Let’s review: Where are the female obstetricians?

iStock_000015682470XSmall

Decades after I first learned about natural childbirth and homebirth I am still shocked that anyone believes in it.

Natural childbirth was invented by a racist, sexist white male (Grantly Dick-Read) who wanted to encourage women of the “better classes” to stop fearing labor and have more children. It has been perpetuated by a cadre of Western, white, male physicians (Lamaze, Bradley, Odent) who subscribe to the notion that pain is women’s heads, or failing that, should make them feel “empowered.”

The “grandmother” of midwifery is Ina May Gaskin, a hippie from a bizarre commune who has no training in anything, AND let her own baby die rather than seek medical care for him. The foot soldiers in the NCB and homebirth armies are women who have no formal education in science, medicine or obstetrics and seem to think that is no problem. They are women without college degrees who enjoy attending other women’s births as a hobby and who couldn’t be trusted with any professional responsibility, let alone one that involves life and death.

The current “thought leaders” in the NCB and homebirth world are all Western, white men like Michel Odent, the late Marsden Wagner and Michael Klein.

Did you notice that there is rather important group missing from the movement? I did, because I’m one of that group: women obstetricians.

Women obstetricians routinely favor high levels of interventions for themselves. They are open to C-section on maternal request and often have C-sections for maternal request. They love pain medication and freely use epidurals when they have children of their own.

Why aren’t they on board with NCB and homebirth, like some of their male colleagues? Let me count the ways.

1. They have personally experienced the pain of labor.

2. They have personally experienced the pain of labor.

3. They have personally experienced the pain of labor.

And having personally experienced the pain of labor, they recognize Dick-Read, Bradley, Lamaze and Odent for the sexist blowhards that they are.

There are additional reasons:

They have a wealth of knowledge about childbirth and its dangers. They have more experience and skill in handling childbirth than any CNM, CPM, doula or childbirth educator. They know that most of the NCB/homebirth trope is nothing more than made up nonsense.

They do not believe their personal value resides in their breasts and vagina. They recognize that their value lies in their intelligence, insight, professional accomplishments and actions in the world. They are empowered by knowledge, not by what passes through their vagina.

They don’t risk their children’s lives to prove a point because they have nothing to prove. Their accomplishments speak for themselves; they don’t have to create faux “accomplishments” out of bodily functions over which they have no control in any case.

I find it quite ironic that while women without formal training in science and male doctors with strong ideas about how women should react to pain prattle on and on of being “educated” about childbirth and interventions, they don’t seem to notice that women obstetricians, the people with the MOST education and personal experience of childbirth, are not on board.

Who the hell is Marsden Wagner to tell me how I ought to give birth?

Who the hell is Henci Goer to tell me that obstetricians ignore scientific evidence?

Who the hell is Michael Klein to tell me how much pain in labor I ought to endure?

Wake up NCB and homebirth advocates! Women obstetricians are not on board. We don’t need men to tell us how we should experience childbirth and we don’t need women who could barely finish high school to tell us their pretend “facts” about childbirth.

If we don’t believe their nonsense, why should anyone else?

 

This piece first appeared in June 2011.

  • auntbea

    OT: Hurry up with the commentary on the premature breech twins in Oklahoma, Dr. Amy! We can’t wait!

  • KarenJJ

    You know this is what has confused me about feminism. In the 1950s the struggle seemed to be get women into areas that required higher education and opening doors to women. Then when I started university the focus changed to how to enhance women just as women – except the mixed message seemed to be that women were becoming too masculine or needing to become too masculine.

    However these women that have gone through have been slowly changing the system. I was the first pregnant engineer to succeed in getting paid maternity leave into my company in my country for all female employees and then to return to work part time. The system is definitely not perfect yet (my “part time” role is, quite frankly, my previous full time role done in fewer days…). But for women to complain about uncaring hospitals and then decide to walk away from that and frame that as a feminist choice seems to me to be wrong.

    I’ve seen it stated on here about why we/Dr Amy are not supporting the “sisterhood” except the sisterhood is also in hospitals and the support has not been coming from this particular subset of women either. No one has been holding bake sales for obgyn’s that have been making changes, sticking their necks out to improve things and supporting women through the hospital system.

    • Sue

      That’s it, Karen! Most posters here are not exercising power by rejecting the hierarchy, but by infiltrating it, and changing it.

  • expat

    I was reading a book about the children of god cult and how they evolved from a regular old christian commune model into a group of 18000 members which condoned institutionalized sex abuse (forced prostitution, sex with children, etc). I read another book on the san fransisco zen center and they exploited their members by using them as unpaid agricultural and kitchen laborers. This brought me to the gaskin cult. They seemed to have an agricultural exploitation model. The alcolytes toil in the fields while the leaders get the cushy jobs and get to decide who marries who and who lives where. The theme that seems to unify all cults is that they exploit the devotion of the members in order to increase the wealth and power of the cult leaders. In this sense, academia can be almost cult like in that they don’t pay the underlings for their 80 hour work weeks and there is no guarantee of future employment. Medicine is the least cultlike, since you are guaranteed a good paycheck once you finish the education. Both are cultlike in that graduation depends on acceptance of a cannon of evidence based truths (not articles of faith). The difference between articles of faith and evidence based truths is that the accepted truth changes when the evidence changes where as articles of faith never change. Freedom from cultlike thinking means freedom to think freely.

    • Sue

      There is also a cultural difference between medical decision-making and what was traditionally accepted in the more feminised professions like nursing.

      Medical training equips you to make critical assessments and be held to account for your decisions and actions. One is expected to conform to accepted best practice, but judgement is still expected, and risk-assessment is real-life and bears impact.

      While the profession of nursing has largely moved on from this, the lay midwifery model seems to hang on to rebellion against the old, disempowered model for nursing, without substituting advanced skills and responsibility. It maintains victim status within a model of rebellion, which is not what feminism is about.

      • KarenJJ

        “While the profession of nursing has largely moved on from this, the lay midwifery model seems to hang on to rebellion against the old, disempowered model for nursing, without substituting advanced skills and responsibility. It maintains victim status within a model of rebellion, which is not what feminism is about.”

        THIS! My mum was a nursing and midwifery student in the 70s. Back then you were to back up the doctor. She extended her training with an Applied Science university degree designed for working nurses to update their skills to degree level in the 90s (yes it is possible to do this, lay midwives!) and she was encouraged and enthusiastic about how the “doctor is always right” mentality had changed and that nurses were encouraged to pick up on mistakes, to take responsibility for their actions (eg checking medication dosages/scripts even if it had come from the doctor) and to have evidence for the treatment they gave to patients.

  • Beth S

    I use the same male OB who delivered me, mostly because I trust him with my life. When I told him I wanted the epidural, he rushed Anesthesiology into the room to get it for me, when I told him I want a MRCS due to medical issues he shrugged his shoulders, gave me the informed consent paperwork and set up the date.
    However he also has a partner who is a woman, and practices with the same level of compassion and decency as he does. So when he retires I’ll move over to her as a patient even though I’m done having babies. She was the one who did my last pap smear and we were joking around and singing songs from The Little Mermaid.

  • Maya Manship

    Hooray for the lady OB/GYNs!! I go to a practice full of them. Plus, their entire staff is female too. Nothing against the males but some of us, like me, have quirks…or issues…that make us more comfortable with women. There’s about 5 to 7 OB/GYNs in the practice. Now these are smart ladies. I’m supposed to have appointments with as many of them as possible, hopefully all, before I have my baby. Why? Because any one of them could be present at the birth, depends on who is supposed to be at the hospital when I go in. Best practice in New York’s Capital Region in my opinion. They’re wonderful!

  • CanDoc

    YES! This. :) Exactly!

  • Beth S

    OT: RIP Robin Williams, sometimes those who make us laugh the hardest are crying the hardest on the inside.

  • mollyb

    Nothing to add except I love my female OB. She’s actually a family practice doctor, so she is also my regular doctor and my toddler daughters’ doctor. When I said I wanted an epidural, she cheered me on. When I said breast feeding wasn’t working anymore, she shrugged and said my baby was, and would be, perfectly healthy. Once, we discussed Fifty Shades of Grey during a colposcopy. Loooove you, Doctor Ward!!!

  • guest

    I think these wanna-be “midwives” and sexist male doctors know perfectly well that female OB’s are not on board with their agenda.. that’s why they are so hell-bent on trying to discredit them any chance they can get… and the hell with the consequences to the mothers and babies they harm in the process…

  • Young CC Prof

    But wait! There’s Aviva Romm! She’s an obstetrician! (Nope, she isn’t. Doesn’t deliver babies, either.)

  • ngozi

    What seems to be missing from the discussions going on in the natural childbirth crowd is that a lot of the hospital interventions and rules that they try to scare people with no longer exist (or maybe never existed) or only happen in emergency situations. Many of them talk about the music they want to have at birth, as if that can only happen delivering at home or some other out-of-hospital location. I have never had a nurse to fuss at me about music or ban it, on the contrary, they have wanted to know what I was listening to and we had a small chat about it. Of course, I didn’t go in there trying to blare “gangsta” rap. When I talk to recent mothers, OBGYNS and nurses about enemas, most of them look at me like I’m talking about picking cotton by hand. Do the NCBers even talk situations when an enema could be helpful? I would have turned my behind up as fast as possible for an old-fashioned 3 H enema after my c-section had I of known how constipated I was going to get.
    Many hospital are pretty bad, I get it, but NCBers often demonize ALL hospitals on the account of some individual bad experiences.

    • Cobalt

      My first was born at a hospital with a ton of “excess regulations”. It was really really unpleasant. So I never went back to that hospital. For anything.

      My next was born at a hospital with basic safety precautions and monitoring unless otherwise indicated, and it was great. I felt safe, because there was a real medical team watching over us, ready for action, but I could still get up to go pee when I needed to.

      Both births ended up needing the same level of medical intervention (basically nothing beyond catching and checking) and I didn’t have an epidural with either. The only real difference was the standard hospital protocols. Even then, at no point were a shave or an enema mentioned by anyone.

    • lucy logan

      gansta rap? what does that have to do with anything. random drive by racism/classism, i guess.

      • ngozi

        WHAT??? I am black!! I just mentioned gangsta rap because it is often played loudly with a heavy bass beat (which would make it sound even louder). Out of that whole post that’s the best you can do?

        • lucy logan

          dont people usually listen to music on earphones at the hospital/while having a proceedure. “its not like i was listening to gansta rap” is weird thing to say. even your post suggests headphones “they have wanted to know what i was listening to”–why would they care if its gansta rap or anything else?

          • Junebug

            ” I didn’t go in there trying to blare…”

            Blare == listen or listen with headphones

            If you’re going to be outraged over nonsense at least pay attention.

          • ngozi

            YES!!! THIS!!!^^^^^^

          • ngozi

            Sometimes I have listened with headphones, but my post doesn’t say whether I was or not. Actually, the time I was referring to I was not listening with headphones and I was listening to some old time gospel music. The nurse wanted to know what I was listening to because she wasn’t familiar with that kind of music or the artist. I certainly didn’t mean anything racist.

          • ngozi

            …and this was while I was laboring, not active labor or pushing.

          • Rabbit

            The hospital where I delivered my daughter had ipod/iphone docking stations with speakers, so everyone in the room would hear the music. If I recall correctly, the hospital where I had my younger son had cd players. I don’t think most people in L/D are thinking of using headphones when they talk about playing music in the delivery room.

          • Mishimoo

            Mine had docking stations in Birth Suite too. We didn’t end up using them because I’m not usually interested in anything other than silence when I’m in labour, but it’s nice to know that the option is there for people who do want to use it.

            I ended up listening to music for a bit with the last, because my husband accidentally put it on while playing on our laptop, and it was enjoyable. I did worry that the CNM and student would freak out over the lyrics (Ill Nino, Rev Theory, etc), but they didn’t take any notice.

          • anion

            People do not listen to earphones while they’re giving birth, and ngozi specifically said she didn’t go in there “blaring” gangsta rap. The point she was making was that she wasn’t asking for music that had a heavy floor-shaking beat or that would have, as most gangsta rap does, explicit lyrics.

            Saying “they wanted to know what [she] was listening to” implies to all sane people that the nurse entered the room, heard the music, and said, “Oh, what’s that?”

            I get that you desperately want to make ngozi seem racist here by saying she didn’t ask to blast music with potentially offensive lyrics in the delivery room, but I’m sorry, you’re really stretching and by doing so you’re insulting ngozi, upsetting the rest of us, and making yourself seem rather dense.

        • Mishimoo

          I always presumed that with a screen name of ngozi, that you were black because it reminds me of the lovely Nigerian ladies I used to go to church with as a teen. It just seems rather obvious, though I guess it could be mistaken for an asian name, maybe?

          • ngozi

            No, it is an African name. Named one of my children Ngozi. You assumed correctly.

      • ngozi

        Which I am sure the hospital I delivered my children at wouldn’t appreciate loud country, blues, yodeling, etc…

        • Cobalt

          I’m pretty sure if you’re rapping about being a gangsta, you don’t mind the results being called gangsta rap. And its supposed to be blared, just like techno or heavy metal or 80′s power ballads. A beat like that needs to be felt, not heard.

          • ngozi

            This is what I was thinking…

        • Sue

          YODELING! LOL – I’m imagining some magical NCB technique where one yodels through the pain.

          (Don’t worry, Ngozi – whoever ”lucy logan” is has got her wires crossed).

  • moto_librarian

    One of the things that I liked best about my primary midwife for both kids? She had an epidural with both of her children.

  • Dr Kitty

    With my history of endometriosis I am a LOT quicker to jump to gynae referrals, scans and drugs if someone complains to me about period pain.

    If your pain is bad enough that you have come to see a DR about it, it is outside normal human female experience and warrants something better than “it’s just part of being a woman” as a response.

    Which is the difference between empathy and hypotheticals and BTDT.

    • Sarah

      This really struck home to me- one of my brothers friends went to get checked out for severe period pain last year- was found to have metastatic bowel cancer at 25 years old. I couldn’t believe it even though I’ve worked with young cancer patients, but it made me realise I shouldn’t be so blasé about period pain as it can be an indicator of other issues.

  • no longer drinking the koolaid

    And as if to prove your point about non medical professionals talking about what women should be allowed to do, The Big Push for Midwives linked to the Stir’s story about Goodall’s forced C/S. Not sure who the other posters are, but certainly not medical professionals. https://www.facebook.com/PushForMidwives

  • Deborah

    My babies are adopted, but I’ve seen plenty of labor, and I could still figure out it looks rather painful. Maybe I sympathize better cause I have lady parts???? Anyway, no natural childbirth except for the extremely motivated, please.

    • The Bofa, Being of the Sofa

      My babies are adopted, but I’ve seen plenty of labor, and I could still
      figure out it looks rather painful. Maybe I sympathize better cause I
      have lady parts????

      I don’t have the lady parts, and I still sympathize. Completely. So it doesn’t take that either.

    • Suzanne

      When I was pregnant with my second, my 4 year old daughter wanted to know how the baby was going to get out. So I told her. “Doesn’t that hurt?” she asked. Not wanting to frighten her, I flat out lied. “It’s not so bad.” In her little 4 year old way, she put her hands on her hips and said, “Mom, I’ve seen how big the hole is and how big a baby is. That has got to hurt.”

      And yes, yes it does.

      • Mel

        The hoof-trimmer couple who works with our cows has a sweet story about taking their oldest daughter with them to a farm while her mom was pregnant with her sister. While they were working, one of the cows went into second-stage labor in a nearby pen. The school-aged daughter watched the whole process fascinated. She then looked at her Mom and said “Are you worried about having the baby?” Her mom replied “No. Having a baby is a part of life.” The daughter whips her hands up over her head with her shoulders tucked against her ears in a surprisingly good impression of the position the calf was born in and says “I don’t think the baby will FIT like this!”.

        Which was a good point – that’s not a good position for a human baby….so the parents explained about the fetal position.

        On a semi-related note, my oldest brother-in-law was 5-ish when his second brother was born. My mother-in-law noticed he was quieter than normal as she approached her due date. One day at dinner, he blurted out “When you go to the hospital, will Dad be sure to bring bailer twine in case the baby is in a bad position?” She gently explained that the hospital has their own supplies that can be used to help if the baby was in the wrong position – and bailer twine was not needed.

        Apparently that’s not an unusual question for dairy farmer’s kids to ask – although most kids today want to know about the chains and/or calf puller since bailer twine has been replaced with easier to sterilize materials…..