Elizabeth Petrucelli

Author, Blogger, Educator

Category: childbirth education

What Pregnancy is this for you?

I remember when I attended my last pregnancy prenatal yoga class. On the first day, the instructor asked, “What pregnancy is this for you?” She asked all the attendees. She started with “Raise your hand for #1,” then said, “#2?” “#3?” With each number, women would raise their hands but she stopped at #3.

I felt left out. I hadn’t raised my hand yet. She only went to pregnancy #3. So after a few moments, I raised my hand and said, “#5.” The instructor was happily surprised exclaiming, “WOW!! You are amazing! How wonderful that you can get away for self-care.” Then I thought, “Geez, that’s kind of presumptuous.” I responded, “Well, not really.”

She immediately jumped up off the floor and ran over to give me a hug. She embraced me and told me how amazing I was and then I became embarrassed and angry at the same time. She assumed I had four children at home because this was pregnancy #5 for me. I became quiet. I didn’t want to scare any of the other attendees, especially on the first day.

But as the class continued, she kept focusing on me and asking me for advice to share with the class, such as how to manage the schedules of four children. I ignored as much as I could and offered advice where I could. This continued through several classes and it became harder and harder for me to participate, not because I was sad but I was annoyed. Her question, “What pregnancy is this for you?” did not leave any room for explanation and left tons of room for assumption.

This created a conundrum. How do I explain to her at this point that I only have two living children? I thought about talking with her after class but this instructor was not good with time management. She consistently held us over by 20 to 30 minutes each class and I had a family at home to feed. If I really did have four kids at home, I couldn’t understand how she could be so inconsiderate of my time.

I ended up dropping the class. Questions like this make me wonder if I am approaching my questions about pregnancy in my childbirth education classes appropriately. While I don’t ask what pregnancy it is for my students, I have asked if they are first-time moms. It doesn’t really leave an opportunity for babies born early. I have decided that asking the question differently is the way to go.

I could ask, “how many of you have given birth before?” but that would probably confuse women who have had miscarriages as many of them (especially early losses) do not believe they have given birth. “How many of you are first-time moms?” is really no different.

“Is this your first pregnancy?” might offer better availability for an answer but could also be awkward if the family isn’t acknowledging their prior losses. So what DO you ask?

It’s complicated. You have no idea who is in your classroom and I have had several students talk about their stillbirth or losses. In one of my last classes in particular, the mother blurted out that this was not her first pregnancy and that she had lost her son at 20 weeks. She was attending this birthing class at 20 weeks and I think she was attending as an act of bargaining or a way to validating the pregnancy. 20 weeks is very early to attend a birthing class. I suppose it could be useful if there is a concern the next baby would be born early.

Still, “what pregnancy is this for you?” puts mothers enduring pregnancy after a loss in a precarious situation. It’s often anxiety provoking because mothers want to share their deceased children yet do not want to scare or upset a person and if they don’t share then they may feel guilty for not sharing. A seemingly joyful question has turned into an anxiety provoking question.

When I think about it, why even ask? What’s the purpose of asking? Maybe it’s an “ice breaker?” I know I ask in classes because if a woman has given birth before, her experience this time around might be different and we talk about that. I am considering no longer asking the question.  It’s important that all mothers feel comfortable in class and asking “how many children do you have,” or “what pregnancy is this for you?” is not necessary.

So what should we ask? How about, “How are you feeling about this pregnancy?” “What anxieties are you experiencing that we can talk about?” Be prepared for someone to share about their loss and if they do, please don’t blow them off. Recognize what they have said, offer condolences, ask about their baby/child, share if you have had a similar experience, and follow-up. drt5ye

Termination

Eighteen months ago, I embarked on a journey. A journey I have never been on in 26 years I have been employed. I have been relatively silent about this journey, mostly to protect myself from embarrassment and my current employer. But like most things, opportunities present themselves and doors are opened which allow the silence to open into dialogue.

I am an educator. I have been a certified childbirth educator for over four years but I have been teaching childbirth education on and off since 2004. I have also served in the role of educator in various occupations so teaching isn’t new to me. Whenever I teach, it’s been important for me to share as much information as I can so people can make informed decisions about what I am presenting to them.

As a childbirth educator, it is not my job to sway a parents choice in one way or another. New parents have so many decisions to make and as their educator, I try to make that process easier by presenting all facts. I take great pride in having a diverse curriculum.

As a pregnancy loss advocate, I too try very hard to present all the options and choices families have. Options which are rarely presented to them by their care provider or hospital staff. Even though hospitals believe they have strong bereavement programs, they still miss the mark on some of the tiniest of options which parents should have the benefit of choosing because it can make all the difference in the world.

Care providers may begin to sway families in a particular direction because they feel it may not be important to the family or because it takes more time and/or effort to provide a particular option. It’s a huge disservice to families. I have written about organizations who are agenda driven and aren’t clear on the populations they serve. I have shared experiences from families who felt their care provider didn’t care. And today, I will share an experience that is so very hard to tell but really needs to be told.

I was fired.

I was fired for providing evidence-based information to students within a hospital prenatal class; which led to them asking questions during appointments with their care providers. Various complaints came from these care providers such as: “my patients are asking too many questions and I am getting behind in my patient load,” “I only allot five minutes of time per patient and they are asking too many questions,” “it’s not my job to inform them about ____,” “What kind of information is the educator giving because it’s not evidence-based,” and more. If you think that doctors enjoy educating parents on important topics, this study shows how doctors find less job satisfaction by spending more time talking with parents concerned about vaccinations.

I worked closely with my manager any time a complaint about my curriculum came up. So much so, that my presentations were reviewed and approved numerous times throughout my tenure. After receiving an update that I shouldn’t talk about delayed cord clamping (which is now a standard of care at nearly every local hospital), future complaints involved my education on circumcision. If a student asked about something that was too controversial or a topic my manager “implied” that I should not speak about, I was told to defer them to their care provider to ask those questions. Despite the changes, nearly every few months, I was pulled into my managers office because of the information I presented about newborn circumcision.

The information I provided was given to me by my manager from the hospital’s system “Up-to-Date.” My manager informed me that they didn’t care if patients weren’t choosing to circumcise but too many questions were being asked and I needed to stick with the evidence. Each time, my manager would review my presentation and approve it. I was sure to stick with what was on the slide during my classes but I couldn’t stop students from asking their doctor questions about the procedure.

After two years teaching at this hospital, I was fired. Patients were asking too many questions of their care providers. Were they upset that parents weren’t choosing newborn circumcision? Did they feel the patients were questioning their ability? If they weren’t going to present the real risks and benefits of procedures, who would?

I had worked for this hospital in varying roles for six years. I knew the in’s and out’s of the political environment there and I knew that doctors were to be kept happy at all times. Doctors must be catered to at all costs and were not subject to the same rules and policies that regular employees were. Doctors were special; they were to receive free meals, special lounges stocked to the brim with food, and were not subject to discipline if they were found stealing food or destroying property. The more prestigious their specialty, the more important they were and the more they got away with.

So it was no surprise that I would take the fall when these doctors complained about what their patients were learning in childbirth class if it didn’t fall in line with their opinion. In the last class I had, before I took the fall and was fired, a student kept asking if a doctor could force her into a particular procedure. I had been suspicious of her probing because she kept asking and other students were getting nervous. It seemed she didn’t have trust in her care provider. I explained that she should work closely with her doctor to ensure a mutual trust but ultimately, she cannot be forced. It’s assault, it’s against the law. That statement sparked an investigation and led to a meeting with HR.

But in that meeting, HR was only focused on the circumcision information. “We think you are teaching out of scope,” she said. “Really?” I replied. “I was hired to teach newborn care. It is well within my scope to provide the risks and benefits of circumcision. The information I provide was given to me by my manager and approved several times.”

She fell silent. After she explained their concerns, she presented me with two options. Resign or be terminated. I have never been terminated in my life. As a 40-year old woman with a military service-connected disability, I played the card. “I am not resigning, you will have to terminate me,” I said.

She then explained that she couldn’t fire me and would have to call me back in next week after talking with my manager. My manager was not on my side. She was tired of having to field phone calls about what I was teaching. There was a six-month period of time where I did not have her as a manager. I reported to a director and not once during that six-month period was I summoned to her to answer questions about what I was teaching.

My current manager had a bias against me. I don’t say this lightly but she did. Numerous times she talked about how I was a doula and that skewed my view of childbirth. She thought I was focused on “natural things” only and that I was against epidurals (never mind that I had an epidural at each of my births). She was angry when students called me in to support them through the death of their baby and required me to put up a flier for staff stating I was not employed by the hospital when I assisted families through stillbirth. So my manager was definitely not on my side and I knew she would do everything in her power to fire me.

I felt I had a good standing though. Not a single poor evaluation, 4 and 5 star evaluations from students, and of course, I had followed her requests and my slides had been approved by her. A week later, I received the call. “We could not come to an agreement from both parties,” said HR. “What is the solution?” I asked. She would call me in a few days.

A few days later, HR called with my manager where I was informed that I would be terminated because I present too much controversial information. I knew what she meant. My manager frequently stated that our patient population is “highly educated.” She stuffed that down my throat nearly every meeting. However, she hasn’t taught the classes and she didn’t hear their questions. Just because patients have high school diplomas and college degrees does not mean they know anything about childbirth and the procedures that come with it. They may have the means to look things up but they take a class to learn all they can.

I asked for a termination letter and received it. Then I applied for unemployment; which I also received for a short time.

The bottom-line was this; the hospital did not want their “educated” patients to ask questions. Even though my slides were approved and my manager stated that what I was teaching was great information, I was thrown under the bus when the pressure was too much for her. Instead of standing up to what her educators were teaching, she chose the easy way out. Fire the educator who encourages students to research and develop a trusting relationship with their care provider through asking questions.

By now you must be thinking that I am some sort of “intactivist” who is against circumcision and that I had to have been breaking rules or giving biased information. Students in my classes were taught the “evidence-based” information from Up-to-Date; the hospitals own resource center.

BENEFITS OF NEWBORN CIRCUMCISION
May reduce the incidence of urinary tract infections for the first six months of life.
May prevent certain sexually transmitted diseases such as HIV (although this study was done on adult African males circumcised as adults).
May reduce the incidence of penile cancer.
May reduce the incidence of inflammation of the glans (head of the penis).

RISKS OF NEWBORN CIRCUMCISION
Pain
Bleeding
Infection
Meatal Stenosis
Removing too much foreskin
Buried Penis
Loss to or damage to all or parts of the penis
Death (mostly attributed to infection and/or bleeding)

Students were informed of the statistics such as circumcision is on the decline in Colorado, that the AAP does not have an official recommendation and leaves it up to the parents, and that this is an elective procedure so double check with your insurance company to see if it’s covered and if your doctor performs the procedure.

Numerous times I had been called by students because their doctor would not do it and they needed a recommendation. They were referred to call a urologist when their OB or pediatrician would not perform the procedure. So you can see, the information I provided was not biased.

I still teach. In fact, this information is or has been presented at three other metro hospitals with no complaints. It is the culture at this hospital. A culture where they don’t want patients informed. They don’t want patients to ask questions or to research information. It’s a culture where “I am the doctor, therefore you will do what I say.”

I am not making this up. I have witnessed doctors making these statements to women and their partners during labor. I have seen doctors threaten patients with child protective services or calling law enforcement if they don’t do what the doctor recommends.

What’s the big deal with circumcision anyway? It’s just a snip right? Check out the video below and tell me if you think it’s just a snip? Wouldn’t you want to be fully informed before you subject your baby to this?

I have two boys. With my first, I was never informed about circumcision. I assumed it was a painless procedure where they just cut of a bit of skin. I had no idea that the foreskin is attached to the penis and they would tear it off. I had no idea the foreskin was functional. No doctor or childbirth educator talked with me about circumcision other than to say, “everyone does it.” When my son was returned to me after his circumcision, I knew something wasn’t right. I knew he would never be the same. I knew I had taken something from him and what I saw when I opened his diaper was shocking. It was an unexpected outcome.

This prompted me to learn more and as an educator, I wanted parents to be informed. I wanted them to know what to expect, not just with circumcision, but with any decision they make for their labor, delivery, and newborn period. Those decisions can affect them and their baby for the rest of their lives. How can a parent make an informed decision about any procedure if they are only given a one sided view or pieces are left out?

By the way, I also educate on how to care for the intact penis. I have observed five different newborn care educators and only ONE also educated on caring for the intact penis. Did you know that not everyone chooses to circumcise and if parents are not educated on how to care for their intact son, damage can be done? A patient population is being blatantly ignored.

We cannot leave out the bits and pieces to sway parents into a decision we believe is right for them because they may fail to research or understand it. They may not have known there were other options available to them because bits and pieces were left out.  Isn’t it a childbirth educators job to inform?

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