers...[If men gave birth] I think there would be more transparency in the process, and that patients would be treated with a modicum of respect, and as intelligent, functioning human beings with the right to participate in their own care."

In our personal relationships we usually have the luxury of measuring the quality of communication over time. When it comes to doctors and caretakers, the stakes are different and often more immediate. If a woman is in pain, frightened, and trying to take care of herself by seeking professional help, respectful communication should be the standard of care.