Birth Attendants and Lifeguards - When Helping Isn't Helpful

Birth attendants are much like lifeguards. Picture this. You are swimming along in the ocean as the tide is starting to gradually rise, it takes a lot of effort to stay above water and swim against the tide so you aren't swept up onto the shore and beached like a whale. Even though your body is working very hard, you're doing fine, it's not scary, you are literally treading water. You may not be exactly physically comfortable, but you are strong. Everything, though full of effort, is going along swimmingly when all of the sudden the life guard, perceiving danger, jumps in and tries to "help" you swim. He starts grabbing your arms and swinging them around simulating the free stroke. He dives underwater and starts kicking your legs for you. Can you imagine your efforts at swimming being made easier or more difficult when someone is trying to "help" by actually taking control away from you? Certainly this life guard is well-meaning. After all his job is to watch over the swimmers and protect or save them from danger. But what if in an effort to save you from danger (in this case a danger that wasn't even there) he actually put you in danger? Perhaps he is remembering the woman he just rescued yesterday. She was swimming along fine and suddenly got into a rough patch of water and was swept under the waves several times, lost her footing so to speak, started to really struggle and went under. He gallantly jumped into the water, pulled her up, swam her to shore and began to revive her. It worked, but only after much panic and worry that she may not survive. As he is basking on his stand in the sun today, he sees you in the water splashing around and thinks, "hmm that's how it started yesterday. At a moment's notice a person could just be swept under." I am not going to let that happen on my watch. I will be ahead of the storm...proactive. And this is where our short story began. As you are being helped from perceived impending harm, the life guard takes over and starts doing everything he thinks your body (and mind) aren't doing well enough. Thanks to his help, you have started to actually drown now and are struggling not only against the tide right now, but also your "helper." You slip under the lapping waves and inhale water. Is the danger real? Well, now it is, but it wasn't even there before the rescue commenced. The gallant life guard, just like with the woman yesterday, pulls you up, up out of the water swims you to shore and revives you as you cough and sputter. Like yesterday, the lifeguard is once again hailed as the hero. In his mind and perhaps onlooker's minds it might appear that wow, he just knew that swimmer was about to drown and instinctively jumped in to rescue her just as it was all going down the drain. Thank goodness that life guard was there! 

What? Goodness me, what a terribly frightening and inaccurate assessment of the real circumstances. The life guard actually put his charge in harm's way. He didn't intend to, he just got caught up in the "what if" and his mind raced all the way to "I remember when such and such a person started like this and in a flash, she had drowned." This is easy for providers particularly trained in an obstetrical (which by the way is a surgical specialty, and we will discuss that in the future) mindset to do. Easy not because it is normal or even rational way to think about labor and birth, but easy because they really have seen the worst of the worst and have a hard time not putting every patient in to a "worst-of-the-worst-waiting-to-happen" category. This is a tremendous weight to carry, though it is able to be shaken with the right balance and perspective checks. 

The truth is, this is not how life guards perform their duties. It's a little absurd and neurotic to picture actually. A life guard knows his place (yes, there are always the few jocks who do not...). His place is not to intervene unless danger is really present. When he does otherwise, he will likely create new problems that did not exist or make the original problem even worse. Certainly there are exceptions to this analogy. There are those cases where a patient was seemingly doing just fine, and suddenly crashed. But all too often, those clients received an intervention just a short time earlier. Sometimes these emergencies happen regardless of what a practitioner does or does not do. Even the most healthy of us, is not perfect. We are physically imperfect people with physically imperfect bodies and physiology. On occasion, people's own bodies do not perform at the optimal levels and do need help or intervention or rescuing. Yes! And thank goodness for modern advances and skilled practitioners who know what to do in an emergency. Many lives have been preserved because of timely and skilled intervention. But, the ones who really need it, I mean really really need it, are far less than you think.

Erring on the side of caution. Defensive medicine. These may sound good on the surface. It is sad we have created this culture because it often has lasting negative effects on real people. And let me say, it is not primarily medical professionals who have created this culture--it is primarily consumers, patients, clients, birthing families! You may disagree with me and I would love to keep that discussion open. But, I will harp on this issue of wise and responsible consumerism till I am blue in the face. We initiate the directions in which prenatal and birth care go, not providers, though we often want them to be a scapegoat. And yes, modern obstetrics has it's own set of weaknesses, so neither side can be free of responsibility. Nonetheless--supply and demand is no less true in health care than in any other industry or service.