Sunday, April 19, 2009

Childbirth PSA

I've been doing a lot of thinking about the Public Service Announcement we have to do as a project for college. Obviously I'm very keen on making a PSA that involves childbirth in some way.

The best PSA's always use a metaphor to make a simple statement of fact. But how do you do this with childbirth.

I've heard the metaphor used which likens labour to a butterfly emerging from a chrysalis. If you pull a butterfly out of it's chrysalis it will die as it needs that struggle to emerge in order to live. This metaphor has been used to promote natural childbirth (in low-risk pregnancy's obviously) but I don't feel happy with this. Although c-sections have their side effects, many baby's have no immediate adverse side-effects from it. Perhaps one day in the future when we have generations of c-sction baby's reaching old age we will discover what the true side-effects are, but right now they aren't immediately life threatening for a great number of people born this way.
So what is the message I really want to get across:

Make an Informed Choice.

When a woman is pregnant she can often be overwhelmed by all the information she receives, and often it's even worse when so much of what she hears is conflicting information! This can actually make it harder to make a truly informed choice because how is she to know what is correct and what is not.

One might think that listening to your doctor and taking his/her word on things is the best solution. But what about when a doctor says something like "Once a C-section, Always a C-section" or "You pelvis is too small" or "Your shoe size is smaller than a size 4 so you won't be able to give birth to your baby vaginally" (last one is something a doctor actually said to someone I know).

Disagreeing with your doctor is a very scary position to be in, and women who do often get flack not only from medical staff but from friends and family as well because of societies belief that "Doctor knows best".

There are more and more times that it has been shown that questioning your doctor is not only good, but a necessity. Most recent example I can think of is a friend who was worried about a lump and was told it was nothing by more than one doctor. Finally a doctor was found who investigated it properly and the diagnosis was inoperable cancer.

But back to childbirth! The survey's I did only showed a very clear feeling among the women who took it that doctors were pushing women into interventions that probably had more to do with being convenient for the doctor than being for the good of mother and baby.

But in South Africa we also have some important things to take into consideration:

  • There are many, many women reliant on government health services to care for their pregnancy, and that in itself gives them very little choice
  • Government Hospitals are direly understaffed
  • Government Hospitals have no money and lack many basic facilities
Method of childbirth is so far removed from the realities of many pregnant women in this country, so why should we bother focusing on that?

My conclusion was that we shouldn't - we should focus on something far more important and very needed in government hospitals as well. It's one word that represents so much:


Already these women do so much in the government maternity wards - providing the much needed care that overworked, underpaid nursing staff just don't have the time or energy to give. In some cases doula's have been the one's delivering the babies because there was just no one else!

For women who have more money (and they aren't necessarily rich) they can afford more choice by opting for private healthcare. However, in private healthcare the c-section rate is a staggering 80% (approximately) and so the Doula has a very different role to play.

In government hospitals they perform a very practical service, helping nursing staff and offering support and company to women who almost always come to give birth completely alone. In the private sector they offer much wider form of care, through information during pregnancy, physical and emotional support through pregnancy and birth, and even being an advocate for a woman when she is in a vunerable position.

I feel this is the best focus for a PSA. To bring attention to what at Doula is and what she does.

Government should pay women to be birth doulas in Government Hospitals and medical aids should cover their cost as an important part of the team caring for women in private facilities.

But how on earth does one say this in metaphor?!

It's easy to come up with one's for woman in private care (eg. doctors pushing unncessary interventions, overuse of technology), but it's almost impossible to think of a single one that would cover the important role in both government and in private care.

Here are some ideas I've got so far:

  • Old wives tales, medical myths, and random strangers - all giving advice to a pregnant woman. Who can help her know the truth? A doula.
  • A woman goes to reverse her car out of her driveway. Suddenly a variety of experts (eg civil engineers, builders) come to measure, calculate and give advice. The woman is overwhelmed when they say they're just going to go ahead and lift the car out of her driveway with a crane. [NB this is the only one that is actually a metaphor]

So far the best idea is:

  • A serious of childbirth related problems (such as mentioned above, women giving birth alone in govt hospitals etc) are shown but a fairy godmother character appears and waves a magic wand and the scene is "fixed". It could end with a voice over saying something like "You might think such a magical creature doesn't exist, but the birth fairy is real. She's called a Doula - and every woman deserves one!" and then give information as to where someone could find out more about this.
Please feel free to post comments directly here or email me directly.

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