What does it mean to treat a patient respectfully?


Can you imagine someone declaring: “A successful kidney transplant isn’t enough. I am devastated that my doctor did not agree with my assessment that I could have had my kidney inserted laparoscopically and thereby avoided that big scar in my side.”

Cna you imagine someone declaring: “A cure of my colon cancer isn’t enough. My doctor should have listened to me when I suggested that herbs would work just as well as chemotherapy.”

Or how about someone insisting: “Successful anesthesia for my appendectomy isn’t enough. I wanted enflurane, dammit, but my anesthesiologist gave me something else.”

I can’t imagine it, and I bet most of you can’t either. So why do some women say, as Christen of ImprovingBirth.org does:

We hear all the time, “a healthy baby is all that matters.” That’s simply not true—especially when, all too often, “healthy” simply means “surviving birth,” for both moms and babies. That’s not nearly good enough.

Why would someone make such a statement and why are they very wrong to do so?

Self-described birth activists make claims like this for one major reason, they are ignorant of the single most important thing anyone providing care to pregnant women needs to know: Childbirth is inherently dangerous. It only looks safe because liberal use of the interventions of modern obstetrics has made it safe.

Why don’t they know this? They have been indoctrinated by a group of people whose interests are met only by denying the inherent dangers of childbirth. It started with Grantly Dick-Read who wanted white women of the “better” classes to have as many children as possible; acknowledging that birth kills mothers and babies wouldn’t help achieve that aim. It has been perpetuated by a group of women who make their money (and build their fragile self-esteem) by pretending that their dreadfully inadequate training as midwives, doulas and childbirth educators is “enough” since nothing is going to go wrong.

Indeed, as I wrote about yesterday, major childbirth organizations like Lamaze don’t even bother to mention the most dangerous pregnancy complications or to educate women how to recognize them. The same people who piously bleat about maternal mortality don’t do a single thing to prevent the disaster that they claim to care so much about.

Obviously, if you are ignorant about the fact that childbirth is inherently dangerous and that it only seems safe because of modern obstetrics, you are going to have a low threshold for complaining about anything that ruins your perfect birth fantasy, but there’s more to it than that.

Natural childbirth advocates demand respectful care, but don’t seem to understand what respectful care entails. Christen says:

The truth is that in this day and age and place, a higher standard can and should exist: a healthy baby, a healthy mom, and a positive, respectful, family-centered birth experience for everyone.

Most hospitals have nicely decorated labor and delivery suites, perks for new parents and are extremely solicitous of siblings and other family members. So when NCB advocates complain about lack of respectful, family centered care, they are referring to something entirely different than respectful family centered care.

They are referring to unmedicated vaginal delivery with no interventions at all. Respectful care is perfectly consistent with using every possible obstetric intervention. Family centered care is completely consistent with epidurals and C-sections. Since respectful, family centered care has absolutely nothing to do with unmedicated vaginal delivery, how did NCB advocates come to conflate the two?

They do so because they have a very idiosyncratic view of respect. For them, respect means boosting their self-esteem by pretending they are educated about childbirth when in reality they are ignorant. It means collaborating in the delusion that “trusting” birth has anything at all to do with safe birth outcomes when, of course, it is meaningless. It means acknowledging dangerous choices as wise and lies as truth.

Ironically, they have no respect at all for obstetricians. They denigrate their knowledge; they equate caution with fear-mongering; and they are absolutely sure that C-sections are done for no better reason than doctors wanting to get to their golf games.

Can you imagine a kidney transplant patient insisting that he or she knows more than the transplant surgeon? Can you imagine a cancer patient insisting that her oncologist is recommending chemotherapy because he likes to play the “dead person card”? Can you imagine a surgical patient insisting that anesthesiologists choose one anesthetic over another so they can get to their golf games more quickly?

Most people would consider such behavior presumptuous, misguided and needlessly provocative, but when face with an obstetrician, NCB advocates label such obnoxious behavior as laudatory.

Contrary to the beliefs of NCB advocates, there is nothing respectful about a doctor pretending you are right when you are wrong. There is nothing respectful about pretending that vaginal birth is an achievement when most of the women who have ever existed have done it (or died trying). There is nothing respectful about pretending that there are medical benefits to avoiding pain relief in labor when there aren’t any.

NCB advocates aren’t looking for respect. They are looking for validation. That’s fine, but they should stop pretending that validating ridiculous beliefs is respectful. And it might be helpful if they showed even a modicum of respect to their obstetricians in turn.