by belbab 22 Replies latest watchtower medical

  • Clam

    I'll stay inside this thread in the hope I don't need to start a new one. My wife when doing a degree in Midwifery wrote a reflective essay about her experiences as a student when first confronted with a pregnant JW patient.

    Are the ajwrb people quite happy to look at anything like this and post it on their site?? I'm hoping someone on here has experience in dealing with them. The essay in my mind shows up the confusion that exists, and certainly the ludicrous deference shown by "sisters" to their husbands, in even matters of life and death.

  • belbab


    I am always open to reading all sides of any discussion that takes place. After all, it is from between the cherubs that the light of creation springs forth. It is from between the two halves of each one's brain, that a yes, yes, comes forth. If the two halves of our own brain are not in agreement then it is a yes, no, and confusing activity arises.

    I cannot speak for AJWRB, but I would be glad to see your wife's essay posted here, or if that is not comfortable for you, then send it to me by pm.

    It is written, do not hide your light under a basket, but let it shine.


  • LDH

    The JW live in a world of black and white.

    Could you imagine the lawsuit a DR would have on his hands if someone said, "Doc do you treat JWs?" and he said NO WAY!!!!

    Of course they are going to say they will work with you. Doctors take the Hippocratic oath, "First, do no harm." If they are able to treat you as a patient without HARMING you they will do it. This does not mean they agree with you!!!!!

    Doctors frequently treat people whose lifestyle they do not agree with.

    A gay man who has frequent unsafe 'encounters.' A pregnant crack addict. On and on.

    C'Mon, Jdubs, use your brains and THINK!!!!!


    I smell smoke Class

  • Clam

    Ok Bellbab I'll send you a copy!

  • DannyHaszard

    pointblank: Commentary and opinion by Chris Stevenson www.voiceoffreedom.com Drowning in Hemoglobin: Can New blood Article narrow gap between religious doctrine and doctors. "We've had long and distasteful contact with many cults-Christian, Hindu, Jewish, and others. They hold wildly different beliefs, but all seem to share several common characteristics... 1-Love bombing, bombard him/her with love 2-Separation from family, get target to sever connection to their families... target must be made to believe family is evil 3-Brainwashing, loss of critical thinking 4-Exploitation." The God Squad-Monsignor Tom Hartman & Rabbi Marc Gellman In this era of purging religion and references to God and prayer from the classrooms, government buildings, and even that most famous holiday, Christmas, questions are now surfacing as to just how far some faiths have gone in order to establish and maintain control over their followers. Many churches have enjoyed a judicial free pass over the decades due to the First Amendment Clause: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof." Well, in hindsight, perhaps Congress should have made a law, but it errantly viewed the church to be under the control of someone higher than man, and in so doing, allowed religion to be essentially controlled by select groups of men. The world in general has too much potential to be hindered by religion, how much more-so a civilized society? In spite of such seeming governmental immunity, ways have been found to take some churches to task through the very courts these churches no-doubt prayed they'd avoid. Through the misuse of they're own guidelines, you can actually grab confident, smirking, church leaders by the proverbial collar, and nail them to the cross examination. A new article may-in the long run-result in a good day for God, and a bad day for fundamentalist religions, especially one religion in particular with a 60-year-hold on it's members due in part to it's well-known principle on blood transfusions. The essay; "Jehovah's Witnesses, Blood Transfusions, and the Tort of Misrepresentation, (JW/BT)," by Kerry Louderback-Wood is featured in the latest edition of the Journal of Church and State (vol.47-no. 4), a 1,000 page quarterly magazine published in paperback textbook format out of Baylor University. If indeed blood is thicker than water, then the JWs are the jealous waters endlessly hoping to seep into all aspects of human life as much as possible, watering down relationships people commonly enjoy primarily between family members, individuals and doctors. They're the driver going 55 while on the fast lane that refuses to move to the right lane, they insist you go slow also. The "American Heritage Dictionary" defines tort as: "Any wrongful act that does not involve a breach of contract and for which a civil suit can be brought." In other words, personal injury due to misrepresentation. JW/BT invokes another legal breakdown on torts called "Prosser and Keeton on Torts," Their take on this in part is: "(1)ambiguous statements [that are] made with the intent that the listener reach a false conclusion (2) literally true statements that create a false impression (3) words or acts which create a false impression covering up the truth; or (4) nondisclosure when 'the parties stand in some confidential or fiduciary relation to each other such as... old friends,... where special trust and confidence is reposed (brackets mine).'" Louderback-Wood cites examples where "freedom of religion" itself was breached by government in a case where the Supreme Court upheld a law against polygamy because it was seen as a threat to the traditional family unit (Reynold's v. US). JW/BT concludes by citing another religious/judicial hot potato, and drawing comparison to the government's duty to represent what is in the best interest of the American citizen if it is proven the religion they belong to isn't willing to do so: "...courts historically have been unwilling to meddle in religious affairs, and rightly so because the state should not dictate religious matters. But that tide is turning with the recent church sex scandals. Should a court allow victims (children and adults whose lives are at stake) to sue their religion when it has misrepresented either (1) its own policies or (2) secular writers to bolster its doctrinal position?" Louderback-Wood makes no attempt to prove whether or not said religion is true, or should be shut down, nor is she a blood advocate. What she does, is track the array of JW articles on the blood rule by their timeline, and finds some stunning intellectual misappropriations, small enough to go unnoticed over time if you are a practicing JW, yet significant enough to cost lives. Having grown up in a Witness family, and seeing her mother encounter the blood issue twice over, her interest on the subject motivated her to stop attending the JW meetings when she grew up, and pursue higher education (another no-no in that church, although fortunately-unlike the blood restriction-they are unable to make it an official rule outside the realm of power of suggestion. But that's a subject for another essay) at Georgia State University, and Florida State. The administrative arm of the Jehovah's Witnesses (JWs) is its Watchtower Bible and Tract Society located in Brooklyn New York. They base their whole blood or whole blood cell transfusion prohibition on three scriptures, Genesis 9: 3-6, Leviticus 17: 13, 14 and Acts 15: 22-29. Of course several Bible passages have been fair game for various religions to enforce their chosen abstinence, even though many a given verse or verses had more relevance during the period it was written, or it was a small part under a completely different set of laws. The article cites the JW pamphlet "How Can Blood Save Your Life?"a strange title for a people who don't want blood to save your life. The seeming misrepresentation doesn't stop there, Louderback-Wood sees unnecessary attempts by the Watchtower to give the blood restriction credibility through the quotes of several authorities on blood that could prove costly to them and their followers. The quotes are crucial as the Watchtower advertises these doctored statements as "medical evidence" to prospective converts. Thus ancient biblical historians, scientists, and doctors such as Joseph Priestley, Eusebius, Tertullian, and Dr. John S. Spratt, had statements used in the pamphlet or their flagship magazine The Watchtower that were taken out of context, spinning isolated quotes as if they were advocates of the Watchtower's cause, exaggerating the medical risks of taking blood, and risk of contracting diseases such as AIDS, with the intent of leaving the JWs and their potential members with an immediate fear of dying, in addition to losing out on any hope of being a part of that faith's prime carrot; living forever in a peaceful new world (formerly called the "new order" and "new world order") through excommunication. The JW blood pamphlet quotes Priestley at it's conclusion, from a book he wrote during the 18th century: "if we interpret [the] blood prohibition of the Apostles by the practice of the primitive Christians, who can hardly be supposed not to have rightly understood the nature and extent of it, we cannot but conclude that it was intended to be absolute and perpetual; for blood was not eaten by any Christians for many centuries." To most Witness followers this is enough of a quote to give the impression that Mr. Priestley was against "eating blood" and therefore blood transfusions must fall under his "perpetual" list. After all, if a non-JW like Priestley rejects taking in blood, then it must be wrong. Louderback-Wood however, read further into Priestley's work, and found a striking discrepancy: "Priestley argued elsewhere that Christians could indeed eat blood because nothing that goes into the mouth defiles a man... It is a misrepresentation for the Society to quote Priestley as an adherent to an absolute prohibition, when in fact he was not committed to either eating or not eating blood and did not think the argument was important enough to include in his main text." This end-justifies-the-means approach may surprise some regarding the JWs, what stands to be more surprising is their apparent about-face regarding blood components, fractions and hemoglobin. In the same pamphlet (31 pages) the Watchtower states that Jehovah's Witnesses may accept blood components. Strange but true, for what are blood components such as hemoglobin, but blood itself? Will the Watchtower continue to prohibit adultery, but allow married men to go to strip clubs and get a lap-dance? Well this controversy runs deeper, according to JW/BT: "From 1954 to 1974, the Society banned most blood fractions. In 1958 the Society carved out the first exception, which provided that antibodies (such as tetanus, rabies, and snakebites) derived from blood could be accepted by individual judgment. In 1961 and 1964, the Society carved out another exception, permitting vaccinations and inoculations derived from blood to be accepted by personal judgment... In 1980, the Society began allowing any fractions of plasma,... and in 2000 purportedly began allowing any components of whole blood cells and plasma." Louderback-Wood goes on to state that it was a 1975 (again that dreaded year) mixup that eventually left a few members' blood boiling: "Indeed prior to 1975, followers with hemophilia were permitted to receive one infusion of Factor VIII, as it was considered medicine and not a feeding on blood. On February 1975, however, hemophiliac followers were directed they could no longer receive any clotting factors, including Factor VIII." What few knew, was that on 6/75 the Society reversed their ban on multiple infusions of clotting factors for their hemophiliacs (make up your minds will you), only they didn't publish it in their journals, particularly the Watchtower and Awake, or release it in any outside printed medium as the New York Times. Nope, reportedly the decision was to notify individual hemophiliac members, this became too much of a case load and there was a fear of upsetting the various congregation elders (their equivalent to Pastors etc.), so by and large, the JWs were kept in the dark about the reversal until an article in the 6/15/78 Watchtower. In 1981 avid JW readers of the Journal of the American Medical Association (virtually none) witnessed the official announcement of the change to the world at large. Things could be worse, that organization is more decisive with its hemoglobins than its homo-globins (child molesters). This is just the tip of the iceberg of Louderback-Wood's essay, implications get deeper once you read it. Imagine people suffering because a few religious officials wanted to needlessly add some secular-sauce to their blood edict, only to try to avoid embarrassment by covering up a time sensitive reversal. Followers of the strict faiths-like the JWs, Mormons, Christian Scientists etc.-do a better job defending their sect than their Organizational heads, unfortunately the JWs can't defend the Society in court as official legal representatives. The Watchtower wings it on researching the blood issue, and then hire real lawyers. Stevenson is a columnist for the Buffalo Criterion , his column Pointblank can be read at email comments to Stevenson at [email protected] ---------- Danny Haszard's comment:squirm watchower hacks

  • sf

    Danny, may I suggest you submit this piece in a thread all its own? Lest it get buried here in this one.



  • belbab

    Thanks Danny, for posting your news article here, it is a propos to the discussion. I agree with Skally that it is also so important that it needed a thread of it’s own. If any one comes upon this article in this thread, to find out further the impending shockwaves of it go to the new location:



  • belbab

    So much information is surfacing on this board that it is like a flush of mushrooms after a rain storm. The underground network of the mushroom mycelium, in an ever expanding area, are pushing new mushrooms to the surface at an outstanding rate.

    I have received a copy of Ms. Clam’s essay and it is an excellent essay. Although it is not specifically directed to Jehovah’s Witness mothers, it definitely contains necessary information regarding birth plans that every expectant mother should consider and especially Jehovah’s Witnesses. Reading her article led me to consider and reflect upon the following:

    The Jan 6, 2006 letter addressed TO ALL CONGREGATIONS contains the following advice to: Pregnant sisters: complications can arise throughout pregnancy. Identifying an experienced, cooperative doctor and medical facility in handling situations involving hemorrhage or other blood-related situations can save valuable time, often safeguarding the health and life of the sister and her child.

    What is wrong with this statement? Upon what is it focused? Is it focused upon the safeguarding the health and life of the sister and her child in all aspects of the bearing, birth and post natal care of both mother and child?

    Ms Clam’s essay has the answer to these questions, perhaps if she is agreeable, she can be prevailed upon to add some comments to her essay to show how it applies to Jehovah’s Witness pregnancies and childbirth.

    I shall post further documentation as soon as I can.


  • Clam

    Hi Belbab - here's the essay, courtesy of Mrs Clam

    Use a model of reflection in an elementary way to reflect on practice

    Reflecting on practice is not a new concept, but within midwifery education the importance of reflection has become increasingly emphasised. Reflection has been described as a learning tool (Clarke, 1986) and a way of aiding integration between theory and practice. Student midwives undertake supervised educational training in clinical placements and due to the characteristics of the work will regularly encounter new, complex and challenging circumstances. To both understand the art of reflection and develop the ability to reflect results in learning being enhanced. Indeed some theorists, (Benner, 1984, Champion, 1991) have suggested that for learning to occur from experience, reflection is vital.

    In this essay I will use Gibbs (1988) reflective cycle to support my reflective process. A copy of which can be found in appendix A. This is a commonly used model and the one which I felt most appropriate for this essay. As a first year midwifery student currently on my first clinical placement, I will be reflecting on an event which I observed. I have chosen an experience, which for me, was incredibly emotive and raised many issues and was therefore appropriate and necessary for me to reflect upon. The experience involved my mentor discussing a birth plan with primigravida lady at thirty-six weeks gestation, who in accordance with codes of confidentiality (NMC, 2002) I will call Mary.

    Where I am currently gaining community experience the birth plan is usually discussed and written with the mother at her home around thirty-six weeks gestation. The birth plan can be described as a list of the mothers’ preferences for labour, birth and postnatal care (

    I had no prior information regarding Mary except that she was thirty-six weeks pregnant and the purpose of this home visit was to discuss her birth plan. As this was not my first experience of this I expect I had some preconceived ideas about what the visit would entail. Mary invited my mentor in and had no objection to a student being present.

    Firstly my mentor asked Mary if she would like to write the birth plan herself and turned to the appropriate page in her antenatal notes, to which she declined and said she would prefer a midwife to write it. I did not think that this was unusual as I had seen other ladies ask my mentor to write the plan.

    However, as my mentor began to go through the sections on the birth plan (see appendix B) Mary’s responses to every part portrayed disinterest. Responses included, “I don’t care”, “I don’t really mind”, “I haven’t thought about it” and “what does everyone else do” followed all of my mentors’ questions. Mary admitted she had not read any of the information that had been given to her and she had not attended and did not want to attend any antenatal or parentcraft classes. I noticed that her non-verbal communication was closed. Mary tried to avoid eye contact and sat in a manner that suggested she was uncomfortable with discussing anything.

    As my mentor continued to progress through the birth plan Mary became increasingly distant and this appeared to worsen whenever my mentor offered explanations of the terminology. An example of this was when my mentor explained what is meant by the third stage of labour and the choice between active or physiological management. Mary interrupted my mentor saying that she didn’t mind which she had even though my mentor had not had the chance to continue giving all of the information.

    After all the sections of the birth plan had been mentioned, all that Mary had actually decided upon was that she wanted her partner or mother with her and that she would like to try and breast feed. Next to every other section in the birth plan, my mentor could only write ‘discussed’. To conclude this visit, Mary was asked if there was anything she was concerned about or if she had any questions, to which she shook her head and said, “No”. Upon leaving her house my mentor commented that it had been one of the quickest birth plans that she had ever done.

    These events that I had observed evoked many mixed feelings. My initial reaction was one of frustration. It seemed ludicrous to me that a woman would not be interested in what happened to her during labour and birth. As Mary said that she had not read any information or attended any antenatal classes, my feelings changed from frustration to concern. I began to worry about how unprepared she is and any repercussions this might in turn have for her newborn baby; if she had no knowledge of labour and birth, did she have knowledge of how to care for a baby?

    Following this I began to feel guilty. Perhaps I was being too judgemental. I knew that I was probably biased, not only because I had seen other mothers actively write a birth plan, but also because I am a mother of three children and knew that I wrote several birth plans when pregnant to cover all eventualities! In addition, I had read about the importance of birth plans and am a firm believer in empowering women. I was aware that this could have given me an altered view of the situation.

    Nevertheless, I was worrying about why Mary was uninterested and why her responses were so indifferent that she almost appeared apathetic. This was supposed to be a time when a discussion could occur and she could make informed choices concerning her body and her baby, but I could see that the more information given to Mary, the more withdrawn she became, and the more frustrated and concerned I became.

    Succeeding recognition of my feelings, I began to evaluate them. Firstly I felt angry that we had not done more to help her by alleviating any fears or by spending more time with her. She still seemed completely unprepared for labour and birth, and importantly did not want to be prepared and I felt that we should have tried to find out why. I decided at this point that the best thing I could do was to trust the instincts of my mentor. She did not seem unduly concerned and obviously had years of experience within the community and I supposed it was not uncommon. Again, I knew that I was perhaps having a biased opinion of the situation coupled with my naivety as a new student that was clouding my judgement.

    Writing a birth plan is a significant part of midwifery care. It gives the midwife the opportunity to explain all of the terms and the research or evidence base underlying the woman’s options, especially with areas that the woman may be unfamiliar. In addition it allows time to discuss any particular concerns or fears that the mother might be experiencing.

    In turn, it gives the mother the chance to express her choices and preferences for labour, birth and aftercare. This clearly encompasses issues surrounding informed choice where there has been much emphasis and legislation so as to ensure that women can exercise choice in their delivery of care (Bennett, 1999). However, formulating a written birth plan goes beyond a simple list of desires. Price (1998) suggests that writing a birth plan has an important role in preparing the mother emotionally and mentally for labour and birth. Further, it can empower the woman, making her feel more in control because she has actively participated in the decision making.

    Similarly, the birth plan ensures that health professionals at the woman’s place of birth understand her wishes. On admission of the women in labour it is common practice for the named midwife to discuss the birth plan so that provisions can be made for her. Knowing that everyone involved in the labour and birth understands her preferences can give comfort to the mother, especially as this is a time when she might be feeling vulnerable or distressed.

    I decided to use this experience and my personal feelings as a learning process and a way of developing my own self-awareness. Burnard (1992) proposes that being self aware is being conscious of personal beliefs, strengths and limitations and that self awareness is important, not only for reflective learning, but also for professional practice. I have learned that it is vital to be aware of my own beliefs in order to progress both in my learning and within my profession.

    However, I could not see any definite good that had come from this experience for Mary and began mind mapping why she possibly felt the way in which she did, or the way in which she portrayed. Continuing with Gibbs (1988) reflective cycle, I next tried to analyse the feelings and the experience and attempted to make sense of the situation.

    My first thought was that Mary was scared, either of something specific or of the labour and birthing process generally. This could offer an explanation to why Mary had not attended parentcraft classes or looked at any of the information that had been given to her. Perhaps, as seems common, other mothers had shared their birth stories with her and this could have frightened her. Fear of childbirth is common and a recent survey (Zur, 2002) stated that three quarters of women who participated were anxious and eighty per cent of women were frightened of giving birth. However, it must be mentioned that this survey could have had a biased sample.

    Although labour can be a frightening experience, some of this fear is provoked by fear of the unknown. Information given by midwives could alleviate this fear. When discussing birth plans, midwives have a responsibility to give full explanations of procedures to ensure that expectant mothers can make informed decisions. Difficulties arise when expectant mothers would rather not know. For some mothers, ignorance is bliss and they are confident to let their midwives take the lead.

    There are many other explanations why Mary behaved the way she did. She might believe that birth is a natural process and having too much information of what may happen would give her unnecessary worry. The concern here is that if something unexpected does occur during labour Mary would not understand what was happening and this can be awfully distressing. Again, there can be a feeling of loss of control (Raphael-Leff, 1991), which can have long term effects and is deemed to be a precursor to postnatal depression.

    It could be that Mary is a very private person who does not feel able to mix at a parentcraft class and whom did not feel completely comfortable with her midwife being in her home. Despite research (McCourt and Page, 1996) finding that the majority of women enjoy home visits, others do not and possibly Mary falls into the latter group. Mary may have found the home visit intrusive or felt that we were prying or evaluating her and making judgements based on her home. Perhaps literacy is a problem for her. This could explain why she had not read any information and why she asked the midwife to write for her.

    Following the analysis of the experience, I moved on to the next part in the reflective cycle and considered what else could have been done during the home visit with Mary. It seems fair to say that by asking if she had spoken to other mothers, it might have encouraged her to talk about what she had heard and in turn these fears could have been alleviated. Perhaps it would have been appropriate to mention again the parentcraft classes and tours of the local maternity hospital that are available to her so that she might feel better prepared.

    When discussing the purpose of the birth plan, it could have been beneficial to explain that the hospital staff will want to read it upon her admission and it is therefore important that they understand her preferences. A more direct approach might have been acceptable. To ask the question why she had no preferences for childbirth could have been the invitation necessary to tell her midwife how she was feeling. An alternative angle would be to talk about the baby and her expectations of motherhood as a way of achieving conversation before bringing the discussion back to the actual labour and birthing process. This would also address the issue raised that if Mary was unprepared for birth, was she prepared for and did she have the knowledge necessary to care for a new baby?

    In addition to the issues that have already been raised, it does appear that changes could be undertaken if a similar situation occurred. The midwife should be aware of any problems, not just socially or physically, but also have the insight to detect any psychological anxieties or fears that the client is experiencing.

    Information should be given during pregnancy and any concerns discussed. Similarly, parentcraft classes should be encouraged. It has been detailed (Alexander et al, 1990) how antenatal classes increase women’s understanding and makes them better prepared for events. Parentcraft classes also help women meet others in a similar situation, which alone can be of psycho-social benefit.

    When making the actual appointment for discussing the birth plan it might be preferable to give the expectant mother the choice of a home visit or making extra time at a routine antenatal appointment. The midwife could also suggest that if they haven’t already done so, to read and note down any ideas, preferences and questions that the woman has concerning labour and birth and to look at the birth plan in their notes.

    Undoubtedly there are going to be expectant mothers who do not want to prepare or discuss a birth plan for whatever reason. If this is the situation, the midwife could use the pre-booked time to discuss other issues and attempt to strengthen the midwife-client relationship. This could possibly lead to the mother feeling able to communicate about any concerns during future home visits such as during the postpartum period.

    Although this essay has been a reflective exercise, it has drawn upon many aspects of midwifery that raise ethical issues. For example, the ethical principles concerned with informed consent requires giving information. However, Johnstone (1989) recognises that some clients do not wish to receive information. It is useful within clinical practice to use ethical frameworks and theories such as Edwards (1996) in which judgements, rules, principles and ethics are adhered to in order to assist the midwife with facing dilemmas.

    In conclusion, the process of reflection within midwifery brings with it a deeper understanding of what can often be complex and challenging situations. If midwives are to deliver a holistic and personal pattern of care, then individuality must be accounted for and respected. Using models of reflection means appreciating and accepting each experience which often leads to a different perspective. For some women ignorance is bliss and for others knowledge is power. It is important that midwives recognise that within their framework there are vast differences, as each individual woman, pregnancy and birth is different. On a personal level, I have been on a steep learning curve whilst writing this essay and have not only learned about issues that arose, but also developed my self awareness and my ability to see beyond the immediate and the observable.

    (2,588 words)


    Alexander, J., Levy, V, and Roch, S. (1990) Antenatal Care: A research-based approach. Macmillan.

    Benner, P, and Tanner, C. (1987) Clinical judgement: how expert nurses use intuition. American Journal of Nursing 87 (1), 23-31 in Atkins, S and Murphy, K. (1993) Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192.

    Bennett, V, and Brown, L. (1999) Myles Textbook for Midwives. (13 th edition). Churchill Livingstone.

    Burnard, P. (1992) Know yourself! Self- awareness activities for nurses in Burns, S,

    and Bulman, C. (2000) Reflective Practice in Nursing: The Growth of the Professional Practitioner. Blackwell Science.

    Champion, R. (1991) Educational accountability: what ho the 1990s! Nurse Education Today 9, 271-275 in Atkins, S and Murphy, K. (1993) Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192.

    Clarke, M. (1986) Action and reflection: practice and theory in nursing. Journal of Advanced Nursing 11(1), 3-11 in Atkins, S and Murphy, K. (1993) Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192.

    Edwards, S. D. (1996) Nursing ethics: A principle based approach. McMillan. In Fraser, D., & Cooper, M. (2003) Myles Textbook for Midwives. (14 th edition) Churchill Livingstone.

    Gibbs, G. (1988) Learning by Doing: A guide to Teaching and Learning Methods. Oxford University Books in Johns, C. (2000) Becoming a Reflective Practitioner: A Reflective and Holistic approach to Clinical Nursing, Practice Development and Clinical Supervision. Blackwell Science.

    Johnstone, M. J. (1989) Bio ethics a nursing perspective. In Fraser, D., & Cooper, M. (2003) Myles Textbook for Midwives. (14 th edition) Churchill Livingstone.

    McCourt, C, and Page, L. (1996) Report on the evaluation of one-to-one midwifery practice. Wolfson school of health sciences, , in Clement, S., and Page, L. (1998) Psychological Perspectives on Pregnancy and Childbirth. Churchill Livingstone.

    Nursing and Midwifery Council. (2002) Code of Professional Conduct. NMC publishers.

    Price, S. (1998) Birth plans and their impact on midwifery care. MIDIS Midwifery Digest, Vol 8, no 2, pp 189-191

    Raphael-Leff, J. (1991) Psychological processes of childbearing. Chapman and Hall, . In Clement, S., and Page, L. (1998) Psychological Perspectives on Pregnancy and Childbirth. Churchill Livingstone.

    , D. (2003) Bailliere’s Midwives’ Dictionary. (10 th edition).Balliere Tindall.

    Zur, D. (2002) Mother and Baby magazine. http://news.bbc.co.uk/i/hi/health/2288294.stm

  • Clam

    Here is another essay which specifically deals with a Jehovah's Witness case.

    Advancing clinical midwifery practice

    A reflective account of an event experienced in practice.

    Midwifery is a complex and challenging profession. It is not stable and predictable and has been described at times as being chaotic (Ghaye, 2000). The boundary between chaos and order becomes the leading edge of learning, and reflection plays an integral part in the learning experience. Midwives are constantly making choices and decisions throughout their working day. This is known as reflection-in-action, (Schön, 1991) dealing with on-the-spot dilemmas as they arise; these could be clinical, ethical, moral and so forth. In contrast, reflection-on-action can be defined as recognising personal behaviour and feelings and the effects of these on the self and others when managing care. It is then possible to explore alternative methods and perspectives and this can lead to a positive change within practice (Johns, 1998). Furthermore, reflection can bring about universal benefits when experiences and learning developments are shared with members of the professional healthcare team.

    For students to develop effective learning methods and apply theory to practice reflection is vital. In this essay an emotive experience occurring within practice will be explored using a model of reflection. After the evaluation of various models of reflection, Johns, 1995 model (cited in Johns, 2000) was chosen for the cue questions (see appendix 1) and Gibbs, 1988 reflective cycle (cited in Johns, 2000) has been chosen as a way of guiding and structuring the reflective process. This not only involves a description of the occurrence and the feelings experienced, but also more meaningful and applicable processes such as evaluation and analysis (see appendix 2).

    The event that I have chosen to reflect upon occurred on a delivery suite in a hospital in the South West. As a second year midwifery student I was working under supervision by my mentor, who in accordance with confidentiality (Nursing and Midwifery Council, 2002) I will refer to as Laura. I had worked with Laura before and we had strong trust and confidence in one another. During the previous shift together a client who we were caring for had suffered a primary postpartum haemorrhage of an estimated 1, 500mls blood loss during the delivery.

    The following day the experience of the haemorrhage was still very vivid in my mind when we were allocated the care of a client who was in the first stage of labour. During the hand over, we were told that this client, who in accordance with confidentiality (Nursing and Midwifery Council, 2002) I will refer to as Anne, is a Jehovah’s Witness. For that reason, in accordance with her religious beliefs, Anne had signed a health-care advance directive form (see appendix 3) stating she refuses blood and blood products. Laura and myself introduced ourselves to Anne and her husband who was with her and they reiterated that Anne would not accept blood. During this initial discussion a doctor arrived to ask Anne to sign an additional form, “Consent to medical treatment by patient who refuses to have a blood transfusion” (see appendix 4). Anne signed the form, but once the doctor had left the room asked Laura and myself to clarify everything the doctor had just said to her.

    Laura and I looked at the delivery suite guidelines for the intrapartum care of women declining blood products (see appendix 5), as we needed to be clear of a care plan and treatment should Anne haemorrhage. This included a multitude of pharmacological methods, which we needed to locate and become familiar with. Further, as a student I needed to be aware of which drugs I could and could not administer (Nursing and Midwifery Council, 2002) and that it was crucial to be aware of procedures such as how to alert other members of the obstetric and paediatric team. As with all clients, Anne was risk assessed and although she was not considered to be of high risk for a postpartum haemorrhage, I was aware that it was still a possibility as this can occur without warning (Crafter, 2002, cited in Boyle, 2002). Anne had agreed for an actively managed third stage to further reduce risk as the guidelines in the unit recommend (see appendix 5).

    Laura and myself continued to care for Anne during her labour. As the strength of her contractions began to increase, Anne requested an epidural which was sited and effective. Once Anne was pain free she began to talk about accepting blood fractions. However, she was not clear what this meant, only that she had read about it in The Watchtower magazine. The Watchtower Bible and Tract Society of New York (WTS) publish the Watchtower magazine twice a month. The corporation is the governing body of Jehovah’s Witnesses, believing that it is inspired by God to be the ‘faithful and discreet slave’ as described in Matthew 24, 45-47. Jehovah’s Witnesses accept the WTS’s scriptural interpretations and directives almost without question. The primary communication is through their magazine, which is printed globally in over sixteen million copies, 600, 000 of which are for distribution in the

    Anne, who is rhesus negative, also said that although she had refused anti-D gamma globulin during her pregnancy, she was considering having it postnatally. Anti-D is derived from human blood plasma containing antibody to the erythrocyte factor Rh D (, 2003), and therefore Jehovah’s Witnesses forbid it. Anne’s husband became increasingly anxious about this and stressed to Anne that due to their religious convictions she was to receive no blood or blood products in any form. It is of note that Annes husband remained with her throughout all of the labour and delivery, not leaving her for even the briefest moment. The labour and delivery progressed without any deviations from the norm and Syntometrine (0.5mg ergometrine and 5 units of Syntocinon in 1ml) was administered intramuscularly to actively manage the third stage. There was a minimal blood loss, estimated to be approximately 150mls. Fetal blood was taken from the placenta to determine the rhesus factor of the baby and Anne decided that she would have the anti-D gamma globulin injection if it were necessary. There were no postnatal complications noted.

    Continuing with Gibbs (1988) reflective cycle, I explored my feelings surrounding the situation. Initially I felt concern for Anne. Having witnessed a primary postpartum haemorrhage the previous day, I was very aware how suddenly and quickly it can occur. This is an emergency situation in which it is vital to act quickly (Crafter, 2002, cited in Boyle, 2002). With the added risk of refusing blood and blood products, I was aware of feeling incredibly anxious, as was Laura, who is an extremely experienced midwife. The Confidential Enquiry into Maternal and Child Health (CEMACH), 2000-2002 states that there has been an increase in the number of deaths from primary postpartum haemorrhage. Yet four of the women who died from primary postpartum haemorrhage had declined blood transfusions, which would probably have saved their lives.

    Further, I was aware the other midwives in the delivery suite were feeling somewhat uneasy. This was largely due to the fact that the previous year a Jehovah’s Witness woman had died following a primary postpartum haemorrhage in the unit. With such a traumatic event having occurred there were still some feelings of apprehension. This is not necessarily negative, as it can give a greater insight, awareness and preparation.

    When reading Anne’s hand held antenatal notes I found that she had changed her mind numerous times concerning whether to accept the anti-D gamma globulin. In addition, Anne had not signed the health-care advance directive form (see appendix 3) until she was 39 weeks and 3 days pregnant. This was despite her community midwife discussing it with her, as documented, on three separate occasions. I questioned that perhaps she felt under pressure by her religion, or members of her religious community or perhaps by her husband. On reflection, when asked to sign the form (see appendix 4) by the doctor, it was her husband who read it and told Anne to sign. Although it must be said that she did not appear anxious or concerned about signing or her husband making decisions on her behalf. However, once the doctor had left the room, and Anne asked Laura and myself to clarify what he had said, I began to feel increasingly frustrated as well as concerned. Laura also said that she felt uneasy when this occurred. Overall, my feelings were of anxiety for the well being of Anne in the event of a haemorrhage and also for the protection of future pregnancies without the anti-D gamma globulin. To continue with the process of reflection, I next evaluated the situation, considering what was good and bad about it.

    Firstly, there are issues surrounding the confusion concerning the ‘fractions’ of blood. Although Anne clearly refused blood and blood products, during her labour she did state that she had read in the Watchtower magazine that fractions of blood were acceptable. However, as previously mentioned, both Anne and her husband were confused by the term ‘fractions of blood’. My reaction to this was feeling that the couple were irresponsible for not knowing exactly what the constrains of their religion are especially with what can ultimately be a life or death situation. Singla et al, (2001) undertook an eleven-year retrospective cohort study to determine the difference between risks of maternal death for Jehovah’s Witness clients compared to the general obstetric population. A total of 332 women who were Jehovah’s Witnesses had 391 deliveries. A primary postpartum haemorrhage was experienced in six per cent of this population and this had resulted in 2 maternal deaths. This piece of research concluded that clients who are Jehovah’s Witnesses are at a 44-fold risk of maternal death. This degree of risk elevation has not been seen with other procedures, such as vascular or cardiac surgery. This may be, in part, due to the rapidity in which a life-threatening postpartum haemorrhage occurs and the potential for underestimating the full extent of the blood loss. This was a significant piece of research and therefore it appears possible to argue that all women who are Jehovah’s Witnesses should therefore be categorised as high risk during intrapartum care.

    The Watchtower Society’s decision to tweak its transfusion policy has clearly created some confusion. The Associated Jehovah’s Witnesses for Reform on Blood (AJWRB) has emerged as a strong lobby group who seek to educate other Jehovah’s Witnesses, their family members, friends and healthcare providers regarding what they believe to be irrational aspects of the WTS’s policy. The group are particularly determined that Jehovah’s Witnesses can have a free and informed choice regarding their healthcare, without the fear of control or sanctions. The AJWRB also argue that biblical directives relate to the consumption of blood and that no nourishment occurs when blood is transfused, it is the same as an organ transplant, which is not forbidden by the WTS. With this confusion, it could be argued that, in the case of Anne, ignorance was her approach and she was satisfied for her husband to make the decisions on her behalf. That is to say that his actions could be seen as being protective of her in conjunction with beliefs that they held and he described as ‘the truth’. Although it could be argued that her husband and members of her religious community could be deemed as controlling and therefore Anne should have been counselled individually, as is suggested in the unit guidelines (see appendix 5).

    There are always issues surrounding informed consent during labour. Anne had signed consent forms, when told to do so by her husband without fully understanding the implications. It must be noted that at the time of making decisions she was in labour and it was pre-epidural. Draper, 1998 (cited in Firth, 1998) suggests that consent must be understood in terms of thorough information and competence before reaching a decision. Jones (1996) discusses consent from an ethical perspective and describes it as a voluntary, unforced decision. Similarly, withholding consent is a womans choice and, must be respected regardless of professional opinion. To determine the womans position on the value of consent, it is necessary to determine the extent to which she values her autonomy. Clearly in the case of this client, her autonomy was vital and nothing should override decisions she has made. However, her autonomy must be questionable in this instance because Anne was frequently wavering and eventually decided to accept anti-D in the case of her neonate being rhesus positive. It is of note that legally the consent, and conversely the withholding of consent by a husband of a client is not recognised in law (Jenkins, 1995).

    Before an analysis, it is necessary to understand why Jehovah’s Witnesses refuse blood. Jehovah’s Witnesses are Christian fundamentalists who strongly adhere to all Biblical directives. On the issue of blood, they point to the following scriptures, Leviticus 17:12-14, “…No soul of you shall eat blood…whosoever eateth it shall be cut off”. Acts 15:29, “Thay ye abstain from blood” and Acts 21:25, “Keep themselves from things offered to idols and from blood”. Essentially all other Christian and Jewish faith groups interpret these passages as referring to dietary laws, but Jehovah’s Witnesses believe that these extend to any use of blood, and certainly a blood transfusion. However, The Watchtower does seem to be altering the view concerning blood transfusion. In June, 2000 the magazine stated, “When it comes to fractions of any of the primary components, each Christian, after careful and powerful meditation, must conscientiously decide for himself” (The Watchtower 2000; June 15:29-31)

    When caring for clients with such religious beliefs it is imperative to remain professional and non-judgemental at all times. The essence of giving individualised care is to ensure that the woman receives the care, which is appropriate and correct for her, despite the beliefs and principles of the midwife and obstetric team. Perhaps Anne’s strong belief in her faith was a comfort to her during labour and delivery, a time when women can feel particularly vulnerable and frightened. Nevertheless, I would question her autonomy and faith in her religious convictions if she was prepared to accept anti-D and in addition by continually deferring to her husband. When analysing my feelings, it could be argued that I would have felt very different if I had not had the experience of a postpartum haemorrhage the previous day. We learn from our experiences, and future practice will reflect that, even if in the short term. Experiencing and being involved in managing the postpartum haemorrhage has certainly made me more aware and more astute in recognising indications of this and how quickly and accurately it must be managed.

    Midwifery is a profession in which ethical and moral dilemmas are commonplace. It is valuable within clinical practice to use ethical frameworks and theories such as Edwards (1996) in which judgements, rules, principles and ethics are adhered to in order to assist the midwife when facing difficult dilemmas. Clearly there are ethical dimensions in all clinical decisions and ethical and clinical soundness could be described as inseparable, as ethics are essential to good clinical practice. Firth (1998) proposes that if the midwife is the lead professional in the majority of ‘low-risk’ births, then she is responsible for decisions made in relation to her client, including moral and ethical responsibility. When considering the client, Anne had made her decisions surrounding blood based upon her religious convictions rather than on the basis clinical information. In such a situation, the midwife providing the care must respect her clients decision (Fremgen, 2002) knowing that otherwise the treatment will impact upon the whole of the clients life (Schwartz, et al 2002).

    I feel that given my training and experiences to date as a second year student that I acted in an appropriate manner caring for Anne, respecting her beliefs at all times. I ensured that I knew where the drugs were, and who to call and how to call them in the event of an emergency. Yet, if a similar situation occurred again I would perhaps ask a senior member of staff to discuss things with Anne without the presence of her husband, as stated in the delivery suite guidelines (see appendix 4) to ensure that she is not under pressure from another person. However, this can be difficult when the woman insists she wants her partner with her throughout the labour and delivery, as many women do. Although I was feeling anxious, I am certain that this was not apparent to Anne or her husband at any time during the labour and delivery. Certainly, in future I will do my utmost to ensure that a woman fully understands what is being explained to her by a doctor, or any other member of staff. A positive aspect of the situation was the way in which the health care professionals involved communicated effectively within the team, remaining professional at all times. This was clearly an emotive situation and could have resulted in a high-risk obstetric emergency. I feel certain that should this have occurred, the team would have respected her religious beliefs and she would have received the best possible care.

    In conclusion, the process of reflection within midwifery brings with it a deeper understanding of what can often be multifaceted and challenging situations. If midwives are to deliver a holistic and personal pattern of care, then individuality must be accounted for and respected. Given such an emotive experience, it is necessary to critically evaluate understanding through reflection. Midwifery is not based on feelings; it is a science with an evidence base, which practitioners must adhere to. Using models of reflection means appreciating and accepting each experience, which often leads to a different perspective. On a personal level, this experience was incredibly valuable. It demonstrated the importance of tailoring and delivering individualised care despite my own beliefs. I feel it was a significant learning curve and that my future practice will show the benefit of undertaking the process of reflection.

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    Confidential Enquiry into Maternal and Child Health. (2004) Why Mothers Die 2000-2002; Midwifery Summary and Key Recommendations. , CEMACH

    Crafter, H. (2002) Intrapartum and postpartum haemorrhage. In Boyle, M. (2002) Emergencies around childbirth, a handbook for midwives. Oxon. Radcliffe medical press limited.

    Dimond, B. (2002) The legal aspects of midwifery. Books for Midwives. Elsevier Science.

    Edwards, S. D. (1996) Nursing ethics: A principle based approach. McMillan. In Fraser, D., & Cooper, M. (2003) Myles Textbook for Midwives. (14 th edition) Churchill Livingstone.

    Firth, L. (1998) Ethics and Midwifery; issues in contemporary practice. . Butterworth Heinemann.

    Fremgen, B. (2002) Medical Law and Ethics. . Prentice Hall.

    Ghaye, T., and Lillyman, S. (2000) Reflection; Principles and Practice for Healthcare Professionals. Wiltshire. Cromwell Press.

    Gibbs, G. (1988) Learning by Doing: A guide to Teaching and Learning Methods. Oxford University Books in Johns, C. (2000) Becoming a Reflective Practitioner: A Reflective and Holistic approach to Clinical Nursing, Practice Development and Clinical Supervision. Blackwell Science.

    Jenkins, R. (1995) The law and the midwife. . Blackwell Science.

    Johns, C. (2000) Becoming a Reflective Practitioner: A Reflective and Holistic approach to Clinical Nursing, Practice Development and Clinical Supervision. Blackwell Science.

    Johns, C., and Freshwater, D. (1998) Transforming nursing through reflective practice. . Blackwell Science.

    Jones, S. (1996) Ethics in midwifery. . Mosby.

    Nursing and Midwifery Council. (2002) Code of Professional Conduct. NMC publishers.

    Nursing and Midwifery Council. (2002) Guidelines for the administration of medicines.

    NMC publishers.

    Nursing and Midwifery Council. (2002) Midwives rules and standards. NMC publishers.

    Schön, D.A (1991) The reflective practitioner. Hampshire, Arena.

    Schwartz, L., Preece, P., and Hendry, R. (2002) Medical Ethics: A case-based approach. Saunders

    Singla, A., Lapinski, R., Berkowitz, R., and Saphier, C. (2001) Are women who are Jehovah’s Witnesses at risk of maternal death? American Journal of obstetric and gynaecology. 2001; 185: 893-5.

    , D. (2003) Baillière’s midwives dictionary. . Baillière Tindall.


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