Sunday, March 12, 2006

Modesty

I was heading to a delivery and before I even entered the room I could see the mother from the hallway, her legs up in stirrups and her business end on display for anyone passing to see. This is not uncommon; we take sort of a cavalier attitude towards most mothers' privacy in our hospital. Our delivery rooms are divided in half by a curtain, with the newborn's warmer in the half closest to the door, then a curtain that can be drawn, then the mother's bed. The OB staff try to keep the curtain drawn, but with people coming and going it's often not doing its job of protecting mother from being seen in this awkward pose. There is a door to the room also, but it's even more rare for that to be closed.

I'm not sure why we're this lax about privacy. The mothers usually don't seem to mind. Maybe it's because they have much more important things on their mind, such as contractions and pushing and trying to get a creature the size of a small bowling ball out of their uterus. Let me assure people that it is in no way a planned effort by the men so they can voyeuristically view womens' private parts. Trust me, there is nothing sexy about the bottom of a woman in labor. When I used to work at a suburban hospital, we seemed a little more conscientious about keeping mother from public view. Maybe modesty is just not that big a deal in the inner city.

The exceptions, not surprisingly, are some of our Moslem mothers from Central and Western Asia. I went to a delivery of one of them recently only to be greeted by an older woman related to the delivering mother, perhaps her mother or aunt, waving her hands at me and saying "No man, no man!" I managed to hide behind the curtain until the baby was delivered and we were sure he was fine. Sometimes not even the father is present at their deliveries.

I suppose we should pay more attention to this and do better, but until the mothers start complaining themselves, that's not likely to happen.

20 Comments:

Blogger La Lubu said...

but until the mothers start complaining themselves, that's not likely to happen.

I did a few days of hospitalized bed rest for my preterm labor in a teaching hospital, and as such had the requisite roomful of strangers looking up my cucciniddu to see what a bulging bag of waters looked like. I was vaguely aware that I had the right to refuse that, but I also felt that if I did so, it would be viewed as a partial refusal of treatment---one that could ultimately have implications for the life or death of my child. It wasn't a chance I was willing to take.

Now, I know saying that is probably going to make you bristle. You're going to be aghast that I would question the professionalism of doctors. But I'm not one of the suburban women from the tonier parts of town---the kind who have the clout to back up their wishes. For working class and poor women in the city, yeah---we have bigger issues on our plate when we're having a crisis birth, and lack of modesty is just one more instance of a lifetime of little indignities that we endure.

I mean shit---I'm a union steward. I know how to raise hell when it's warranted. I also know that one must choose one's battles, and that there are consequences for hellraising for those of us who generally don't have a whole lot of power. I felt too vulnerable as a woman in preterm labor to do much hellraising over my bodily privacy. I wanted more than anything for my child to live. I didn't feel like I could afford to make enemies, or do anything that might get me short-shrift.

Peace.

8:33 PM  
Blogger Dream Mom said...

I can't begin to tell you how much this post bothered me on so many levels.

It's really nothing more than a lack of respect to the patients, who ultimately, pay the salaries. So often there are the "Care Statements" or whatever they are called, that are routinely handed out in every ER that says that they treat "all patients with dignity". O.K. And then there are the Press Gainey surveys, where people wonder why patients didn't get a "warm and fuzzy" at their facility. Perhaps it's because they were treated with a lack of respect for their privacy, at a hospital. It's not just your hospital, it happens at a lot of places.

Then, there is the issue that because someone doesn't complain, that they must think it's o.k. or perhaps they don't complain because they have the labor and delivery on their mind. No, I think they would still feel violated, they just may not comment on it because if they did, the first person they complained to would close the drape. The next person would open it again. Patient would complain again. And this scenario would repeat itself until the patient was upset and the staff was peeved that this woman complained. None of this would make for a good delivery.

The comment that it's not sexy is troublesome too. It implies that a judgment is passed on people who did not intend for this to occur.

The issue that perhaps they don't complain because they are in the inner city. I read that to mean that because they are poor perhaps they have bigger issues to deal with or simply don't care. Does this mean that we only have to treat people with respect and dignity who demand it?

10:20 PM  
Anonymous Izabela said...

I think the power differential is too big for the women to complain. In that I agree that the inner city location is a factor. I believe that the power differential in high-risk delivery pretty big even in the 'suburban woman with a clout', but it is probably insurmountable for a woman with less power. This doesn't mean that the indignity doesn't register. Don't feel that I appreciate you raising this point. I believe that even in the throes of delivery women are usualy very aware of the lack of privacy and that it can be acutely traumatising, both during and after. Thanks for the comment.
Izabela

3:58 AM  
Anonymous armchair ethicist said...

The comments did not bother me as much as it has some. That is to my discredit, I'm sure, as they are probably right. My initial impression is that the sexiness or non-sexiness of the nether regions in labor is, essentially, irrelevent. It's irrelevent that I am ugly when I'm sick. It's irrelevent that I'm fat when I'm pregnant. It's just something thrown out there to help make sense of the situation. (I may very well be wrong, I understand that). I thought it pointed out the grey zone you step into once in the hospital, you set aside (well, honestly, it is taken from you) the finer points of dignity to go about the business of something more important, saving lives, birthing lives, etc.

Having said all that, I hated it too. There was no curtain in my delivery room when 5 NICU people escorted a bassinet on wheels and stayed throughougt the rest of the delivery. No, it didn't have to be that way. They all could have waited outside the door while I cradled my new baby for the 1 minute I was allowed before they took her away.

Yes, it was a violation on top of a crisis. No, I didn't at all appreciate it. The whole damn experience was a crisis. I suppose I didn't realize that I could choose to have one less indignity. I don't know if it would have mattered.

8:52 AM  
Blogger Flea said...

Thank you so much for bringing this subject up. It is one that has bothered me since medical school.

I have given up hoping that my colleagues will develop respect for my patients' modesty.

Instead I close doors, knock and wait before entering, and pull curtains.

If a woman is uncovered I will sometimes cover her.

The scenario that I encounter most often as a flea is entering a room where a woman is or has been breast-feeding. In many cases she will not cover herself.

On one very strange occasion this year, a new mom and I had a 20 minute conversation in her hospital room. I sat in a chair opposite her bed. She sat up completely exposed from the navel up.

It took all of my male self-control for my eye to stay locked on hers.

best,

Flea

10:23 AM  
Anonymous armchair ethicist said...

Dr Flea, would it have been wrong or uncomfortable for you to have asked her to dress, or to say, "Oh, I'll come back when you are dressed/decent/unexposed?".

That person, whatever her story, had no right to expose herself to you in that way.

I guess this all illustrates the many ways a hospital setting disarms us of our usual boundaries -- sometimes it's forced on us all, doctor *and* patient. Strangely though, in all these scenarios, it just didn't have to be this way.

11:13 AM  
Blogger neonataldoc said...

Thank you all. First, let me clarify: I do not endorse or condone this lack of respect for privacy, and I think that every human should be treated with respect and dignity, regardless of their social standing. Our cavalier attitude is due to a lack of respect and laziness.

La luba, the comment about vulnerability is very interesting - I hadn't thought of that. Dream Mom, I didn't understand your comment about the sexy thing. Izabela and armchair ethicist, I agree. I think the power differential idea is right on the mark.

Flea....I'm speechless.

P.S. Tangentially, I find it interesting to see all the euphemisms we create for a woman's perineum and genitals. Cucciniddu?

11:27 AM  
Blogger La Lubu said...

*cucciniddu* (snicker) Sicilian term of endearment for the vulva. I'm not really sure of the etymology, wheher it comes from the term for "fig" or it comes from the term for "kitchen" (as in, if you can't stand the heat, stay outta my..). It's entirely possible that the commonly used term for fig came from the fruit's resemblence to female genitalia. But I'm not asking grandma (who would laugh, anyway.)

Part of my feeling of vulnerability came from the nature of the situation itself---the generalized lack of control over it and hoping for the best---like riding out a storm. But part of it also came from the subtle and not-so-subtle messages I received once being admitted as a patient. I'm used to having a lot of independence and autonomy, and that hits the bricks once you're in a hospital bed. One loses status once one becomes the patient---especially if one is bedridden. Suddenly, I found I had gone from being viewed as an independent adult with my own agency, to being viewed as somewhat childlike, or maybe just not quite as bright.

It was more than irritating. I found people talking around me, as if I weren't really there, or as if I couldn't understand them if I did. The dynamic felt similar to being pulled over by a cop---you just sit there on your best behavior and hope you don't get the ticket---because any response that asserts your equality is likely to be seen as "mouthiness", and isn't going to get you anywhere you want to be.

11:44 AM  
Blogger Flea said...

Armchair,

The story I told is more a mea culpa than anything else. In fact there would have been nothing wrong with my having asked this mother to cover herself up (she was not actually breastfeeding her daughter at that time - just sitting up in bed seins nues).

Ironically, what kept me from saying anything was fear of embarrassing this woman whom I didn't know very well.

best,

Flea

7:31 PM  
Blogger Dream Mom said...

"Trust me, there is nothing sexy about the bottom of a woman in labor."

Neonatal doc-I was just referring to your general comment above.

Also, I did understand that you were merely commenting on this lack of privacy and not necessarily condoning it.

11:53 PM  
Blogger Bardiac said...

If the problem's structural, is there any way to move beds around or something, so they face in a different direction?

8:52 PM  
Anonymous Anonymous said...

Oh we care! ALOT!! just at that time there's nothing we can do about it.
i'd like to see the ins and outs of scrub techs/housekeeping etc minimized as well.

8:22 PM  
Anonymous Anonymous said...

Many of these comments highlight something that is not quite addressed in the way that I'm going to address it.

Research after the Abu Graib abuses came to light. Humiliation from cruel and degrading treatment causes more psychological damage than physical torture.

Psychological trauma happens when something horrific or unexpected happens. Trauma comes from three sources: war, disaster and sexual assault.

Some of the comments on this blog talk about women being publicly exposed. Some of the comments talk about women not "covering up" when a doc walks in while breast feeding.

I was sexually abused just prior to delivering my first child. The treatment was cruel and degrading. A male doctor was disciplined.

Twenty four years later I found I had issues dealing with what happened to be. Medical care is now almost impossible due to the medical industry's importance of putting people to work over privacy rights.

This kind of treatment can take a mentally healthy person who can develop Post Traumatic Stress Disorder. Avoidance of anything reminding them of the trauma, erosion of trust, physical illness due to increased stress hormones and most of all changing the way you think about healthcare has taken a toll on me, my family and possibly the newborn.

It is now known that women psychologically traumatized during pregnancy causes aggressive behavior in the baby due to stress hormones released at the time.

Someone else made a comment that women don't cover up after delivery. I was one of those women. That deviant pediatrician came into my room. I was so full of dispair that I made no attempt to cover up what he spent a half hour gawking at watching his snear followed by the sexual comments when he came into my hospital room.

Now ad advocate for victims of sexual abuse to get the same gender care they deserve.
marjorie starr

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