• Last night I had the opportunity to speak on a panel at The Scarborough Hospital (Grace Campus). The discussion was organized by the Family Advisory Council on Maternal and Infant Care. My role as a member of the Advisory Council was to speak on the valuable role that choice plays in improving outcomes in pregnancy and birth care.

    Overall, I think the presentation went very well! I was very pleased with the points that I chose to raise, as well as the audience response. The bad news is that my digital recorder failed on me (or maybe I failed on it) — so was not able to present My First Podcast (as I’d hoped). Well, maybe next time. Instead, I’ve listed some of my notes here of the main points that I put forward in my presentation. Your feedback and comments are always appreciated.

    • What solidified my interest in Family-Centered Care (FCC) is what I call my two-track prenatal experience
    • RELATIONSHIP WITH PHYSICIAN: My physician and I had a good relationship prior to my pregnancy
    • She was open and kept me informed on all matters, illnesses, checkups, etc.
    • Bonus: We also had a shared cultural background so she understood my issues and perspective, jokes i.e. “I’m wearing my Sunday baggie.”
    • My pregnancy changed the Code of Conduct, script, choreography of visits
    • I lacked an understanding of this new “prenatal culture” — i.e., concept of “trying to get pregnant” and question of “are you keeping it?”
    • Suddenly I was not qualified to participate in my own care
    • Even shared cultural background wasn’t enough to bridge the gap (the culture of prenatal care trumped our previous relationship)
    • Handouts were not culturally relevant
    • Ongoing issues around diet, midwifery, homebirth, birthplan, sick vs. healthy attitude, etc.
    • My husband and I would joke about what government secrets were lurking in my med file (information not shared, results of tests not forthcoming)
    • Increased tension; not enough information provided to make informed choices and doctor seemed offended by my questions
    • Issue of control of my care at a time when I was “losing” control of my bodily function — control of any kind was very important to me
    • Parted ways with physician over issue of HIV Test (physician made bad judgement call when I refused an HIV Test that I believed was optional)
    • MIDWIVES: I transitioned my care into that of midwives
    • I was treated with respect
    • I was allowed and encouraged to participate in my care
    • Weighed self, tested own urine and reported results to midwives — medical file always open on the desk, I could see and comment on the comments
    • Debated pros and cons of all tests, final choice always mine
    • Birth plan was encouraged, discussed and respected
    • I didn’t always get my own way but discussion helped me to understand why not
    • My culture was respected
    • BLACK WOMAN AND CHILD: At that time, I felt that mothers of any cultural difference or having any difference in perspective could not get fair treatment or choice in a physician-run hospital system
    • As a result, I began publishing a magazine to promote and validate the cultural perspectives of Black women around the world
    • I held fast to the ideology that “smart,” healthy, empowered women gave birth at home with midwives and only “sick,” scared women gave birth in hospitals with physicians
    • home birth = choice and hospital births = challenges
    • Working with the magazine, I had an opportunity to speak to many different kinds of women
    • Learned that some women were having healthy, safe, empowered and successful births in hospitals too — what made the difference was the level of involvement or choice
    • I learned that it doesn’t have to be polar opposites
    • Home birth is not for everyone but having choice can empower birth outcomes for families even in a hospital
    • NEW VIEWS: Hospitals like TSH are promoting that they are open to Family-Centered Care
    • Women and their families can benefit from having options, benefits also roll over to staff and overall view of hospital
    • Example: a birth plan helps to address issues and opens dialogue between pregnant mothers and caregivers
    • A birthplan also takes pressure off staff: the hospital is note solely responsible for successful birth outcomes
    • Example: Cultural ideals can be good ideas that staff can learn and pass on to other patients
    • Culture doesn’t happen in a vacuum
    • We all want to belong; not check our culture at the hospital door
    • In childbirth, we may be at our most vulnerable but mothers are not monsters — we can actually be reasonable
    • Example: I like to eat barley porridge right after giving birth. I don’t expect to get that in the hospital cafeteria BUT is the hospital open to having a family member bring some for me? Let’s work together.
    • When a mother is relaxed, happy and confident, we get better outcomes, better births, less snapping at nurses and bad attitudes
    • The input of relatives is validated, helps mother, speeds healing
    • The birth experience, whether hospital or home, set the tone for future attitudes about childbearing and child-raising
    • I am on Baby Number Four, so I know that there’s some truth to this

    Nicole Osbourne James

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