What does a grown man wearing a baby-doll dress have to do with your healthcare? by Michal Klau-Stevens

A few years ago, a critic said something that stuck with me which led me, recently, to an unusual experience. Back when I was president of a national nonprofit organization working to reform maternity care practices, a critic of natural childbirth accused leaders of the reform movement of being insular. She claimed we always heard from the same experts who touted the same studies, and our tunnel vision kept us from viewing the “big picture.” At the time I considered whether she had a point. After all, there was a fairly small pool of experts – the “usual suspects” who published books, appeared in documentaries, and spoke at conferences. Were we operating in a bubble? That critique made me aware of the importance of seeking out other sources of information as a kind of reality check. So earlier this year, when I received an email about The Tenth Annual Transgender Lives: The Intersection of Health and Law Conference being held at the University of Connecticut in April, and saw there were presentations on healthcare advocacy, I was inspired to attend. I was curious what experts who specialize in issues that affect another, very different, population would have to say about healthcare delivery.

I was excited about the prospect of hearing from a whole new group of people who would expand my horizons. For weeks leading up to the conference, I envisioned myself soaking up new information and being re-energized by learning cutting-edge research and ideas. In my mind I pictured myself being totally focused on the speakers in rapt attention.

On the day of the conference I was thrown out of my comfort zone in the parking lot, before I even walked into the building. As I got out of my car, one of the first conference attendees that I saw was a grown man, about 30 years old, wearing a baby-doll dress with a lace bib collar, white eyelet knee socks, mary-jane shoes, with his hair in pigtails. He was carrying a purse over his shoulder. I thought to myself, “Whoa – I guess I’m not in Kansas anymore…” You see, while I envisioned myself at the conference, I had not envisioned anyone else who would be at the conference. I’d been looking forward to learning about healthcare from a new perspective, but didn’t fully anticipate that the perspective would be that of transgender people, who in case you don’t already know, are a bit different from the pregnant women, midwives, and doulas I usually attend conferences with.

Once I got inside the building, I saw that the baby-doll dress was the most radical outfit in the place. Most of the attendees were much more low-key, although the energy of the environment was different from a birth-related conference, and the culture was different too. When I was given a name tag to fill out, I was asked to put my name and which pronouns I prefer to be called on it. I learned that pronouns are a very big deal in the LGBTQ community. The vendor gallery was filled with organizations that offered STD testing, HIV testing and support, mental health services, and legal support. Bright colored condoms were given out along with the usual pens and water bottles. The bathrooms were non-gendered, and frankly, it was sometimes hard to tell who was a man and who was a woman anyway. Once the stall doors closed, it didn't matter. Everyone was very polite and respectful, though. I did overhear more than one person say that this conference was one of the few places they felt safe using a public bathroom, but that’s another blog post.

While so much of the environment felt different to me, when it came to discussions about healthcare, much was similar to what we discuss about maternity care, and about healthcare in general. While technology and surgical techniques have made incredible advances, they are not foolproof, and there is still much more that remains unknown. It is vital to your well-being and your safety to have someone at your bedside to help advocate for you while you are in the hospital. Access to certain kinds of care is challenging and costly. Sometimes doctors and other caregivers are heroic and champion our needs, and other times care is paternalistic, disrespectful, and traumatic. Being able to use your voice, express your preferences, and have them be respected is an important component of good health outcomes. Minority people, people of color, and other oppressed populations do not get the same quality care that upper-class white cisgender men get. The advocacy skills necessary for getting good care are basically the same, whether you are going into the hospital to have gender-confirming surgery, to have a baby, or because of some other health reason, like cancer, heart disease, or other illness.

I learned a number of new things that day, and also confirmed some things I already knew. Hearing from experts outside the field of maternity care assured me that I’m not being insular or looking at healthcare with tunnel vision. There are serious issues with the way healthcare is delivered in this country, and they affect people in similar ways, regardless of the different reasons why people seek care.  Attending that conference was an unusual experience, which expanded my horizons. It reminded me of the value of moving outside my comfort zone and seeking out other people and places to gain valuable perspective.

And that man in the baby-doll dress? They (yes, that’s the right pronoun) are advocating to make healthcare better for you.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

My Secret Addiction

I’m embarrassed to admit it, but I think I suffer from an addiction. It probably isn’t healthy, and it makes me question my view of reality at times, but still, I cannot stop myself from watching medical TV shows. As a healthcare consumer advocate I am drawn to the show Chicago Med. It offers a view into places where human experience, with all it’s power, uncertainty, emotion, and messiness, is portrayed in Technicolor detail along with bloody surgical procedures. That show really gets my adrenalin pumping! Sometimes the scenarios posed in the show leave me replaying scenes in my head for days. You see, television is a powerful medium that exerts a huge amount of influence. It offers a vision of the world and then leaves us to decide whether the vision is accurate or not. It makes us ask the question, “Is this really who we are, what we do, and what we believe?”

A recent episode of Chicago Med has me pondering some deep questions about the current state of medical care decision-making.

In the show an alcoholic was brought into the emergency room with a broken leg. He was a “frequent flyer;” a regular visitor to the ER, and so one of the nurses was familiar with him as a patient and knew he was an alcoholic. The man began to experience delirium tremens, a painful and potentially deadly symptom of alcohol withdrawal. The man stated clearly that he did not want to stop drinking, and he was not going to take any steps to kick his addiction. He was brought in for an injury, not for getting clean. The patient was having seizures, hallucinations, vomiting, and suffering internal bleeding because of the DTs. All he wanted was a drink, yet the doctor on his case refused to allow him to have one, because the doctor believed that getting the patient sober was what the patient needed. The nurse tried to sneak in a bottle of liquor, but the doctor stopped her and told her, “I’m the doctor. I know what’s right for the patient.”

Who gets to make the final decisions about what the patient “needs?” – the doctor or the patient? What values are wrapped up in the decision-making? This was a juicy scenario to consider for a number of reasons.

First, it raises the question of the ethics of treating a body part or treating the whole patient. Should the doctor have just stabilized the patient enough to treat the broken leg, and not concerned himself with the alcoholism? Does the patient’s assertion that he wants his leg fixed but doesn’t want to be treated for alcohol addiction carry any weight? Does stepping over the threshold of the hospital doors mean the patient must follow hospital protocol, give up his autonomy, and give up his rights to make decisions about his body and the course of his medical care? Medical ethicists and human rights advocates argue that the patient retains those rights, and that doctors are supposed to respect them, even if the patient may suffer or even die as a result of those decisions. In this light, treating only the broken leg and not the alcoholism would have been the appropriate thing to do. It’s understandable the doctor may feel that because he has the training and the resources to treat the whole patient, he should treat the whole patient, but only if the patient consents.

Second, it raises the question of which drugs are acceptable, under which circumstances, and why. The doctor treated the patient with benzodiazepines and with Haldol, which are both prescription medications. He refused to allow the patient to have a medicinal dose of alcohol, even though it’s a substance that anyone over the age of 21 can legally consume without a prescription. Why are the prescription drugs acceptable while the over-the-counter one is not?

Third, how do we judge another person’s capacity to make medical decisions when that person appears to be flawed? In this case, the perceived moral failing of being an alcoholic influenced the doctor’s belief in the patient’s ability to make good life choices. The doctor asserted that his medical authority also gave him the moral authority to override the patient’s authority to make medical decisions for himself.

Lest you be tempted to say, “Michal, it’s just a TV show,” realize that these questions play out in real life every day. As the concept of patient-centered care plays a bigger part in how healthcare is delivered, questions like these, which expose the tensions between patients’ rights and doctors’ responsibilities, cause judgment calls to be made in almost every medical interaction.

Doctors and patients may disagree about what the patient needs to stay healthy or get well. They may have different approaches to health, illness, and questions about quality of life. That’s why things like Do Not Resuscitate orders and living wills came about – so that mechanisms would be in place for patients to express their wishes about how to be treated in circumstances in which they could not speak for themselves. When we are patients, we are dependent upon medical caregivers for their expertise, but we are not required to completely submit to their medical authority. We still retain rights that must be respected. Doctors are human beings who are tasked with using their knowledge and skill to improve the lives of others. Sometimes they use their abilities wisely, and sometimes they make the wrong the choices. There will always be a dance between doctors and patients, and we all need to learn our steps so we don’t trip over each other’s feet.

As a society we make fairly arbitrary rules about things like drug use. The perception is that prescription drugs are safe because doctors prescribe them, yet the over-prescription of narcotics is one of the main causes of epidemic heroin use across the country. Patients become addicted to prescription pain medications, and then switch to using heroin because it is cheaper. And prescription drugs may not be the most appropriate remedy. An over-the-counter product or natural remedy may suffice, but those are unlikely to be used in a hospital setting. When I was in the hospital after giving birth to one of my children, I was told I was not allowed to take the ibuprofen (ADVIL) I had brought from home. There were two main reasons why. First, any medication taken by the patient needs to be noted in the patient’s chart, in case of side effects and to make sure no drug interactions will occur. This is for patient safety. Second, the hospital can charge a premium price for the medications it distributes. They often charge up to $15 for a tablet of Tylenol, which otherwise would cost around 11¢. I was scolded for being a noncompliant patient each time I told the nurse I took the ibuprofen anyway, against their medical advice, so they could mark it in my chart.

Coercive care is a common problem for anyone who is deemed “less worthy.” At a conference I attended recently I heard story after story of patients who were told by medical caregivers something was being done “for their own good,” because they were overweight, a person of color, young, female, transgender, or different from what the mainstream consider to be normal. This is what the Chicago Med episode highlighted; that mainstream medicine does not equal moral authority.

As the practice of medicine continues to change, as it has drastically over the previous few decades, we are challenged with examining the changing nature of the authority and responsibility of both patients and doctors. We need to be mindful of patients’ rights and also be clear about our expectations of doctors and medical care. We need to recognize our biases and morals, and see clearly how they intersect in medical situations.

Watching healthcare scenarios on medical shows like Chicago Med reflects choices back to us and inspires us to compare our beliefs to what we see on TV. Rather than viewing it as straight entertainment, I use the show as a catalyst to examine my own beliefs and to learn more about how these scenarios unfold in real life, for real people. Does that make my compulsion to watch the show an addiction, or a healthy desire? I guess that depends on what the people in the mainstream think.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Pregnancy and Infant Loss Remembrance Day by Michal Klau-Stevens

Pregnancy and Infant Loss Remembrance Day

By Michal Klau-Stevens, The Birth Lady

October 15 is Pregnancy and Infant Loss Remembrance Day. It is a day for families and friends to remember all the babies that have passed too soon, either through miscarriage, pregnancy loss, stillbirth, neonatal loss, SIDS, or illness. Light a candle on the evening of October 15 to create a Wave of Light around the world to honor those whose light was extinguished before it could shine bright.

On October 15 at 7 pm in every time zone around the world people will light candles and let them burn for at least an hour to remember the losses they have suffered, and celebrate the lives that could have been. The Wave of Light is an international event where the result is a continuous chain of light spanning the globe for a 24 hour period in honor and remembrance of the children who die during pregnancy or shortly after birth.

Twitter on October 15: #pregnancyloss and #waveoflight

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Wash Your Hands Please!

By Michal Klau-Stevens


Would you have the nerve to tell your doctor to wash his or her hands?

We all know that germs travel from one surface to another, often carried by human hands. For people with healthy immune systems, contact with many types of common germs does not always lead to illness; in fact, it’s often not a problem. For people with compromised immune systems though, contact with common germs can lead to illness. Even worse, in a medical setting such as a hospital or surgical center, the types of germs that can be transferred from patient to patient can cause serious illness, and even death. We expect doctors, nurses, and other healthcare workers to be conscientious about washing their hands, but you might be surprised to hear that in some hospitals the hand washing rate of caregivers can be 50% or lower. What can you, as a patient, do to reduce the risk of having germs transferred to you?

During the mid-1800’s a doctor named Ignaz Semmelweis discovered that when doctors in his Austrian maternity hospital washed their hands after doing autopsies before examining women in labor, fewer women and babies died from childbed fever. He implemented a hand washing protocol on the labor ward, and demanded that all the doctors and nurses wash their hands in a caustic solution when they arrived on the ward and before they touched any patients. Death rates from puerperal fever plummeted in his hospital, and thousands of women and babies survived their hospital confinements because of the hygiene measures in his institution.  This took place in the very early days of microscope development, and before germs were viewed by human eyes. Sadly, because Semmelwies was never able to isolate the cause of transfer of illness between people, the other doctors of the time refused to believe him when he said their unwashed hands could be the cause of people dying. He was reviled by the medical community and died an unhappy death in an insane asylum.

Decades later, after microscopy was more advanced, germs were discovered and germ theory was created. Doctors finally understood that indeed, their unwashed hands were the travel mechanism for microscopic organisms that transferred illness from patient to patient.

These discoveries happened in the late 1800’s, so we’ve had well over 100 years to make hand washing the norm in our healthcare institutions and as part of medical training. Yet, a recent study showed that while some hospitals have excellent hygiene practices and compliance, others have compliance below 47.5%. According to the World Health Organization, caregivers are supposed to wash their hands:

• Before touching a patient,
• Before performing a clean/aseptic procedure
• After body fluid exposure risk
• After touching a patient
• After touching patient surroundings

There are a number of reasons why caregivers might not wash their hands, including lack of understanding about the importance of hand washing, a hospital culture that places it at a low priority, lack of time from being overloaded with patients, too few hand washing or hand hygiene stations, and skin irritation from frequent washing.

Even though caregivers know that washing their hands is an effective way of limiting the spread of infectious diseases, it’s not always top-of-mind for them. Since they can’t see the germs, it can be difficult, if not impossible, to connect an illness with a handshake that occurred days before. The importance of hand hygiene can fall by the wayside if the administration and peers within the workplace do not strictly maintain it.

You, as a patient, are the person who will be most seriously affected if hand hygiene is not practiced in the healthcare facility where you’re receiving care. You are the one who will become sick. Therefore, it’s to your benefit to make sure that no one touches you before they wash their hands. Take a few minutes before checking in to familiarize yourself with hand hygiene protocols, so you’ll know when and how it should be done, and when it’s appropriate to be touched with gloves and without. When someone enters your room, watch to see that they take the time for hand hygiene before making skin-to-skin contact with you. If they don’t – ask him or her to do it.

Some people feel uncomfortable taking that stance and making a demand of their doctor or nurse, but it’s your right as a patient to do so. Don’t let embarrassment, discomfort, or over-politeness stand in the way of your health. With the super-bugs floating around in hospitals these days, it’s too big a risk to take. Just a little soap and water or some hand sanitizer could prevent serious illness or even save your life! Be an empowered patient and demand good hand hygiene, because there may be a 50% chance that your caregiver isn’t taking care of that for you.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!