Past As Prologue




Criticizing the past can lead to inappropriate complacency in the present.  For example, the recent film “Philomena” takes a negative view of an Irish convent, birthing centre and orphanage in the 1950s.  Repressive leadership, bureaucratic bungling and corruption (putting profit before fiduciary duty) led to maternal death, lack of pain control and frustration for the families trying to reconnect.


I liked the film’s sophistication.  It did not just blame the villain, Sister Hildegarde, for her vengeful ways.  It showed the madness-making environment that occurs when fiduciary institutions slip into money making to serve their own ambition.


In terms of our potential to provide a good birthing experience, we could be as far off the mark today as the film’s institution was in the 1950s.  The maternal death rate in Canada in urban centers is almost zero — a magnificent achievement.  But short of catastrophe, there are difficulties with optimizing the match of delivery method to the needs of the mother and baby.  There are unnecessary Caesarians and obstructed labor, ending in Caesarians that should have been undergone earlier.  Women may be traumatized for lack of anesthesia.  Anesthesia may end in complications when it was not necessary.  Natural childbirth occurs by default rather than preparation and choice.


Mothers are young or in early middle age.  They have a lifetime of responsibility ahead to their childen, their families and their employers when they go back to work.  The cost to society of less than best birthing practices is still very large.


The root of today’s problem is conflict between service expectations and protection of vulnerability.  Parents want to choose good service and institutions need to guard against medical disaster.  Pregnant couples research their needs and select a delivery method, a health care professional and setting as if they were shopping.   But young people cannot understand or pay for the obstetrical knowledge that may be necessary if a particular birth becomes difficult.  They choose, but chaotic reality intervenes.  Two of my children did not even end up in the hospitals they had selected, let alone with their doctors or delivery methods.  Obstetrics must guard its patients, in one of these cases moving heaven and earth to get her out of the car and into a delivery room in time.   


Hopefully, today’s professional staff will not get as burned out as Sister Hildegarde.  But some may and then allow defensive complacency to set in.  When mothers have a bad experience and nobody is held accountable, there are costs to families and society.


The film “Philomena” inspired this discussion of childbirth.  I wonder 60 years from now what they will say about today’s banking.



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