Loose lips - sink nothing?

[Everywoman]

(I got a new username for this one.)

I was at a party describing a birth. I changed the state, I did not reveal the name, I left out any identifying info. Very simply, "I was at a birth in xxx state during which the mother . . ." It could have been home, it could have been hospital.

The midwife who attended the woman was also at the party. She said the name of the woman loudly so all could hear, then she revealed the town. The mother is known in the area. No one acted as if anything was amiss.

The MW went on to laugh at the party about how I had labored in front of me and the others in the room. She imitated me. No one acted as if anything was amiss.

I recently went to a chiropractor who is a friend of the MW. The MW emailed me, telling me when I could fit my chiropractic appointments into my schedule. I concluded the MW must have been told about the chiros treatment plan for me. I called the chiro, telling her that I would like the MW not to be bothered with my medical info. The chiro. responded that no medical info. was given to her, just how often and badly I needed to be seen. I thought that was medical info.

Is it everyone else or me?

[notyourusual]

I was just talking recently about loose lipped situations like these. Here is my story:
http://www.mothering.com/discussions...d.php?t=366976

It's becoming epidemic I think there is too much information is being given out still. I'm becoming more and more hesitant to discuss any aspects of any previous births that I've been at. It's not appropriate and is illegal to even acknowledge that someone is even a client/patient. There are confidentiality laws that are becoming more and more strict that are not being adhered to as much as they should.

[Everywoman]

Your post is where I got the idea to address this.

The situation, to me, is epidemic. Midwives often cross boundaries and even flirt with it in their advertising. Midwives bask in the triumph of their client's births. They may take credit, and how easy it is given alternatives that exist in care. When a midwife is so close to the family, there is a familiarity that is not seen in many other professions.

How might this be addressed within the midwifery community?

[cathicog]

I hope *i* have not overstepped that boundary. But if we have a question about a particular aspect of care, what is the best way to present our question and get an answer without jeopardizing client confidentiality. And is it ever permissible, even with client permission to post a birth story online/ in a blog.( I know of several) Where does one draw the line? and if I have crossed it *please* let me know! I am still new at some of this...

[notyourusual]

The only way that it will ever be addressed within the community is for people like us to speak out about how it effects our feelings. There is an assumption that sharing positive birth stories is okay and that it doesn't effect women the same, but that is a highly inaccurate assumption that needs to be brought up!! After my situation, I am always very sensitive to bring up the subject whenever I see it - it has to be, because I think so many are ignorant to it.

I think that sharing questions about midwifery care, etc. is completely appropriate when discussed in the proper environment where it is a discussion between professionals that typically understand confidentiality. Even after my whole situation, posting in a personal blog, IMO, as long as it is protected and not shared publicly is okay as long stories are extremely vague (not using clients names, pictures, locations, or even first initials). I also question motives for those posting in such public places - praise? It cannot all be based on wanting to share positive stories that birth works, etc.

[Everywoman]

Notyourusual, praise, you ask? Yep. midwives have knowledge that is lost on much of the rest of the chilbirth community. . .and their knowledge is wonderful for outcomes. People listen to their midwives, they praise them heartily, midwives bask in the glow of it all. I remember attending a breech birth. The family called me heroic. They said I saved the day! I was in the midst of reading a book at the time that outlined different approaches to medicine. I felt like I was being pushed into the mold of heroic (or patriarchal) thinking.

Cathicog, I don't know what you have disclosed about clients. Consider yourself a client who is EXTERMELY private. Would you feel remotely rattled about anything that was said?

There is a teensy provision in Hipaa for peer-review-type discussion.

I have, however, seen "professional" midwives get together and call their clients deregatory names, crazy, etc. . .and show a significant lack of compassion. Imagine if another group of professionals did the same thing. Imagine therapists talking about their whiny fruitcake clients.

It might open a beehive, but, should this knowledge be integrated into the training of midwives?

I have written a piece for doulas on the subject of professional boundaries, of which this is a part.

[notyourusual]

Originally Posted by Everywoman

It might open a beehive, but, should this knowledge be integrated into the training of midwives?

Absolutely . I remember taking a class on ethics and the instructor talked about just this and it has stuck with me forever. She talked about how some women don't want others to know the size of their babies, how they had a wonderful homebirth, how they were so strong, etc. Hopefully there will be more written on the subject. You should write something for Midwifery Today!!!!

[Everywoman]

Hmmm, then my MW might actually read it.

How is the doula one for starters?

As doulas, we often do not recognize ourselves as professionals with the same
boundaries that exist in other professions. This bleak conclusion has been
reached after years of interfacing with those in the profession. Doulas
examining the subject of the doula/client relationship would benefit from
further edification of the topic. In essence, doulas require the introspective
examination of boundaries clients are allowed to cross with us, those crossed
with clients, and those crossed within what would otherwise be a professional
arena.

Perhaps the most examined boundary is that which is set in relation to clients. In part, the practice of boundary-setting with clients informs them so they do not devalue the doula as a professional. In receiving the overstepping of boundaries, the doula has become unprofessional, and is required by one's own fault to have no complaint.

How satisfying it is when clients like us, when they believe us, when they trust us. They may ask what to do, and we may want to tell them. It can be
comforting for the client to hear; it is gratifying to us to be heard as
someone with authority. "The fever seems really low," or, "Any nurse
would have told her to drink fluids," may seem benign enough from the
outside, but granting of such information is out of the scope of a doula, and
can be a stumbling block to the client?s continuity. In some cases, it can
be a stumbling block to clients believing in their own parenting skills. How
liberating for parents to have their independence encouraged in this subtle
way.

Next, it can be difficult for doulas to retain client's boundaries. One example
of a breech of professionalism is the use derogatory slang to describe the
mental state of or one's relationship with a client, a breech seen with many in
the perinatal field. Words about our clients speak strongly to attitudes about
them. One cannot serve well a client about whom there is disdainful or overtly superior feeling. (This mother belongs on the moon! I don't know what else I can do for these people. I need to hold her hand with everything. She doesn't even think she wants to breastfeed!)

Professionalism dictates doulas recognize their boundaries and accept or refer
clients according to individual limitations. Some doulas do not work with
smokers: others recognize that they cannot serve lesbian clients. Failure to
properly recognize and respond to one's own boundaries results in poorly-served clients.

All doulas, however, need to, as a matter of definition, house the mental,
social, and informational preparation to serve clients with what may arise
during the time with them. To fail to do so adds hindrance or even insult to
what may already be a difficult situation. Doulas do well to be reminded to
update their knowledge on fetal demise, molar pregnancy, cesarean birth, abuse, ventouse, undiagnosed breech, postpartum depression and PPP, as well as the remaining litany of unintended situations that may be experienced within a birthing family. To fail to do so is to poorly serve or even become a
stumbling block to clients.

Of particular importance are the boundaries we cross amongst ourselves. Even in case studies in professional publications, the circumstances are altered in addition to names so there is not the possibility of one inadvertently making a connection to the subject of the study.

Doulas can easily humiliate their contemporaries by the disclosure of
inappropriate information or the making of disclosures in an inappropriate
manner. These disclosures thrust the receivers of information into the
position of ignoring the information, coming to see dissemination of
inappropriate information as normal or desireable, or trying to improve the
integrity of the profession by speaking to a wayward communication. It is very appropriate to seek the professional opinion of others within this forum, hint: keep it vague and hypothetical (this practice may help with apropriate
professional distance, too); it is not appropriate to gripe and complain about
clients' deletirious effects on the otherwise professional doula.

[MamaTaraX]

Wow. Interestingstuff.

HIPAA and confidentiality kind of scare me. Have you ever read through one of those big fat HIPAA books? Basically, everything is off-limits. If everyone followed it to the letter, doctors couldn't even treat patients with their partners or collegues. It's insane. I think that in many instances, it's taken too far. I'm not saying that care providers (doctors, midwives, therapists, doulas...even office workers for those people..) shoudl go about shouting personal info fromt he rooftops, but I think that some people really do the tightlipped thing a little too much. How do we learn about things if we don't share with others? 100 years ago, this wasn't an issue. Read through medical texts. You can get names of people, their care providers, all kinds of info about their care. Nobody balks at that.

Having said all that: I strive to be confidentiality-concious. I freely admit that when I come home from a birth, I'll tell my family the gender of the baby or if the birth seemed positive or not. No identifying details. I've never said anything about any of my clients that would in any way identify them. That is what HIPAA and confidentiality rule sare all about -- no identifying information. You can talk about specific cases, but not specific names. I can talk about Jane Doe as long as I don' tmention the mole over her right eye and that her husband only has three fingers on one hand. Things like that.

I think that professionals should be able to share with each other in a non-specific manner. and I agree with whoever up there said that no one is going to take it as sucha big deal until the people being talked about speak up about it. If it has happened to you and it truly bugs you, speak up. Me? I wouldn't care. Wanna use my info to share a story that can teach someone something, please do. But I' mnot everyone.

Namaste, Tara
mama to Doodle (7), Butterfly (2), and Rythm (due at home 1/06)

[Everywoman]

After an employee signs a hipaa waiver, the employee is allowed to see records of those seekling care within the practice.

100 years ago, people did not recognize abuse to the extent it is seen today, either.

In my original post, I was describing how I was appropriately (I think) using information to explain someone's "groove" in labor. To give identifying information is not ethical, nor is it ethical to turn someone's very personal experience into an urban legend.

I show birth videos of people who let me. A homebirth midwife showed my friend's birth video with neither her knowledge or consent. The former is fine. The latter is not.

Proessionals do speak of their experiences with clients and learn from each other. This review differs from unethical practice.

I am attempting to bounce my 'speaking up' off those in the forum so it may be implemented where it can do the most good.

Do you think I have gone overboard in some way?

[Charmie981]

I'm a very private person and try to treat my clients as I want to be treated. I remember coming home from a friend's birth, which ended up being a suprise breech at the back door of the birth center...very shocking and a bit stressful, too. My sitter (who also knew the client and had deduced that it was she who was in labor), asked how the birth was. She knew me well enough to know there was something else besides "great" to the story. In a situation like that, it IS really hard not to say "OMG, she had her baby breech at the back door of the birth center and it was CRAZY," BUT, you can't say that. I go home and write about it or something, always making sure I never write her name with the story. In this case, the mom did eventually tell everyone her baby was a suprise breech, but I still don't say anything about it. Even almost two years later, it's a lot easier to say "you'll have to ask A about that. I'm not at liberty to discuss her birth experience with you."

My first client of my own is a friend of a lot of people I know. I keep waiting for someone to say "is X a client of yours?" I can't answer that! But people don't get that. They think you're being a b*tch. Whatever...I'd rather people think I'm a PITA than be sued for violating confience. If X wants to say that she's having a homebirth with me and she's excited about it, that's her thing. Even if she says to them that she's having a HB with me, I still can't say yes or no to that. Basically, I can't talk about what I do for a living at all!

I do talk about birth stories at times, but never with any identifying information. Yeah, I've probably crossed the HIPPA line a time or two, but all in all, I am tight-lipped when it comes to who I'm taking care of and how their care is going. I don't think it's unreasonable to expect a midwife to adhere to HIPPA laws to the same extent that an OB adheres to them.

[mwherbs]

and yet our experiences are our greatest teaching tools-- how about if the same were to hold true that unless everyone at a birth agrees no one can tell the story, certainly my actions as a provider without being referenced are not just to be had by anyone either. How do we feel about hospitals and birth centers that don't allow pictures or movies to be taken... birth is both joyous and scary and we share it and process it we are women and it is important to share .. I have been going to births for over 20 years and I do pull from those births sounds and experiences to help others-- not for veinglory -- but lets say one woman who was disheartened and gave up and the other midwife with her up all night long too was ready to throw it in - but nothing was wrong, we are preparing to go to the hospital but ...... ah nope not telling... nope
and yet that same story that story can happen again, or similar enough do I not use it.. say something act like something reference it. it is reality not just a concept or theory it is something that happened in the world and is useful now.

continuity is what has been broken with women, a doctor in California who was fighting against natural birth in the 60's and 70's said all they would have to do is wait out the fad, and then they could do what they were doing all along.. and he was right, because the continuity of how birth is taught in medical schools and what do we have- schools of thought that tie us together no very small tribes that rely on word of mouth and a few very revealing books-- thank you Ina May. unfortunately we also have tons of parents we cannot or do not trust to help us learn things from their experiences...

other ideas...erased because it is an example and is someone's story..........

on the other hand here in AZ the state requires basically a complete chart on everywoman that has a birth with a licensed midwife and the HIPPA rules don't apply... because it is a state rule, midwives have tried to tell the state that clients refuse to allow their info to be released but the state just threatens the mw's license.. or that DH got some advertising in the mail from a company selling x drug because our insurance co gave them his name...or when DH was in the hospital and I was not allowed in except for certain visiting hrs because the sick need their privacy-- and yet off hours any staff that can, pool there and eat- so they have a pizza delivery guy walk right in and look at each person he passes the beds even at 2am -- privacy my eye. or how when I gave birth to #2 in hospital I sang that last 1/2 hour in labor and everyone in the hospital was talking about it and singing and laughing patients and care providers alike -- I would not even have to introduce myself with my name just say ya I was the one singing in labor last night.

we own our experience and we share them as well, no easy answers I guess I will have to have a disclaimer form when I talk to clients-- that I use experiences , actions and birth stories to normalize birth.

[mwherbs]

Originally Posted by Everywoman

(I got a new username for this one.)


I recently went to a chiropractor who is a friend of the MW. The MW emailed me, telling me when I could fit my chiropractic appointments into my schedule. I concluded the MW must have been told about the chiros treatment plan for me. I called the chiro, telling her that I would like the MW not to be bothered with my medical info. The chiro. responded that no medical info. was given to her, just how often and badly I needed to be seen. I thought that was medical info.

Is it everyone else or me?

so I am not sure what you are asking-- do you work with this midwife or just go to her? I am just trying to imagine how you came up in a conversation between the chiropractor and mw. even if they are friends. if you are working for the mw she may have been working on a schedule or complaining she needed more help and you were missing alot mid-day or something and the chiropractor just spoke up like she really cant cut out her appointments. there are times I have held my tongue and others where I have spoken up-- rather than have a misunderstanding continue and we have written notes to schools or work to dismiss people from certain kinds of work, or to make a needed appointment.
------------------------

then there are other things that get messy with personal and professional relationships. A young woman I would assist on occasion was very aggressive with all the women she worked with very giving but also demanding and a pregnant woman changed plans or did something different than what the young doula/mw wanted she may abandon the client- mid pregnancy, mid-labor what ever... with one such woman youngdoula/mw left her mid-labor because she got a shot (not an epidural a shot) youngdoula/mw screamed and fought with laboring woman and then she not only left but went around to everyone they were friends with and said how she was bs and not to trust her and don't let her stay with you or what ever else she did to hurt this gal in the community, because she was not trustworthy-- evidenced by the betrayal in labor and lack of commitment ...... when youngdoula/mw has her own baby she gets to 5 cm and wants to go to hospital for epidural-- and screams the entire time until she gets one-- this story was shared with first woman that she shunned and hurt.... if everyone was professional none of this would have happened. on the other hand there is a bit of justice in everyone knowing rather than just letting youngdoula/mw tell just the story she wants to tell everyone..

[Everywoman]

I do work for the MW. She is not my provider. The MW refered me to the Chiro. as a friend, then checked up on my care. The scenario you suggest did not happen, Even if it did, there is no excuse for it.

Originally Posted by mwherbs

on the other hand there is a bit of justice in everyone knowing rather than just letting youngdoula/mw tell just the story she wants to tell everyone..

There is no justice in betraying someone. There is no other hand but the gratification of one's own self, and from their clients is not where the professional is to receive this. It is a violation. It is a patriarchal abuse of one's power. What did you do when in the face of seeing this woman abuse her clients?

[wildflowermama]

Thanks for sharing the doula piece. I'm torn on the issue. I tend to be really sensitive to what people think about me and I also have a child who is a very private person. I tend not to share my kids names or information about that because of the lesson I learned from my child. So I'm figuring I will have to be that way with clients (I am a doula). I have gotten a lot from reading birth stories and I hope people continue to share but maybe it might be better if the mamas themselves share or if the birth workers have express permission.

I'm sure it is not the norm to have privacy so breached. I hope not! I have a relative who is an md and to hear her talk about patients is chilling (like she is annoyed by them if they have a different opinion or she is annoyed by mental illnesses, I've heard her use the word crazy!) So I could be extra sensitive, and I can own that.

Communication is very important between birth workers and clients.

[Everywoman]

Originally Posted by mwherbs

. unfortunately we also have tons of parents we cannot or do not trust to help us learn things from their experiences...

I do not understand the above quote.

I am not trying to quell the learning of information. I do not know how you could get that from my postings. I began the thread speaking of how I was relaying parts of another's experience. There is an ethical way to have these discussions. And the stories in Ina May's books are the stories of the parents published with their permission.

It states in the HIPAA rule that info. in charts can be shared with government authorities. Also, info. must be shared upon subponea. That is in the HIPAA rule as well. Info, according to HIPAA can be shared with insurance companies if the pt. signs a release for the info. Privacy is an excuse for the hospital visiting hours.

It is easy. Glaringly easy. A client/patient can choose to share his or her information at will. Anyone can obtain his or her chart and mass photocopy it and distribute from the top of the Empire State Building!

Is using the clients experiences. . .to normalize birth kind of cryptic? Does that mean you can put it in a blog? Does that mean you can show their birth video to other families? Can the people in her church see crowning shots? Hear about how the police showed up at her birth?

If the purpose of a thing is not known, abuse is inevitable.

[mwherbs]

miss read original question sorry--------

[mwherbs]

[QUOTE=Everywoman]I do not understand the above quote.



I can see that it could be misunderstood-- what I was saying is that we in our culture do not trust our parents or other elders to give us advice-- sometimes rightly so because of choice they made because of fears or fads......
but I think I am also caught up a bit in some other recent dialogues on similar subject--and I am so sorry that it took me so long to figure this out
in re-reading your first post several times I think I have what you are saying and I am sorry- someone intimidating you or making fun of your birth story is not ok--- but I can also think of a senario where you take this back away from the raven mocking you and portray the ravens actions-- KWIM ah yes this is what I did and you -you raven jumped up on a chair to get away from the flood you thought was going to come out of my body... ravens usually have poor senses of humor and don't invite other story tellers that can tap their shoulder.
I think we must be in different time zones-- I did not see this post until after I sent the 3rd... some of it still applies but I really really do not approve of any type of derision used against a birthing woman-- it is one thing to tell an illustrative story but intimidation is not useful most of the time. forgive me, forgive me

[Everywoman]

Originally Posted by mwherbs

this would not be how I treat my clients- but this is what people came to and stuck with--

Does it remind you of how abused women do not speak out, and if they do come to the place that they are made to challenge their previoulsy-held beliefs, they often return to the abusive situation because the elaborate farce surrounding their lives was better than complete isolation and lack of connectedness to the true healing community women need?

It seems that you are saying these women deserve what they get. Even this subtlety in attitude can drive a woman back into a harmful situation.

Originally Posted by mwherbs

--- no matter if this was a hut or a tenement -- what sounds and view do we have of birth now-- those horrible, horrible birth shows on cable... and what a birth training that is--

Never did I suggest that one should not share: it needs to be done apropriately and with compassion. Look at my OP.

The story I was speaking about sharing in my OP was for the benefit of a student of mine, the woman to whom I was speaking. A mother in Iceland* received her own baby s-l-o-w-l-y, first the head - all the while moaning - then slowly the shoulders, telling the MW to go away - then one more inch - "oooh, yeeeeeeeeeeeeeeees, yes, aaaaaaaaaaah, and I backed away, far away and sat low on the floor - the mother continued making orgasmic noises over and over, releasing the baby bit by bit - when the knees were eventually out about two full minutes later, the MW said, "Okay, the kid is turning funny colors." The mother scowled, protested, and pulled the baby the rest of the way out. How would the mother feel knowing her name-and town (she is well-known) were connected to that story? She might be proud. She might feel humiliated, betrayed, raped.

. . .and if she does it is not because she is silenced by barbie dolls.

How is one to have a multi-orgasmic birth knowing her midwife is going to talk about her actions at a cocktail party and identify her? Again, the birth is not owned by the midwife. It does not belong to her. Period.

Originally Posted by mwherbs

so if clients do not complain or protect themselves, or tell their stories with joy, no matter if I am in the hospital or at home- and I see this stuff, stuff that makes me want to scream or cry or the tremendous strength and beauty the hard ships I am to be quiet, quiet and not share this-- because they do not share it

Many will share it. Many will be fine with you sharing it. When you speak with them about their births, just ask, as we ask before we touch women. If clients do not complain or protect themselves, you can start by bringing the offending action to their consciousness and asking how they feel about it. "I know your (husband, midwife OB) wants something different than you. Do you feel that you are being heard and respected?" Share it first with the client before you tell others about the woman who did not 'protect herself.'

Supporting clients in their decisions means not 'knowing' better than they do. It means not judging people as afraid of what cheerleaders think. It means not insulting ones who are private, the ones who may otherwise be shunned because they are socially and culturally different.

Originally Posted by mwherbs

---no do not tell anyone -- I was so out of control, so animal, so afraid-- so powerful, don't tell that poop comes out, or blood, don't tell that I sang to my baby, don't tell I cry, scream, ordered everyone around, I am embarrassed --

Don't tell my friends that you judge me as out of control. Don't tell my co-workers you see me as animal. Don't tell my bratty little brother I was afraid. Don't tell my mother-in-law I pooped on the midwife. Don't tell my clients I screamed or my dentist I cried. It is none of your business to break my trust. . .and don't you dare tell me it is my fault because I'm 'embarassed.'

Originally Posted by mwherbs

and it is also very much a social experience-- many traditions not one person can tell a story- so many stories are only told in groups- one piece or another is acted out or told by another can we tell this story together....--

For some it can be a social experience. Midwives need to socially and culturally respect those for whom it is not and not tell their clients how they should act or think about it.

Originally Posted by mwherbs

does any of it sound like your birth-- --

Thanks for asking. I love to share to the extent that I am comfortable, and I am extremely comfortable in an environment that is remotely supportive.

Originally Posted by mwherbs

no do not tell that story of strength and rock the boat, really its nothing.....--

I will take the comment as sarcasm. Is it nothing if I do not wish to share it with you and the rest of the cocktail party?

Are you accusing me of not wanting to rock the boat? My addressing this is because it IS quite something, not because it is nothing, and I appear to have struck a nerve.

It is something.

Originally Posted by mwherbs

of course telling names can be wrong- and cross some boundaries I am not condoning this completely but I am also of a mind to want to tell things tell all the sounds....

go ahead. Tell the sounds. I do.

Originally Posted by mwherbs

we are of a community and some deep darks do not get spoken of but birth ,

Please clarify.


I am glad you seem to like your chiropractor. He seems like a good friend.

I am also glad I haven't had close relations with with you. You might have a mind to tell everyone how I shook the Earth.


* identifying details have been changed.

[cathicog]

Originally Posted by Everywoman

Cathicog, I don't know what you have disclosed about clients. Consider yourself a client who is EXTERMELY private. Would you feel remotely rattled about anything that was said?

There is a teensy provision in Hipaa for peer-review-type discussion.

I have, however, seen "professional" midwives get together and call their clients deregatory names, crazy, etc. . .and show a significant lack of compassion. Imagine if another group of professionals did the same thing. Imagine therapists talking about their whiny fruitcake clients.

It might open a beehive, but, should this knowledge be integrated into the training of midwives?

I have written a piece for doulas on the subject of professional boundaries, of which this is a part.

It is the peer-review part I am thinking of, since I *have* very few people I can confer with....If I have a question of something, I have my contacts, however, I sure would love more input...that is what I was thinking of...