People tend to ask interpreters if it is hard to “say all that” and to find the words. To speak quickly enough and not leave things out. To remember what someone said, and to switch from consecutive to simultaneous. But for some of us, the hardest part is not how we say what we say, but what we are not allowed to say. We are not allowed to speak in our own voice, except to clarify a linguistic issue. There is an argument that we may be “cultural brokers” as well, but I want to bring up something else today. I understand all the reasons why interpreters must “stay out of it” and mind our business, which is to provide clear and transparent communication for others. Our clear professional duty is to be impartial messengers. And yet at times, it can be painful to be tongue-tied.
The vast majority of interpreters have multiple skill sets, multiple degrees, and even several professions. And we may change hats and take on a different role from one day to the next. Yours truly, for example. I happen to be the first certified doula in the state where I live, and for those who are not familiar, we accompany women on their birth journey, providing support, encouragement, information, and sometimes negotiating on their behalf with staff, something an interpreter is absolutely not allowed to do, according our ethical guidelines. And yet in almost 100% of interpreted sessions, we know that one party is vastly more defenseless, while the other is powerful and competent within the society they serve. So standing by silently when it appears that someone is pressured, overlooked, or disrespected can be quite traumatizing.
Moral distress is defined as the painful gap between how you envision something should go, and how it plays out, while being helpless to make it go the way you want it to, or believe that it should. A very few interpreters tell me they just disconnect (or even dissociate?) and interpret by rote, thinking only of the words, guarding themselves against feeling anything, especially helpless compassion. And all good interpreters make it a practice to “stay in neutrality” and remind ourselves that we cannot possibly know what is best for the patient in any situation, and it is not our job. Yet we are still human, with our full range of emotions and values, and interpreters naturally suffer from moral distress in varying degrees while interpreting in healthcare and other settings.
As we witness the care people receive, whether they get it in a safe and respectful environment, whether they seem to fully understand and truly consent to the care they receive, or even when they are denied needed care, we find ourselves both helpless witnesses to what appears to be avoidable human suffering and at the same time complicit in conveying the communication leading toward less than ideal outcomes. But we cannot do anything about it, because after all, we are just “doing our job” – and what a loaded phrase that is, coming out of all the war trial testimonies. There is a conundrum here that is rarely talked about, well worth pondering and contemplating as we go about our daily tasks at our respective jobs.
To change hats, though, for a moment. Let me share with you the honor, the pleasure, the deep love and gratitude, that I am flooded with, having recently been chosen to be the doula to a wonderful and brave birthing mother. The details I provide here are with the mother’s permission.
As doula, I had the power to encourage at every step where the mother was discouraged. As staff kept warning the mother that she was going to need technical interventions – not for any medical reason – but because the contractions would get “bad” and “painful” and “hurt” and I kept reminding her that they would be “strong, powerful, effective and intense”. They kept telling her she was getting too tired, or looking uncomfortable, while I reminded her that she had the innate strength and endurance to ride out the contractions, one at a time. They kept treating her overall like something was wrong, when nothing objectively was – it was an extremely low-risk, completely healthy mother and full-term baby showing zero signs of distress, and the labor was advancing very typically and normally.
Why does one institution treat childbirth as a terrifying disease, while another treats it like a natural event that most mothers and babies can get through just fine? Why, at last count, did this hospital have the highest cesarean rate in the whole state, a whopping 40%, while another hospital had only 8% cesareans and the state as a whole averaged out at around 25% including all the high-risk pregnancies? This hospital is not particularly high-risk. Mothers were generally coming in very healthy. The nurse told me they were aware of their high cesarean rate, and had instituted a “better communication” policy with a whiteboard in each room that all staff were to read and write upon. The doctor even had a hospital-issued jacket emblazoned with a “use the whiteboard” slogan in large letters. But the communication they were praising was among staff, not with the mother.
I did not hear a single doctor telling the mother that she was doing great. That she was perfectly healthy. That the labor was quite normal. That everything was going fine. That she was going to be able to do this. That her body had its own wisdom and knew what to do. That it was natural for her to feel fear and doubt, but that we were all here to support her, and the doctors could intervene if needed. But no interventions were needed at this time, because this mother was rocking it. This mother was riding the waves of every contraction as it came. This mother’s body knew how to open up for her baby, just as a baby bird pecking it way out of its egg shell already instinctively knows and can sing the melody of its family birdsong.
The overall message was “things can go wrong so we’d better hurry up” rather than “you are doing great, but we’ll keep an eye on you and we’re here if you need us!” Throughout the birth process, staff kept telling Mom that it was going to take so long and be so hard, unfortunately so. They talked about childbirth as if it were some kind of cancer that needed high-tech treatment to relieve Mom – of the baby. The doctors seemed intent on convincing her (against all science) that she was not a live-bearing mammal. That her body would be totally bewildered about how to birth a baby, and thus she would have to rely on their expertise, their interventions, their technology, and at this hospital, for 40% of mothers, their operating room, to get the baby out of her mammalian womb.
How can this be? How did this patient, this first-time mother, this non-staff member, out in the community at large without a stethoscope, miraculously and unwittingly – without studying the matter – manage to grow every fingernail, both eyeballs, and every hair on the baby’s head? How did she quite naturally, in the dark, build a lovely placenta and nourish her baby from a two-cell creature to a full term baby, complete with all its organs and parts, without a doctor micro-managing the process? Well, nature is mysterious and miraculous. And natural.
I remember specifically that this mother spent four hours between exams laboring to fully effaced (the cervix is then paper thin and ready to open quickly!) and very stretchy and soft, all the while the baby was doing just fine and so was mother. But the doctor focused on how she had “only” moved from 5 to 6 centimeters dilation, ignoring what she must, as a doctor, know as well as I do, that labor tends to speed up once the cervix is fully effaced. Instead of any encouragement, the doctor came out with a dire prediction: If you keep taking 4 hours to open each centimeter, it will take you 16 more hours, and then you will have to push for 4 more hours, and you will not be able to do that, so you will need a cesarean! A false premise leading logically to a false conclusion, and for what purpose? Oh, and by the way, the average pushing time for first-time mothers is 1 to 2 hours, not 4.
So here was Mom advancing by thinning the cervix and making it soft and stretchy, as the doctor had noted. She was in a regular, intense pattern of contractions every three minutes, as the monitor displayed. Mom was rocking it like a snowball heading downhill. Mom was absolutely speeding up in the process, as is predictable in a normal, healthy birth, but our births have been taken over by the medical establishment and abnormalized. Even pathologized. And here was a doctor standing in front of this healthy birthing mother, telling her she needs to start her on IV Pitocin, a hormone to speed up labor, right away, although it is carries a risk of stressing the baby and mother out with too frequent, too long, and too painful contractions. When she was already in a great pattern of healthy, active labor, heading close to transition. But on the off-chance that it takes 16-20 more hours, she will be too tired to keep going, so let’s intervene right now!
As interpreter, we all know what we would have to do. Ignore our own voice. Tie our own tongues. Our job is exclusively to be the messenger of other people’s opinions and words, not our own. In this case, the interpreter would tell the patient, because the doctor just did, that her labor is abnormal. That her body will not work. That she is simply incompetent to have a baby without intervention. But I am here as a doula. Blessed hat change! Blessed freedom. I was able to appropriately encourage the patient. It was even my job to do so! I was able to remind her that her body was working, that there no signs of any distress in the baby, and that she was advancing. The baby was tolerating labor just great. That she could change plans if and when she medically needed to.
After thinking it over, the patient told the doctor she would like to keep going without interventions for now. The doctor shook her head in disapproval, then raised her eyebrows and reluctantly agreed that she would “let” us have a “trial” of two hours, but then she would have to insist, because this mother was NOT going to have the baby without the doctor’s help! “Remember, if you don’t get Pitocin soon, you’ll end up laboring all day and all night and then end up with a cesarean tomorrow. I’m trying to help you here! You can’t go on forever!” the doctor ominously warned her.
A doula is not going to leave such a discouraging message hanging over the rest of mom’s labor like a black cloud, so this doula told the doctor with a smile, “Here’s our plan – why don’t you come back when you said, and I predict that you will find this mother fully dilated and ready to push, and she will absolutely NOT push for 4 hours, because she is strong and athletic. So I predict that she will likely push around 57 minutes or so. Besides which, I know this baby, and she is a daytime baby, and her birthday is today, not tomorrow! So this mother doesn’t have to ‘go on forever’ because she is having this baby today! She has the strength she needs, and she is doing a great job!”
The doctor just laughed and said she liked our plan better than hers, but she didn’t think it would happen. We need to be realistic! This mother needs help! “I’ll be coming back in at 2:00 to Pit her,” she concluded, then walked out. Now here is the lovely part. The doula part. When I turned back to the patient, I saw a sparkle in her eyes. She had focused on my encouraging words. I saw renewed confidence, renewed energy, a deep realization that she was able to give birth, and that she was giving birth. She was filled with determination. With sweet hubby on one side, and doula on the other, she was ready to labor on, unless and until she needed an intervention. Which she didn’t end up needing. Woohoo! Yay biology.
When the doctor came in 90 minutes later to “set her up” for Pitocin, guess what? She was already 10 centimeters and pushing! And when doctor gloved up and announced herself “ready to deliver the baby,” this doula reminded us all that it was the mother delivering this baby. Yes, folks. Believe it or not. We have been trained to consider it the exception to the rule, but the mother herself was actually giving birth. The mother, a live-bearing mammal, was delivering a live baby mammal, capable of giving birth in her turn, hopefully in a more natural and more humane setting, a quarter of a century from now. Yay mothers. Yay Mother Nature.
When did the industrial medical complex take over? Was it when they burned the midwives, witches and healers? Was it when we founded a country on the principles of greed and profit, and set up a for-profit medical care system (with a few charity programs to take the edge off and avoid revolution) in which patients are told they need doctors for everything from acid indigestion to constipation? In this birth, my job as doula was to help this mother find the space and tap into her strength and confidence so that her body could do its work unimpeded, within a very distracting and discouraging hospital environment. And I did it, to my absolute delight, by using my own words. Which is absolutely forbidden as a medical interpreter. Sweet, wonderful words!
Let me be clear that I have been to many births as interpreter where it was healing, safe, respectful and appropriate. But I wish to point out that treating the human body as if it cannot eat, poop, birth and die without lying in a hospital bed hooked up to massive amounts of expensive medications and constant monitors, being “rounded” upon by a team of so-called experts who will decide how to treat you, and who believe they have done their job as long as they measure and document every step they take, and treat you more like a helpless, diseased animal needing to be “relieved” of your birth experience and “delivered” of your baby … no. Humans are mammals, and not so surprisingly, most of us are quite able to naturally get pregnant, bear our offspring and breastfeed.
Let me assure any worried readers that never have and never will, whether doula or interpreter, stand in the way of a mother getting the medical care she needs, or even the medical care that she wants. I am certainly no proponent of putting babies or mothers at risk. The ultimate goal of every birth is to have all parties come out of it alive and well! Mothers with complications, diseases, premature labor and unhealthy babies should absolutely have access to the high-tech cutting edge medical care available at teaching hospitals, from fertility treatment to sewing the cervix shut to hormone treatment and even surgeries in the womb. Mothers who want pain meds or anything else that is safe and available to them should get it. Absolutely, and no shame! But let us not forget that childbirth for the vast majority of healthy women is a natural process that interventions, noise, interruptions, constant monitoring, negativity, and technology will only disrupt and complicate rather than serving. And I am glad I could say so, and be a part of welcoming this baby into the world, as only a doula can.
The ancient wisdom encapsulated in the saying that “The person who says it cannot be done should not interrupt the person doing it.” Yes. That. It was so healing and satisfying to be able to remind this mother, over and over, that she has inner knowing. That she has a body capable of birthing her child. That she can trust herself, and trust the process. And seeing her progress through her labor, in spite of constant interruptions and even discouragement, yet stay strong and focused within herself …. What a wonderful testimony to this mother’s courage. And how utterly sweet for me not to be tongue-tied, for this magical, life-affirming moment.