Wednesday, 6 August 2014

Those Walls of Babies

Back when I was doing my Masters in Political Science in the early 1980s, a fellow student and friend was writing her thesis on the Patriarchy and Women’s Reproductive Health.  She researched the way women were treated in the reproductive health field, ranging from contraceptive prescription practices, to the voice (or lack) that women had in their treatment.  I remember her commenting on the lack of privacy given to the woman in the layout of operating theatres and delivery rooms, where the hospital bed ensure that the patient faced the doors.  Fortunately, these days, this no longer occurs (I can personally vouch for that given my recent experience).  But there are other areas where women’s needs are ignored, even in the practice of medicine that is devoted to women’s health.

What I am about to discuss may seem trivial to some.  I don’t put it in the same category as the lack of physical privacy and dignity that I referenced above.  But it is real, and for many women, very distressing. 

I’m talking about the dreaded Wall of Babies.  Those of us who have been to fertility clinics are probably familiar with these.  The photos sent in by happy customers, spreading their love and thanks to the doctors and staff of the clinics who helped them have their children.  (Given my situation, I’ve never been to an obstetrician’s office, but I would expect the same there.) For those of us who visit these clinics, the photos are both a source of hope, and a source of pain.  Personally though, by the time I got to the fertility clinic they were mostly a source of pain, reminding me of what I had already lost, and what I might not be able to have.

So back in March, when I first visited my gynaecologist (here in NZ we go to GPs for regular smears, and other routine gynaecological issues, so I’d never actually seen a gynaecologist - outside of hospital - before), I was surprised to find that behind the examination bed there was a board covered in photos of babies.  I will say that it gave me an unexpected ouch moment. To be fair, it may have been a particularly traumatising examination that made me react to all those photos.  But it felt like a bit of a slap in the face, nonetheless.  I want to say that it didn't really bother me, but obviously, months later, I'm still thinking about it, and remember how I felt.  But I have been thinking primarily of women who might have been through the same things I've been through (pregnancy losses and infertility and unsuccessful fertility treatments), or worse, but more recently than me, women who aren’t 12 years on, women who still feel the pain of their experiences or situations acutely.

It surprised me to see a Wall of Babies at this doctor’s office, and I didn't expect it.  His special interests are listed as laparoscopic surgery for a range of gynaecological conditions, and it seems to me that this is the larger proportion of his business, rather than obstetrics (though he does do some obstetrics work).  He doesn’t (as far as I can see) work in the infertility field at all.  (And I have to say I really like him as a doctor, and wouldn’t hesitate to recommend him.)  But he is aware of the impact of losses.  He was my doctor 12 years ago, when my second ectopic pregnancy was diagnosed in the public hospital, and I remember him being kind then, despite having to deliver the news in the waiting room under a huge diagram of pregnant bellies.

It does though seem to be an “industry standard” where doctors like to show off their happy thank you photos.  From my years in this field, it seems to me that there are dreaded Walls of Babies in OB/GYNs' offices all over the world.    

And it made me wonder: 
  • Do the baby photos give their pregnant patients comfort and confidence in the doctors’ abilities?
  • Do the baby photos ever upset any of their patients?

 The answer to both these questions is obviously yes.  

I wonder what the overall impact of such photos is on patients?  Are they beneficial?  Do more patients walk out happy as a result of feeling hopeful or inspired? I hope that the answer to this is YES, that this is what doctors believe and is the reason they display these photographs (rather than from pure ego - "look how my patients love me!").  

Or do they do more harm than good?  Do more patients walk out of their offices upset by these photos, feeling "less than," and/or reminded of loss?  

Does the good outweigh the damage done to gynaecological patients, or obstetric patients who have lost their babies? 

I suspect not.  I suspect that the trauma of seeing such photographs when someone is being diagnosed with cancer or other fertility-threatening conditions, or when they are losing or have just lost their babies, far outweighs the comfort a worried obstetric patient might feel during her consultations.  None of us visit an OB/GYN for fun, not even pregnant patients in New Zealand.  (Seeing an obstetrician during pregnancy here suggests a high-risk pregnancy, as midwives handle the majority of deliveries.)  Making it more emotionally upsetting seems thoughtless and even cruel. 

I wish that doctors would think about the principle “first, do no harm” in every part of their practice, and pay attention to the emotional as well as the physical well-being of the women who are their patients. At the very least, I wish that they would think about these photos and wonder how they affect their patients.  Maybe someone could even get a Master’s student to do a study?

22 comments:

  1. Interesting. The only baby photos at my specialist are his kids. Very artistic pictures, all over the place. I tune them out now. And they are not in his office ( or not behind his desk at least) and not in the exam room, so less problematic than their previous office.
    I think sometimes people who are in a little specialist world ( not just medical) forget others don't

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  2. I the US, the wall of babies is very common practice. Especially with REs. It is a form of advertisement (look at how good of a doctor I am!) and it is also seen as a source of hope. Yet I know that for me, these Walls were knives to the gut while I was riding the fertility treatment roller coaster. It was a constant and painful reminder of how my body was failing over and over again. I felt so strongly that I requested the Beats's ultrasound photos not be posted (which surprised my doctors).

    I think there is a misunderstanding of the benefit of this wall. That unilaterally it is assumed it provides hope and joy. I'm willing to bet there are more women who feel this way too but don't want the negative connotation. I think a good solution is to be mindful of where this wall is. Not to post it at the entrance to the clinic or the exam rooms but instead more to a private area.

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  3. There was a wall of babies in the NICU, but my clinic AND my ob/gyn do not have walls of babies (though my ob/gyn has other triggers including a video that plays in the corner of the waiting room on continual loop asking, "do you think you're infertile? Are you having trouble getting pregnant? Staying pregnant...") Which seems odd because like Cristy says, it's pretty common here in the US. My clinic once had one, but they moved it somewhere private. You no longer see it when you're in the office.

    That said, I wonder if the same thing is true for cancer walks. You have the people who lived or the people carrying pictures of loved ones who lived (or the opposite) walking amongst those who are walking for someone who has died or someone who is currently ill. The people who lived are supposed to give you hope, and some would be devastated if those walkers weren't there. If there wasn't a visible sign that there is an "after" that they may or may not reach. And at the same time, it's devastating for another group of walkers who did not get the coveted ending that those walkers got.

    I will say that I was extremely grateful for the NICU wall. You saw it as you washed your hands, before you went into the actual NICU. I would stare at those pictures, sometimes paired with a "here and now and healthy" picture, and sometimes marked with a death date. (No, all the pictures of the babies were not currently still alive; they were all just babies who had been in the NICU for an extended stay.) And they made me feel as if I were moving forward rather than stuck in limbo. Moving forward towards what, I didn't know. But moving forward nonetheless; a reminder that we wouldn't always be at the NICU.

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    1. I think the NICU wall makes sense, because it acknowledges the lives of the babies who were there, showing that you and your babies are seen, really seen, regardless of what happens. Cancer walks too perhaps because they are an acknowledgement and remembrance of the people who have had cancer, regardless of their outcomes. If they were restricted to only people who had survived, then it might be more an equivalent.

      I cringe at the thought of the looped video in your ob/gyn's waiting room though. It was your post about going for your annual exam (http://www.stirrup-queens.com/2014/07/go-quickly/#comments ) that inspired me to write this, as I'd been thinking about it a lot.

      I was considering writing my surgeon a note about this. (Though I've already complained about their quoting practices, so I don't want to be THAT woman who complains all the time!) And then as I write that, I think that maybe I should send all the gynaecologists in my city a note about this. But first perhaps I should run a poll of all our readers to see if they get hope or sadness from the Walls of Babies? Hmmmm ... thinking now!

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  4. I think, doctors display photos of the babies for the same reason I display Christmas or birthday cards I receive. I display the cards across my mantel because I'm obviously happy to know that someone thought of me, I enjoy looking at pretty cards and also I display them out of respect to those who sent them. I do not collect cards so I trash them after some time as I suspect what happens to the majority of the baby pics from baby picture boards in docs' offices.

    Doctors' offices are really nothing else as their homes, and I don't think they think too hard about how the decorations can impact their patients (i.e. guests). I don't think the pictures are there to inspire or hurt or harm anyone, they are just there. I never really gave them a second thought.

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    1. I think you're right - that they don't think too hard about the impact on their patients, and that they display them much as we would cards. However, it is very different than displaying things in their homes, I think, because there is a very different power relationship in those rooms, and many of their patients are worried and often vulnerable. So it would be nice if they did think about their patients.

      I think you're very lucky you never gave them a second thought. So many of us weren't able to do that.

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  5. One of my RE clinics had a policy of no children in the waiting room and no baby photos on the walls. My other clinic had baby photos plastered everywhere -- by the front door and across from the u/s rooms. In online reviews of the latter clinic, more than a few people complained about the Baby Walls.

    Personally, I had no strong feelings (Just get me pregnant!), but other people clearly did. So why not put the photos where they were more visible to staff (who were the recipients, after all) and less visible to patients? The photos wouldn't have to be hidden, just maybe, you know, not the FIRST THING a woman would see when leaving the u/s room after hearing awful news.

    I think the Baby Walls barely registered with me because, by that point, I was already bracing for each RE appointment. It would be a different story at the GYN’s office, though! I’ve never seen baby photos in that context. Because my guard would be down there, it might be more upsetting. In fact, seeing a wall of babies in an office that specializes in women’s health (but not obstetrics) might feel like a subtle message that women = mothers, when of course not every woman can or wants to fit that mold.

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    1. YES, to displaying the photos where they were visible to staff, not patients! And I agree with your last points.

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  6. Having the pictures in the exam room itself, where you are undressed, waiting, & vulnerable, is unsettling and I have honestly never seen that. I have seen the "wall of babies" at the RE office and the OB/Gyn (on a hallway), but I walked by quickly and didn't have time to really consider it too much. There is no need to have anything of that sort in a patient exam room, those are SUPPOSED to be sterile and bland!
    I specifically go to a Gyn who does not to obstetrics because I don't want to see pregnant bellies and newborn babies brought with the mom for the first post-partum and all that. Just do my exam and get me out.

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  7. And, no, I don't think the doctor's office should be thought of as their "home". They have, presumably, homes they can decorate how they wish. This is a place of business, of service, and the customer's needs come first. There are lots of jobs where you cannot decorate how you wish, you have to fit the "message" of the company, etc... There is no "right" to put up those photos. I assume it was thoughtless, or as mentioned, out of respect to those that took the time to send the photos to the doc. I think you absolutely should bring it up to the office staff/manager, because if it WAS thoughtless, you are finally bringing some thought into it, and it might inspire them to change.

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  8. I left my previous OB/GYN because I found the large staff's comments often insensitive, because I kept getting different doctors and nurse practitioners (it was a large, impersonal setup), and because it was full of pregnant women. I love my current doctor. He is kind, and I never bump into pregnant women, nor have I heard much chit chat from his staff regarding pregnancy, babies, etc. But, though he seems to be dealing less with obstetrics these days, he not only has a baby wall... he has a baby CEILING! So, yeah, you get to have your pap smear while starring at newborns and smiling parents. I do see the similarity with the Christmas cards... now with the family portrait Christmas card trend, it is harder to throw these away. Plus, every birth is like a little certificate, award, of trophy. I think I am less sensitive to this, for some reason, though, than I was about the chit chat from staff that included things like commiserating with women upset to find they are pregnant again at 42, or saying, "No, thanks, I could not imagine having a baby at my age...."... while I was waiting for tests to be done at the lab, or getting a prescription for testing at age 41.

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  9. Hmmm...I don't think I've ever seen anything like this either in Indonesia or in Finland. However, if I saw something like this when I was still hurting inside and hoping for my own child, I'm pretty sure I'd be crushed inside. I remember being at work and then someone else's daughter waved at me and said hi to me a few times and it made me want to cry right there and then and I had to really compose myself so much in order not to bawl at work.

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    1. P.S. This event happened back when I was still hoping for a child.

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  10. I remember being shocked for my first IUI that there was a collage if baby faces on the ceiling. I commented on it, and they said it was supposed to be hopeful. I thought it was odd.

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  11. In my experience, the clinics I went to that proudly displayed the baby photos have generally been the same ones that didn't discourage kids in the waiting room. Most of the time, I'm not fazed by them, but it seems insensitive. I guess I think a fertility clinic should be a 'safe place' for people struggling with infertility, and all manner of yoga classes and psych staff starts to look disingenuous to the mission statement if the place is blatantly crawling with triggers.

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  12. Interesting timing for you post:

    http://nyti.ms/1ovHH3h

    The “baby wall” at obstetricians’ and midwives’ offices is gradually going the way of cigars in the waiting room, because of the federal patient privacy law known as Hipaa.


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    1. Yes, interesting timing. The comments section had some interesting points, as well as the usual thoughtless responses.

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  13. You might find this article interesting -- it was on the front page of today's Sunday New York Times:

    http://www.nytimes.com/2014/08/10/nyregion/baby-pictures-at-doctors-cute-sure-but-illegal.html

    My ob-gyn has never had a baby photo wall, thankfully. He does have framed photos of his grandchildren in his personal office, and of the quintuplets that he delivered -- the first quints in the hospital's history, back in the early 1980s. I think he earned that one. :)

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  14. There were framed baby photos lining the staircase leading up to the fertility clinic at the hospital I went to. I think there were also some framed letters gushingly praising the consultants, who I found quite lacking in warmth. How painful, and increasingly so as it became clear that I wouldn't have a photo of my own baby in my own home, never mind in a fertility clinic. I hated going up those stairs. I stopped looking at the walls and concentrated on trying to breathe evenly! Also, I started thinking about how false the hope it is they are selling. The clinic's own statistics show that most fertility treatments fail. I think the idea of these 'thank you' images staying within a staff space is great. (Towards the end of the school year, I get a few cards and tokens from families of children I work with. I display them on my desk, for me, then I put them away ready for the new academic year.)

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  15. Excellent blog post and a really good set of questions.

    I didn't mind my RE's office wall of babies much until I was hurrying past them out of the office after I'd just been told that there was no longer a heartbeat and I was miscarrying. It just felt like insult to injury (and to top it off, my RE's office is located directly over a pediatrician's office, so I always have to pass families with new babies and small children when I go in or out). The wall of babies made me feel like such a freak - I mean, I know the statistics, but it made me feel like so many other women could keep their pregnancies, so why couldn't I?

    Funny enough, I mind the baby photos less at my OB/GYN's office because the practice seems to do a lot of obstetrics and I just see it as catering to that demographic (although I'd definitely wonder about it if I was going to a GYN surgeon...that does seem odd). The RE's office it bothers me more because they know that people are likely to go through failed cycles and miscarriages and be in a generally fragile place surrounding pregnancies and babies.

    I do like the idea of putting thank-you letters and baby photos somewhere where the staff can see and appreciate them. That seems like a win-win - they get the encouragement and praise for their work, people like me don't have to feel like other people's ability to conceive are being rubbed in their face...

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  16. Yes, the painful Walls of Babies. I am just leaving a short comment to confirm that there are plenty of them also in Europe.
    (I am always bringing with me a magazine or a book to distract myself, but it does not really work).

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  17. I remember thinking it was odd for my clinic to ask if I would email them a baby picture. I'm pretty sure they didn't have a Wall, and one of the reasons we chose them over another option was their brochures weren't covered with baby pictures.
    They managed to make their waiting rooms feel like home in other ways. (the other had hand sanitizing stuff standing around everywhere and nasty plastic seats, we really didn't want to come back there)
    In the Dutch hospitals it was easy to avoid baby pictures (not so easy to avoid pregnant people or babies)
    And yes, I found them painful. Would still.

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