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Blogging About Clients

writing from the Contemporary Resort at Walt Disney World - Thanksgiving vacation with family (extended and immediate) - 2005

I have been struggling with this issue hard and recently the entire thing came to an explosion about some of my writings on-line. I do want and need to lob ideas back and forth with other writer/midwives & doulas to get a feel for respect for confidentiality, heart, feelings, and, at the same time, sharing incredibly valuable "inside" information that benefits all of us in our introspection and movement through life.

I know that reading other women's stories, through a midwife's or mother's perspective, has benefitted my own practice/style. If it weren't for reading about birthrape on-line, I'd still be a midwife thinking vaginal exams were vital to a baby's entrance into the world! If I hadn't read other midwives speak about their own introspection and inner questioning of what they learned, saw, or did, I don't know if I would have come as quickly to the realization that what I learned, saw, and did wasn't quite so great after all.

I do understand that a woman's birth story is incredibly valuable in her re-telling it. I also know that a midwife's re-telling is incredibly valuable in a different way. Women in birth have altered senses of time (and should!), altered perceptions (and should! [such as who was in the room when, if the back massage was helpful before the saline injections or after*, etc.]), and because a midwife charts, she writes HER view - slanted as it is - of the birth.

I also know that NONE of us sees ourselves as others see us. Listening to other midwives share about a woman's reactions to her husband's marijuana smoking during labor* or a husband's withdrawal from the birth room at every opportunity* just isn't going to be said in the woman's own birth story, eloquent as she is.

I am reminded (a LOT) of the old adage: There are three sides to every story - yours, mine, and the truth.

Easily, my favorite birth story scenario is layering a mom's story either on top of or under my own re-telling of her story. It adds diminsions and layers to the complete story not "gotten" otherwise. For every person who tells the story, they also add to the whole. It's a mosaic, a prism, a never-ending and always-transforming fluid even though it happened in a moment in time.

Most women do not write their birth stories (and I am speaking of writing since this is a blog/list/group/Net discussion) for a long time simply because of time (understandable!) and I know that I write birth stories as quickly as I can so the details remain fresh and sharp. In my Outlook list of Things to Do are no less than 15 birth stories yet to be written, some from as long as 5 years ago. While the blunt edges will remain (transfer, suturing, giggly toddler, etc.), nuances are certainly lost - the halo of the sun's rays as she tilted her head to kiss her husband's hand*, the look on her face as she learned her baby might need further genetic testing*... aspects such as these - seemingly dramatic at the time, fade slowly as more and more moms, families, babies, situations, life experiences shade the memories.

I've debated this writing a composite woman idea - making up a woman (Kate)* and putting aspects from several women together to make Kate experience many of the situations two, three, or more women experience during their pregnancies, labors, and births. To me, that is fiction and I suck at writing fiction. I am a storyteller - an essayist - a blogger and must find a way to continue writing what I know yet protecting my client's privacy and dignity (even if what I share is how she orgasmed during birth - a delightful aspect to me, but for a Moslem woman [or anywoman], might not be something she'd want shared).

I also know that I like real stories! I don't read much fiction at all. It's just who I am. I can't be alone or there wouldn't be the plethora of non-fiction tell-all's available about every conceivable topic, including birth. I want the stories I read to TELL ALL! Real stories grab me... I can "see" them much more clearly, can "watch" the action of a shoulder dystocia's recovery or an extensive suturing job's relief when it is not fiction.

While looking into blogging ethics for my own hoopla, I am discovering how other people are attending to this really, really, really new course we are traversing. I have gotten at least 2 ideas from this thread alone that I am considering incorporating.

First, I am working on a Blogging Informed Consent (BIC) for my client's charts. I hope to have it complete within a week or so (I'm having a lawyer and several extremely trusted Net-savvy birth community friends/peers review it before I publish it or incorporate it into my practice.). I will ask any of my former clients I can find to sign the BIC - and by sign, I mean either yay or nay - and will adjust my movements appropriately.

(I'm tweaking with "you can share this, but not that" sorts of permission... like what I do with photographic releases.)

I'm in a lost place about the clients I cannot find or had a blink of a moment with (many of the migrant women, for example - or the women in the military). I await an answer from inside as well as listening with an open heart to those whose stories might be being told by someone else far, far away - how does that feel?

I'm also lost with what to do about women who give consent, I write, they withdraw consent. With photos, once the woman signs, that's the end and it's court before they can be "given" back to her. What happens if it's a blog entry? Sure, it can be removed, but what if it's published in a magazine? When is consent complete and absolute?

I think I have also decided to write the birth stories as always and then put them in a Birth Story Folder and periodically pull one out to share as if it had been "last night." Even if the mom gave informed consent, I wonder if sitting on it - waiting for awhile to give her pause to choose again - shaking head - (am I going to call her weekly and say, "is it still okay to write about you?" probably not - this is the issue in the BIC I am coming up against).... (Another provider's) situation is what brought this part about because of the small town aspect and finding birth records and cocktail party discussions, etc. While I don't have that very small community to contend with, there are only a couple handfuls of midwives where I am and it's easy peasy to figure out who had the 14 pound quadruplets at home.*

My family of origin (and it's a big one at the moment!) has asked several perceptive questions.

1. Why does anyone even care that you write their birth stories? Why would you need an informed consent at all?

Several family members who have had children stated they were extremely private in all aspects of their lives, yet would be honored to have someone tell their story. When I explained that it isn't always happy or pleasant, they began to understand.

2. Why would you write birth stories? Who reads them?

Women read them voraciously when pregnant to try and see what's coming around the corner, to assimilate into their community, to familiarize themselves with the lingo, the options, the mishaps others have taste-tested for them. Of course, there are a million other reasons, but I suspect voyeurism is also high on the list despite protestations to the contrary.

(And yes, I am hyper-aware of writing's exhibitionistic intent.)

I believe voyeurism is also present when it comes to midwives or doulas (or docs), but I think it's a different flavor than a mom's. New birth "workers" might not see a umbilical cord break off (without pulling on it) for 20 years, yet by reading, she can learn it isn't an hysterical 911 emergency and can feel reassured that she does, indeed, know what to do. New doulas might find information about how to best serve an extremely conservative Christian family by reading about another doula's red-faced suggestion to the mom to "take your shirt off."*

(As I write these fake people and scenarios, they easily fit someone - or many-ones - I have had contact with over 23 years. This makes this entire topic even more challenging! What happens if a woman who signed a NO on the BIC thinks a story is about her, but it really, really isn't? What if I decide to be stupidly daring and write fiction, yet it turns out that my composites are spitting images of birth stories of women I've never met or even heard of? Lawyer stuff, I know.)

Reading over this before sending, I sigh about the amount of asterisks in my piece. I wonder if I will learn to know the SHIFT 8 as much for disclaiming as for emphasizing (*like this*). Should I put a disclaimer at the beginning or end of anything I write? What would it say?

I.e. My entire world knows that there is a parenthetical disclaimer on any appointment made. "Would you like to go to the picnic Saturday?" "Absolutely! (unless there's a baby)" "Mom, can you take me to the ballgame on Tuesday night?" "Sure! (unless there's a baby)" They learned this looooonnnnggggg ago and when meeting new non-birth people for things, the parentheses are removed for awhile, re-placed in time.

Am I going to go overboard with asterisks and make my papers look as if snow flakes are falling down, down, down the essay?

This is long and I find some resolution in its production, but still see the gaping holes (I picture those lace thingies my Nana used to make for the arms of chairs) I don't yet know how to fill. Once again, I'm watching, listening, learning, trying hard to grow and change where the situation requires it, and want more than anything to preserve a woman's heart, spirit, and dignity.

I also want more than anything to make my writing mean something - not just be white noise in the world of essays and blogging. The balance is there - and I pray not always so precarious. I'm visualizing clear, thick lines of right and wrong - ethical and unethical - appropriate and inappropriate. Foggy worries float around my head, but I hold tight to the belief that it won't always be so confusing and my (and others') learning won't always be so difficult and painful.

Blindly, I move forward.

* not a real scenario or person

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Reader Comments (4)

you are being very considerate Barb, I too find it is going to be impossible to get a decent permission from many old clients, and the way people change their minds it could just end up generating a bigger problem-- telling stories I just find essential to how I think /how I do midwifery... also sometimes I can't help but to end up with partial fictions because my memory will blur similar stories now that I am middle aged.
so are you enjoying your vacation at all?

November 26, 2005 | Unregistered CommenterAnonymous

I can't offer any black and white answers...only support that you keep seeking *your* truth and keep asking questions.

I really wish though - that you would prohibit anonymous comments (JMO tho)

November 28, 2005 | Unregistered CommenterWash Lady

Grace under fire, that's a terrific stance you're taking Barb.

I'm soooo sorry that this all came down while you were taking a much needed vacation. I hope that the remainder is joyous and light filled.

You're plowing your way through this brilliantly.


November 28, 2005 | Unregistered CommenterAnonymous

I am surprised at how this issue is reverberatng in my life. It is going through me on multiple levels. So for what it is worth to anyone who reads...these are my thoughts.

My husband is a doctor and his patients want to know about his experience, etc. re: other patients for multiple reasons. They even want to know details....as many as possible. Yet would the ones asking want themselves used as an example?


Not many of us like to look at ourselves with much scrutiny. When we hear things from others we can feel betrayed and wounded even if (sometimes especially if) what they say is true. Hard to say what can and can not be said no matter what the situation.

I know I want to know. I want to know others experience. I want to share my experience. Not in an exploitive way but in a compassionate/learning way.

Just the other night for some reason I was watching "wife-swap" I only caught bits and pieces of it with everything else I had going on. However, one thing came clear and made me uncomfortable. One woman had her way of living and handling her family that she had justified as totally appropriate and right examined and scrutinized. However, it was obvious to EVERYONE but herself that she was denying the truth about how she was really behaving and relating in her life. She was so uncomfortable with everything that she attempted to hold the show hostage in order to get her own way.

Now, did I really want to know everything about this woman's life? No, I don't really need to know all the intimate details!! The bits and pieces I saw were enough.

However, I am PROFOUNDLY grateful to her. I became uncomfortable. Not because I was seeing her and didn't like it. I was uncomfortable because I had the thought that I needed to look closer at myself. Was I doing some of those same things? Maybe not the same details but was the tendency the same? The pain I felt told me the answer was YES.

I am WIERD though. I like that! I want to examine myself that closely. I want those in my life to help me look that closely. Most of us most of the time though (and even myself on MANY occasions) want to close the door of the messy room and pretend it is clean in there or at the very least that we have no idea it is indeed messy.

The other night I wanted the truth more than pretending there was a messy room. Tomorrow, who knows how open I will be or how willing I will be to receive it. My openess varies like everyone elses.

I do hope that the people in my life will find a way to share the truth with love and even tough love the times that is needed. I hope I will continue to be open and learning about myself. I hope that I will be able to learn about myself through the stories of others as well. I need them because they help me learn my own story.

There is strength in truth...even when it hurts.

November 28, 2005 | Unregistered CommenterJunipurr

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