Do midwives put their needs ahead of their patients?

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Yesterday I asked whether promoting unmedicated vaginal birth is unethical. Today I’d like to ask a corollary: do midwives put their own needs ahead of the needs of their patients. I’m not the first to wonder whether this has compromised the care that midwives provide to women.

Canadian midwife Mary Sharpe and colleagues have written about the situation in Ontario in Essentialism as a Contributing Factor in Ideological Resonance and Dissonance Between Women and Their Midwives in Ontario, Canada. Sharpe starts with a definition of essentialism:

Essentialism is understood as the tendency to view entities according to a set of distinct and limiting characteristics, or essences. Furthermore, an essentialist approach regards these characteristics or essences as inherently true or correct…

Sharpe details how essentialism is expressed in the foundational documents of Ontario midwives:

While the values embedded within the document, when viewed pragmatically, simply set ideals for practice, they also tend to support the culture of essentialism within the midwifery community by making certain assumptions about the meaning of midwifery care, the women who seek midwifery care and the nature of the woman-midwife relationship…

But those beliefs and assumptions are not shared by a large proportion of women. Instead of acknowledging that essentialist beliefs are not held by all women, the Ontario midwives react with disdain and an unwillingess to care for women who have different beliefs.

While some midwives interviewed stated that they were delighted to be able to provide care for the more diverse group of women seeking midwifery care … they nevertheless noted that they remained wary of those who do not overtly behave in ways that correspond to Ontario midwifery’s stated values and philosophies… Some Ontario midwives indicated that they felt there are “ideal” or “peak” midwifery clients and that certain women are therefore particularly “deserving” of midwifery…

As midwife Vicki Van Wagner explains:

There is a real tension in the midwifery community between narrow essentialist views of women, midwives and birth, connected with the lure of the “natural” and other concepts such as choice and diversity… In a countercultural movement such as midwifery, the need for strength to combat outer forces can create narrow views, dogmatism and a fear of diversity…

Sociologist Helen Lenskyj notes:

It does not serve women’s interests well for midwifery supporters to essentialize women as either mothers or midwives… Where does this leave the non-conforming mother who does not view the midwife as her best friend … One [also] needs to consider the messages that [such] rhetoric convey[s] to a woman who has no … regrets about her conventional medicalized birth experience. Is she less female/ feminine/ feminist because she does not … reflect on [her] birth experiences with feelings of anger, regret, mourning and loss?

Ultimately:

Ontario’s model of midwifery care reflects the essentialist tendencies of the feminist movements of the 1970s and 1980s that led to the legislation of midwifery in Ontario… The essentialist tendencies revealed by midwives and women in Sharpe’s study tend to pose dilemmas for midwives in the manner in which care is provided, the manner in which women are selected for care and the ways in which the philosophy of midwifery care is upheld.

Helen Lenskyj offers midwives advice that they should take to heart:

It is not productive for midwifery’s advocates to cling to exclusory or essentialist notions of woman and midwife. Rather, it is important to respect the feminist principle of choice … and to allow for diversity and difference among women, both midwives and clients.

What I find most intriguing about the views expressed in this paper is that they highlight the fact that midwifery has become obsessed with the feelings of midwives to the detriment of patients. It suits certain midwives and virtually all midwifery theorists to claim that “the natural” represents the pure essence of what women should want and how women should behave.

The profession of midwifery has been led astray from the values that have preserved midwifery across time, place and cultures. Those values were to minimize the risk of death to baby and mother by observing the ways that treatments and preventive measures could improve outcome. In contrast, contemporary midwifery often seems devoted to a stylized piece of performance art where the process is viewed as more important than the outcome. It is ironic that a profession that proposed in the mid-twentieth century to offer women more choices has devolved into a profession that insists that only one choice is acceptable.

A version of this piece first appeared in December 2010.

  • no longer drinking the koolaid

    I was looking for a midwife book on amazon and am used to all the midwife promotional material. Little things like parking signs “Midwife at work. All others will be crushed.” and was struck by how much midwives need to promote themselves to attain credibility.
    Decided to search the term “doctor” and the first few pages are all games, toys, and books about being a doctor.
    Made me think that lay midwives really do know they provide substandard care and have low self esteem related to what they do. Why else would there be a market for all this promotional material?
    And, Dr. Amy and several other posters are correct. The focus is on them, not on patient care.

    • Ardea

      The violence in the language of, “…all others will be crushed.” That’s too much ego.

  • Sue

    The medical profession is often accused of setting up services to suit their preferred models of care, rather than being patient-centered.

    It seems to me that ideological midwifery is doing exactly this – emulating the “Medical Patriarchy” for which they otherwise show disdain.

  • TheCrankyTorontonian

    As a resident of Ontario, I find this appalling but not surprising.

    The arrogance and narcissism inherent in those who practice this profession infuriates me.

    Ontario midwives need to learn their place: They are publicly funded thus they are servants of the taxpayer.

    Any midwife who cannot provide equitable care to a diverse range of clients needs to be stripped of their license to practice.

    I had a great OB at Mount Sinai, and I received excellent personalized care in their high risk clinic. I know women who are not high risk and who did not experience the complications that plagued my pregnancies would not have been followed so closely but….I would have vastly preferred not to have been high risk, or had complications, nor to have multiple appointments every week and not feel constantly worried about fetal death.

    My OB didn’t become my friend…neither did my nurse…why should a midwife? Isn’t it unethical to form personal relationships with patients? That doesn’t mean the relationship can’t be friendly…but friends….that seems a bit questionable to me.

    My nurse was available to me at all times…in my first pregnancy I had two because one only worked part-time. They were great….I really liked them; I am grateful to them.

    Ontario midwives aren’t the only health care providers that need to learn their place….doctors, nurses, hospitals, all need to start understanding that they are also servants of the taxpayer. We pay them quite well for their expertise but there also needs to be a greater amount of transparency. There is no oversight of Ontario hospitals, little oversight over physicians with complaints and disciplinary action kept secret by the College of Ontario Physicians and Surgeons.

    The Ontario Nursing Union also prevents taxpayers from learning about disciplinary action against nurses and the College of Ontario Nurses only provides information that pertains to finding of gross misconduct like sexual or physical abuse.

    Obviously, this issue makes me feel quite angry. I would have loved to give birth in a nicely decorated setting…..the Toronto Birth Centre looks quite lovely….but because I was high-risk, and even if i wasn’t, I wouldn’t have been able to become a client because I would not have wanted a midwife.

    It’s apparent to me the reasoning behind the Ontario midwife push is the drastically lower salaries commanded by midwives compared to obstetricians.

    Ontario midwives earn between $73,000 and $95,000 per year (http://www.aom.on.ca/AOM/Career_Opportunities/Becoming_a_Midwife.aspx) depending on experience, while the median income of an obstetrician is $270,063 (http://www1.salary.com/CA/Ontario/gynecologist-salary.html)

    As a side note, an Ontario nurse earns from $53,040 to $73,000 per year, but that’s after 20 years in the field (http://careersinnursing.ca/why-nursing/work-expectations/nursing-pay).

    So, why wouldn’t the province allow the Ontario Midwives to push their natural childbirth agenda? Convince women they have to have natural, intervention-free childbirths…and because they are indoctrinated, many won’t complain if they or their child suffers severe consequences….

    And as Dr. Amy points out, the NCB lobby is powerful….

    I’ve actually met three women who have had homebirths….I’m pretty shocked…and most ladies I have met at mom groups in my neighbourhood had midwives and wanted natural childbirths. One lady told me her midwife at the Toronto birthing centre really stalled and discouraged her from having an epidural.

    I really don’t see how the Ontario midwifery community can change…not when one of the goals of the midwifery programs specifically promote natural childbirth:

    Ryerson University (upon completion of the program its graduates will be able to):

    “Promote childbirth as a normal part of women’s health with an understanding of its cultural and social meanings” (http://www.ryerson.ca/midwifery/program.html)

    McMaster University (on the “Beliefs and Goals” page):

    “WE BELIEVE…
    that midwifery has the potential to be one of the most important components of women’s health care in Ontario. Midwives’ expertise in the care of normal pregnancy and childbirth arises from their understanding of childbearing as a social, cultural and biological process and from their ability to competently exercise clinical skills and decision-making. Midwifery education must provide the base for sound professional practice.”

    There’s also a program at Laurentian University but I had a terrible time finding any specific information. Either the site, the search engine, or my searching abilities, is terrible.

    Aargh….

    ANYHOW….that’s my rant.

    • Belle

      As for your comment regarding other healthcare providers needing to “learn their place”, I completely disagree. Most nurses certainly aren’t nurses for the exorbitant salaries, 12 hour shifts, weekends and holidays spent at the hospital away from our families, and many times, the abuse and disrespect we frequently have to tolerate from patients. Most of us work our butts off and give the best care possible. And I know that applies to most physicians as well. As the saying goes, there are always bad apples in every profession, but the good ones far outweigh the bad. You said so yourself in your post in regards to the wonderful care you received from your OB and RN’s. I’m sure your comment was meant in a generalized sense, but it’s irritating to those of us who are dedicated professionals. As for your opinion of Ontario midwives.. I think you hit the mark..

      • RNMomma

        Thank you for commenting on this. I certainly agree that most nurses and NPs, PAs, and docs don’t do this job just for the benefits. Speaking from personal experience, I have done my job at the expense of my own health in order to provide better and better care for patients. For now, I’m grateful for this short period of respite in which I’m caring for my own child but will soon jump back into the stressful life of caring for people in some of their worst moments. The benefits, in all honesty, could be much better for many, who continue to do their job despite the lack of proper compensation. (Some areas of the US pay less than $20/hour for starting salaries)

        • Belle

          Absolutely! I worked in the US too, haven’t worked there for a while so I’m not up on the latest salary numbers.. I do make more in Canada, but there are trade-offs there too.. I think nursing is difficult no matter where you are, and unfortunately, most people who are not in the profession, truly do not understand the stress and commitment involved..

      • guest

        %100. Compassionate people (in general) are attracted to careers in main stream medicine.

    • fiftyfifty1

      “.doctors, nurses, hospitals, all need to start understanding that they are also servants of the taxpayer.”

      Are they though? I don’t know as much about the Canadian system as I should, but I thought that hospitals were NOT owned by the government and that doctors and nurses were NOT government employees, but rather independent? Granted, there is an ethical obligation under any payment system for healthcare providers to “serve the patient”, but that’s different than being a literal “public servant” i.e. government employee. The distinction matters for things such as who should be in charge of oversight.

      • Belle

        You are right. I’ve been working in the system for a only a few years, but from my understanding, hospitals are funded by the government but basically run their own show..

      • AlisonCummins

        The taxpayer still supplies all their revenue.

        • fiftyfifty1

          Sure, the taxpayer supplies all or most of their revenue, but the distinction between “employed directly by the government” and “employed by a private employer which contracts with the government” still stands. CrankyTorontonian argued that because doctors are nurses were “servants of the taxpayer” that their disciplinary actions needed to be made public and that hospitals should have less independence. But is the same true with, for example, blacktop road crew companies? Should the public have access to the performance reviews of their employees or be able to mandate that they have less independence in their company decisions because all or most of their revenue comes from the government? No. If the government wants more say in the way hospitals or blacktop companies run their businesses or wants free access to the performance reviews of their employees, then they need to be willing to go to the trouble of owning and running hospitals and blacktop companies and making the doctors, nurses and road crew members ACTUAL public servants, i.e. take on the risk of hiring and monitoring these people directly. Want more control? Then take more responsibility. Want less responsibility? Well the downside of that is less control.

          • DaisyGrrl

            Even if they worked directly for the government, privacy laws in most Canadian jurisdictions prohibit revealing disciplinary actions of government employees absent a compelling public interest. So there wouldn’t be any increased transparency.

          • AlisonCummins

            fiftyfifty, you’ll like this:
            http://t.thestar.com/#/article/news/canada/2013/08/26/proposed_quebec_ban_on_religious_symbols_takes_step_forward.html

            Last year our provincial government proposed a bill banning the wearing of ‘ostentatious religious symbols’ (such as kippahs, sikh turbans and headscarves) by public servants. This would have covered doctors, nurses, teachers, university professors and employees of private but subsidized daycares. They are either government employees or contracted to provide government services.

            A conservative muslim woman working for a cleaning company cleaning government offices after hours would not have been affected because even though she’s paid by the government she’s not provid

          • AlisonCummins

            … she’s not providing government services. The sikh president of a university would have had to either resign or remove his turban while working. According to some interpretations, since municipalities receive money from the province all municipal employees would have been affected as well. (We didn’t get into roadwork companies contracted by the municipality.)

            The bill was never passed into law (I wore a headscarf for six months in protest) but they had the ability to impose the requirement.

            Not everyone makes the clear distinctions you do.

          • fiftyfifty1

            “Not everyone makes the clear distinctions you do.”

            Ah, perhaps it’s a US thing then. In the US, there is a distinction.

          • fiftyfifty1

            From the link:

            “A majority of French-speakers surveyed said they backed the ban while a majority of anglophones and allophones, whose mother tongue is neither French nor English, were strongly opposed to the proposed measures.”

            Very interesting that support for the ban would break down so neatly along francophone/anglophone lines. I know that bans like these have a lot of support in France but would be completely unsupported (indeed unconstitutional) here in the US.

          • AlisonCummins

            It was almost certainly unconstitutional here too. That would have been fine, politically. The ban was proposed by the separatist provincial party and if it had passed into law would eventually have been overturned by the federal government. The separatist provincial party could then complain about excessive federal interference.

            The unconstitutional part would not have been about whether the government has ultimate authority over nurses, though.

          • toni

            What’s ostentatious about any of that headwear? sheesh. I would understand not allowing niqqabs and the like but a headscarf/turban? Probably more hygienic than loose hair!

          • AlisonCummins

            It wasn’t even about the headwear. If I wore a pretty scarf on my head for a retro look or a kerchief to keep my hair out of my face during dirty work, that would have been ok because I am not at all religious. It would only have been not-ok for *muslim* women to wear scarves on their heads.

            Can you imagine being a boss and quizzing employees about their religious convictions before deciding whether they were dressed legally? It was truly awful. Sometimes my province is wonderful and sometimes it displays a vile dark side.

          • Dr Kitty

            So this is unacceptable:
            http://www.smh.com.au/ffximage/2008/06/06/headscarf_narrowweb__300x389,0.jpg

            But this is OK:
            http://fashioninsideout.co.uk/wp-content/uploads/2013/03/head-scarf-sophia-loren.jpg

            Or a Jewish man couldn’t wear a kippah, but a Christian man could wear a toque…

            Don’t get the need for policing what other people wear as long as it doesn’t cause an actual health and safety risk at work. You mind your own damn business and get on with it.

          • AlisonCummins

            Exactly.

            The upside is that the bill was the focus of the last election resulting in the ouster of the separatist party and the dropping of the bill.

          • The Bofa, Being of the Sofa

            This would all be resolved if nurses just wore those white hats like they used to….

          • guest

            In Ontario, the hospitals are owned by the government, not by a private employer. Hospital staff are considered public employees.

          • auntbea

            If taxpayer money is going to hire a blacktop crew as part of a government infrastructure project, then information about the contracting agency should be (and in the US is) entirely transparent. Not necessarily whether everyone gets an “exceeds expectations” on their yearly evaluation, but certainly if anyone in the crew has been investigated for misdeeds relevant to their ability to build a safe, high-quality, reasonably cost-effective road. Not only because that road was ultimately built with taxpayer money and so taxpayers should get to know how their money was spent, but because it speaks to whether the politicians who chose that contractor have good judgment or not. If CrankyToronton is right, and these investigations are secret, the politicians in charge of health care could be saving cash (or getting kickbacks) by intentionally funding shady hospitals who hire bad providers on the cheap. Politicians should be punished for that, but how can they be if they public can’t get information about the quality of the provider?

      • guest

        Nope, health care in Ontario is administered by the Ministry of Health and Long Term Care. The hospitals do control spending of their own budget, but comply with common Provincial regulations & guidelines.

        Unions (nurses) negotiate with the Province regarding salaries etc.

        • guest

          I should elaborate, the employer is technically the Hospital. But for wages to increase etc., the hospital budget has to be increased to maintain other hospital standards. Similar structure as Public Education.

        • Deena Chamlee

          Think analytically at root causes instead of symptoms. Codependency and caretaking are synonomous with the nursing profession. Codependency is about one who is a caretaker and one who is an abuser, many times the dynamics stem from childhood abuse issues. Violence and incilvility in healthcare workforces stem from this same codependant environment. The caretaker nurse professional trusts freely, everyone. The psychopathic narcisstic nurse professional seeks positions of authority whether it be management or in unions. If the union nurses are the ones with authority in negotiations with hospital self intrested management, and the salary has been negociated low for the freely trusting nurses, I would encourage questioning the salary and overall pay including kickbacks possibly from hospital management to the union nurses. You can bet the union nurses did not negociate a low salary for themselves. Back to the environment of bullying, harrassment, and incivility caused by psychopathic narcissitic nurses. This is causing the future nursing leaders to leave the profession in return causing a nursing shortage. The snowball effect continues with an abusive management implementing policies for mandatory overtime which is extremely abusive.
          I think the time has come to question why are professions without a conscience, amoral, unethical and psychologically and emotionally abusive psychopathic license giving free will to harm with impunity. Logically speaking if the imementation of emotional intellegence assessment tool and Hare psychopathy checklist was made a standard before entry into the profession and to all licensed professionals including management and unions grossly impaired professionals would cease to exist in the workforce. Psychpathic individuals should be barred due emotional impairment and their inborn need to exploit. Acceptance of reality, implementation of policy change is necessay in my opinion.
          Nurses must not trust freely and negociate salary on behalf of self. Furthermore, picketing for right for fair pay, refusal of abusive mandatory overtime, and for their human right to practice in a safe work enviroment
          would put a hault to the abuse inflicted upon them decreasing burnout, increasing retention and enhancing personal empowerment.

          • Belle

            I have seen and worked with the psychopathic narcissists you describe. They are inherent in all professions. However, when people’s lives are caught up in the cross-hairs, the dysfunction is more obvious..

      • DaisyGrrl

        My understanding (Ontarian but not a hcp) is that doctors are reimbursed on a fee-for-service basis. The fees are negotiated with the province, which administers the single-payer health insurance. The doctor is then expected to cover all expenses related to running their practice from the payments received.

    • alsmph

      And Canada wonders why it has a nursing shortage (never mind the crap they put up with day to day). https://cna-aiic.ca/~/media/cna/page-content/pdf-en/rn_highlights_e.pdf

      • Anj Fabian

        That sounds something like the American military’s (mostly Army) “stop loss” program.

        Ohnoes! Our recruiting is down because of this unpopular war! We can’t afford to allow troops to leave, so we’ll tell them they can’t.

        Ohnoes! We need more RNs. We’ll “increase their productivity”, cut their time off, decrease the number who leave the profession and voila! Problem solved.

        • The Bofa, Being of the Sofa

          There was something about “work environment” there, but I did notice that one of the things they didn’t talk about was “pay them more so they feel like what they are doing is worth it”

          Kind of the elephant in the room.

          I realize there are times and people for whom you can’t pay them enough to do this job, but before that point, there are people who say, it sucks but at least the money is good.

          • Anj Fabian

            The hours suck is one of the biggest complaints. 24/7/365
            If you don’t like it, go work for a clinic, but in the big ‘H’ you will be expected to work days, nights, weekends, holidays.

          • The Bofa, Being of the Sofa

            The reason the “hours suck” is because there aren’t enough nurses, so the ones that are there have to work more.

          • Liz Leyden

            Lots of American nurses can’t find jobs; why not recruit them?

          • Belle

            In some provinces there are no permanent positions to be had, they are all “casual” status.. you have to pay for your healthcare, no vacation etc.. at least in the US most open positions are full-time permanent with full benefits.

    • Carolyn the Red

      I was actually asked to sign a petition for midwives in Ontario to be paid more, the claim was that it was sexism, that they should the same as OBs. I declined.

      • Deborah

        I was preceptor to a doula/student midwife awhile ago who vehemently exclaimed “why do we even need obstetricians?” and “what can they do that a midwife can’t?” I quietly told her to go away and look up the training and length of time required to complete each qualification and not to come back until she knew the difference.

        • Belle

          Excellent!

  • Heather Dalgety

    Article in todays online Daily Mail about UK Midwife Rebeccca Matovu who despirte being asked to call the crash team , left the Unit she was in charge of & went home ! The patient & her baby both died later . Matovu has been struck off ! Her claim was that she’d finshed her shift & was no longer in charge .

    • Jocelyn

      Unbelievable >:(

    • Amazed

      My God.

    • Guesteleh

      “She arrived with her husband, mortgage consultant Usman Javed, at the hospital at 10am, but by 7.05pm she was in obvious difficulties.

      Between then and 9.40pm, Mr Javed went to the nurses’ station for help three times but was ignored by Ms Matovu and her colleagues.

      He told the inquest: ‘The midwife just laughed and said that once she is in labour the pains are just going to get worse.

      ‘One of them told me “have you not been reading books? What have you been doing for the last nine months?”. But I told them I am not a doctor, I don’t know what to expect.’”

      http://www.dailymail.co.uk/health/article-2759456/Midwife-went-home-instead-helping-heavily-distressed-mother-unborn-baby-BOTH-later-died-struck-off.html

      • Young CC Prof

        There isn’t one thing about that story that’s atrocious, it’s everything. I can think of about five different places where even doing one thing right probably would have saved her.

        • Heather Dalgety

          When she left , she knew the patient was unresponsive . Good thing it will be a minimum of 5 years before she can reapply for registration .

          • Lisa from NY

            Who would want to hire her? Rebecca Matovu is arrogant, cruel and indifferent to a patient dying on her shift.

          • MLE

            Someone who thinks they could do pregnancy better/right might hire her.

    • lilin

      I hope against hope that, because it’s the Daily Mail, the story is entirely made up. That’s too horrific.

      • Heather Dalgety

        Nope , see below . I know the Daily Mail is biased against all mistakes in the NHS but this is true !

    • lawyer jane

      Yikes. Stories like that make me wonder what I would do if I were pregnant in the UK. It almost seems preferable to hire a reputable home birth midwife than be subjected to the miwife-lead units.

      • Siri

        It wasn’t a midwife-led unit I don’t think. Most homebirth (=community) midwives are employed by the same trust as hospital-based ones. You could hire a private midwife, but not Rosie Kacary.

        • Siri

          Cause she was struck off too…

    • InvisibleDragon

      Whiskey tango foxtrot… What is that “three months suspension” about? Can’t she be charged with something criminal? That whole thing is horrendous…

      • Siri

        The suspension would be an interim suspension, pending further investigation by the NMC. She was later struck off the register, so the suspension was to prevent her from working in the interim. Her employer would also likely have suspended her during the disciplinary investigation. It doesn’t look as her actions were criminal, but they certainly were incompatible with remaining on the register. Have a look at the NMC website; you can read transcripts of every fitness to practice hearing, and they make fascinating reading.

        • InvisibleDragon

          Thanks! The three-month thing made me choke on my coffee. Can she or the hospital be sued by the patient’s family? In the US, the lawyers would be crawling all over this, but I know next to nothing about the UK rules.

  • OttawaAlison

    As an Ontarian I find this fascinating. Midwives have been advocating and have two pilot stand alone birth centres (one in my city, but it’s “just 5 minutes by ambulance”).

    I on the other hand after have had a csection after labour and now 8 years after having my daughter and being pregnant again I just want the baby, I seriously couldn’t care less about having a vaginal birth and have decided on an RCS. It’s sad that people meet this view with disdain. That I’m brainwashed by the medical community or that I have let fear get the best of me (what they call fear, I call risk management). I want a good provider, but I’m not looking for a new best friend. Good bedside manner is an asset, but at crunch time I want them to be an awesome surgeon.

    Looking on birth boards I seriously started questioning myself, is this view normal. I put it out there on a fb board and the reality is, most women are not super invested in a perfect birth and are more concerned with the outcome. I’d say I probably lean towards a less emotional view of birth itself than even the average non-birth obsessed women, but it’s not out of line or an aberration. I

  • Guesteleh

    OT but interesting: 10 Men Explain Why They Became Gynecologists.

    The male gynecologist can be a polarizing figure: Some women avoid them as a personal policy, while others actively seek them out. Regardless of your stance, though, they’re becoming a rare breed. Nationally, 80% to 90% of people graduating in OB/GYN are women; and at NYU School of Medicine, approximately one out of seven OB/GYN residents are male. But what motivates those who do choose this female-dominated — and female-focused — field?

    • Dr Kitty

      I know several male OBGyns and have had interesting conversations with them about why they chose the specialty.

      One is gay, and OBGYN, unlike the macho surgical cultures, is a specialty where his orientation is an asset, not a detriment.

      One wanted a surgical specialty with the opportunity for a big private practice and quick advancement.

      One is the son of two OBGyns, who is deeply, deeply passionate about women’s healthcare.

      All very different motivators.

    • AlexisRT

      I find the prejudice I hear expressed against male OB/GYNs to be disheartening. It’s tricky because some women have been abused and have understandable reasons for avoiding male providers, but there’s a lot of squishy bias in how male and female OBs are perceived and being “more comfortable” with a woman.

      (I have noticed some difference in how bad attitudes are expressed in male vs female OB/GYNs, but women are not on average better, as some think.)

      • Guesteleh

        Whenever midwives/NCB advocates describe the horrible OBs, it’s always assumed the doctor is male, which is completely out of line with reality.

      • Zornorph

        I blame The Hand That Rocks The Cradle for that. I still haven’t gotten over the image of Q as a molester of women, myself.

        • Roadstergal

          Ha, I was thinking of just that movie when I read Alexis’s first sentence…

    • DiomedesV

      Also OT: I recently discussed the rise in C-section rate in the US with a male high-risk OB in his mid-40s. He said that he had a private theory to explain it that, he claimed, would never be tested.

      He speculated that the rise in C-sections was directly related to the increase in female OBs. Not because they were more concerned with the negative sequelae (sp?) of vaginal birth, but because they, unlike older and current male OBs, were more likely to have children themselves but without a SAH spouse. These children would constrain their time. They’d section a woman at the end of a long labor in order to pick up their kids in daycare, whereas a male OB would most likely have a SAH spouse and would not have to worry about meeting child-related deadlines.

      I didn’t get a chance to react as I would normally (with scorn) but it struck me as terribly ironic. NCB regularly portrays male OBs as heartless moneygrubbers obsessed with their golf games and sectioning away to get to them on time, and here, a male OB just told me that he thought female OBs simply didn’t have the time to stick around because they were mothers themselves.

      • fiftyfifty1

        Well his idea is clearly wrong and it’s easy to prove it’s wrong:

        Over the past 40 years CS rates have gone up substantially in all countries in the world (except for a handful of the most war-torn and impoverished nations in Africa). They have gone up in nations where the work force has shifted from 90% male to 90% female. They have gone up similarly in countries where nearly all doctors are still male. They have gone up in countries where doctors still tend to deliver all their own patients. They have gone up in countries where OBs work shifts in the hospital where when your time is up, a different doc is there to take over.

        C-sections have gone up substantially because over the same time period CS have become substantially safer. The higher CS rate is a natural and rightful consequence of the shifted risk/benefit ratio.

        • Roadstergal

          That last paragraph needs to be shouted from the rooftops.

      • Sue

        Hmmmm – the same subtle discrimination comes out when people bemoan the effects of ”feminisation” of the medical workforce, by which they usually mean that people don’t want to work long hours any more, and this is because there are so many women with conflicting demands.

        The reality of the workforce data in Australia is that there is what I like to call a “humanisation” of the workforce, with both men and women working less hours. Gen Y doesn’t want to kill themselves working, and have other interests in life – both family and non-family.

        We used to have overt discrimination, with ”women aren’t smart/capable/strong enough to practice medicine”. Now we’ve moved to “women are smart and capable, but they only want to work part-time” or “they always have to leave early to pick up the kids.”

        We will have made real progress when everyone accepts that a good work-life balance is healthy, people can collaborate in group practices, and sometimes the female OB can stay back because their partner will pick up the kids.

      • OttawaAlison

        The OBs at my hospital work the same hours whether male or female. If a patient wasn’t done while one OB was on duty, it would be passed to the next one . it’s a team approach.

    • lawyer jane

      Huh. For some reason, a male OB for prenatal care and delivery doesn’t give me any issues. But a male OB for normal well-woman care and pelvic exams? I don’t know, that would just seem to add stress to an already stressful procedure.

  • Alanneh

    No other type of healthcare professionals spend so much effort on campaigning for their profession to the exclusion of actual patient care.

    Open up any midwifery journal: how many articles are about the `midwifery model of care`, the standing and scope of midwives vs OB`s or NCB/breastfeeding ideology, and how many are real patient care?

    Now grab a journal meant for any other midlevel provider, let`s say anesthesia or cardiac nurses/PA`s…. notice a difference?

    That is what is wrong with midwifery nowadays. It`s all about advancing the profession and getting women to perform according to what midwives have decided is the only right way to have a baby. What those mothers really want or need is deemed irrelevant.

    Once upon a time we had paternalistic doctors telling us how to give birth. Now we have come full circle, only worse: the bullies don`t have medical skills anymore and they are against pain relief.

    • Young CC Prof

      Oh, the chiropractors and acupuncturists do.

      • Roadstergal

        There seems to be a commonality among all of these providers (acupuncture, naturopaths, non-medwife midwives, etc) – a simple black and white view of the world. This is good and this is bad. This is the problem, and I will fix it. If something doesn’t go right, it wasn’t meant to go right – or it was your fault, so don’t question me. Funny how the paternalistic model persists.

        • Amy M

          And an absolute refusal or inability to see reality. Just because they “think it should be” doesn’t mean it is. I think part of it is they have a very vocal minority (midwives and their advocates) and they drown out the majority. Meanwhile the majority, for the most part, want to have healthy babies and mothers, with adequate pain relief.

        • Sue

          “Funny how the paternalistic model persists”

          My theory is that many of us have an innate need for reassurance and certainty, and want simple directed advice. It’s no longer fashionable to have the kind of relationship with your doctor, and doctors are being educated to discuss choices, make collaborative decisions and express doubt. That need for simple certainty therefore has to seek out the “New Paternalists” – those woo merchants that validate your issue and give you a simple “remedy”.

      • The Bofa, Being of the Sofa

        I don’t think it is a coincidence that midwifery, chiros and acupuncturers are three professions that are classic examples of Bofa’s Law (“if the defense of a profession is ‘not everyone is bad’ or ‘there are some good ones’ then that profession has a problem”)