labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, May 10, 2009

Keeping Religion Out Of It

I've never been one to feel religion should cross the lines into health care. Before I go on, let me just say that I am not talking about the birth where the woman prayed throughout or a blessing was done for the baby shortly after birth. Because in those cases, the people are doing what they believe and their faith has helped them through the experience without involving others into it who may not share the same beliefs. Those things do not force others into care decisions or take away options. It is those things I have a problem with.

For instance, I recently stumbled upon a website of a birth center that is faith based in their care. Ok, totally fine. Absolutely wonderful for those women who want faith based care. I wondered, however, if this birth center was the only birth center in that area (I'm guilty- I didn't search to find that out) and I was a woman who really really wanted a birth center birth but wasn't Christian. Perhaps I was a Wiccan woman, and didn't want Christian prayer to be a part of my birth. Would that be possible? Could the birth center meet my needs outside of just having a birth center birth? I don't know...I guess it would be a dilemma for me if I were that woman. The practical thing to do is make and appointment and see how it goes and express my concern; but what happens when it's clear the midwives at the Christian birth center can't keep God out of it or the numerous religious relics make me uncomfortable?

Catholic hospitals come to mind as well. Clearly Catholic hospitals deliver faith based care. I realize that this doesn't mean that each person who comes to care for you performs mass or whatever, but it does guide what services are offered. I have personally never chosen to get my care at a Catholic hospital because I have a problem with places that deny certain aspects women's health care. I've even chosen not to work at Catholic hospitals for the same reason. I had been naive about their denial of birth control, emergency contraception, and abortion services until I was in nursing school and did an internship in a teen clinic. After being there a short time, it seemed like a major oxymoron of care. It's mission was to provide pregnancy care to inner city teens, but they couldn't discuss birth control with them!!! What the fuck? Does that seem wrong? It sure does to me! It seems to me the best way to serve these girls is to get them on birth control and discuss STI prevention. And what about the rape victim who asks for EC but is denied it? I would hope that she was at least told where to find it, but there are some providers who, based on their faith, would not.

I know many would say, "Just go elsewhere", which is fine when there is another local hospital to chose from or you can easily get yourself to it. But I do know of some areas, even near me, that the only accessible hospital for some is a faith based institution because its on the bus route. Getting to the non-faith based hospital would require more difficulty.

I've even worked with nurses who've commented on a patient who was being treated for a second trimester miscarriage or even a fetal demise at 30 weeks say they are being punished by God because of their previous history of abortions! Good grief! You know, fine, whatever, if you want to believe that, but keep your freaking mouth shut about it at work. Religious beliefs should not factor in your care for that woman. It makes me nervous, frankly, that somehow that would permeate how that nurse might treat that woman.

Ok... now I feel better getting that off my chest.


Jill said...

My primip friend's midwife told her that her cervix was slow to dilate because of sin.


She blogged about it so I hope it's ok to share. It made me really sad that someone would say that to a woman in labor.

lostinrain said...

It sounds like you are blaming faith-based hospitals and birthing centers for the lack of secular hospitals and birthing centers. That's a pretty big stretch. It's not the Catholic hospital's fault that there is not a secular hospital as conveniently located. It is certainly not the Christian birthing center's fault that there is no other birthing center in town. Birthing centers are suffering and closing all over our country due to political pressure from ACOG. If the Christian ones are the only ones who manage to stay open, it is because their clientele's moral convictions can not be bullied.

Are there giant chunks missing from our available health-care system? Sure. But you can't demand that one business provide services just because there is not another business to do so. We have a for-profit medical system. If you want separate health-care and religion, let's socialize.

As for nasty comments made by nurses... I have found that nurses say all sorts of mean things--religiously inspired or not. Is one type of mean-spirited gossip really any worse that another?

Point is: There should be wider range of service and healthcare providers should abstain from saying mean things--even among themselves. Religion has nothing to do with whether that happens or not.

River Eden Doula said...

"I've even worked with nurses who've commented on a patient who was being treated for a second trimester miscarriage or even a fetal demise at 30 weeks say they are being punished by God because of their previous history of abortions!"

Wow that really is disgusting. :(

Reality Rounds said...

If that Catholic hospital or any religious based hospital accepts tax payer funded insurance (ie public aid), they better keep religion out of their care (or they can stop being tax exempt). "But you can't demand that one business provide services just because there is not another business to do so." Yeah ya can if they are accepting public tax dollars. If the religious hospital will only accept private insurance, than do as you please. Otherwise, medical professionals need to be just that, professional. Care for your patients with compassion and evidence based practice, then pray for them at home if you must.

Renee said...

Agreed! I understand that they have reasons for not wanting to provide the EC service, but isn't it cruel to have a rape victim and tell her to go somewhere else? When someone needs support and care but giving her the run around?

Jack and Lexi's Mom said...

It is impossible for me to separate who I am, what I believe, and what I do. My faith, be it Wicca, Christianity, Judaism, or Shinto, will be a part of every interaction I have. Before I speak, I must remember I represent my faith. How do I want that faith portrayed? I want my patients to feel the love of God, his accceptance and grace, everytime they talk with me. Faith is not a mantle I can remove at the door of a patient's room. I will not condem her, as that is not my place. I will show love, compassion, acceptance, and grace. How a patient reacts is left in her hands, as it is in yours. Congrats on the new job. I pray your hands, heart, and mind be strong and good. Ours is a demanding but rewarding profession.

Rebecca said...

I feel the same way when I go to my GYN and there is all this information about birthcontrol and none about NFP. I think, what, can't these people support folks who want an alternative to medical birthcontrol? Something more in-line with their faith? Or when my GYN suggested birthcontrol to me, knowing I was Cahtolic and I have to explain to her, yet again ... that birthcontrol is not an option for me.

I guess it goes the same way.


Ciarin said...

I work in a pro-life practice. It's not at all obvious. Most women we see never even know. We don't offer abortions or referrals for abortions. We don't do IUDs but offer other birth control options (the owner believes IUDs are abortifacents *sigh*). Many of the midwives in this practice ar not pro-life. It's rarely a problem but can be difficult at times (i've blogged on this if you want more thoughts). I do find it a struggle to know that I can't even offer referrals.

Labor Nurse said...

Rebecca, I think you bring up a very good point! I think its just as important to incorporate the woman's religion into her care decisions as it is for the provider to keep theirs out of it. What I was trying to articulate with this post was having the provider keep their religion out of health care options when presented to patients/women.

Jack & Lexi's mom- I understand what you are saying. I personally am not religious in any traditional sense. I do not belong to any religion because I have never felt any of them were right for me. Instead, I've come to believe a certain set of things that work for me- and that is part of what makes me me! So, like you've said it's not something that can just be seperated from you. But, this doesn't enter into the care I provide in the sense of leaving out an option or forcing others just because it might or might not fit in with my personal beliefs. I hope this is making sense.

man-nurse said...

I'm not sure there's a real connection between praying over a client, or telling them they're being punished for theological sin, and refusing to perform particular medical acts because you think they're harmful. Anti-abortion (including anti-IUD and anti-EC) practitioners are not trying to proselyte; they're seeking to avoid harming what they believe is a human being.

If Catholic hospitals were like the pray-over-you clinics you're talking about, wouldn't they be, well, praying over you? No Catholic hospital I've seen makes their faith any more intrusive than the artwork on the walls and maybe praying over the intercom.

I think there's a difference between not violating one's code of ethics, and pushing your faith on someone else. If someone were to require me as a nurse to perform or assist in an abortion, or some other act that seems to me to be a clear violation of ethics, then I'd stop working. If I ran an institution, I would feel the same.

Reality Rounds: Catholic hospitals are required to accept public aid. Chicago's St. Francis Hospital was just recently closed and then later sold to a secular company essentially because the religious order which owned it was losing too much money on their largely public aid clientele. I'm guessing many hospitals, religious or otherwise, would rather not accept public aid! :)

Laura Grace said...

Just a quick note -- as a Christian, I think I understand what Jill's friend's midwife was talking about. Christians understand sin not just to be about human actions, but as the effect of the "fall" (when sin entered the world) on the whole world. So all negative experiences would be the result of sin in the world. I don't think the midwife was saying, "If you weren't such a bad person, your cervix would be dilating quicker." I think what she probably meant to say was, "If sin hadn't entered the world, this would be going more quickly!"

Just to clarify!

Amy said...

In 1954, my 5' 4" slender grandmother gave birth to a 12 pound 2 ounce baby - my uncle - in a Catholic hospital. He was her second child. He was over a month late. The hospital told my grandfather that "their policy" based on their religion (my grandparents were Methodist, for what it's worth) was to do everything they could to save the baby.

They told my grandfather that if it came down to a choice between my grandmother and my uncle, that my grandmother was going to die.

My grandmother, who was a respected businesswoman and not at all the type to see aliens or ghosts, had a near-death experience during my uncle's birth. She described it to me, and said that she felt no pain, and was floating down a tunnel toward a light when she thought "I can't wait to tell my husband about this!" and slammed back into her body.

Meanwhile, there was a nurse with a hypodermic needle full of knock-out-juice waiting at the door of the birthing suite to knock my very large, very angry grandfather out if he tried to get to his dying wife. She did ultimately, somehow, deliver my uncle vaginally, in spite of the fact that she was unconscious for a good part of the ordeal.

Thankfully, the story has a happy ending, and both my grandmother and my uncle survived. My grandmother went on to have three more pregnancies (twins that she miscarried, as well as my second uncle and my aunt), and lived to be 62. My uncle is now in his 50s and runs a very successful internationally influential company.

You can imagine how I felt, though, when the ONLY hospital in my town (county population approximately 100,000) was a Catholic one (the same Catholic group owns both of the hospitals here - since then a for-profit secular hospital has opened). I even had a nun who visited me during every day of my hospital stay.

I decided not to tell her my grandmother's story. But, in my humble opinion, I'll see the Catholics in hell. Every last sadistic, judgmental, matricidal one of them.

DramaMomma said...

Hummmm, I am a doula and a DEM. I have real varied feelings about this. I am LDS, some Christian's say I am not a Christian. And as a care provider my religious views don't have any bearing on caring for my clients. I support their religious beliefs and honor their birthing space.

As a doula I was present at a birth of a catholic mother who requested last rites in a LDS hospital, I went out with a phone book, found a priest, and he came in and performed her last rites, I stayed, was present, closed my eyes in prayer, knelt my head and said, Amen. I was supporting my client and respecting her beliefs and my religion has nothing to do with hers.

I do believe that religion, spirituality, and culture has a place in birthing. But it is the mothers that matters and it is only the mothers who matters. If we were all a little less motivated about being right about our own beliefs then maybe it would be easier to care for these women in their belief systems.

It doesn't matter what kind of a hospital that you go to, I was raised baptist in California and only went to catholic hospitals. I never felt pressured into anything and my beliefs were respected. Sorry that you have had such negative experiences otherwise.

As a care provider it is my job to understand various cultures and religions and what is acceptable. For instance Orthodox Jewish Men cannot touch their wives during any loss of blood, kind of an important thing to know at a birth.

If we are uncomfortable with our clients needs and beliefs perhaps it is our responsibility to find a referral for a provider who can respect their choices and their beliefs.

Basiorana said...

"I feel the same way when I go to my GYN and there is all this information about birth control and none about NFP."

Well, they aren't going to advertise it because they don't want teenagers thinking it's as good as hormonal birth control. If they advertise it alongside hormonal birth control then young people think it works just as well, when of course it is much less effective particularly when the woman is younger or older and her cycles may no longer be regular, or when she is lower-income, has poor health care and a crazy schedule, etc and can't keep up with it. Keep in mind, a lot of the advertisements for birth control are aimed at unmarried women who don't want children yet-- people who will not have religious prohibitions against birth control, at least not stronger ones than the ones against premarital sex they're already breaking.

Of course, your doctor should immediately have brought it up once you stated you were not able to take contraceptives. Have you mention it to her at each appointment (lest she forget)? If you just said you can't take BC, she may have thought that since NFP is birth control, that would also be out...

Amy: I am pretty sure that would be very, very illegal today. While I would probably avoid Catholic facilities for other reasons (I and my health care surrogate both agree that any brain damage=pull the plug, which is not going to go over too well), I'm not too worried about them murdering me in favor of my fetus-- they would never survive the lawsuits and criminal investigation and they know it. They'd find a secular practitioner.

If that happened today every doctor and nurse on the team would be charged with conspiracy to commit a negligent homicide or worse.

MomTFH said...

Wonderful post. I was just talking about this today. At my medical school, one of the physicians did a wonderful presentation about spirituality and health care, and talked about how to be sensitive to and supportive of your patient's spiritual beliefs and desires.

A classmate listened to the whole presentation, and his only question at the end was, "I am a Catholic. I don't want to prescribe birth control pills. Is that OK?"

(This coming from a guy who took half of the condoms from our med students for choice safe vacation condom bowl after our last end of semester exam, and is known to frequent strip clubs).

My answer? Go into radiology, dude.

MomTFH said...

Oh, and I heard a midwife say a woman had a late term fetal demise because her father was an ob-gyn and performed abortions. WTF?

I don't think this post faith-blamed anyone. Catholic hospitals buy secular hospitals and force them to close down services like rape crisis treatment that includes emergency contraception. A Catholic hospital system that provide health care delivery for an area should be required to provide comprehensive care.

man-nurse said...

Basiorana: I think birth control pills are marketed to women not because they're too poor, busy, and dumb to learn FAM, but because FAM isn't work-free and it doesn't make anybody that much money. Birth control pills are an easy moneymaker for pharm companies and an easy panacea for doctors who would never have the time to actually teach women about their ovulatory cycles. Once you learn it, it seems kind of mind-bogglingly criminal that sex education and gynecologists never talk about it. What do we want, a pill or education about yourself?

And NFP/FAM is still extremely effective when cycles are irregular. That's kind of the point of the method! You learn your cycle and its signs, so you don't have to depend on a number of days.

MomTFH: What Catholic system bought a secular hospital to close things down? And as I said above, I don't think you can call things "comprehensive care" when people think they're harming lives. You might not agree, which is fine, but that's why they're not doing the things you want done. Catholic hospitals don't want to do EC because they think it's killing a human life. It's an ethical thing to them. It's a little different from other religious scruples like not eating pork or refusing blood transfusions.

MomTFH said...

Well, the medical literature says emergency contraception is not an abortifacient. So, choosing to ignore medical evidence to follow a papal edict is religion, not medicine. Hospitals should use medical definitions, not religious ones.

Access to emergency contraception for women who have been victims of rape is compassionate care. EC prevents ovulation. This has nothing to do with life by anyone's definition. But, it is oral contraception, which itself is against the rules when strictly interpreting the Catholic faith. This has nothing to do with life or murder.

This has to do with people narrowly interpreting religious law to control women's sexuality and reproduction, even when she is the victim of a violent crime, and in the guise of a health care center.

BTW, here is information about Catholic hospital mergers and removal of services from entire counties. Catholic hospitals own 15% of the beds in the United States.

man-nurse said...

The medical literature clearly states that EC not only acts to block ovulation, but can inhibit transfer of a fertilized ovum through the Fallopian tubes and block implantation. Clearly EC is not given only to women who haven't yet ovulated. So as I said, if you think that EC destroys a human life, then it is an ethical matter not to give it, rather than a "narrow interpretation of religious law."

Unless EC can be made purely contraceptive, it is not going to sit well with pro-life medical professionals—and it's not really fair to castigate them for narrow-minded religiosity. That's all I'm saying.

Anonymous said...


Apparently, there needs to be a new term made up to properly describe what certain drugs do, because "contraception" sounds like it is "against conception" -- i.e., that it works by preventing conception. Pro-life people do not have a problem with that. But many forms of chemical birth control (including "emergency contraception") do not always prevent conception, although they have a high rate of preventing pregnancy. Every chemical form of birth control I've ever read about (package insert, or the drug manufacturer's website) says that one of the ways the drug may prevent pregnancy is by keeping the fertilized egg from implanting into the uterus. How can something rightly be called "contraception" if it works after conception has already taken place? Only because the medical establishment has defined the terms in an unusual way -- a way that most people would not use them, if they really understood what was happening.

So, certainly, the medical literature says that EC is not abortifacient, because that term is reserved for an agent that works to remove an already-established embryo or fetus. Likewise, it says it does not "end" a pregnancy, because pregnancy is defined in this instance as beginning when the embryo implants into the uterus, which is about a week after conception occurs -- a week during which the living embryo multiplies, divides, grows, and replicates.

While the primary function of these chemicals is to prevent conception (by delaying or stopping ovulation, or preventing the sperm from reaching the egg), the back-up function does not prevent conception, so I have a great problem with calling that "contraception."

So to be honest to the public, most of whom would understand the term "contraception" to mean preventing the egg and sperm from coming together, there needs to be a new term for post-conception birth control.