At every step of the pregnancy, right through childbirth, we had the sense, even as foreigners, that the medical system was designed for the child and for us. There was never the creepy moment that one has inside American commercial medicine: when you wonder just why something was done or not done, or why some weird evasive phrase was just uttered, or why a doctor or nurse behaved oddly or slipped away. In the United States, one often has the feeling that there is a hidden logic dictating events, because there is: a logic of profit. In Austria, it was clear that the goal was the welfare of the unborn child. Prenatal visits were mandatory, in exchange for access to the welfare state.
The difference between a logic of profit and a logic of life can be seen in the timing. In the third trimester of pregnancy, women in Austria are instructed to come to the hospital if they are bleeding, if their water breaks, or if their contractions are twenty minutes apart. In the United States, expectant mothers are told to wait longer, until their contractions are three or four minutes apart. This is one reason why babies are born in back seats here, and why American mothers and newborns end up dead. In America the worry is that expectant mothers will arrive too early and occupy a hospital bed for too long; in Austria the system is designed to get them where they need to be in good time for a healthy birth.
On the evening that my wife went into labor in Vienna, we were immediately admitted into a clean, quiet room in the public hospital. We had to sign one piece of paper. We fretted that we had come too early, but there was no pressure to go back home. Marci’s labor was long, difficult, and complicated, so we were glad to be in a hospital for the duration. After the birth, mother and baby were required to remain in the hospital for ninety-six hours. The idea was to ensure that newborns got a good start and that mothers learned how to breastfeed.
I was allowed to visit from nine in the morning until five in the afternoon, so I could see how this worked. Every day there were sessions for parents about how to bathe a baby and change a diaper. The nurses rotated through the ward, adjusting nipples and mouths, and giving instructions. The new mothers lacked the privacy that Americans might have expected, but they did have the unremitting attention of qualified people whose priority was their babies. The nurses were not interested in how the mothers felt about breastfeeding; they had a program to make sure that breastfeeding began. They knew what they were doing, and after four days the newborns and the mothers did as well. About ninety percent of mothers in Austria learn how to breastfeed. When we walked out, mother and baby were ready. We signed no forms and paid no bills.
During those birthing classes I had been the object of pity. Each session began with instruction for couples, during which my wife and I shared a mat and puzzled over Viennese slang for body parts. Then the men and women were divided and expected to talk amongst themselves about common concerns. I don’t know what American men would talk about at such a moment; the Austrian dads talked about the freedom afforded to them by their welfare state. They had a choice among three parental leave options, all of which seemed impossibly generous to me. The other guys were making decisions about how two years of paid parental leave would be divided between the mother and father. I tried to tell my new friends that my wife and I had a relatively good deal, thanks to my university; they found one semester for one partner sadly inadequate. Their expressions turned to horror when I told them about the norm of parental leave in the United States. The idea that mothers might have twelve weeks but might have nothing, and that fathers expected nothing, seemed barbaric. They were right. It is barbaric. And it makes parents and children less free.
As they pointed out, and as I was ashamed to realize, my notion that three months of parental leave for one partner was generous depended wholly on my knowledge that what my wife had was better than what other Americans had. My own attitude was contributing to the general problem. My relative satisfaction with health care that was less terrible than others’ kept me from seeing how disastrous the entire system was, and how much better it could be. Every American could and should have parental leave better than what my wife and I had. If Austria could do it, why not us? Every single citizen of Austria, regardless of status and wealth, had better choices than I did. I had been duped, like many Americans who have less-bad access to health care and public services. Everyone, my friends sensibly proposed, should have the same options, and those options should allow a family to make it through.
After our son was born, I wanted to have time with him and give his mother a bit of a break from us, and so took walks with him around Vienna between his feedings. I enjoyed pushing a stroller around the city. I’d like to think that I would have done this anyway, but it is important to acknowledge how policy changes practices, and how practices change norms. Thanks to parental leave, walking around with babies was a normal thing for men to be doing. It was nice to occasionally share a nod of acknowledgment with other guys: hey, what a great thing, we are dads. It was also nice to be treated kindly by the waitresses and waiters at the cafés where I would stop when my son slept.
Thanks to such encounters, my attitude to the German language began to change. The horrors of the twentieth century had made German a language of death. As old ladies on the sidewalk complimented me on my beautiful child, German became a language of life.
* * *
The birth of our second child two years later in America was different.
Our son had been born without the artificial induction of labor and without a caesarean section. The obstetricians in the Vienna public hospital had been very patient during the labor, far more so than their American colleagues could have been. My wife turned forty during her second pregnancy, which triggered an American protocol for labor to be artificially induced by her due date. These protocols make little sense: it’s not age as such that matters, but certain conditions that become more likely in women with age.
In large matters and small, machine protocols get between patients and their caretakers. The computer programs are about billing, and so fail to account for basic human needs. Doctors and nurses who get used to following protocols retrain themselves to ignore the actual patient. When I was in the hospital I noted some examples of this in my diary.
I took medications on a schedule. I wrote down the times and doses, partly because I had lost trust in the system, partly because I wanted to sleep at night. I was allowed to take acetaminophen every six hours for pain. I would ask the nurses not to wake me at night simply because six hours had passed. Sometimes this worked; sometimes it didn’t. When I would skip a dose, I would try to explain that the schedule should reset, and that my next dose could be at any time, rather than six hours after the scheduled time for the dose that I had not taken. Sometimes nurses went along with me, sometimes with the screen. I might in the evening have three medications to take, one at 10:00, one at 11:00, and one at midnight. A savvy and motivated nurse would alter the timing of the doses during the day so that, after a couple of days of nudging, I could take all three pills at the same time and then go to sleep. Helping a patient sleep meant bucking the system, which is absurd. Another nurse, though, might insist that what the computer told her to do she had to do, and would wake me up to satisfy the algorithm.