Wednesday, February 23, 2011

For anyone considering the path to becoming an Obstetrician... from the women they will one day serve.

I am not a stranger to the unique position that we, as caregivers, inhabit every time we go to work. I spent the first several years of my nursing career working in an ICU where people were undergoing huge, life-changing events. People were realizing they were sick, or realizing exactly why they've been sick for a long time. New diagnoses. Body and soul-assaulting interventions. People making difficult choices, walking down difficult paths they never dared imagine they would have to endure. Family members watching loved-ones die. And all of this happening while I packed my lunch, chose my scrubs for the shift and clocked in. I was there making my living. They were there fighting for their lives.
It is a dance that requires a great deal of self-awareness. Like driving a car down a familiar road, getting lost in the mundane, and they almost hitting a deer. Or losing control of your car on the ice. You drive differently, more presently, at least for a little while until the mundane once again lulls your brain back into the business-as-usual mentality until you are shocked back into the realization of the extreme weight and import of the moment.
I get that being an obstetrician can be the very same way. You are a human being. We all have lives and families and inhabit a world that is broader and deeper than the walls of the hospital can contain. Good days. Bad days. Loss and renewal. These are universal. These are a part of the human condition.

I understand that you went into medicine for your own list of reasons. And that those reasons are valid and that they belong to you.
I understand that dealing with people is difficult and that you are not consciously coming from a place that devalues human beings and their rights.

Consider for a moment that the life path that you have chosen is inherently different than many career paths in that it involves the sacred. The eternal. The universal.

Please, for your sake and for ours. Consider with a great deal of thought and self-reflection that a day in the birthing room should never be just another day at the office.

If you can not model your practice around the truth that pregnant women have the same basic rights as any other patient seeking medical care, you should reconsider your career choice.

If you are unable to let go of the idea that women hire you because they want you to CONTROL their birthing experience, please do not become an obstetrician.

If your first reaction to a woman presenting you with her expectations regarding your role in her birth is to feel defensive, please consider why you want to work with laboring women.

If you do not believe that the time you spend providing prenatal care is as important, if not more important, than the time you spend urging a woman to push, please reconsider your choice to work with expectant women.

If you can not be a confident and professional enough provider to meet those whose personal search for information leads them to make conclusions about their birthing choices that you would not personally make with respect and openness, please consider another specialty.

If you are not able to control your urge to mock a woman's birth plan, regardless of how much it challenges your idea of what constitutes a "normal" birth, please, consider becoming a different kind of physician.

If you are not committed to spending as much time familiarizing yourself with the current research regarding NORMAL birth as you are to learning about anomolies, high-risk situations and how to avoid lawsuits, please do NOT offer your services to laboring women.

If you can not educate yourself enough about normal birth to dispell your beliefs that birth is a dangerous and abnormal condition that needs to be controlled, you will most likely find a different specialty less stressful and infinitely more rewarding.

If you are not able to honestly answer a woman's questions regarding your willingness and ability to support her in making informed choices, you are not doing women a service.

If you think it is appropriate to treat women's most intimate and sensitive body parts as just another group of "things" and are unable to align yourself with the notion that women's rights to self-determination and informed consent include both the uterus and the cervix, please consider another specialty.

If you like the feeling of getting your way and showing who's boss more than you like the feeling of empowering women and supporting them in what is for many people a very emotional and spiritual experience, please become a different kind of doctor.

If you think that birth is only about getting a live baby from inside the womb to the outside and believe it is acceptable to set the bar that low in your practice, please reconsider your choice to become an obstetrician.

If you are not able to get your head around the idea that the power dynamic in medicine is shifting and that it is encumbent upon you to facilitate choices rather than dictate, please don't go into the business of caring for laboring women.

If you think that women care more about the decor of the birth room than they do about their rights as healthcare consumers, please reconsider your decision to become an obstetrician.

If women making noises -- often quite primal and sometimes even sexual noises-- during labor makes you feel uncomfortable, you should not be with laboring women.

If you don't like going to the hospital during "off hours" or making more than one trip there a day when you've been seeing patients all day in the office, perhaps you should consider a different specialty.

If you get a sense of satisfaction when a woman who came in requesting a drug-free birth changes her mind and requests an epidural, please do not work with laboring women.

If you think it is even remotely possible for you to understand a woman's body better than she does, please think again and do not go into obstetrics.

Most of what you have learned as a new doctor has been passed on to you through the culture of practice embodied by those who went before you. Future generations of medical students and residents are going to be looking to you as they develop their practice.

It is far too easy to pass on negative, misogynistic and outdated attitudes and practices to these new providers than it is to stand with women for the change that is so desperately needed in the medical community.

This is a change that women, your patients, are demanding.

I respect the degree of hard work and dedication that it takes to become a physician. But after taking a long and honest look at the beliefs that will shape your practice and around which you will model the way you care for women, I ask you very seriously: If you are not ready to deliver care from the heart, to acknowledge the sacred and spiritual aspects of birth as a rite of passage for women, to have a spirit of humility and willingness to continue to learn about women and birth, to be compassionate and to place your prejudices and fears aside in order to improve maternal healthcare in America, then please, please consider the valuable contribution you may be able to make in a different specialty.


  1. Exactly. I don't envy today's OB's and the conflicts they must face. I dream of the day when they will only be responsible for very high risk pregnancies---just think of all the time they will get to spend JUST helping the women who really, really need them.

  2. Oh Justine, that would indeed be a much more logical way of doing things and I think that women would be much better served were it the case.
    We can dream... and work toward making the dream real.

  3. I think you're going to be a great midwife someday.

  4. ...and also addressing Justine's comment about physicians, specifically OBs, facing conflicts. SO MANY TIMES on blogs and discussion boards, OBs are characterized as people acting out as individuals with dubious motivation or greed coupled with disregard for women's rights to consent, self-determination, etc. -- when the system is actually so intricately interwoven with the idea of pregnancy-as-pathology that the very fact that one studies medicine to become a doctor most often = "Ive been taught to approach pregnancy as a disease process. No matter what I say about believing that birht is natural and normal, I am ALWAYS looking out to make sure I don't miss pathology." This is yet another reason a much more effective system would look more like this: Women experiencing normal pregnancy with no underlying health issues that may complicate labor are served by midwives under the midwifery model and those with complicated pregnancies or risk factors that might contribute to a complicated labor are served by a physician under the obstetrical/disease process model.

  5. Heather, I just passed along a blogging award to you. Check out my post from today and pick it up. :)