Trust

I was listening to a radio journalist in the car on the way home from the hospital. He said that he and his wife were very nervous with her first labour and childbirth experience as they didn’t really know what was going to happen. He said they were ‘way out of their comfort zones’ as they had never been in this situation before. They were in ‘unchartered waters’ for them. Those comments are so true.

This couple had to put their trust in the people who were managing her labour and delivery. This is often not easy to do especially if you have never met, never heard of and had no relationship with those managing your labour and delivery, which is the usual case for public patients.Trust in Pregnancy

The Cambridge English dictionary defines trust as: “to believe that someone is good and honest and will not harm you, or that something is safe and reliable”. When you trust someone, you make yourself open and vulnerable to that person. It is often in the context of needing the help and support of the person you are trusting.

Patients put their trust in me as their doctor and make themselves vulnerable. I consider being their doctor incredible honour and would never betray that trust and vulnerability. I always endeavour to do what is in the patient’s interests.

That trust can be betrayed and the person you are trusting can delivery take advantage of the situation as their goal may not be the same as your goal. When your trust has been betrayed you may find it difficult to trust again, as you don’t want to get hurt again.

As well, you may have trusted someone who you find in retrospect did not have the expertise and experience you were hoping for.

I have personally been hurt on several occasions when I trusted people. My first accountant, when I started working as an obstetrician, I found out was dishonest. He gave me bad financial advice and was more interested in his own financial wellbeing than mine. This accountant, who I trusted, was recommended by a friend and colleague who used him (and also got stung by him). This accountant’s wife came to me for pregnancy care.  My care of his wife was very different and much more honourable than his care of me.

My attitude is not like some people in business who are primarily interested in their own financial and business interests. Sadly, I hear and read stories about some doctors who are more ‘business people’ in their thinking in patient management and seem to be more motivated by their own financial and ego goals, rather than by what is in their patient’s interests. I often call such doctors ‘proceduralists’ as they seem to want to maximise the income they can make from a patient by recommending surgical procedures which may not be necessary and may not even be in the patient’s health interests.

Unchartered waters

No matter how much a woman reads or watches online, no matter how many people she talks to nothing really prepares her for with will happen in her pregnancy and childbirth. I tell patients all the time pregnancy and childbirth are totally unpredictable. She only has certainty ‘all is well’ after it is over. A woman can be classified as ‘low risk’ of complications but ‘low risk is not ‘no risk’. Over the years I have seen many low-risk women have major pregnancy and childbirth complications.

A pregnant woman needs to be able to trust those who are supporting he on her pregnancy and childbirth journey. She needs to trust that they will do they will make the right decisions and do the right things to help ensure her and her baby’s wellbeing.

I take this responsibility very seriously. I care greatly for my patients, their wellbeing and their babies wellbeing. This attitude and my excellent training and considerable experience, have managed over 10,000 pregnancies, puts me in good stead for achieving excellent outcomes.

When a woman chooses me to be her obstetrician, I can’t guarantee all will go well. I can’t guarantee there will not be a major complication. I can guarantee I will always be supporting her and doing all that I can to help her on her pregnancy and childbirth journey.

I value the relationship I have with my patients. When a patient sees me for the postnatal visit of her last pregnancy I reflect while is has been a joy looking after her it is also sad as she won’t be seeing me again for another pregnancy.

The outworking of my caring and my patients being able to trust me is I have many, many patients who are very loyal to me and return for subsequent pregnancies. As well, I now have many second-generation patients. That is where I was the obstetrician for the parent of a patient or her husband/partner and delivered the current patient or her husband/partner. That is truly wonderful!

When someone tells me, they are going through the public system I am concerned for them and their wellbeing. Being a public patient means you give up the right to choose who looks after you and the hospital has the right to make the decision who will be involved in your care. This usually means you need to trust strangers who most likely are junior and so often lacking experience.

Most couples are way out of their comfort zone with pregnancy and childbirth, especially the first time. Antenatal classes are of limited value and they are just a general overview and don’t really prepare them for their personal pregnancy and childbirth experience. Birth plans don’t work. A birth plan is an attempt by the pregnant woman to have some control over her labour and childbirth experience. But as the list of preferences is written before labour they may not have any relevance with what happens when she is in labour. For example, there was a couple who decided and write in her birth plan “no epidural”. But when the real labour pains started she realised she was not coping and wanted an epidural. Her husband said to her: “we had agreed – no epidural”. I value being able to discuss with patients at antenatal visits their preferences, their wishes and their fears about childbirth. I always endeavour to comply with their requests.

Trust needs to be well-founded in the right person, someone who has a genuine care for you and your wellbeing and the right level of expertise.  When choosing to have a baby through the public system it is very hard to trust and so anxieties about pregnancy and childbirth are increased.

Posted by Dr Gary Sykes on - Latest Posts, Pregnancy

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