When in Rome/London walk like an Egyptian

As a child I remember an almost paralysing fear of being caught breaking any rules. I once spent a good 15 minutes silently head-down, kicking about having fallen in to a large recycling bin. I did this rather than shout for help and alert teachers to the fact I was in the technology lab when I shouldn’t be. Most of my life I’ve stuck steadfast to the rules and, as an adult, I’ve always enjoyed driving my husband mad by insisting we don’t even transgress the most minor of customs and etiquette (woe betide him should we arrive too early/too late, forget to mute a phone or park too far from the kerb).

Nevertheless the thought of my plump, little legs waggling around in a giant metal bin do rather serve as a reminder to me that, when it comes to the more important aspects of life, we sometimes have to forge our own course rather than subscribe to rules, customs and protocols.

What am I waffling on about? Well, as a doula working across London I’m lucky to be able to work at different hospitals and with midwives from different NHS trusts. From Queen Charlotte’s to the Royal London, Barkantine Birth Centre, Whipps Cross and Homerton to UCLH to Kings’ and St Thomas’ (I could go on) I reckon I’m pretty promiscuous when it comes to London hospitals, birth centres and homebirth midwives.

One of the biggest revelations to me has been that protocol on everything (from admission to the birth centre when a mother has Strep B, eligibility criteria for a homebirth, induction to VBAC and much, much more) varies from hospital to hospital and sometimes from doctor to doctor and midwife to midwife.

Now, while I don’t necessarily see this a bad thing I think it has taught me (and maybe will demonstrate to you) a couple of important things.

Protocol is just that: something standardised across a group or organisation. It isn’t the law, it isn’t often a worldwide/national/regional recommendation. It’s what that hospital or doctor feels is the best way to proceed across the board, without looking at individual cases. Sometimes it isn’t really even based on evidence. Now protocol can be a useful thing to have and it’s certainly a good starting point. But, but, but its generalised nature, and the fact that many hospitals take a different view on the same issue, means that it is something that can and should be questioned. Of course there are plenty of times when the suggested course of action is exactly the one you’ll want to take, but it’s worth looking behind the protocol for more information.

You can feel free to ask questions about a course of action, challenge it and ultimately you can decline to go along with it. It doesn’t matter if ‘that’s how we do it in this hospital’. If you aren’t sure, you’ll want to ask for references to back that course of action up. You’ll want to check if there are alternatives, what the risks and benefits are and what happens if you do nothing whatsoever. Because (and this is one of the benefits of being a London doula) I know that if you’d happened to be booked in at the hospital down the road there’s a good chance you might be getting a different suggestion. Which does rather indicate to me that the ‘best’ course of action isn’t ever set in stone but should be adapted to you, your body, your history, your plan and your baby.

So, when I’m working with a couple, I always make sure they know there isn’t really such a thing as a hard and fast rule. I often lend them the AIMS ‘Am I Allowed’ booklet so they can feel empowered that ultimately it is their choice.

And on the big day if I feel at all overwhelmed by my inner goody-two-shoes’ desire to silently accept a rule or protocol without question I think about my seven year old self tipped upside down in a bin and remember that had I been less worried about doing ‘the right thing’ and done what was right for me I would have saved myself a world of embarrassment and a lot of cuts and bruises.

Comments
4 Responses to “When in Rome/London walk like an Egyptian”
  1. Rebecca, really loved reading this. Think it’s so important that we’re aware that we can have choices, especially when protocol might be governed by restrictions on time/legal issues/shift changes! Don’t know if you’ve seen this but it’s really worth a read – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122835/

    • Rebecca says:

      Thanks so much Emma – totally agree. And what a great link. I hadn’t seen it and will now have to blog about it!

  2. Beautifully written. I will be sending my mums-to-be this link when I talk about informed consent and protocols.

    • Felipe says:

      Candy: that is so wofrednul! I happen to know a momma right now who is facing having her hubby away when their little one is due. This will undoubtedly be a great comfort for her!

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