The Art of Listening

Posted by Andrea Altomaro on April 29, 2019
Spoiler Alert: This post discusses events in Season 8 Episode 5.
Ctm s8 ep 05 004
Credit: Neal Street Productions
Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Listening. It seems like such an easy thing to do, but is it really? Listening intently, not interrupting, and not casting judgment on what is being said is something that certainly takes practice. Did you know that women are statistically less likely to be taken seriously about their health complaints? Or that overweight or obese women are even less likely to have their concerns addressed? Often, their complaints are chalked up to being overweight, and they are given a vague reply about how their problem is likely weight-related, and if they lost weight, they would probably see an improvement in whatever ails them. Women are often seen as overreacting or exaggerating their problems, and serious health problems can be overlooked. We see examples of this in maternity care. Women of Color are less likely to have their concerns taken seriously during pregnancy and the postpartum period. Black women are significantly more likely to die from pregnancy-related causes than white women.

I noticed when we were first introduced to Lois Parry, we even saw Trixie initially dismiss her concerns. She saw Lois as a nervous young woman getting ready to be married, and told her that she had nothing to worry about. Trixie assumed that someone like Lois was probably just visiting the clinic because she wanted contraception.

Now, one thing that I’m certain was not discussed openly in the 1960s was sex versus gender. A person has their sex assigned at birth, based on what their external genitalia looks like. Gender identity, however, is a spectrum (not simply male or female, woman or man), and refers to the personal sense of one’s own gender. In the case of Lois, who had come to the clinic because she was concerned over never having started her menstrual cycle, the appearance of her external genitalia at birth did not match her internal reproductive organs. We learned that while it looked like Lois had a vulva, she had a short vaginal canal, but no cervix, uterus, or ovaries. She did however, have internal testicles. Does Lois’s lack of female reproductive organs make her a man? Of course not! Lois’s gender identity is female, which we know, because she tells us that she still feels like a woman; she wants to wear dresses, do her makeup and hair nicely, and has always felt like a woman.

Going back to my original point about listening, I was appalled by the bedside manner of the physician that examined Lois at St. Cuthbert’s Hospital. Lois recounted the situation, saying, “It was horrible. He had these students there, all men, and he didn’t tell me what he was doing, or why. He found something in my stomach. I know he did.” I cannot imagine the trauma of that experience. I wish I could say that things like this never happen today, but I know from my experience as a nurse and a midwife that they certainly can. All health care providers today go through training regarding how to sensitively care for our patients, however, I’m not certain that in all medical programs, this practice is emphasized.

The CDC actually has a wonderful infographic showing the 6 Guiding Principles To A Trauma Informed Approach. I think all health care providers would benefit from looking this over and incorporating it into our every day practice.

There are a couple of small things that health care providers can do to improve the quality of our care. First, listen to clients. Really listen. Acknowledge your own biases and then let them go. If you have immediately passed judgment on someone because of their sex, weight, race, or socioeconomic status (because this is something that everyone does no matter how uncomfortable that might be to acknowledge), let that go, and do not let it impact your plan of care for that person.

Every person deserves to feel safe, feel heard, and to collaborate with their provider about the plan of care. This is how we help people leave our care feeling empowered, instead of defeated.

Finally, ask before your touch someone’s body. Yes, I know that this client is here to see if she’s in labor. We’ve already talked about how I’d like to check her cervix for dilation. She has laid down, brought her knees up, and let them fall out to the sides (and while we’re on this topic, please don’t ever tell someone they need to open their legs, or tell them to “just relax!” and by no means should you ever force someone’s legs apart). I still tell them that I’m going to touch their leg first, then, here’s the clincher – I ask them if it is okay to go ahead and check them. Of course, we’ve already established that was the plan, but making sure they are ready for the exam is so important. I do this as well with all pelvic exams in the office. Once someone is laying down for an exam, I always let them know that I have the speculum, I touch it to their leg, and I ask them if I can go ahead. Can you imagine what a difference that would have made for Lois during her visit to St. Cuthberts? If the doctor had asked if medical student could be present, and then had provided sensitive, trauma-informed care, Lois probably would have had a much different experience there.

As midwives, we are caring for people at an extremely vulnerable time in their lives. It’s important that we don’t lose sight of that. Every person deserves to feel safe, feel heard, and to collaborate with their provider about the plan of care. This is how we help people leave our care feeling empowered, instead of defeated.

About the Author

Andrea Altomaro MS, CNM, IBCLC has been nurse-midwife since 2012 and is currently working for the Henry Ford Health System. Andrea knew from a young age that she was interested in pregnancy and birth, and decided to become a nurse. When she learned about the role of certified nurse midwives when she was in nursing school, she knew she had found her path.