Birth Matters

Auto mechanics and Obstetricians

I was talking to my husband over breakfast this morning about a friend of mine.  This friend has had 2 unwanted (and fundamentally unnecessary, by her estimation) cesareans, mostly because of big baby fears in her obstetricians.  At any rate, she’s pregnant again and wants to have this baby at home.  She knows that her chances of having a VBAC in the hospital after 2 cesareans are slim to none.  But her husband says no.  He’s absolutely opposed to the idea.  Why?  Because as far as he knows, babies are born sick (both of their previous children spend some time in NICU, probably the result of the inductions/cesareans and the other interventions at the time of the births).  To him, it is reckless to have a baby at home, when babies need to go to NICU after birth.  I’ll admit, it makes sense, if it were actually true.  I’m not sure what my friend is going to do but at least now she knows why her husband is afraid of a homebirth and that’s a step in the right direction.

 

So I tell this to my husband and bemoan the fact that this man is unlikely to get any exposure to the simplicity and health of the vast majority of homebirths.  And then I wonder (since I actually have his attention and there are no kids around to interrupt) – why are men comfortable with turning over the care of their wives to the hospital and obstetricians – is this just “how its done” or does it bother them on some level as protectors of the home and family, to give up that place to a stranger?  Well, he said, men really don’t know anything about having babies and men don’t like to be responsible for something that they aren’t an expert in.  So, when you have a problem and you don’t know enough to fix it, you turn to an expert.  That’s what happens when you go to the hospital – you let the expert (obstetrician, to most people) take care of the problem.  So of course, I respond, but the expert in birth isn’t the obstetrician, it’s the midwife.  And he says, yeah, but most men don’t know that (true, most women don’t know that either) – to them it would be like taking your car to Joe down the street who fixes cars vs. the auto mechanic.  Hmmm, I got to thinking.  He’s sort of right, but this needs some tinkering, as long as we are using a mechanical metaphor.

 

So, you have this car.  It’s not a fancy car, it doesn’t require a lot of advanced stuff to keep it running well.  In fact, it really runs well most of the time. But its time for a tune-up – time to see if there is anything going on that needs attention.  You have a couple of choices.   There’s this guy down the street – he knows a lot about cars.  You know him, he’s lived there for a long time.  He doesn’t have a big shop with lots of fancy stuff, he just knows a lot about cars.  You could take your car to him.  He wouldn’t charge you huge amounts of money and he knows how it is to be working and supporting a family, so he’s good about working something out if money is tight.  And you know he won’t tell you something needs to be fixed unless it really does.  And you know he’s an honest man, he’ll stand behind his work without a lot of double-talk.   Since he lives down the street and he isn’t that busy, he can look at your car today or tomorrow and you’ll have it back by evening.  You can just walk down and pick it up.  And if you’ve already made a habit of taking your car to this guy, well, he knows your car – he knows its quirks and the things it does that might not make sense but are how your car is.

 

Or, you could take your car to the dealer.  After all, there are lots of highly trained mechanics there and they have all the best and most modern equipment and diagnostic tools.   They’ll be able to get your car in about a week from now.  They will go over your car with a fine –tooth comb.  They will find everything that’s wrong, everything that could be going wrong, everything that might go wrong sometime soon and then some other stuff too.  And of course, they’ll tell you that if you want your car to last, if you want your car to perform to its peak, you should have all these things fixed.  Oh, it’ll cost you a pretty penny, but you do want the best for your car, right?  They aren’t too keen on prioritizing – discussing which things really need attention and which things aren’t critical to the function of your car.  And it’ll only take 3 days to do, if everything goes well, the parts come in and they don’t find any more unexpected problems.  If you don’t have the money, well, they might be able to put you on a payment plan…but truthfully, they’ll be more worried about getting paid than they will be fixing your car.  But they are the experts, with all the training and certification and you do want to do the best for this car, and what if something happened?  They don’t know your car but that’s ok, all cars are the same.

 

Of course anyone who’s ever tried to work with anything mechanical knows that the danger of “fixing” things is that sometimes they end up more broken than when you started.  I think this might be some sort of universal law.  Be careful what you fix…this certainly holds true for cars --- anyone who’s ever had an older higher mileage car knows that there comes a time when you just don’t want to upset the equilibrium that keeps the car running with unnecessary work.  And though it doesn’t make any logical sense, we also know that things like cars do have quirks and even “personalities”.  Same with birth – if it’s working, even if not to some arbitrary man-made standard of efficiency, trying to “fix” it is just as likely to make things worse as it is to make things better.  And certainly, women are not all alike and do things (including labor and birth) in their own particular way.

 

Now, if you don’t know the guy down the street, then taking your car to him would seem pretty crazy.  After all, how do you know if he really knows what he’s doing?  Sure, you know the dealer is likely to recommend things that you really don’t know, and yeah, you are going to pay a lot and you might be without your car for several days but what other choice do you have?  If your car needs work, you take it to the dealer, that’s what people do.  Any other choice is second rate.

 

Well, no.  You could go talk to the guy down the street.  Find out what sort of stuff he’s done.  Find out how long he’s been fixing cars.  Ask him if he fixes cars for other people in the neighborhood and go talk to them, see what they have to say.  Take a little time to get to know him, and for him to get to know you and maybe it won’t seem so crazy to let him work on your car.  And maybe, your car will get much better care than you expected, maybe it will run better and longer for having someone who knows it.   Maybe the culturally defined experts weren’t the best option for your car.

 

Now, lest anyone think that I have no use for either auto mechanics or obstetricians, let me say this – there’s final way they are similar.  If you have a good auto mechanic, he’s as good as gold.  Same could be said for an obstetrician – if you find one who understands cars (I mean birth) then that’s a rare prize.  Just like an honest mechanic, they are hard to find.  But they do exist.  You just might not want to assume every obstetrician is honest, even if you know some are.  And you certainly shouldn’t assume that they have the car’s (your) best interest in mind unless they are willing to prove it.  Get to know you.  Understand your quirks.  Let you talk to satisfied customers.   You get the drill.

 

July 16, 2006