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	a quiet place by peggy o'mara

Compatibility
Issue 104

For the last two years, I have been trying to figure out the cause of my allergic symptoms: swelling, dryness ,and itching. While I've been cared for by fine practitioners and have been involved in helpful treatment plans, I am still the one who has to manage the situation and the sometimes contradictory diagnoses. Even with good care, I am the one ultimately responsible for my health.

I hear the stories of many parents who are treated by health professionals in an adversarial manner because they want to be the ones to make the final decisions regarding their child's health care, because they want a second opinion, or because they want to use integrative medicine. And yet if we as parents give up our authority we would be irresponsible.

One mother I know noticed dark spots on her toddler's teeth and took her to a pediatrician, who told her that her baby would need dental work. The dentist she went to wiped the dark spots off of her daughter's teeth with a cloth and told the mother not to give her any more cereal with iron. Another mother whose toddler actually had cavities was told to stop breastfeeding immediately. A second opinion revealed that breastmilk is not, in fact, a cause of decay because breastmilk is sucked and swallowed at the same time and does not pool in the mouth. She found another dentist who understood this and who filled her daughter's teeth without "requiring" weaning.

Both these mothers worried greatly over the conflicting opinions, but they made their own choices and were happy to have practitioners with whom they felt compatible. Other mothers are not so lucky. Some families who make choices not to vaccinate, to refuse prenatal testing, to question HIV drug treatment or cancer treatment, are threatened with the loss of custody of their children if they do not comply with standard practice and state laws.

This is unconscionable in light of the fact that standard practice changes decade to decade, and scientific thought, by nature, is always evolving. In the 1970s, silver nitrate was routinely used as an eye prophylaxis for newborn babies. Many refused it because it blurred the baby's eyes during the sensitive bonding period. Today, erythromycin is the eye prophylaxis of choice. In the 1950s, X rays were used commonly with children. Today, we know that they should be used sparingly.

It is unethical, if not downright illegal, to coerce someone to receive treatment that they conscientiously object to. There seems to be an alarming increase in efforts to dissuade individuals from making choices of conscience regarding health care and a growing misconception that individual freedom of choice is at odds with the common good.

Both the political climate as well as the restrictive and expensive nature of health care in the US underscore the importance of taking charge of our own health and the health of our children. By this, I don't mean running away to the woods and abandoning modern medicine. On the contrary, modern medicine should be used in an integrated way in conjunction with all appropriate modalities and with final decision making resting in the hands of the individual.

Just because a procedure or drug is available is not always a compelling enough reason to use it. We must also feel that it is appropriate for our child and that it is considered in the context of everything that is good for the child. For example, a parent whose child is in remission from leukemia may want to postpone chemotherapy and reevaluate it based on the child's progress. From a parents' view, this makes perfect sense. From the public health view, it is heresy.

This inevitable conflict emphasizes the importance of the relationship we have with our healthcare practitioner. If we have a relationship that is unequal and authoritative, we will feel reluctant to discuss our values and our fears. We may prefer a practitioner with whom we can collaborate and who will tolerate our choices even if they are idiosyncratic.

This kind of collaboration can be found with practitioners of all persuasions. We should not assume that collaboration is only possible with alternative-minded practitioners. Traditional, allopathic practitioners, as well as alternative, complementary, and integrative practitioners, can understand this type of collaboration, and yet they can be hard to find. I have discovered that these types of practitioners became easier to find once I was willing to take responsibility for my own health care.

In addition to a willingness to collaborate, we want practitioners who share our values. Sometimes we think that if we explain ourselves well we will be understood by practitioners who have different values from our own, but there is no guarantee of this, and different values can indicate an inherent incompatibility.

The importance of the issue of inherent compatibility is perhaps best illustrated with regard to our choice of the practitioner to be with us at the birth of our baby. We will get the type of birth that he or she specializes in. We naively assume that if we write a great birth plan and present this to our practitioner all will go our way. This is not always so. If our practitioner shares our values and already incorporates the practices "requested" in our birth plan into his or her own practice, then things will more likely go our way. If, however, the things that we value are uncommon in the practice or the setting where our birth will take place, then the likelihood of things going our way diminishes. It is as if we've gone into a restaurant that routinely serves fish and chips and fried food and ordered a salad. We may get a salad, but it is unlikely that it will be the salad we had in mind, and it may include side dishes we never even knew were on the menu.

However, even when we find compatible practitioners, we cannot abdicate responsibility for our own health or the health of our children. We still have to make the final decisions. Will it be antibiotics or not? Will we add some vitamin C, echinacea, and zinc? How about some mullein ear drops. Maybe some chicken or miso soup. A humidifier might help. Acidophilus and probiotics will be good after the antibiotics to rebuild the intestinal flora. Many of these complements to drug treatment are home remedies that parents have been using for years and that have only recently gotten the medical stamp of approval. Unlike the FDA and other agencies, we don't have to wait for approval. We know when something works.

The process of discovering which remedies are effective for individuals and for family members, as well as the act of taking responsibility for our health, is greatly enhanced by accessing our intuition. I've found that in trying to discover the cause of my own sensitivities, I've had to develop my intuition because it is my intuition that helps me to sort out the sometimes contradictory information provided by my different healthcare "consultants."

I believe that we have an inner sense of self-protection and a fierce protectiveness for our children. We can't give ourselves or our children up to anyone's care without understanding it and monitoring it, without managing it. In a way, then, healthcare professionals do become our "consultants."

It is this idea of consultation that underlies the tradition of informed consent. I have been thinking a lot about informed consent lately in view of the stories that I have mentioned before of parents who have had custody of their children threatened because they held minority viewpoints on health care. Certainly, there are rare cases where a parent's extreme beliefs threaten the health of their child, but parents who hold minority healthcare beliefs are usually exceptionally well informed. Minority viewpoints should not be summarily dismissed as it is the minority opinion that grows into the majority view.

When Mothering questioned routine medical circumcision 22 years ago, we were considered mad, but today the pediatric medical associations of Canada, the UK, Australia, and the US have published statements opposed to routine medical circumcision. When we questioned antibiotics 15 years ago, we were considered mad, but while they are still frequently prescribed today, it is common knowledge that they can be overused. When parents question antibiotics or other drug therapies, or when they decline routine newborn testing or new vaccinations, they do so with the full support of the Bill of Rights and the traditions of jurisprudence.

For nearly 100 years in the US, we have recognized the tradition of informed consent. It is more accurate, however, to use the term informed choice. Consent implies authority; choice implies equality. Instead of assuming that blanket consent forms constitute informed choice or waiting for the practitioner to inform us, we can ask the questions that are required for us to make a choice. Prior to all treatments--allopathic, alternative, complementary, integrative--we should be able to reflect on the following things:
A complete description of the treatment.
The benefits of the treatment/drug.
The risks of the treatment/drug.
The alternatives to this treatment/drug.
We should not feel coerced into making a decision, and we should have the choice to do nothing at all. Many of us feel coerced into treatment for our babies. We feel coerced to give medicines we question, and we do not feel safe asking questions about commonly accepted practices like vaccinations, ear tubes, dental sealants, mercury fillings, and antibiotics. We want the advice of healthcare professionals, but we do not want to be humiliated or patronized when we ask legitimate questions.

It is a rocky time in health care. The US healthcare "industry" has made health care into a business not a service, and as such, we're often compromised regarding our health. By finding practitioners who share our values or who respect us despite our differences, we can breathe a sigh of relief.

I have learned this the hard way. My son was born with a birth defect that required several surgeries during his infancy. My requests to be with him in the hospital where met with ridicule by one well-respected plastic surgeon. As a young mother intimidated by the medical profession, I didn't know what to do, but I refused to accept this opinion. My presence was not negotiable. Sure enough, I found another, even more well-respected plastic surgeon who openly accepted and accommodated my concerns. However, the nurses in the hospital were less enthusiastic about my presence, and once again I was considered mad.

Ironically, by the time my five-month-old daughter was hospitalized with spinal meningitis four years later, rooming in was routine. I was no longer considered the mad mother but rather a helpful part of the healthcare team.

Through my experience, I learned that I cannot abandon my health or that of my children to pills and platitudes. I cannot assume that following the doctor's "orders" is always right. I have to make sure that the doctor's "orders" do not conflict with my orders. I have been entrusted with this child. I must be the one who knows. The knowledge must be in me. Otherwise, this gift of faith who is my child would not be safe. I must not abandon my inherent responsibility, even if it means losing social mileage, looking like a fool, or making a mistake. My orders precede the doctor's. I am, after all, the mother.