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Friday
Jun232006

Humanizing an OB/GYN Visit

Kristina, in her RedSpiral blog , brings up an interesting project. What would we ask of our OB/GYNs to make our experiences more humane and respectful?

The responses to her call for submissions led off with TIME with the doctor. I'm willing to bet docs would like some of that commodity, too.

What you read below began in outline as a comment to her original post (noted above):

An Ideal OB/GYN Office Visit:

- would include having huge gowns - large people gowns are made to fit folks up to 600 pounds and ALL laundry services carry them.

- would offer a variety of speculum sizes and the appropriate size used without making me/women feel bad about our vaginal tone or shape.

- would have the staff be able to lay their hands on the correct BP cuff size for the woman's arm - rummaging through 20 drawers doesn't count and neither does muttering about how difficult it is to find the cuff. BP cuffs come in many sizes, including thigh cuffs to do BPs on women over 300/350 pounds. KEEP THEM IN EACH ROOM! And don't make a woman feel like crap for needing them.

- would NOT make fat women feel like shit or blame every ailment from hangnail to cancer on their fat. Any discussion of weight loss or fat-related illnesses can be precipitated with, "I know you are aware you weigh more than what medical research feels is healthy, do you have any questions that might include discussing your weight?" If the woman says she does not. DROP IT.

- would have in-services for the staff on how to treat people with love and respect.

- would have a space for children that is clean and safe.

- would have Mothering Magazine and Midwifery Today in the lobby. Some La Leche League and International Cesarean Awareness Network materials would be important, too.

- could include a lending library visit - burning every copy of What to Expect When You're Expecting that is donated to the office.

- would include knowing they ban that American Baby shit they give OBs for free.

- would allow women to feel safe accepting a prescription because they need them, not because the pharmaceutical rep just visited with a dandy perk to keep the medication at the forefront of the doctor's writing hand. My ideal OB would NEVER accept any gifts or freebies from pharmaceutical companies.

- would include knowing my doctor doesn't prescribe psych meds for depression before, during or after pregnancy, but instead, refers women to psychiatrists because that is their gift - to prescribe the right medication for depression. I'd prefer my psychiatrist not remove my ovaries, even if they were trained to do so; let the psychiatrist do their specialty as the GYN does theirs.

- would let me hang my clothes on hangers in the room.

- would have cloth drapes instead of paper drapes and have them in big girl sizes, too. (Extra laundry, I know.)

- ALWAYS includes laying a Chux down before we sit on the table with our naked butts. So what if it costs more - it's disgusting to imagine the spooge other women leave on those tables after soaking/sweating through the paper.

- Always includes being handed Kleenex BEFORE the start of the exam.

- would demonstrate respect for the mother by wiping her belly first, before wiping the doppler. People before things.

- would include knowing my doctor's office would call with positive OR negative lab results. I would know a nurse or tech might call with normal results, but that would be okay. Abnormal results would be handled by the nurse - scary results, by the doctor.

- would reassure me that if I happened to get the doctor's partner, they have basic philosophical similarities concerning such vital topics as VBACs, birth plans, breech births, etc.

- would have me also seeing CNMs! Physician practices with CNMs have a more satisfied client-base, have lower cesarean and epidural rates and have their work-load spread over more people. The CNMs could focus on the normal woman, leaving the complicated cases to the physician specialists.

- would also have a Pediatric Nurse-Practitioner in the office for well- and sick-baby care, too.

- would find the office meticulously clean. There is nothing more disgusting than seeing old blood splattered on the wall or inches of dust around the vagina light.

- would be welcoming - friendly and bright.

- would include pictures on the walls of birth and breastfeeding women, normalizing the naturalness of the childbearing year.

- would never find my care provider wearing a white coat!

- would not find the office staff wearing scrubs in the office, either.

- would include knowing the staff has strict rules about returning phone messages in a timely manner.

- give me an invitation to the once-a-year celebration picnic my doctor throws for his/her clients and families. I always love getting those birthday cards for "our" babies, too.

- let me wander through the office and see the thousands of baby faces on the walls - the walls are covered with pictures of women birthing, nursing, families, and growing up. A special place is right over there that has my doctor holding each of the babies s/he has helped come into the world.

- include touching me gently when the news isn't good and I hurt. I am hugged when I cry and my doctor isn't afraid to feel when they are moved.

- finds me feeling safe because I know my doctor will ALWAYS ask to touch me before s/he does. S/he asks permission before doing procedures and thanks me afterwards. I know if I say "stop!" s/he will stop and remove his/her hand if I ask him/her to do so. S/he won't make me feel bad if I need her/him to move slowly through an exam.

- lets me be honest with my sexual history because no judgement regarding my morals is occurring.

- allows me to see my care provider as a human being - the most vulnerable and difficult aspect of caring for people must be saying, "I don't know," but my respect quotient soars when my doctors are honest and clear instead of faking it and guessing.

What have I forgotten that would be important to you?

Oh!

FUCK THE STIRRUPS!

Probably not very lady-like to say that.

How's this:

- would remind me that my doctor doesn't make me climb naked in stirrups but knows how to do an exam with my legs on the table, heels together and knees apart. S/He knows to turn the speculum the other way (handle up instead of down) to visualize all that needs to be seen.

- has those speculums warmed by heating pads in each drawer.

- includes lists of doulas on the bulletin boards and on hand-outs so I can find a doula that fits my personality and that has worked with my doctor before.

- reminds me why I come to this practice - their support groups, their respect for women and their families, their information base without being condescending, their laughter and kindness all make me want to return. And refer others who need a physician to come here.

Is this only a dream we have?

Reader Comments (8)

I know that samples from drug reps can be a problem but there have been many times I have been profoundly grateful to receive medication I could not afford for free.

Although sometimes I am sure the cheaper drug would have worked just as well; free birth control (I know, ok, I was young and stupid) in the brand I was already using was great. Also even the cheaper drugs aren't free like the free ones.

June 23, 2006 | Unregistered CommenterBrenda

A lot of these suggestions are good - some I'm horrified to know don't exist in other officies. Like cleanliness.

But some of these suggestions, such as exactly which magazines to put up, and what decor you'd like, and having a party every year, while nice seem kind of nit-picky.

It all comes down to this: treat the patient as you would want to be treated under their circumstances, and try to understand their circumstances and trust them to know themselves.

July 4, 2006 | Unregistered Commenterthe granola

Brenda: I do understand free meds and their being needed, but for them to be motivated by the drug reps is what I find disgusting. I hope that makes sense.

Granola: This is *my* IDEAL OB/GYN visit. I said that in the beginning. My own office strives to accomplish many of the things on my list including those magazines and birthday parties with my clients.

I didn't even begin to get nit-picky!

July 4, 2006 | Unregistered CommenterNavelgazing Midwife

You know, my OB(ex-OB)had gowns that didn't fit me before I got pregnant(and I'm not overweight). When I got pregnant, I'd have to sit there with my big belly hanging out. Definete pet peeve. And good for you-fat isn't the disease...it just means you're at a higher risk for different diseases. Many of which, I feel, come from fat people being too self conscious to exercise. But I digress. And Granola, you can't underestimate the power of images of bottle feeding, epidurals, etc in our culture, so I don't think it's nit picky to include magazines and images with alternatives. Hospitals that don't give out free formula have ENORMOUSLY higher BF rates. Just my 2 cents.

July 8, 2006 | Unregistered CommenterTC

You might like to know that I just blogged this piece in http://laurietobyedison.com/discuss/?p=264" REL="nofollow">The Big Fat Carnival.

Thanks for writing it!

August 8, 2006 | Unregistered CommenterDebbie

My ob/gyn's office has a nice touch - when you go in, there's a paper gown for the top half and a paper sheet for the bottom half, so no matter how big you are it wraps around, sitting folded on the bench with a Hershey's kiss on top and a note to the effect that we all know visiting here isn't fun, here's some chocolate to try and make up for it. Not much, but it speaks volumes to their whole attitude about treating women like people.

August 11, 2006 | Unregistered CommenterAnonymous

Damn those paper bolero jackets and sheets. I advise women (and do so myself) to take their own darn comfy bathrobe along. They know it fits, they won't freeze, and it's a little bit of home.

~MTM

September 7, 2006 | Unregistered CommenterAnonymous

You just discribed my midwife. So yes it does exsist, just not sure if it exsists in OB form but it really shoud. I'd like to see stats showing an aim to improve care...like intact perineums 65% last year 72% this year, goal for next year 80%! Aw its nice to dream...

July 27, 2010 | Unregistered CommenterKelli

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