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?