Loyally Devoted to Doctor

I recently read the book The Highly Sensitive Person by Elaine N Aron, Ph.D. In the chapter called Medics, Medication, and Highly Sensitive People, the author states:

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

This entry was posted in Birth Trauma, Breastfeeding, Doulas, General, Homebirth, Hospital Birth, Induction, Informed Consent, Jennifer, Labor and Birth, Midwifery, Obstetricial Interventions, Postpartum, Postpartum Depression. Bookmark the permalink.

15 Responses to Loyally Devoted to Doctor

  1. Melissa says:

    Wow–what an interesting, well-stated post.

  2. I had been pondering this concept a few weeks ago, but didn’t take the time to articulate it. I had different points to express it, but this adds even more evidence. If I have the chance, I’ll try to remember how I expressed it.

  3. tigaseren says:

    I’ve read about this phenominon (sp?) as well as it relates to other situations mostly. I find it interesting that someone finally published it as it relates to medical situation. In other situations I have read that the difference between some people becoming attached and others becoming traumatized by the person (doctor in this case) involved has a lot to do if the person reacting is responding to the ‘fight’ or to the ‘flight’ response. If they are geared towards ‘flight’ then they will work with the situation, forming a strong attachment in an attempt to garner help to flee. If they are geared towards ‘fight’ they are more likely to feel traumatized/angered by those involved as they become agressive in an attempt to fight through/against the situation. I have read this is why some people are more likely to develope stockholm syndrome than others. A woman in labor is instinctually inclined towards ‘flight’ since she isn’t in a physical condition to ‘fight’, and most of them aren’t going to have a strong enough pre-existing personality inclined towards ‘fight’ to overcome that, people who are strongly inclinded towards ‘fight’ under normal circumstances may be too torn to do anything but freeze (which is likley to cause trauma later because they won’t feel like they did what they ‘should’ have done to protect themselves and/or they feel like the decision was taken from them, which in most cases it was).

  4. Jennifer says:

    tigaseren,

    That is really interesting. It also sheds some light on why women who have a history of trauma are more likely to be traumatized by childbirth (they must have already been conditioned to ‘fight’). I have never read of the relation between fight and freeze either. I knew about fight, flight or freeze, but didn’t realize that freeze would be something that your body would go to after failed attempts to fight. Do you happen to recall where you read that?

  5. Dou-la-la says:

    What an epiphany. Wow. Thank you for this.

  6. jenne says:

    Tigaseren, yup. My response was to fight, and when I gave up fighting, I froze.

  7. Very insightful….I do believe most women need a safe person to anchor to in labour. As doulas we have tremendous power to help a woman and often her mate attach to someone confident in her abilities, someone who is invested in her humane treatment…basically, someone who is lovingly rooting for her to feel amazing about herself. This attachment provides the springboard for calm, grounded mothering.
    There are also those who prefer to be solo, like those who choose uc. That’s cool too. Better to attach to the experience alone than to attach to someone negative, of you’re looking at it from a purely attachment point of view.

  8. Elizabeth says:

    For more information on trauma resulting from an unresolved fight/flight response, check out “Waking the Tiger” by Peter Levine.
    http://tinyurl.com/yan4a4u
    (This is not an endorsement of Amazon, just a convenient link.)
    The ideas offered by Tigaseren closely follow Dr. Levine’s work too.

  9. Guggie Daly says:

    Has anyone read “Pleasurable Husband/Wife Childbirth: The Real Consummation of Married Love” by Marilyn Moran?

    She works through the same issue within the context of sexuality on a spiritual plane (she is a Catholic).

    Her agument is that this attachment during birthing is the same as the attachment made during sexual intercourse. She argues that birthing with the partner present creates a strong bond and impression upon the woman, the same as having sex and that if the woman instead births with a health care provider, she will have a disordered bond with another person. (Of course, this was written back in the day when partners weren’t allowed to be present).

  10. courtney says:

    there is also some reference to fear as an inhibitor during labor in ‘water birth’, a book on a loosely related topic. the authors talk about how women in an unnatural setting can’t birth as easily, may have early release of catecholamines or have other physiological responses leading to the ‘cascade’ of interventions common these days to hospital birth. i have been trying to get a logical answer to the question of why there is acceptance and mostly happiness with scheduled inductions and elective cesareans among my peers to no avail. maybe this is the psychological link. thanks for sharing.

  11. As a Midwife, I have been of the impression for a long time that, in truth, women don’t “need” help bonding with their babies, or in “learning to breastfeed” since both are as inherently present as the “knowledge” of how to give birth. I’ve found over and over that the best outcomes on all fronts happen when “we” stay out of the way, only offering help and guidance WHEN IT IS ASKED FOR and not when we “think it’s needed”. I’ve rarely had a mother fail to bond with her baby or figure out breastfeeding; I had more “problems” back in the day when I thought I had to get in there and “assist”. My personal conviction is that the job of the Midwife is to support the husband/family in caring for the mother, during labor, birth and postpartum, not to replace their care. We often unwittingly disrupt relationships within the family by making our role too central. As to why women continue to see and venerate Physicians; it is far more complex than you are asserting here. Women continue to choose Physicians as maternity care providers because their level of education and expertise if culturally mandated and supported. We live in a country where the level of formal education and training correlates highly with the level of trust given to the provider and that’s true across the board in all disciplines, not just in maternity care. One of Midwifery’s glaring blind spots is in NOT taking seriously how impacted women are by cultural expectations about education and training and what is pereceived to be normative for a “Professional Health Care Provider”. Apprenticeship education, or education outside the University system is viewed as sub-standard by most people in the West whether we like it or not and it’s going to hold Midwifery back especially since CNM’s are now going to require a PhD. for entry into practice and ADN Nursing programs are going to be turned into B.A. programs across the board. It’s very hard to make a case for an educational process that requires only a High School diploma for entry when all other Health Care Professions are requiring more and more edudation and Degree attainment for entry. I don’t like it either, but it’s a fact and facts are stubborn things!

  12. Jennifer says:

    Michelle Wilbert,

    I completely agree with you!

    The reason I wrote about “teaching” a woman to bond and breastfeed with baby is because hospitals often corrupt this natural process by their routine practices, and then “teaching” does become necessary – yet it is not happening. By “teaching” I more meant what you said: staying back and allowing mother to let nature take it’s course. But also, jumping in with helpful advise if things don’t go so smoothly, for example if a baby is having trouble breastfeeding. I maybe could have explained that more, but I was just searching for a shorthand word I could use that would get the point across.

    Also, I realize that the reason women choose physicians and not midwives is far more complex than I could cover in this single blog post. However, I was more discussing the aspect of why women choose to stay with a physician and “love” him and treat him as a hero, when the evidence right before her shows her that it may not have been a great choice. As to why women choose physicians in the first place, yes I totally agree that is cultural and does have a lot to do with perceived expertise in the field (which is also why more US women choose OB’s over family practice doctors or CNM’s).

    As for the education level of midwives, I agree that this is one reason many women do not choose them. I chose a CNM hospital birth over a midwife because everything I read at the time emphasized how the education level of “lay” midwives was not standardized and some were not even licensed and that really turned me off to the option at the time. I plan to use a homebirth midwife if I have another child, but I completely agree that education level is a huge obstacle in ever bringing homebirth midwifery to the mainstream, and it is something I rarely see addressed.

  13. Pingback: Best of the Birth Blogs – Week Ending December 20th | ICAN Blog

  14. 2Shaye says:

    I’m so glad to find this post. I hadn’t heard of another account of this situation, but I’ve been asked to speak to others about how this bonding phenomenon impacts a mother/family and future births. When we’re in a situation where we are purposefully led to believe we’re in danger and that we need an expertise that resides outside of our bodies, everything is in place to begin a life-long dependency. The providers I spoke with at the last conference (mostly midwives) were a bit freaked out because it all made sense. And if we can just get our moms into an iatrogenic cesarean, then we will usually have them stuck on c-sections for any future births.

    I don’t believe it is just the (unnecessarily) traumatic situation we’re put in, I also think there’s something to be said of the surge of hormones that we experience during birth and just after. When you’re left alone in a room with your OB during that portion of birth (they took my baby away and my hubby went with her while my OB stayed with me through the end of my surgery as I began recovery), it makes perfect sense that our providers are the ones we bond with instead of our babies and spouses. For me, I bonded with him so much so that I let him talk me into another c-section two years later. After all, he would never do anything to harm me, right? It’s scary to remember how I wanted to cry when we left the hospital because I wouldn’t get to see my OB anymore! After my iatrogenic c-section, I even remember the urge to refer to my OB as daddy! I was SO looking forward to my 6 week postpartum visit so we could recount the experience and adore my baby together.

    I’m just delighted to hear more about this and to see that this article is still being circulated on Facebook and beyond. Thank you!

Leave a Reply

Your email address will not be published. Required fields are marked *

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>