Bringing About Change to the Maternal-Infant Care System

An industry ‘insider’ was recently asked what should be done to bring about positive change to maternal-infant care practices. Their reply comes across at first as really positive and helpful until you let the implications sink in. In fact the suggestions are reflective of just how big the problem is and unfortunately they aren't unusual at all. I'm going to assume the person meant well by trying to keep things “positive”, but truth be told sometimes change is a messy dirty business. Here's what the "insider" had to say about how change can happen:


  • ~ Small suggestions are best. Instead of complaining about the terrible care everyone got, identify an issue which can be stated without blame/accusation/anger/frustration and come up with one step to make change.

~ Blaming people and submitting complaints is not the solution.

~ Without also giving a proposed solution, a complaint is not productive.

~ Negativity is not productive.

~ Complaining and placing blame gets us nowhere other than creating anger and resentment and job burnout.

~ There is a lot of work to do in the area of maternal-infant care. It is no one’s fault.

~ Individual healthcare practitioners are not at fault. 

~ It’s a systemic issue that needs systemic change and that will take time.

~ It will take a long time to get those in power to make changes.

~ When someone criticizes us we get defensive and feel hurt and become resistant to change. 

Spread the word: 
Sometimes change is a dirty mess business.

"Passing the Buck" is not the answer.

I was stunned. But really, I shouldn’t be. 

Shifting responsibility to the nefarious, untouchable, “system” so that individual practitioners are not accountable for the harms they cause (the system did not grab food out of a labouring person's hands and throw it in the garbage, or use the ultrasound wand so aggressively they caused bruises, or tell the woman she had to stop breastfeeding an infant based on incorrect information, or do a stretch & sweep without consent during a vaginal exam)...

Telling victims that they shouldn’t complain because it makes the recipient feel bad as well as angry and resentful and defensive and no longer able to do their job (which is actually a subtle warning that if you make waves you could be treated poorly in future and also taps into that deeply rooted cultural idea that it is the woman's job to keep everyone happy/be a people-pleaser. If you don't do that you are a selfish b***h and will deserve what you get)...

Telling women they shouldn't bother complaining because it's such a big problem and is gonna take so long to address (aka this is too tough to worry your pretty lil head about)...

Telling women that if they aren't ‘nice’ it's their own fault that they aren’t listened to because the person in power whom they’re addressing is too fragile to cope...

... Those things are not ok. 

Spread the word: 
Blaming "the system" does not absolve individuals of responsibility for their actions.

Asking victims to educate those who caused them harm is not the answer.

It is NOT the victim’s responsibility to put aside emotion, examine the big picture issues, then calmly and graciously educate the offender (being careful not to upset them in any way), about why what they did was wrong, and then to ALSO educate that person about what they need to do differently. (And for real - how seriously is the offender or their employer going to take even a perfectly presented suggestion about how they should do their job, from an outsider who isn't trained in how to do their job, doesn't understand working in the system etc etc). Nope. I don't buy it.

The victim’s ONLY responsibility is to heal their own heart as best they can; to make the best decisions they can for themselves, that will allow them to be whole and to live with integrity.  And if that includes screaming from the rooftops (or writing over and over to the complaints department until they feel heard) that what happened was WRONG, the offender has NO right - NONE - to say: “But wait, you aren’t speaking nicely to me so I don’t have to listen to you. Come back when you’re calm and try again. Besides it's not my fault anyway and you're making me feel bad.” (note that I am NOT saying its okay to be emotionally or physical abusive when expressing hurt. That of course is unacceptable. Those ‘receiving’ the hurt words have to very cautious though that we don’t demonize legitimate emotion and label it as abusive as a means to shut it down simply because it makes us uncomfortable.)

When someone tells you they are hurt by your actions, or that your institutional policy caused harm, the correct response is to acknowledge the hurt and work with the victim to make it right.

It is not the victim’s responsibility to do all the emotional work and practical work so that it's  easier for the professional to handle.

I do get that being complained about is hard. Being called out for something is always hard. It's harder still when you're ‘just doing your job’ because you have bills to pay and mouths to feed. It does make you feel angry, hurt, afraid, defensive... when you or your department receive another complaint. I hear that and your feelings are legitimate. That doesn't mean though that the person who expressed the complaint should remain silent. Your discomfort does not trump their trauma.

Spread the word:
Heal your heart and do what you need to be whole.

Changing "the system" requires both a change in policies AND in values.

So many medical professionals start out with a passion which has slowly been eroded by the crushing patriarchal mindset that dominates modern medicine and which DOES need to be addressed at a systemic level. The system is not it's own entity though. The system is made up of people. It is made up of people from the top of the food chain all the way down who are each responsible for the choices they make and the values they hold. The system is created by the people who work within it and the values they hold privately and collectively. If we want to change the system that means changing how people see the world of maternal-infant care and that means telling people what happened that is wrong so that the process of making it right can begin.

If you have been a victim of poor or harmful maternal-infant care, and have already been through the process of healing your negative or even traumatic experience, and you truly wish to make it easier for professionals working in the medical system to consider changing then by all means “Identify an issue which can be stated without blame/accusation/anger/frustration and come up with one step to make change. “ It would be an extraordinary gift to give. Choose to be gracious and calm and to figure out what you think the problem is and how you wish for them to address the problem if that is what you're passionate about. But remember that it's a gift you are giving, it is not something you owe them if you want to be heard. Remember too that they don't have to accept that gift of your insight. They may very well look at it and say “Thanks but no thanks. That doesn't work for me/us/our institution.” Or “That's a great idea but our supervisor/insurance would never approve" Or "Great idea but it would take too much time/too many people/too much money” 

We have to ask BIG questions to find true solutions. Like the chicken and the egg (which comes first?) we have to address both small scale policies and large scale values. 

In the midst of all of that, women’s voices deserve to be heard. Your story needs to be told (when & where & how you are ready to tell it). You do not have to swallow your trauma and play nice. You do not have to offer solutions as payment for the privilege of expressing your hurt. Your experience matters because you matter. 

The answer to how positive change comes to maternal-infant care is not honey-coated gift-wrapped suggestions. At our core we all want to be seen and heard and respected.  That's where the answer lies. In the messy business of victims making themselves heard and in professionals truly listening. 

Spread the word:
Your story matters because you matter.