Archives for: December 2010, 03
There's a lot in the health marketplace calling itself "holistic" which isn't; you and I may not mean the same thing when we use the term, which, etymologically, indicates respect to/for the Whole. In a health context, it usually means that a patient's/client's entire Life picture - biochemical, behavioral, social, spiritual - is, again, respected at the very least, and incorporated into treatment modalities, ideally. But there's a particular angle that's got me miffed, because it usurps the "holistic" adjective and some of its positive rhetoric while advocating/promulgating practices that are anything BUT.
I work with urban, upper middle class postpartum women, their newborns and mates, older children and extended families. It's a particularly vulnerable demographic, insofar as the postnatal transition of a family (especially the transition of an erstwhile buttoned-up, professional 30-40-something woman, at the top of her game, to "beginner Mom") is somewhat of a crisis. I have lectured publicly about this crisis to future doctors and nurses ("The Matrescence Crisis: Modern Transitions to Motherhood" - UCSF) because the education of tomorrow's pediatrician, obstetrician, psychiatrist, and nurse is of great importance to all of us. But I've also spoken to more "alternative" and "natural" modality audiences about "Phony Holisticness". What do I mean?
In my field, there are all sorts of questionable practitioners vying for the ignorant and easy dollars of the expectant and new parent. The deal is: You take a couple at the peak of their dual-career attainments, with plenty of discretionary income and natural fear, and you convince them they need to spend it on your product or service. Then, if you're particularly unscrupulous, you throw in some scare tactics to reel 'em in to a more insidious proposition: Fomenting the Revolution, Sister, one obstetric/pediatric patient at a time.
There are extremists out there who believe that this life-transition is the crucial time for converting a woman from reliance on Standard Western Medicine to "the alternative" and, more subversively, from her own previous life-orientation to "the Cause".
Second- and Third-trimester pregnant women of established wealth and lifestyle, innocently taking Yoga or Pilates classes in order to "tone" for their labors/deliveries, are sidelined by instructors who smilingly suggest they investigate a different birth model and "attend an informative tea / evening". Sometimes its a childbirth class instructor who uses a particular "Western model"-bashing book or ideologically-skewed handout. In many late-term cases, it is a covert attempt to derail the pregnant couple's set plans for their imminent labor/delivery (and, often, postpartum and early parenting practice), away from the norms of their own established sociocultural group, i.e., from the pre-existent setting into which the child shall be born and integrated, indeed: From their truly holistic reality.
Follow me closely here, lest you entirely misconstrue my point. If I thought Standard Medical/Hospital practices were always the Absolute be-all and end-all, and that no alternatives or auxiliary approaches are ever to be considered, I wouldn't have the column-location I do. So here's my point:
It's a gross distortion of "Holism" to, at this major and vulnerable Life juncture, separate the mid-term-or -later pregnant woman from – and propagandize her against – the person she is probably then trusting as much as her own husband or mother: Her obstetrician. For the urban 38-year-old corporate attorney in her 3rd trimester, and residing 3000 miles from her mother, and who doesn't have a strong clan- or church-based community of helpful friends nearby, to be hijacked, at that critical time, from the OB with whom she's comfortable (not to mention from the social construct in which she's used to living), verges, to my mind, on the criminal. We make a mockery of the word "holistic" if it means we ever berate/vilify/malign, or even subtly cast doubt upon, another human being's very support system. Yet this is repeatedly done by "alternative" practitioners in the birth/postpartum/newborn field, as it is in others, too, in the name of the "natural" and "holistic" approach.
I have been present when circles of "energy healers" and yoga teachers (in rent-free spaces granted them by the liberal San Francisco medical establishment!) have "lovingly" addressed upscale 3rd trimester couples who'd been very happy with their reputable and excellent OBs, "lovingly" imploring them to take on a more militant and adversarial tone with their doctors and their hospitals ("Demand her 'interventions-record'." "If 'change' is going to happen, it'll have to start with YOUR letting your doctor know you insist on her changing her [fill in the blank] policy, or you'll change OBs, even though you're due in 4 weeks! THEN she'll get the message!")
In the absence of outsiders/prospective clients, these "healers" would giggle together, mocking the "probably Republican" voting tendencies and "hopelessly straight" lifestyles of their clients: "I'm scared of these couples!" they'd gasp, commiserating about the life choices made by the professional women who sign $1000+ contracts with them.
Can we step back here, folks?
Can it possibly be loving and "holistic" for a labor-doula to meet, for the first time, a 37-year-old in her 8th month of pregnancy with her first baby, and under the care of the city's top obstetrician, and try to persuade her that the latter is "backward" for not permitting the labor-doula at the birth, and that the woman should therefore ("It's NEVER too late!") switch OBs and hospitals? At that late date? I heard that one last summer.
Is it loving and "holistic" to tell an anxious 40-year-old sleep-deprived mother (whom you've just met) of a 2-week-old, with trusted private lactation consultants and pediatrician, whose baby is struggling with latching onto the breast and thus failing to optimally thrive (an anguishing state of affairs), that her lactation consultant, postpartum coach, and pediatrician and her nurses are ALL "definitely ignorant" and "part of the problem", "on a mission to make [her] milk dry up", and then take her by the hand to an "Infant Chiropractor"? And when that "doesn't work either" (surprise, surprise) leave her high and dry, mistrusting everyone she knows? I witnessed that case just over a year ago.
Often the "alternative practitioners" who "know better" than the OBs entrusted with these higher-risk cases (Yes, the over-35 primipara - first-time childbearer - is at higher risk for such real complications as placenta previa, preeclampsia and eclampsia, gestational diabetes, obstructive leiomyomas [fibroids], premature labor/delivery, etc., than a woman in her 20s, much as some radicals refuse to acknowledge it) are simply lately-certified masseuses or instructors of swaddling-burping or of meditation! And the 3rd-trimester woman had never heard of a "labor-doula" until this evening's meeting!
And yet the activist rhetoric is militant and often supplemented with articles, monographs, references and websites versus everything these vulnerable women (my precious "mommies") trust and depend upon.
NOTE: A minority of urban women have prepared for the more natural birthing modalities, well in advance of their FIRST birth. Other urban women, another perfectly worthy minority, choose on their own to investigate different "birthing" styles and practices AFTER their first birth, when the've chosen to do it differently the second time. I'm all for either scenario for the healthy mother-to-be; the educated consumer, choosing without being pressured or diverted, investigating alternatives under her own steam and in a timely manner: Ideal.
NOTE: The employment of statistical horror-tactics, and the (ab)use of real, ignorant, and frightened human beings (as first-time imminent parents are) as a crowbar for a forced Revolution in Obstetric and Pediatric Medicine is not my idea of "holistic".
Do we say we stand for Holistic Medicine, i.e., treating the whole person within her (not our) whole situation? Then we certainly do not advocate the de-stabilization of the holistic setting, the comprehensive pre-existing support team/community, of a fellow human being in her hour of crisis. Nay, we honor those boundaries, we bow to those structures and endeavor to tread lightly, even invisibly, on the sacred ground of her (not our) story. A Revolution based on trashing the landmarks and lifebuoys of those seeking healthcare - of any kind - is not only not holistic, it isn't even humane.
I know I speak for many in medicine and, especially, its auxiliary and "alternative" orbit, when I decry this thorn in our side. It's painful to see unethical behavior such as this, and downright malpractice on the part of our ostensible/self-proclaimed "colleagues"; it also makes those of us with higher principles
-- come under unfairly pessimistic scrutiny and
-- exert heroic energies to distinguish our noble practices from those of the Ideologue-pack.
Who pays your fees, fellow practitioners? If you can't respect and embrace the Totality of your clients'/patients/ rooted setting(s) and orientations(s), then Guess What: There's nothing Holistic about your work.