Problems With Obstetrics- The Top Ten


Pregnancy and birth: something most women will only experience a few times in their lives.  And yet, most describe the entire experience as something quite awful.  In true David Letterman style, I would like to break down the top ten things wrong with the current state of obstetrics.  

10)  Rotating Call-

This is one of those things that makes me quite sure that most Ob's never actually talk to their patients.  If they did they would know that most pregnant women who are delivering with an OB in a hospital are scared to death that they will be having their baby with a complete stranger and not their OB that they have been seeing for their visits.  

Hint- if you want less women to birth at home, show up when your patients birth.  This is one reason women give for birthing at home.  Many of us simply don't want to share this most spectacular of life's moments with a complete stranger who smells like mothballs.  

Yes, I realize that this lifestyle is difficult- if you want a regular schedule then maybe obstetrics is not the right field for ya.  And yes I realize that many docs remedy this by scheduling everybody for a c-section or an induction.  NOT what I had in mind.  

9)  The 5 Minute Visit-

Fully realizing that most obstetricians pay an unholy amount of money each year for malpractice insurance and so must see lots of patients just to break even, I still think this sucks.  

When I talk to pregnant women, they often don't even know WHAT their doctor thinks of their birth ideas.  Why?  Because they never get a chance to talk to the man.  

Into office- Pee in cup- Get weighed- Blood pressure-  Testing- Out.  

That might cover some of your bases, but it certainly isn't CARE.  It is a quick visit.  It is a joke.  It does send a message though- "We don't care what you think and we don't have time for your opinion."  

Message received.  

8)  The 40 Week Pregnancy-

For goodness sakes and for the love of all that is holy!!!  I am not a turkey!  This baby doesn't just pop out when the thermometer turns red.  

I am a woman, unique in size, shape, and genetics.  I am carrying a baby, which is also unique in size shape and genetics.  40 weeks is an average, not an explosion date.  Mama is not a grenade with the pin pulled.  "Everybody duck!!! She's gonna blow!"

7)  The Fetal Monitor Printout-

"Oh, excuse me.  I didn't realize there was an actual woman laboring in this room.  Pardon me while I look at your fetal monitor printout."  

For Pete's sake folks, there is an actual HUMAN BEING behind that printout.  Two to be exact.  They are busy trying to get born and they are not a machine.  Take a look at them.  Talk to them.  Touch them.  Smile.  It won't break your face. (Being human might even help with number 5.)

6)  Assembly Lines-

Truly, obstetrics must be irritating.  People have their babies any which way and time.  They come in at all hours.  They take forever.  

How exactly am I supposed to make money off of that?  How can it become predictable?  How do you schedule your staff?

Well, you take birth- something that is organic, uncontrollable, unscheduled and surprising and you make it mechanical, controlled, and scheduled.  Then you can reliably schedule your staff, your rooms, and even your electricity bill.

Understanding the desire, even the need, to run birth like an assembly line that is operating at maximum efficiency, doesn't make the end result- a scheduled birth- any more pleasant.  

Let's get back to remembering that women and babies are not cars.  You are not building machinery and you can't run a birth with an efficiency expert.  The baby runs it.  

5)  Liability-

Let's go there.  People often blame the current c-section rate, not on the people holding the knives, but on the women who are getting cut.  

How is it their fault, you ask?  

Well, it is their fault because the doctor is scared crapless that said laboring woman is going to sue him from here to kingdom come because something went wrong.  So the c-section is her fault ANYWAY.  Stupid woman, what was she thinking getting pregnant?

I actually have more to say about this, so keep reading.

4)  Paternalism-

Ahh, yes.  One of my favorite words when it comes to obstetrics- paternalism.  This dude isn't just your Ob- he's your daddy!  He will take care of you.  You don't need to worry about a thing. 
"Honey, I went to med school for about 100 years- I am the expert and I will take care of everything."  
(You have to imagine this with a husky voice and reassuring pat on the back.) 

But wait!  If something actually DOES go wrong then it was all the woman's fault- she could have sued!  He had to do the c-section.  

I am gonna call foul on that one boys.

When you take a paternalistic model of care in which the woman is encouraged, expected, and told to hand over her autonomy, you are ASKING to get sued when things go wrong.  Why?  Because you have not allowed her any power, and so she will want to blame YOU when something hits the fan.  

If you don't want women to sue you, blame you, hate you, resent you, etc- then respect them enough to remember that THEY are in charge, responsible, intelligent, and capable of making decisions.  

Angry children file lawsuits.  Empowered adults take responsibility.

(I realize that there are plenty of scumbags just out to make a buck off of some rich doctor.  But the way that medicine is run, and has been run for many years is based on the doctor as a high and mighty expert bordering on deity.  When you put yourself on a pedestal, people expect perfection.  But doctors are human and they mess up.  The pedestal has got to go, and so does the way we treat patients.)

3)  Testing....Testing.....Testing

Did you think you were pregnant?  Did you want to enjoy one of life's most miraculous experiences?  Amazed by that little life growing somehow inside of you?  

BE AFRAID BE VERY AFRAID.

Things could go wrong at any moment.  For this reason, every woman, everywhere must be tested from here to infinity and beyond.  Why?  She is very possibly dysfunctional.  She is probably a liar.  Plus, her insurance pays for the test.  

Prenatal tests certainly do have a place and most definitely do serve a purpose.  They are however a sad replacement for actual prenatal care and rather than teach and encourage health, they just instill fear and encourage interventions.  

I wonder how much money we could save if women had the time to talk to their care provider about their lifestyle, their diet, and their pregnancy?  I wonder if we would find less need for tests done by strangers if we actually knew our patients?  I wonder if women would have more enjoyable pregnancies, less fear, less interventions and healthier babies?  

We may never know.  Maybe we should do a study on it and then test doctors about what happened.  Yeah, that would work.

2) Nutritional Know-nothing

I had a medical doctor tell me once that the only thing that could be prevented in pregnancy with a healthful diet was spina bifida which can be caused by a folic acid deficiency.  

He was dead serious.  Scary part is, he isn't the only one.  

Go ahead and leave me a comment about how I am not a doctor and don't know anything and how nutrition has nothing to do with a healthy pregnancy and baby.  I still won't believe you.

I think it is quite tragic that women are not encouraged and instructed on how to eat well while pregnant.  The sad truth is that most Americans have no idea what healthy food is (no a LEAN Hot Pocket is not health food.  It is a lean chemical.  Icky.)  Pregnant women are often no different.

I admit, I can't prove that how you eat will influence the health of your pregnancy or your baby.  But frankly, it just makes sense.  If eating garbage food leads to diabetes and cardiovascular disease how does it make no difference to your pregnancy if you eat that way?

Over and over again I see women have phenomenal changes in their health and how they feel when they eat well while pregnant.  Check out the Brewer diet- it isn't what you think it is.  It is just a healthy diet with lots of fruit and veggies, whole grains, healthy protein and no junk.  

Drum roll please.
1)  Obstetricians-

(I know, I couldn't help myself.)

Could it be that the number one thing wrong with obstetrics is the Ob?  
Oh, I realize that good obstetricians are wonderful, important, lifesaving and a gift of modernity.  But, they probably are not needed for every single birth.  Wouldn't it be lovely to have somebody well versed in normal and healthy birth present for your babies arrival?  Or would you rather have a pathologist who is well trained in abdominal surgery?  Is there a possibility that your surgeon will see pathology when it isn't there, or predict it when it hasn't happened yet?  

It isn't just a possibility, it is a reality.  A well trained midwife for healthy women who has access to and can get advice from a working relationship with an OB just might be the magic bullet in starting to fix a broken maternity system. 

Midwives and doctors working together......
Well, a girl can dream, can't she?

Comments

Misty Pratt said…
Just heard of researchers out in Vancouver who are studying how a woman's different fat intakes can impact how a baby's gut and "flora" develop. Their argument is that once it develops, there's NO CHANGING IT. Which means, what we eat in pregnancy affects our child for the rest of their lives, and will dictate rates of obesity, diabetes and cardiovascular disease. Amazing!!! We need to begin treating our bodies as temples...I was guilty of not doing this with my first, but I'm hoping to improve on the second :)
You know that one book... that book that every mainstream pregnant woman reads? Something about what they should expect? I hate that book. The natural birth community as a whole hates it and can't understand why every expectant mom reads it. I have finally figured out why (about a week ago) every mama succumbs to the awfulness that is that book, and it relates very closely with this blog post.

OBs spend very little time with mommies, don't really talk to them about anything of significance, they teach them nothing unless they have time and the mom asks the perfect question at the right time. These moms are clueless, and the only way for them to understand what is happening to them is by reading a book. But what book should they read? The one with the amazing name and the pretty image on the cover, of course!

That book has two thing going for it: the name and the way its organized. And that's it. Everything else is garbage. There are a few good facts thrown in here and there but really, its worthy of a book burning.

It is my hope that someone writes a book that knocks that one out of the running for favorite pregnancy book, so that more moms have the opportunity to learn what their care provider should be teaching them.
Teresa said…
This comment has been removed by the author.
Teresa said…
In regards to numbers 5 and 4, a poem I wrote-

"Liability"
by Teresa Henderson

Just call me a liability,
That's what they see me as anyway.
One glance at my chart and they recall,
I'm the one who refuses all their protocol.
A court case, a settlement, is what they see,
I'm just a liability.

Just call me a liability,
Refusing things so sternly.
No glucose test, no dopplers,
No peek to see if there's one, two, or three.
How can they make a guarantee,
I'm just a liability.

Just call me a liability,
They can't provide prenatal care to me.
Refusing this and this and that,
Right down to that pap.
Why would I refuse they ask?
A liability is that.

Just call me a liability,
The OBs, Nurses, and Medwives agree.
Refuse their life saving devices,
And baby will arrive with many vices.
Their Insurance warns them of me,
That big, old, scary liability.

I'm not a liability,
Informed consent is my priority.
Refusing things I don't view as necessary,
To avoid their interventionary.
A normal birth is what I desire,
Risk or liability I am neither.

What then is a liability,
For those OBs, Nurses, and Medwives three?
They say, if you want a baby of perfection,
Do as they say without inquisition.
When things go wrong who do parents say hold accountability?
Implying perfection is the true liability.
Jenene said…
Most of my friends and coworkers thought I was crazy for wanting a natural birth, and outside of a hospital no less. I just want to know: who WANTS to be in a hospital if they don't NEED to be in a hospital?!

I don't want to be treated like I'm sick, like I'm a giant problem waiting to happen. When OB's (and thus their patients) start out with the assumption that something will go wrong, well, it's a self-fulfilling prophesy!
Jessi said…
Love it.

Also to add to what "Your Loving Birth" said, the other reasons that that trash book is so popular is that 1) they've got the whole top shelf of the pregnancy books at B&N to themselves and 2) it's been canonized in pop culture by movies like "9 Months" (which I loved at the time but now look at the birth scene and want to vomit).

Anyway, I absolutely LOVE this post, and wholeheartedly agree, thanks.
Ashley said…
Seriously on the care. As a pregnant woman and something of a birth junkie I realize that things can, and do, go wrong regardless of what you do. I hire an experienced midwife because I want someone with more training than me who can recognize when a problem occurs and can encourage me to transfer care, but I ultimately take responsibility for my own birth. Last time I knew when things were bad (if not dangerous) and transferred. If something bad happened at home I probably wouldn't take legal action against my midwife unless it was pretty obviously gross negligence on her part, largely because we have a relationship and I trust her as much as I can trust any human.

But when the hospital was mean to me, when they called DCFS on me for not doing the eye goop, you better believe I expected a perfect outcome. And when a few weeks down the road there was evidence of liver problems, my first thought was "if I contracted hepatitis during that c-section I'm suing them." Thankfully my liver was fine and it was a non-issue, but the golden rule REALLY does matter in pregnancy care.
Jen said…
I agree with your points and think something is missing. I think this is missing in most of our society and parenting. That is thinking for yourself and with good gain comes pain.
I just delivered baby #3 in 4 years and while I saw an ob and delivered all three in a hospital, I had no problem telling my doctor what I wanted and would do and not do. Actually during labor with #3 I said "see Dr Peck, told you I wasn't going to be induced!!" (Baby was 9 days past due date)
But beyond that I had a friend who induced early because it was convenient and she didn't want to be surprised and another who just commented again how horrible her birth was because her epidural didn't fully take. I feel like birth is mentioned to hurt and parenting will always be unpredictable and inconvenient.
HipMama said…
This is one of the reasons why I am going to med school to become an OBGYN. We need more OBs, and doctors who stand up for a woman's right to birth however she sees fit, and to do what a true OB is meant to do; promote natural birth, support mothers and families, and be there to assist if a true emergency arises. I can't wait to work closely with midwives, doulas, and other birth professionals, and give OBs a better name :).
CKThom said…
Too funny. My OB actually has a set of midwives on staff and unless something goes wrong, I will see one of the midwives for my delivery. I wish more OB offices worked this way.
CKThom said…
Actually, following from someone else's comment, I do think one thing should be added-- the fact that everyone always wants a quick fix and doesn't want to have to do any work (even if that means avoiding all the negative things that go along with c-sections and induced labor). I also think the ignorance of the patients is part of the problem. Most don't try to educate themselves about their options and that is why the paternalism thing works so well.
I do agree that much of obstetrics IS paternalistic - but female OB's are just as guilty as that, too. I think it's because they have a uterus they think they can make decisions for your uterus, too, or at the very least they think they know how you feel.
Shanna said…
I love the comment on nutrition. So many women eat whatever they want and then act all innocent when they develop Gestational Diabetes, have pre-eclampsia, etc. As though they couldn't do anything about it. Good nutrition just seems like common sense when you're growing a human!!
M Mommy to 4 said…
I absolutely LOVE my Women's center that I go to. I choose to have medicated births. I've had a back injury and therefore have a LOT of back labor and, despite my high pain tolerance, the back pain is really more than I can bear for any great length of time. My women's center is a great example of doctors and midwives working together. Yes, we rotate through midwives, but we do it throughout the entire pregnancy so that we don't have to worry about the midwife on call being a complete stranger when the actual day comes. And, having recently had a miscarriage and having to see an ob because of a placenta that did NOT want to budge for a while, I can say that he actually answered the questions I wanted to ask without me actually having to ask them and he was one of the most sensitive people I talked to about everything. No, I wouldn't want to see him for all of my pregnancies, but mostly because I really like having a female doctor and I've fallen in love with having midwives who won't leave me with the nurses to have my baby. I like that I have the option of going "natural" if I choose to and my midwives being completely supportive. I even had a midwife laugh a little when I was waiting for an epidural because she thought I was handling the pain so well that I didn't need one. I like that they're that supportive of me. But it seems to be a wonderful combination of midwives and doctors working together!
Anonymous said…
Where do I even begin? I'm so grateful I had friends who recently delivered or were pregnant along with me who were aiming and preparing for natural births. They encouraged and supported me from the beginning. More than I can say for any medical staff. Throughout my entire pregnancy *I* educated myself. *I* researched what I should be eating. *I* trained for pain management.

I loved the OB office I went to for yearly visits and just continued when I got pregnant. I loved the nurse practitioners I saw... but the Doc?... only met her in the middle of my final trimester... because I asked to! At my Tuesday appointment, on my due date, I was casually informed that my induction was scheduled for Friday. Excuse me?! "Well, Doc is gonna be outta town this weekend and Placenta isn't meant to go past 41 weeks". (Yes, Placenta with a capital P as if it were a person capable of making its own decisions. I'd heard this sentence from everyone there as if they all had to memorize it... but not until I hit 40 weeks). Um, thanks for the heads up.

I did end up being induced (a week later at 41 weeks exactly) but still refused the epi even with pit surging through my veins. Not an experience I'd ever like to repeat but so so glad I knew what I wanted, was informed and had a husband and mother there as advocates. And let me say, as hard work (duh, it's called labor) as it was, I think I did pretty dang good considering the circumstances. At one point a nurse came in and thought she had the wrong room because it was so peaceful and calm.

I was ready to push for an hour before Doc made it in there (she was doing a c-section... surprise) and first thing out of her mouth as she got into position all up in my *hmmhmm* "shoulda gotten that epidural! This wouldn't hurt so bad if you did". At that point I had been in labor for about 13 hours, the last 4 or 5 being pretty intense. I was tired (and not thinking) but my feet were up... right by her face... shoulda kicked her when I had the chance! Ok I don't think I'd ever have the guts to really kick someone in the face, but I did have the guts to stand up for myself and push for what I wanted overall.

I don't love hospitals but I respect medical advances enough to deliver there should they be necessary. That's why I don't think I'll ever deliver at home. But, if there's any encouragement or soapbox preaching my friends, coworkers, anyone who has ears have heard from me since my experience, it's to educate yourself!! Take initiate to prepare and train for it!! Don't just take their word for it (or lack of). I have a lot of respect for doctors but their advice is just that... I have even more respect for my body and what it was made to do...

I've since changed OBs and think this go around will be a much different story. :)

(sorry so long. I guess I had a lot to get off my chest.)
Wendyrful said…
I am a doula, and there is an OB in my area that is so paternalistic it just drives me crazy! He has said to a mom who was wanting a 2nd opinion about her care, "It sounds like you don't trust me! I went to Medical school..." He also pat's the mom not just on the back, he pats the momma's on the HEAD, absolutely making it seem like they are just little children, that he will just take care of you and tell you what to do!
Steph T said…
Thank you for this post it helped lighten my stress. I am a first time prego, and unfortunately living in one of the worst states for such the occasion...Kentucky!! I am now 7 months pregnant, it took me that long to find a doula (no midwife will come within 100ft of a hospital, apparently it is illegal for them to assist births here unless they are employed by the hospital as nurses and just happen to be certified nurse midwives.) Anyway I have fought/negotiated these past pregnant months for the right to give a hospital water birth. If all goes well I will, at least the policy is in effect now (your welcome western ky) this was a very agonizing negotiation having obstacles thrown my way from every angle; friends, family, doctors, and yes, midwives. The policy is still VERY strict but with the first bricks laid hopefully other woman in the area will have more options, and more ground to stand on if they prefer a hospital birth. I have practiced and meditated on a low-risk pregnancy and so far have succeeded....am now preparing myself for the antibiotic debate (agian) with my ob concerning GBS I will as of now consider myself colonized and like I said preparing to argue the unnecessary use of the antibiotics.Thanks again for posting this made my day. :)
Steph T said…
lol I havent even been tested yet, and I need to have the what if mentality to motivate the research. Like said already on this blog it doesnt hurt to be informed, and prepared, it is almost a necessity.
I loved this article... until number 2. It's not that I don't agree, diet is a HUGE thing. But the only thing 'proven' preventable by diet is spina bifida (and not all kinds of spina bifida are preventable by folic acid, at that.

However, I took the prenatal vitamins and ate healthy and my son was born with Down Syndrome (I was 22 at the time) and a severe Congenital Heart Defect that took his life just before his first birthday.

So praising the diet as if it prevents all illnesses and issues is really hurtful to people who are in similar shoes.

But other than that, the article was awesome and I loved it.