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?