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Monday
Jun282010

Why Doctors Don't Care

So, a couple of weeks ago, Abi Cotler O’Roarty wrote a piece for the Huffington Post called “Why I’m Protesting for My Natural-Birth Friendly OB.” In there, she shared the plight of Dr. Robert Biter, an OB/GYN here in San Diego and his suspension and reinstatement from Scripps Encinitas Hospital. During the suspension, hundreds of women came out and protested in front of Scripps Encinitas, even Ricki Lake joining us one day. If there was ever any question about Dr. Biter’s magnetism, these demonstrations took care of that. For those that’ve read my blog for any length of time, you know I’ve written about “Dr. Wonderful” for years now. (The first birth I did with him was three years ago last week!) While I knew I wasn’t alone in admiring the man, it was stunning to see the outpouring of compassion for his situation. 

Abi’s article spoke eloquently about her birth experience with Dr. Biter and how different it was from her first birth where she’d been given a mangling episiotomy from a resident at UCSD. Dr. Biter repaired her severe damage and then guided Abi, during a tumultuous labor, as she birthed her baby over an intact perineum. All sorts of legalities are going on regarding Dr. Biter and six lawsuits pending (all GYN), but hoards of us continue supporting him in his calling to help women. 

Then, Abi wrote a follow-up piece asking “Are Today’s OBs Giving Women What They Really Want?” Much of the article continued with Dr. Biter’s ordeal, sharing why women will sit for hours in his waiting room or holding placards in the street, all the while being nine months pregnant! It wasn’t until the last paragraph that she says: 

“But I wonder, if more doctors were willing to stay present with a woman in birth and allow her labor to move at its own pace, would they too have a packed waiting room and hundreds of picketers clambering to support their mission? If word of mouth has any place in medicine today, then Dr. Biter's success might just be a lesson to OB's everywhere: start respecting a woman's right to choose the kind of birth that's right for her, or lose your business to someone who will.” 

I wanted more of that meat, the flesh I expected the article to explore. So, I decided I would explore it myself. 

Over these last three years, I’ve watched woman after woman abandon their doctors and traipse over to Dr. Biter’s practice. Once I learned what he was about, his style (if you will), I totally understood the draw. Others make snide comments about Hero Worship or deifying him. I chuckle knowing those that throw the epithets around are seriously jealous and/or don’t have any other way to explain the loyalty Dr. Biter enjoys. Women don’t throw themselves at his feet, don’t keep their husbands from going to prenatal appointments so they could have him for themselves and certainly don’t see him as anything but a kind and giving man who happens to be an OB. Why is it so strange for a man to be loving to another human being? Why are his motives questioned by those that don’t know him? What is so hard about believing someone really can perform an act of kindness without expecting something in return? Amusingly, his tactile motives have been called into question, again by those who don’t know what they are talking about… that he must be hitting on the women, that he must be being sexually inappropriate with them. What’s so funny about that is the ongoing speculation that he must be gay to be able to be so kind to women in labor and birth! For crying in a bucket, who gives a whit about his sexuality! (None of the women I know do.) He just is

So, why don’t doctors offer care like Dr. Biter does? Office visits that linger, company to women during long labors, gentle hugs of encouragement, standing back and holding the space as women wander around in their own clothes during their rites of passage… and cooing over a mother’s success and the perfection of the new baby she just brought into the world… why don’t they mimic these behaviors? 

I know there are a myriad of reasons that, collectively, create the doctor’s attitudes. Talking to doctors, nurses and nurse midwives over the last couple of decades, this is one of the questions I’ve often asked. 

Over and over, one remark kept coming up: It is too painful to make such a deep emotional investment in a client. Apparently, caring (not just attending) for a patient sucks the life out of the doctor, so it’s easier to put up walls and treat everyone as a thing instead of a living being. Even as a midwife, we are taught not to cry with our clients. Well, I break that rule, probably with each woman. Of course, there is the importance of not sobbing on a client, not turning the tables so she is soothing you, but showing compassion through tears, in my opinion, is never a bad thing. (Probably because I do it, right?) Dr. Biter typically cries at each birth. I am sure other doctors are equally horrified and disgusted by his behavior. Patients, on the other hand, find his empathy validating of their triumphant experiences. 

Lately, I’ve noticed a difference in my care at Kaiser (an HMO… a damn good one, as far as I’m concerned). My weight isn’t the primary issue discussed, the triage nurses have been offering to take my blood pressure on my lower arm so the cuff isn’t so tight, the doctors have begun sitting on the stool (lower than the patient on the table?!? Horrors!), looking me in the eye and not standing with my chart in one hand and the door handle in the other. Might compassion be becoming fashionable? (I haven’t heard there’s any change to the gross care of women in L&D, unfortunately.) 

Compassion takes time. For most doctors, there is never enough time. The things that must be done are crammed together so the things they want to do get the bulk of the day/week/month/year/career. Compassion requires listening to women and seeing each one as an individual. It might require remembering her name or, at the very least, her face. Compassion puts the others’ feelings and experiences above your own. Convenience is not a hallmark of compassion. 

It’s distressing hearing how prenatal visits are with pregnant women’s doctors (and even some nurse midwives)… how they wait and wait and wait, then go pee and wait some more, sometimes undressed on the exam table. The nurse does the vitals and once the doctor comes in, s/he is there for maybe five minutes, seeing the woman as a batch of numbers: blood pressure, weight, weeks pregnant, fundal height and fetal heart rate. Psych-social issues are to be addressed elsewhere; if the woman is lucky, she might even get a piece of paper with referrals on it. The doctor doesn’t have time for chitty-chatting (I’ve heard that phrase on several occasions), so assembly line-ing patients doesn’t begin in the delivery room, but here, in the doctor’s office. Chitty-chatting would not only mean taking time, but getting emotionally invested in the woman. If he’s emotionally invested, he will think about her after she’s gone. He might worry about her when he should be listening to the next lady’s baby. He might find concern disconcerting as his concern for woman after woman piles into a giant heap of hardships, difficulties, happy thoughts, worries, joy and pain. It’s far easier to blankly stand before every woman, giving her equal care, adding a few more tests for this patient or sending that one in to be induced. 

What’s baffling to me is how women put up with this! This is care?!? 

Doctors continue this practice because it works for them. In and out, both in the office and in L&D. Herd them in and spit them out; the faster the better. And we are well-trained patients, following the un-written rules created by a society of men. 

I have a distinct feeling that care in labor isn’t going to change until we change the care we receive as prenatal patients (clients!). Those who want a natural birth in the hospital often choose a CNM for their care. CNMs are wont to spend, if not buckets more time, at least spoonfuls more than most doctors. And that time spent is reflected in the labor process. CNMs spend much more time (typically) with moms in labor than an OB would. Doctors, however, breeze in for prenatals and breeze in to catch the baby, deliver a placenta and sew up a mom… before zipping out once again. 

We homebirth midwives spend loads of time with our clients. If we only see them for their regularly scheduled appointments (rare for me), we’ve spend a whole lot more time with them than the doctors or CNMs would. The average CPM prenatal (from what I know around the country) is one hour and then, factoring in the labor, birth and postpartum visits, we really do get to know the nuances of our clients and their families. We see them as those numbers the doctors do, PLUS as spiritual, emotional and integrated human beings that have thoughts, wishes, hopes, dreams and fears. In our time with women, we address these aspects that, while not directly affecting the baby as, say, GBS might, do affect the entire family, including the baby. 

Women share with us things they would never share with their doctors –because the doctors not only have a wall for themselves, but that wall also keeps women at arm’s length. We’re able to hear that a woman’s husband might be having an affair or that her dietary habits aren’t what she tells the OB they are. Women will ask us about sex, saying, “I can’t talk about this with my doctor.” If a woman can’t talk about the very act that created the reason for the doctor appointment itself, there is something very wrong with that system. 

There are some notable exceptions to the status quo of the OB in America today. But, it is sad that they can be called out by name and city. It should be the other way around! The yucky ones should be pushpins on the map to avoid and the great OBs everywhere else. 

I haven’t come up with the “cure” for the crappy prenatal care/crappy birth care situation. And as stupid as it is that we have to figure out a solution, no one else is going to. I know that, until doctors take the time to see women as whole human beings, they will never be able to respect the choices she makes in birth. One cannot happen without the other.

Where do we start?

Reader Comments (36)

I can't say for sure where we start, but I think childbirth education can help. If we help women discovery what they really want their birth to look like, hopefully they'll seek out the providers that will give it to them.

But it could go back even further. It could go all the way back to sex education, where we deprogram young women to think that birth is scary or icky, and should be left up to the "pros." One thing I know for sure is no matter where it starts, there's always a chance for change. I was changed at 37 weeks pregnant with my second son. It's really never too late to make a difference.

June 28, 2010 | Unregistered CommenterTheFeministBreeder

Excellent article. I agree, and I will happily call out the name of the OB who treated me with kindness, love and respect:

Dr. Christopher Pearson
Burbank, CA

June 28, 2010 | Unregistered CommenterMichelle H

I don't think there is a cure, honestly. Beyond lobbying to have insurance cover midwives so that women actually can leave en-masse. But as you've pointed out- it can be HARD for midwives to accept insurance because of the delays and hassles in getting paid. Ugh.

June 28, 2010 | Unregistered CommenterSara

Y'know...this isn't new...and DD's arm made that really clear to me this week. The whole med-legal and insurance issues get in the way a whole lot. OK, DD breaks her arm, we get a sling and a referral to ortho, drive 20 miles, and pay my copay (again) for 5 min of doc's time and a safety pin to tighten the sling...no cast come back in 2 weeks. (wanna bet how much that bill's gonna be?)

Why on earth were we sent to ortho? When I was a kid, I broke my arm, my ped put me in a cast, and took me out of it...now the Ped is little more than a gatekeeper to a myrid of "specialists". They can't put on casts, or say you don't need one..that's ortho's job. (Med-legal issue)

Is it any different in OB? If there's a problem, off to the Nutritionist, or the Perientologist, or whatever other specialist...there's no connection. "Care" is defined by the number of specialists you're sent to, the number of tests run, and what numbers come back....

What happened? Seems to me plenty more folks want a connection with their docs...regardless of speciality...but those that care, regardless of speciality are as rare as hen's teeth. I have a far better "relationship" with H's OT who we see every 2 weeks. But for the most part, it seems the doc's all carve folks up by speciality....very few in the medical system seem to look at the whole "organism" let alone look at their patient's as people, who can be frightened, hurting, or in pain.

June 28, 2010 | Unregistered CommenterJill H.

I had a beautiful birth with an OB just a few weeks ago. Most OB's would consider me 'high risk' and there are very few who would 'let' me VBAC-let alone stay off the monitors, walk the halls, push standing etc..... I have so many acronyms in my OB hx that it looks like alphabet soup. Without going into the whole birth story, suffices to say I felt respected and safe from beginning to end and had great low-key mother/baby friendly care from all involved.
At one point in early labor my OB, nurse and I were discussing his 'philosophy'. He said something that made me sad. "When I started [in OB] I wanted to change the world of obstetrics." and he shrugged. "now I just try and respect the mom". He is older and will probably retire soon. I tried to tell him that he may not have changed the world but he did change the world of every woman who experienced his gentle and respectful care and belief in her and her ability to birth.
He just seemed so beaten down when he said that.
There are more Dr. Wonderful's out there but they get so much flack from their colleggues and so little support from the public it must be exhausting to keep doing what they do.

June 28, 2010 | Unregistered Commentermom9

You inspired me to share my professional stories of some Dr Wonderfuls that I have worked with in my time. I posted on my blog about it. Thanks for the fantastic reminder that we need to continue to spread the word about how we DO have Dr Wonderfuls out there in the world!!!

June 28, 2010 | Unregistered Commenteratyourcervix

And I'll call out the name of my former OB:

Ira Jaffe
New York, NY

I'm 10 weeks pregnant with my second. I switched to a practice of a similar minded OB and great midwives, a practice several friends have had wonderful experiences with, because my doctor moved from upstate down to NYC. But I'm still sad I am starting over new, I'm still disappointed that I am having to work with this practice, even though I already know I am comfortable with them.

He had his own practice, a sole practitioner. Now, he's teaching at NYU, and is part of a high-risk pregnancy practice. His goal there is to help women with high-risk and complicated pregnancies have as normal a birth experience as possible. He does VBAC and vaginal breech deliveries.

So they ARE out there. They may be few and far between, but they are there.

June 28, 2010 | Unregistered CommenterJen

Barb,

I can say I don't know what compelled me to keep going to OB's after my experiences except that I knew no other way. I began to hear about midwives after baby 3 was born and we were not living in Kansas but in the Seattle area. Not until my D&E for IUFD at 16 weeks did I begin to realize OB care was less than ideal. I wanted to grieve and my OB offered me drugs for depression and to sleep. I thought it was crude...I had never taken medication for depression before, I certainly wasn't going to use medicine to treat something as natural as grief. When OB's missed 2 births in a row at the hospital (and nearly 3 actually), I began to wonder what in the world I did this for. When I began searching the internet, I discovered more options. Women were having midwives at home, at birth centers, at the hospital. I had already chosen to go pain med free at births, but learned I had even more choices and rights...I could say no to the IV, I could ask for minimal monitoring. I could weigh my options and decide what risks I wanted to take. After my horrible experience with a nurse and another missed birth by the OB, I had to do something different. I looked into center birth with midwives, but the center I was looking at closed before I was even pregnant and then when it was opened it couldn't take my insurance. I had to pay up front, and couldn't do that. I considered a doula and even asked one to come but then didn't call her while I was in labor. I did however switch to a CNM who was much different. I accepted the spoonfuls of time she gave me because I didn't need more from her. I was actually quite stand offish myself, not used to being hugged by my provider at the end of an appointment. She listened to me, and assured me my birth would be healing and yes, she would be there. She was there the whole labor (except once to pee and once to call home for like 2 minutes). She did keep the monitor on me because the baby was having true decels...but encouraged me to dance upright while she held the thing on my belly for hours. Baby did have a cord confirmed at birth, and was op...so that's likely why the weird heart rate. She never panicked. She did, after I bathed for some pain relief, dry me off (with my husband). I mean, she dried my body off with a towel and I've never experienced someone doing that for me. I'm the mom of 7 now, I do everything for myself and others. She told me I was to be the princess for that day...it was labor and birth and I was to be treated like a princess. She told me wonderful things, I could do it, I was amazing, I was handling labor well, I was strong. I believed her and I was strong, amazing, I was handling it well. She acted like a person who actually enjoyed what she was doing, but more than that, enjoyed me for me.

Because of my experience with doctors, I actually have struggled though since the birth. I want to connect with my midwife again. At the 6 week she said, "please do come back again and keep in contact." I have a hard time stepping over the boundaries and actually caring about her. I feel like a strange stalker, like it's wrong to want to chat with her like we did for those weeks before the birth. I feel I'm imposing on her time. I am just another client, I shouldn't expect to build a relationship. I struggle because I really do want to connect with her, I do want to be a friend. I mean, she was there at the birth of my little girl. She respected me, she listened, she put that baby right up on my chest just like I asked. She validated my choices, and I trusted her with my life and my baby's life. Why should I not want her involved in my life? Why should we not want to care for one another? Birth is a very intimate moment, and love waltzes into the room, why can we not share more than a client/provider relationship. Because we have become a society that doesn't value our family relationships much less ones a step outside...not sure....

June 28, 2010 | Unregistered CommenterDawn

Ahhh sex. When I had the blood clots last year and wound up in the hospital, I made the overseeing physician blush. "okay so what about sex? would that be too strenuous? should we wait, or do we have a green light?" I was 14 weeks pregnant and pretty hormonally happy and in the mood, so I wanted the green light. he literally blushed and studdered out a response about it being okay, then quickly left the room. Not very professional. Come on!! It's sex and we're married, I'm pregnant, we're allowed to have it you know!

The only two physicians in that entire ordeal that sat down and spoke with me at length was (surprisingly) the high risk MFH and the hematologist. And the latter wrote a lovely note on my chart about me being a very cheery and positive patient, whom he enjoyed visiting with! lol I was in a huge teaching hospital and only 2 doctors sat down to talk with me. How wrong is that?
Well I can certainly say, and I'm not sure the others would care.. but only 2 received thank you notes. lol

June 28, 2010 | Unregistered Commentermommymichael

You know, reading this, the traditional OB model (which is what I've had) sounds a LOT more appealing to me. I certainly don't wish to discuss spirituality with someone I want focusing on the science of my high-risk pregnancies. And why should my caregiver want to hear about my personal issues? I don't really get that. It just seems tacky for me to go on about that kind of thing to a professional I am seeing for a different purpose.

Maybe it's because of my complex health and pregnancy history, but I LIKE the idea that the doctor focuses only on those issues, and doesn't waste time and energy on irrelevant ones (though I guess the idea is those aren't irrelevant?)

Recently I moved to a country where the standard of care is midwifery, and I think that is great. Not for me, though. I want a maternal-fetal specialist. Doctors like the one you are describing here, and the midwifery model, and home birth, I think are wonderful choices if people want them and they should be available. Just remember that some people prefer the model you don't appreciate so much. In my case, it makes me feel safer, and, coming from a family of doctors, feels more comfortable to me. To each his own.

June 29, 2010 | Unregistered CommenterAntropologa

Just to chime in and point out another factor that may contribute to the issue. In order to afford malpractice and overhead of running an office, one must generate enough income. In order to generate that income, one must see a certain amount of patients each day. One must be 'productive'. Unfortunately, that's counted in numbers not compassion.

As a CNM, we are alloted 10 minutes for an OB vist which is definitely not enough time. Now, we all take whatever time is required for each patient as we focus on individualized care. Needless to say, we are all typically running behind at any given point :p

June 29, 2010 | Unregistered CommenterTiffany

I have been reading your blog for a long time. I highly enjoy it and even thoughI would never even consider homebirth for myself.

I just want to throw out one possible answer to the question...

perhaps a good percentage of the pregnant women out there don't care either?

I think I am one of those women who, during most of the years I was bearing children, never really realized that there were different options out there. For my third pregnancy, in the midst of years battling my firstborn's cancer, I certainly was more aware of the medical world in general. In some ways I think it made me feel even more like my pregnancy should be just treated like a medical condition.

Truth is, I just didn't mind the hospital, clinical approach. I had epidurals...loved them. With my first I had a vaccuum assisted birth - didn't love that! To me, giving birth was not a spiritual event. It was very special to give birth but I just didn't feel strongly about the process.

This is all not to say there is anything wrong about those who do - just that there are those of us out there, who even though informed, still just don't care that much!

June 29, 2010 | Unregistered CommenterSusn

Happily for you gals that want all the technology and sterile-ness of typical OB care can find that ANY-WHERE. You can't throw a rock at all the OBs and not hit a doctor that will suit your style.

It's those of us who DO care who are screwed.

June 29, 2010 | Registered CommenterNavelgazing Midwife

I have to echo Anthropologie here, not so much in my wishes but the type of people that are OB/Gyns.

I like all the women that are the doctors and midwives at the clinic I go to, they have a united perspective that is womencentric but I will say the one doctor who has delivered me twice (who is there at birth is determined by who is there when you show up at L&D) is not too clued into intuitive care. She is a very fine surgeon, and when I say that I mean it - my c-section scar healed quickly and well and it is now barely visible, I had no pain after the surgery because I think this doctor respects the integrity of tissue and has a light touch when performing surgery. Certainly my repair on my 1st degree tear 2 weeks ago has healed much in the same way, with little to no pain, the stitch that did come out was incredibly neat and well done - and I recall hardly feeling the stitches being put in as opposed to the 2nd degree tearing I had last time.

However, this sweet and fine technician has a bad habit of bringing up permanent birth control at bad times. The last time it was at my postpartum check up after the delivery of my first child (my first! COME ON!), this time it was in THE DELIVERY ROOM. I don't think she means to be insulting or rude, she's advocating for what she thinks is great and wonderful birth control and she is offering what she has to give - it just is presented in a gauche manner. And that is what it comes down to, her temperament is what brought her to the profession and makes her a very fine surgeon, however it also means she kind of lacks some grace sometimes. I am still thinking about how to approach her about her lack of tack at my 6 week check up, I really like her and I think she would feel bad if she knew how poorly it comes across so I want to tell her in a way that is kind.

Anyway, Dr. Biter is an exception I believe - I think those who find themselves in the profession tend to be fairly similar in temperament and social skills that sort of preclude the kind of care a midwife or Dr. Biter can provide simply because their skills and temperament got them through the training that made them doctors.

June 29, 2010 | Unregistered CommenterEthel

You know, Cori (my CPM for those that are reading and don't know me) and I had this conversation once. She said something brilliant I will repeat here:

OBs give prenatal monitoring; midwives give prenatal CARE

Amen to that. She CARED about me, on all levels. She spent quadruple the amount of time watching me and the twins while I was gestating that a normal provider would have done.

For example, the day of the u/s when we found out it was twins she came back to the house with us and had lunch and helped me process. I was able to ask questions as they occurred to me. We laughed together and would occasionally make eye contact and just start giggling over the miracle before us! Then, later that night she called to see how I was handling the news and answer more questions. What OB would do THAT!?

It's something I also choose for my non-maternity care now that I'm not having any more babies. I seek out care providers who listen, who spend time, who remember me, who CARE about me and my family. I take my dollars (and often pay OOP for this care since they aren't on my insurance plan) to people who meet my needs and are invested in me. That's what I PAY them to do, kwim?

June 29, 2010 | Unregistered CommenterChantel

I guess I could only side with essentially one person in your comments: I, too, do not really care for a physician who asks me about my private life or cries when my baby is born. Be it he or she, OB or Internal Medicine. Of course, it's nice to talk to someone civil and nice and chat here and there, it's nice when they ask what the baby's name is going to be, blah, blah, blah... but really, personally, I would prefer my OB focus on my medical issues and treat me as a patient and not as a friend. I don't want them to get distracted and forget something because I was talking their ear off and they were actually listening. I don't care about the pedestal or the white coat or the pretentiousness, I just want the best medical advice and care. Maybe when I'm pregnant and hormonal and crazy, then I'll care about the small talk, but until then, I love my efficient OB who doesn't make me wait in the waiting room, answers all my questions on time, efficiently and doesn't ask extraneous things. But that's just me.

June 29, 2010 | Unregistered CommenterK

I have read this blog for sometime and have always, for the most part at least, enjoyed reading everything on it (esp the birth stories!). I am a fourth year medical student (osteopathic if it makes a difference) and we are taught to care for the patient, to always listen to them and treat the whole body..I am sure you can look of osteopathic medicine principles on your own if you are so willing. As much as I love this, sometimes it is not possible to do this with all of your patients. I am hoping to go into OB or FM-women's health and wish with all my heart that I can bond with my patients and can take the time to talk to them but I know I am facing a system where I only get reimbursed for 10 min visits. I know, it shouldn't be about the money but when I am facing at least 70,000 a year in malpractice insurance and a 250k+ debt from medical school, it is hard not to think about the money. If you don't think about the money, you will just get yourself deeper in debt no matter if your patients love you or not. Trust me, I really want to offer 'Dr.Wonderful' care to my patients but I also want to pay off my debt and have a family where I can see my children.

This is how society is and how insurance has made it. I think a lot of what doctors end up doing is because of insurance and until people realize this and see that it is the insurance and med-legal that has to change first then it is pointless to believe that the doctors will just change on their own no matter how passionate we are about it. In my mind, I want a practice where I can spend all the time I want with a patient and care for them as they should be but is it so horrible to also see that I have so much to do on top of that including pay my malpractice, pay off my debt, have a family who sees me, and be happy with my life outside of medicine? I pray for medical/tort reform and lower malpractice and larger gov't paybacks of medical school loans but until that happens, I am afraid I won't be able to practice as I really want to when I am a physician. Maybe, there are more future/physicians out there who feel the same way and who feel trapped in this medical/gov't construed way of practicing ob/gyn?

June 29, 2010 | Unregistered CommenterLisa

Lisa: That is one of the most honest letters/comments I have seen in AGES. FINALLY! Someone validates what we've been saying.

The Insurance Industry runs our entire healthcare system.

It makes me want to cry.

May I share what you wrote on FB? I think it deserves a more prominent spot than tucked here in my blog comments.

June 29, 2010 | Registered CommenterNavelgazing Midwife

Sure! I love your blog and I think it spurs some great conversations!!

June 30, 2010 | Unregistered CommenterLisa

I just wanted to add this:

I did receive prenatal CARE, not just monitoring with my former OB.

But I agree that while I want someone to listen to my concerns and answer with my questions with respect. And while I want someone who will support my birth choices, I'm looking for a doctor, not a new friend. Yes, we talked about birth in general (as in, not related to my birth or pregnancy), and we occasionally talked about non-birth related things, and I did KNOW that he truly care about the outcome of my labor and delivery, not just the healthy baby at the end. But I'm not interested in any kind of spiritual relationship with my care provider. Frankly, I'd be a little uncomfortable if my OB cried at my daughter's birth.

And yes, that's me, and apparently, several other women commenting here, and I wish there were more providers out there who could offer that kind of spirituality to women who wanted or need it. There should be enough different providers for all of us who need/want something different from our providers.

June 30, 2010 | Unregistered CommenterJen

I'm a homebirther with absolutely no desire for a touchy feely provider, nor one who cries at births. I don't need an hour for prenatals, ten minutes is plenty. Having said that, it does seem like most obs (most doctors even) have zero people skills and are engaged in a power struggle in their desire to control women. Playing god, if you will. I recently was at a friend's attempted natural childbirth in a hospital. I wasn't suprised at the interventions they threw at her last minute, some of them I even understood, but I was shocked at how horribly they treated her. It wasn't about being spiritual, they completely lacked any human decency. The doctor brought in a team and started talking to her while she was contracting on the toilet. She yelled at her for being on her hands and knees. They played the dead baby card. She couldn't wait a few minutes to do a vaginal exam and kept pressuring her to "hurry up and get on your back." I was absolutely horrified, even though I had been reading websites like these for years. There was no respect for my friend and her bodily autonomy. My mom has been a nurse for 30 years and says that probably "many to most" doctors are arrogant jerks. Especially when you ask for a second opinion.

So yeah, Dr. Biter would probably annoy me personally, but the other extreme is so much worse.

June 30, 2010 | Unregistered CommenterAly

Beautifully put, Barb, and I appreciate the comments here as well.

July 1, 2010 | Unregistered CommenterDou-la-la

I want to write a reply in defense of the Obstetricians. I am a resident (not in OB), and have worked in OB, and it is a VERY different field than Midwifery. Physicians are trained to follow a delivery very carefully, know what to do medically when something goes wrong, are trained to recognize birth defects, congenital defects in a newborn, life-threatening situations and be able to react to them immediately. Physicians are strapping on electric monitors and breathlessly watching them while holding your hand, or rushing around the floor, so that they can manage an emergency in seconds.
Hospitals have neonatal intensive care units for a reason. When you're at home sitting in a tub with someone holding your hand, it can feel like a very beautiful experience, as long as absolutely nothing goes wrong. You may be 30 mins away from the nearest emergency room if your child is blue, needs some critical blood test, or, for example, you yourself are bleeding to death.
Physicians work long shifts, performing emergency c-sections at 6 am after working for the previous 24 hours (been there, done that), and still perform the job beautifully.
Please don't beat up physicians when you have absolutely no idea of the pressures on us and the sheer numbers of patients we have to see and babies we have to save - which is, by the way, dictated by state-run agencies, managed care agencies, regular review panels who send inspectors in at the drop of a hat, and the financial pressure to keep the hospital out of debt and therefore available to that locality - not because of physician preference.
I had a wonderful OB for my c-section. I would never ever consider having a midwife instead of an OB - it is better to be physically in the hospital at the time if something goes wrong, with the appropriately qualified people around you. If you need someone to hold your hand, grab the guy who got you pregnant.

July 2, 2010 | Unregistered CommenterMDPhD

MDPhD: This was in defense? Sounds like Exhibit A.

July 2, 2010 | Registered CommenterNavelgazing Midwife

Am I the only who feels like people aren't getting the point? Why should I have to choose between competent and compassionate? Can't a skilled surgeon/physician still be caring, kind, believe in normal birth and evidence based and not fear based medicine?
And not just in maternal/child health but in all fields? Shouldn't patients expect to be treated with respect, receive real informed consent etc...??? Where did this idea come from that good doctors are assholes and if you want to survive you will put up and shut up??
Sorry, but I want both competence and compassion and I have no problem searching those physicians out, traveling farther and paying more sometimes.
One of the best laparoscopic surgeons in the ushas operated on me. He is young, handsome, rich, single, brilliant....has every 'reason' in the world to have a God complex. Nope. He doesn't. He is a plain NICE, down to earth guy who really goes above and beyond. I've had two OB's like that too. Two special men who truly care about women (their physical and emotional well being) and their babies.
Being a doctor isn't a picnic. I know that. I can only imagine the sacrifices one must make, especially if they want to be a good doctor. But being a patient (or family member of one) isn't easy either.

July 3, 2010 | Unregistered Commentermom9

Dr. Behrmann, Madigan Army Medical Center
Treated me with absolute respect and dignity and was excited for me as I had my natural VBA2C!

Dr. Sessions, Madigan Army Medical Center
Treated me with respect and concern, even cried with us and helped my husband give me a spiritual blessing as I prepared to give birth to kour baby right after learning my father had passed away unexpectedly.
Another natural VBAC and an awesome birth!

I have had a midwife attended homebirth for my first VBAC and it was also awesome!

I have had to 2 cesareans, one where the OB truly cared for me as a a person as much or more than my midwives did and did her best to help me when I was so sick with pre-e. Her name was Dr. Roopa Rao, Simi Valley, California.

My 2nd cesarean was a cord prolapse turned emergent cesarean and the OB there lied to me {and I caught him in the lie as well as broke my water without my consent with baby at minus 2 station}. My daughter suffered from oxygen deprivation and has learning difficulties, Aspergers and other developmental delays because of that birth.

I have had the full range of experiences in my births. I am grateful for the Dr. Wonderful's I have had and the midwives. I am grateful for the lessons I have learned. I have become more wary of doctors in general. I believe the majority of them start out wanting to help others and make a difference and they become victims of a system that beats them down.... with the Insurance companies being the main perpetrators.

July 4, 2010 | Unregistered CommenterStephanie

"So, why don’t doctors offer care like Dr. Biter does?"

Because women don't want it.

We have friends and family to hold our hands. We might prefer an epidural. We don't want to trade a pro-active approach and vilgilant monitoring of our babies for smiles and hugs (see friends and family above). We won't risk our lives our babies lives or our babies' well being trying too hard to avoid Evil Intervention. And most of us don't think the midwifery crowd or midwife-like doctors are very scientific or effective. Recent studies show just that.

It's comical to read your post and the Huffington lady's. You don't seem to realize that the vast majority of moms are not enamored with vaginal birth the way you are.

July 8, 2010 | Unregistered Commenter,

"Can't a skilled surgeon/physician still be caring, kind, believe in normal birth and evidence based and not fear based medicine?
Shouldn't patients expect to be treated with respect, receive real informed consent etc...???"

They do. And every other woman is satified with them for the most part.

But natural nazis want to ignore problems until they are completely out of hand and then expect the doctor to pull them back from the edge of the abyss. Many docs don't want to seek out more emergencies than life already gives them. And none can be very successful when things have gotten out of hand.


"Shouldn't patients expect to be treated with respect, receive real informed consent etc...???"

Again, most think we have it already. But, midwifery groupie "informed consent" consists any real or imagined risk, in fact anything that is correlated with the underlying problem of medical treatment being exaggerated and all the risks of doing nothing when the water is broken too long, the labor is too long, or the pregnancy is long etc are downplayed.

July 9, 2010 | Unregistered Commenteranon

anon-
so being told "we tell our patients what we think they need to know" in response to a question satisifies your notion of informed consent? A quote from a surgeon to a patient post-mastectomy that I witnessed.
Yes, some patients would rather let the doctor worry about everything and 'be taken care of' but not all patients have that personality or trust (and often for good reason-it seems you have never had a bad experience with a physician-lucky you) and as far as I am concerned have the right to an honest answer to every question regarding their health and body.

July 10, 2010 | Unregistered Commentermom9

"so being told "we tell our patients what we think they need to know" in response to a question satisifies your notion of informed consent? "

This isn't anything. A casual broad summary doesn't tell anyone anything about a doctor's informed consent.

What did you expect? An twenty minute reenactment of an actual informed consent? (of which procedure). An hour long monologue of an informed consent plus answers to any and all quesitons he had actually had in a lifetime? Would you like him to tell patients things he thinks they don't need to know?

Be careful what you wish for. Next time you need your blood drawn maybe you will have a 12 week 30 credit hour class on all the ins and outs and pros and cons.

July 12, 2010 | Unregistered Commenteranon

What a smart ass you are, anon. It is absolutely appropriate to ask for more informed consent that the hospital/doctor usually gives. The hospital/doctor gives the parts it wants to; midwives give *all* sides -and much of the information is given prenatally, even for possible hospital situations.

And, being told there are no risks to {pick your procedure}, is a flat out lie. One I've heard told far too many times.

July 12, 2010 | Registered CommenterNavelgazing Midwife

What a dumb ass you are, navelgazing.

"It is absolutely appropriate to ask for more informed consent that the hospital/doctor usually gives. "

If you already know what missing, why do need it in the first place?

"The hospital/doctor gives the parts it wants to; midwives give *all* sides -and much of the information is given prenatally, even for possible hospital situations."

Are you informing all your potential clients that new study showing your death rate is about three times higher!! Didn't think so.

"And, being told there are no risks to {pick your procedure}, is a flat out lie. One I've heard told far too many times."

It's not as big a lie as being told "midwives do everything that doctors do in an emergency except surgery". You don't do things like reliably get IVs in, do anything more than pitocin for bleeding, intubate, recognize fetal distress reliably. That's a lot of important information missing.

Accusing other people of picking and choosing, or biasing. Please.

July 13, 2010 | Unregistered Commenteranon

Super post. Quoted on the DC Urban Moms forum in this chain (toward the end):

http://www.dcurbanmom.com/jforum/posts/list/115468.page

July 15, 2010 | Unregistered CommenterFC

My wife recently had a C-section and as I see her writhing in pain daily I feel terrible at times. Throughout her pregnancy I often felt the lack of care and emotional support given to her by the doctors. On several occasions our appointments with the doctor were replaced with a midwife. Even after the C-section operation we never got to the meet the OBGYN. The midwife came a couple of days later and removed the stapled pins. It is this attitude that had been bothering me all the while.

My wifes water broke around 8:00 am in the morning and we arrived at the hospital by 9:30 am but we weren't given a room until 4 in the afternoon. Her labor was then induced by after several hours of failing to progress the OB then suggested that we have a C-section.

Being medically ignorant, I wonder sometimes wonder whether (a) should we have gone into inducing labor after the water had broken (b) were we late i.e. room was given very later. (c) was the doctor right in approaching for a C-section.

Beyond all of this, the lack of care, seemed the most bothersome to me.

August 11, 2010 | Unregistered CommenterMahesh

Mahesh: My heart goes out to you and your wife. I am so sorry things have been so hard and painful.

Re: your questions, it is impossible to know the correct answers because they just didn't happen that way to know. Many women are glad to hindsight re-play your birth story with various plots that end one of two ways... vaginal birth or cesarean. *I* have done this, even in this blog and *can* do it with your story, but am learning that it is much more healing for the mom (and dad) to walk through the path themselves. I will say you are asking the right questions and, I believe, will find the answers you are looking for.

I'm going to send you to a few sites. Explore them all... you and your wife. Know, however, that women often don't come into the processing phase for a long time because Nature seems to cause a little amnesia for awhile so she can focus on the baby and the bonding that is necessary. Some women *do* freak out immediately, so if she is doing either, they are perfectly normal.

You are a rare husband. Most husbands are "What's the big deal? You have a healthy baby!" So your kindness and concern are amazingly loving and beautiful. What a gift you are to your wife. And baby, I suspect. :)

Here is a piece I wrote on the stages of healing from a traumatic birth.

http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2008/2/11/the-gray-grey-messenger-recovery.html

Here is a wonderful site you will refer to often. Unnecesarean is mentioned in many articles and in the news for its great information. Delightfully, the author lives here in town and I see her quite often. Lucky me!

http://www.theunnecesarean.com/

Another wonderful site from a woman who lives a couple of hours away is VBACFacts.

http://vbacfacts.com/

And, the main international support group for women wanting to avoid a cesarean and who need support if they have had one is the International Cesarean Awareness Network – ICAN. Magnificent women there.

http://www.ican-online.org/

I know you will find a lot of second-guessing of your birth story, both within yourselves and by other people, but know that the experience is but one aspect of your lives that has transformed you, whether you like it or not. Many, many of us had earlier births with blinders on, in what later feels like total ignorance, but I tell women all the time… if you hadn’t been there, you wouldn’t be here. I had a stupid first birth that today would be a cesarean… might have been nice since I had an episiotomy that went into my thigh muscle. I had no idea birth could be different, but look at me now… a midwife! Who knew!

Feel free to email (navelgazingmidwife at g mail dot com)anytime. Much love and healing to both of you.

August 11, 2010 | Registered CommenterNavelgazing Midwife

We don't want to trade a pro-active approach and vilgilant monitoring of our babies for smiles and hugs (see friends and family above). We won't risk our lives our babies lives or our babies' well being trying too hard to avoid Evil Intervention. And most of us don't think the midwifery crowd or midwife-like doctors are very scientific or effective. Recent studies show just that.

I know this is old, but this just made me laugh and laugh. Straw man, much? Yes, it's all about smiles, hugs and scented candles for me! My own health? The health of my child? Who cares! And of course, OBs attending a dozen births at once, doing half of their monitoring remotely via highly unreliable machines, are much more vigilant than a midwife who sticks closely to a mother's side. "Recent studies?" The laughs keep on comin'.

September 12, 2010 | Unregistered CommenterDreamy

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