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Tuesday
Jan042011

When Choosing an OB...

…do you choose a male or female? Why? 

This was a recent Navelgazing Midwife Facebook question. The answers were, as expected, all over the place. I’ll comment at the end. 

RR: When I chose an OB (I have a midwife this time), I chose a woman. I don't understand having a doctor that specializes in female body parts but lacks them himself. 

JB: I prefer a midwife. And female. No more MEDwives either.

(The MEDwives discussion comes in a later post.) 

MGD: A woman. No matter how many books a male OB will read, he will never know what a menstrual cramp or a contraction will feel like! 

PNB: I use to believe that having a woman would be best because she could sympathize with what I was going through and possibly relate to some of the issues of pregnancy, but after my first pregnancy and birth I know that isn't always true, even when the Dr. you are seeing is pregnant, which she was. So, after that, I didn't have a preference. 

HFT: I choose a midwife as well, but actually have been under the care of a male OB for the past year or so. Of the available OBs in this area, his practice allies with my philosophy more closely - so I guess my answer is whoever I can find that most closely provides what I'm looking for. I do prefer a female though. I'm not terribly keen on the idea of some strange man poking around my lady bits, medical degree or not. 

JW: Neither has preference. I have met enough women physicians that see pregnancy as a pathology and enough men that respect female autonomy. I have had a female OB, a male OB and a midwife attend my births. The male OB was far more respectful of my birth plan than the female OB. The midwife was the best - but I was much more cautious and thorough when I interviewed her. 

TS-K: A woman. And they have to have had children themselves. 

JD: I would always choose a midwife first. If I needed a surgeon, I would choose whoever I felt most comfortable with, gender wouldn't matter. For some reason I do prefer female Dr. for my kids though. 

CES: I don't think gender matters. What matters is having a health care provider that listens to you and respects your decisions, even if you do not agree. I love my OB. He is kind and very compassionate (to me, I don’t know about his experiences with others, but have not heard negative about him. I have never worked with him as a doula. However, I have a few choice words about his colleagues.) 

SGM: Instinctively, I would say woman. I prefer midwives, but since becoming a doula I would say that the male OBs seem a lot gentler than the women OBs. Males doing OB-GYN work still makes me think... why? Do they love women, or hate them? Money or perversion? I don't know. I over analyze things for sure. 

KBH: Jennifer took the words out of my mouth! Of all the OBs I've seen, I've probably gotten more patronizing, ignorant, and condescending remarks from the female physicians though, personally.

It really comes down to the person, male or female, the practice, and their philosophies to me. 

JA: I always thought a woman until I was pregnant with my first and saw a male OB who respected my birth wishes and who I felt most comfortable with... and cared for my husband as part of the birth team as well. 

AS-K: MIDWIFE. Period. I have seen female OB who loves to cut women so for an OB it doesn't matter which one but they'll never have the same respect for women as midwives do. 

LMS: After being betrayed by a trusted male OB, I am fairly certain I will be seeing female docs from here forward. Sadly, recent events have risked me out of future midwifery care. 

JRBB: Woman. There's just some things that men will never understand. The last male OB I went to drove me screaming for my current midwife. I have been treated by her partner/backup OB, a woman who is by far one of the sweetest people I have ever met. If I needed a surgeon, she's it, no questions. 

SS: Haven't had the opportunity to choose, honestly. I go where my insurance brings me and try to avoid the heavier intervention nitwits where possible. But I always end up in a mixed practice with no control over anything. (Mixed by gender, mixed by approach to birth, mixed by everything really.)

What's below the waist or if someone has facial hair doesn't matter to me. What I would care about is a person's attitude. But I haven't had the opportunity to choose that either. Nor do I think I will with any other births that I have in the future.

I think that I also would want to choose someone who would not have assumptions about my experience based on their own experiences or lack of experiences. Honestly, I would want someone with the same approach as Alex (my partner) during my last birth: I know what I need. He had no preconceptions, or at least did not have any preconceptions that caused him to respond on my behalf other than in ways that I had asked him to.

A woman's experience with cramps or contractions? Honestly, I would prefer someone who simply understood that if I say "it hurts more when you do xyz during a contraction" without applying their own experiences to it. As long as my expressed feelings and wishes are listened to, I don't care.

I could easily and happily give birth alone in Times Square surrounded by strangers. I don't care who is there. I care about the reasons I am being touched against my will, and how the touching takes place.

I do not want to be touched BY ANYONE during labor. Touch is a violation. If I touch you, or ask for touch, yes. But any other contact, words uttered, etc. is a violation.

I would, if I could, choose someone who understood that about me, that believed me when I said that, and that would truly balance that with the safety of my baby taking priority, of course.

I was told on a hospital tour that being "open" to the experience would make it more likely that I would be happy with the birth. I found the opposite to be true. Allowing myself anger and skepticism and not blindly trusting those that did things that raised questions... that is what made my experience a positive one, although had anyone been at both births they would likely have said my first birth (which I found violating) was the "positive" one because I was passive and asked few questions.

(I got angry when my reasonable requests were ignored like the tightening of a contraction monitor during a contraction, and when questions were ignored. I was sort of "meh" about the touching without asking for permission because I expected it and can make excuses for it.) 

EVU: Does not matter to me as long as they have a great reputation. 

SP: The OB who encouraged my VBAC was a man. The family practitioner who encouraged my home births and came afterwards and examined me and the baby-and didn't charge for it, was a man. I don't think openness of mind and spirit is sex selective.

MG: I would not get to choose an OB, if I saw one it would be in a transport from a midwife-attended homebirth, and I would get whomever was on call. Outside of birth... I don't call Dr's I see for Gyn care, OB's, I call them GYN's, because although I understand why the two specialties are conflated into one, I think there's an important distinction between maternity care and gynecology. If I needed to seek care with a GYN, I would have 2 main criteria - who gave me information about my health and my choices and then let me choose, and who was capable of comfortable paps, and while I'd probably rank a woman who provided such care above a man who did, I'd put those two criteria far above the anatomy of my care provider.

I like that you distinguished between OB and GYN. I should have said that in the original question; thanks for bringing it into the discussion.

NY: I generally don't use OBs at all, but during my homebirth transfer with my 4th, I called all of the hospitals to see who was on-call and I chose to go to the hospital that had a VBAC friendly woman- not because I was VBAC-ing but because I felt that if she supported VBAC then she would be more open to letting me do my thang. And she did- she never told me what to do, when to push or anything. She actually didn't even touch me until my son's shoulder's got stuck and his heart tones were dropping.

The prospect of a male Dr. was terrifying for me and I felt that a male would not be empathetic enough for me to feel comfortable birthing with him. Had I been transporting to get a c-section it wouldn't have really mattered. I figure they all do it enough I'm sure they get great practice.

NKW: I also would rather have a midwife....however, (if an OB,) man. Women OBs seem to have a "oh honey....you'll be fine....we've all done this" attitude and it frustrates me. But, that's just my personal experience. 

LH: I prefer female OBs, which also happen to be the majority of OBs in my area. With my first pregnancy I saw a male OB and he said some terribly hurtful things to me so that put me off male OBs pretty quickly.

My current OB and the backup that I've seen are both really nice and seem to be really supportive of more natural birthing.

Then again I'm in a country in which the midwifery model of care is the norm and the only reason I'm seeing an OB is because I'm high risk. Go figure. 

NM: No preference of gender. Want a care provider who listens and considers me a part of the health care team.

Not always easy to find. 

KP: Midwife!! Both my midwives have had male back-ups (one OB, one FP), and I've not gone to an OB/GYN other than those single visits during each pregnancy. I'm not anti "male OB" but would prefer a female, I think, if I had to choose between two equally supportive OBs of the opposite sex. Now, if I had to choose between a wonderful male OB and a horrible female OB, I'd definitely choose the latter! 

CSM: Because of a history of abuse, I do best with a female or a male who isn't Caucasian. 

ND: I would have thought that it would be that women would be more sympathetic to other women... so I thought, in the past, it would be a female. But, from experience, I have found more good male OBs than female. Although, that said, I have found horrendous male OBs and phenomenal female OBs... so, more than anything, one that is good and mother/baby-friendly. I couldn’t care less about gender. But, as others have said, this is why I choose a MW. 

KP (again): In the vein of "a woman understands in a way that a man cannot possibly know" (about childbirth, contractions, or menstrual cramps), I was reminded of something a female friend once told me after she had joined the Army or Navy -- male drill sergeants were in general "better" than females, because they would soften up if the female private claimed PMS or cramps, whereas the females would basically say, "Suck it up, wimp; I had to march whether I had cramps or not, and you will too!" So, I can see that male OBs might have the same response -- because they don't have the female equipment, they may just listen to the woman's complaints, whereas a female (depending on whether she's brusque or not) may assume her own mild cramps are everybody else's bad cramps, and brush off real pain as inconsequential. 

JM: I have always preferred a woman, I think women know the needs of another woman, but I have been proved wrong lately. 

KM: I went with a woman when I was pregnant with my son because I thought she'd know about what I was going through. That she would understand my fears and my beliefs. Nope. Turned out that she didn't care and was "c-section" happy. Now that I'm with my midwives, I'm happier, they understand me, they talk to us like family and I love that they know what we are going through. 

NgM: I used to hire only female docs, mainly because of a history of abuse, but it didn’t take long before I realized that, far too often, female docs have had the femininity beaten out of them in medical school. It is common knowledge that the minorities in a given culture must perform above and beyond, far above, the majority. It’s that way with females in med school (although the numbers are pretty evenly split now, med school is still distinctly patriarchal).

Over the years, I’ve had and seen some ghastly female docs and some phenomenal male docs. But, make no mistake, there are just as many of the opposite out there.

Two female OBs stand out more than all the other crappy/mean/evil doctors. One was Sarah’s doc when she had her son. She was in a damn hurry and Sarah didn’t even push for five minutes… telling her to hurry because she had another delivery to do so she was going to cut an episiotomy. Sarah sat up and yelled at her not to and the doctor said, “I hope you tear,” while taking the baby’s head and pressing upwards on it, causing her to tear into her urethra and right to her clitoris. I know it’s mean to think so, but we gloated when we heard she’d had three days of an induction before a cesarean herself when she had her baby.

The other bitch (and I mean that in the nastiest of ways) was a doctor who Pit’d to Distress a client of mine. Made me sick to my stomach.

I’ve also known a couple of male CNMs, one of whom I liked a lot. I’ve never met a male midwife that wasn’t a CNM, though… and the prospect feels weird. I’m sure that’s what doctors said about females entering the medical field a hundred years ago.

I wanted to say one more thing about the “Why would a male doctor become an OB/GYN… he must have issues.” I’ve actually heard (read) that as a lesbian, that I must be some lecherous homosexual to want to be a midwife. Well, at least for me, that isn’t true at all. While I totally agree there are a plethora of misogynistic (and even abusive) doctors, I also hope there’s a place for believing that not all male OB/GYNs are perverts wanting to get into women’s genitals as a career.

Thank you, all of you, for sharing your thoughts. Really, really great dialogue!

  Dr. Dale Lapp, San Diego, CA. (VBAC-friendly doctor)

Friday
Nov192010

Comment for "Home Birth Plan"

Note: As I am set to publish this, Emma sounds like she might be in labor. She’s having a breech homebirth, so I’m eager to watch along her process. Much of this post becomes irrelevant for her and wasn’t a critique at all of her birth plan, but I wanted to offer other thoughts and ideas; now they can sit out there for others to read. 

Sending love, Emma! 

I read “Home Birth Plan” on the Ramblings of a kajira blog today and wanted to make a few comments. Blogger has been irking me no end not automatically allowing Name/URL as a commenter’s option, so I’ll just chat with Emma here in my blog! 

Emma, the author of the blog, is a kajira… a slave in the Gorean style of Dominance/submission, what many would classify as kink, but others find it a lifestyle choice instead. Her D/s world is irrelevant to her birth plan (on the outside, anyway), but when you go to her site, you’ll have questions; thought I’d give you a head start. Oh, and lowercase “i”s instead of the capital I is a sign of submission, not a typo. 

Emma! I’m so excited for you having a homebirth. I love that you have Jake as such a vital part of your needs and desires. That speaks well for your relationship. 

There’re a couple of things I wanted to mention about your birth plan, clarifications, really. I know you have a midwife and she’s obviously guiding you along nicely, but thought I’d point out a couple of things that caught my eye. 

- I'll need antibiotics for GBS. Once the series is done, i'd like the IB removed.

When antibiotics are given in labor, they are given every 4-6 hours (depending on the antibiotic) until delivery. But, inbetween infusion times, the tubing can all be set aside and you capped off with a saline lock. You’ll still have the IV threaded in your vein (no needle, of course), but you will be able to move around fine, shower and such without a problem. 

Have you talked to your midwife about doing the Hibiclens wash instead of the IV antibiotics? It is what many homebirth clients do and is what most of my clients choose to do as well. It is easy and the research is very positive about the efficacy of its treating/”washing” GBS so the baby isn’t infected as s/he goes over the perineum. If you want the list of studies and my protocol for the Hibiclens, email me and I’ll send it right over. (Navel gazing Mid wife at g mail dot com)

- No episiotomy, i'd prefer natural tearing. - and if a tear does happen, PLEASE use a topical numbing agent to stitch it.

It is extremely rare for a midwife to do an episiotomy. I’ve done two in 15 years! (and might not even do those again if it were today) Hopefully, that will ease your mind. And not sure why you are asking for a topical numbing agent. Instead of injectable lidocaine? Many of us will put the topical on for a minute or two, letting it numb the area a little and then use the injectable lidocaine to really numb the area. I cannot imagine suturing with just the topical lidocaine. Owie, zowie! 

There are midwives that suture without meds, but they almost always will suture immediately after the birth when the birth hormones are raging high and the perineum is still pretty numb from pushing. It’s a philosophical discussion about when to suture, but I find that suturing that close to the birth doesn’t allow mom and baby an uninterrupted time to see and feel and smell each other. When moms are being sutured, it isn’t unusual for her to be so distracted she cannot hold the baby or, if she can hold the baby, have a difficult time nursing. I’d rather wait awhile (45-60 min or so) and let mom and baby settle in before suturing. 

Each midwife does have her own style and preferences, though, so this is a great question for your own midwife. 

- Regarding being told what to do versus listening to your own body as well as Jake, I think you’re going to find that exactly as you picture it. When everything is going great, the usually tact is to be gently encouraging. It is when guidance is needed that a midwife will step in. (It’s what you’re hiring her for, right?)

- Vitamin K shot is not needed, but eye drops after a couple hours are fine if required due to the GBS positive factor. I want that bonding period first though, and if eye drops aren't required, i'd like to skip them.

Actually, there are times the Vitamin K shot is needed (in my and others’ opinion). If there is bruising at birth or if there’s been some trauma to the baby as s/he is being born… shoulder dystocia for example… or if there is a caput (neither of which a breech baby will have). However, it is very common for a breech baby to have bruising on the butt, swelling and/or bruising on the genitals or if any manipulations need to be done, on that body part. As a midwife, I would encourage my clients to seriously consider getting the Vitamin K shot for a breech birth. 

Regarding the Erythromycin eye ointment, it is given for chlamydia and gonorrhea, not GBS, if that helps your decision. 

According to the 2005 Sanford Guide to Antimicrobial Therapy, the ophthalmic ointment is indicated for use in all newborns for the prevention of a bacterial eye infection known as ophthalmia neonatorum due to Neisseria gonorrhoeae and Chlamydia trachomatis."

- Baby will need hep B vaccine AND hbig immuglobulin at birth with in 12 hours of delivery....

It’s so interesting you don’t want the Vitamin K or the erythromycin, but you do want the HepB injection. If moms pick and choose, it is very often the other way around. If, however, you are in a high-risk category, ignore this comment.

- Mom will need Rhogham. She's RH negative - baby is most likely positive. 

Not sure why you think the baby is most likely positive, but care providers almost always (should!!) test the baby right after the birth and then you can get the RhoGam® (aka Anti-D) if the baby is positive. (And yes, readers, I am aware not all mothers choose the RhoGam® even if their babies are negative.) Even in a homebirth, labs can come get the blood stat and let the midwife know so she can get you the RhoGam® before 72 hours postpartum. There are even home tests to determine what type the baby has. 

I’ve poked around and can’t find a percentage of babies that are positive to moms who are negative; do you have a site I can check out? I did find that 85% of Caucasians have Rh positive blood, so maybe that’s what you are going by? 

And do you know if the dad is Rh positive or negative? If he’s negative, then you don’t need a shot at all! 

(For the geeks in us, I came across this interesting (cool!) site that scientifically explains the Rh factors in more depth –and reminds us providers it isn’t just a case of positive and negative, but there are variations on the negatives we need to be aware of. Plus, MoonDragon has a great explanation of the variants of Rh negatives [Kell, Duffy, etc.])

I really do look forward to your upcoming birth, Emma. I know there are now many of us sending you birth vibes and anticipate seeing your precious baby. Thank you for being so out there.

Wednesday
Nov172010

Love Letter

In my email today. Just in time, too.

"Hi, Barb.  You don’t know me. We’ve only communicated a couple of times, and by email or blog comments at that.  But you changed my life. 

I had a hospital birth with my first child – a great hospital birth, honestly, even knowing what I know now.  At the time, I chose family practice OB care and a hospital delivery as not just the safest option, but the ONLY safe option for delivering my baby.  Through a combination of lucky factors, I ended up with a low-intervention OB (who had apprenticed with midwives!), a baby-friendly hospital, and a quick labor with few interventions outside of an epidural, IV, and continuous fetal monitoring. But when my sister-in-law chose to deliver her first child at home, I knew I had only two choices; I could either get on board with her decision, or I could remove myself emotionally from her pregnancy and birth. It’s not OK to be constantly dogging someone’s pregnancy with doubts and fears, and I wasn’t going to do that. 

In my homebirth research, I found your blog, and I read it avidly, and I started to question some of my assumptions.  Between your blog and lots of other research, I learned that the incidence of birth complications that can’t be resolved outside of a hospital AND that come on very quickly with no warning is, actually, incredibly low. Like, you’re probably at a greater risk when you drive to the hospital.  (Further research and some NTSC number-crunching showed that yes, for the majority of Americans, you take on a greater risk of substantial complications by driving to the hospital for a low-risk delivery than you do by delivering at home; the likelihood that you’ll get into an accident while driving distracted for 20+ miles is higher than the risk of a problem developing at home that can’t be fixed by a transfer.)  I emailed you and told you my birth story, and you said “Oh hell yes, when you asked for the epidural, you were in transition, 4 cm or no 4 cm.  You were right there. You could have done it.”  And after talking to my husband and realizing the degree to which he HATES hospitals, I decided that if I could ever get pregnant again, I would deliver at a birth center, with midwives. 

I did get pregnant again.  (After two more miscarriages, totaling four.)  My pregnancy was completely textbook and uncomplicated, modulo a couple of borderlike GDM screens and some preterm contractions that were stopped pretty easily.  At 39w2d, my prodromal labor started amping up and regulating, and after some discussions with the midwife, we decided it was time to head to the birth center. . . 

. . . and then I got the call.  For the first time ever in my midwives’ practicing history? The birth center was full. FULL.  No room at the inn.  We could either drive to another birth center 40 minutes away, with strengthening contractions that I was feeling largely in my sacroiliac joints and a history of precipitous labor, or we could do this at home.  After some quick discussion, we decided to convert to homebirth.  My husband and my doula scrubbed out our giant tub and tidied the hell out of my master bedroom, my mother bought plastic tablecloths and triple-wrapped the mattress, the neighbors brought over a plate of sandwiches, and we sent my daughter over to her best friend’s house. 

I am so glad we didn’t go to the birth center.  My contractions were kinda strong but irregular, and the midwives advised amniotomy (I was having a LOT of ligament pain and couldn’t really walk or change position very easily, and the thought of doing that for hours was very exhausting).  They broke my water at 6 cm, which threw me basically instantly into transition; after 25 minutes I got in the tub, where I instantly began to feel pushy, but my midwives didn’t want me to deliver in the water because I’m heavy enough that in the case of a dystocia or other emergency they couldn’t lift me without risking their own health, so I tried to hide it. (HA.)  But after 20 or 30 minutes in the tub, I had a contraction that I just took a deep breath and bellowed through for 90 unbroken seconds without changing pitch or tone, or pausing, or taking a breath, and they said “Yeah that’s your last contraction in the tub.” I said “I will fucking CUT you if you make me get out of this tub” but they did anyway – my doula had to count me down like a recalcitrant toddler – and got me onto the bed to push.  That was at 3 PM.  My son was born at 3:08, after I just hollered him out of my body. 6 lbs 12 oz of amazing miracle; 78 minutes since the amniotomy. 

It was so lovely. It was so peaceful.  When we were done, we were home. . . he was born in the same bed where he was conceived.  I had very little blood loss, no tearing, and his apgars were 8 and 10.  I’m still not in love with unmedicated labor, but it was worth it to stay out of the hospital.  And my GOD I felt good afterwards. 

Without your blog, without your passionate advocacy, would I have had the courage to deliver at home? Maybe. Probably, even; I had a lot of other resources on the web.  But it was definitely an easier decision to make having read your accumulated wisdom, in large part because you tell it like it is and don’t shy away from the risks.  

My son is ten days old, sleeping on my shoulder as I type this, tummy full of milk.  He’s been out of the house a handful of times already, but every time, it was by my choice. I could have kept him here, at home, in my arms, since the instant he was born.  He is my second and last baby. . . I am so grateful to have had this gift of having him at home.  Thank you, thank you, thank you. 

--Kathryn"

Thank YOU, Kathryn! You were the salve I needed today. Bless you and your family. Enjoy your BabyMoon.