My cousin, the OB - Page 2

[La Limena]

OB/GYN is a surgical specialty which is great for someone wanting to be a surgeon but is brings the consequence of not being so great for normal pregnant women.

I am a surgical subspecialist, but when I applied to medical school I planned on going into women's health (even wrote a great paper on the history of midwifery in America and one on the rise of cesarean sections as an undergrad). I found during my OB clerkship (at a large county facility) that there was just too much intervention and panic and clock watching in the field so I decided to pursue a different field rather than subject my future patients to the over medicalization of a natural process. As a student and then intern (at a community hospital) I got to assist at many a c section but I do not recall seeing a single intervention free birth. Nope, not one.

I didn't find medical education to be too dehumanizing, I think that medicine just attracts an interesting variety of personalities. If one is kind of cold and distant to begin with they are going to treat their patients this way, whereas if one is more holistic and humanistic, it will likely lead to a humanistic approach to patient care (my personal & professional philosophy).

So...you might luck out and find a great open minded OB in your area (like I did with DS#1) or you might be totally out of luck and find no good OBs in your area (like me right now with DS#2, I am using a midwife for a planned homebirth).

[sapphire_chan]

Originally Posted by La Limena

OB/GYN is a surgical specialty which is great for someone wanting to be a surgeon but is brings the consequence of not being so great for normal pregnant women.

I didn't find medical education to be too dehumanizing, I think that medicine just attracts an interesting variety of personalities. If one is kind of cold and distant to begin with they are going to treat their patients this way, whereas if one is more holistic and humanistic, it will likely lead to a humanistic approach to patient care (my personal & professional philosophy).

Excellent points.

Welcome!

[accountclosed3]

i was going to point out what la limena already did, which is that OB/GYN is a surgical speciality, and so it's beneficial for them to spend the majority of their training in surgery. i would rather that surgeries be safe as possible with good training, then have an untrained or inexperienced surgeon handling any surgical procedures.

with this, and as a matter of medical availibility and equity, i believe that doctors should educate patients about what they do and when they are necessary and when they are not in order to provide the best possible care and create space in their practices for women who truly need their services.

by this, i mean it would be better to inform the client that they are surgeons and specialists, necessary for those women who will most likely require some form of intervention or surgery in order to deliver a child in a safe manner.

these women do exist, and i believe enough of them exist to maintain a healthy practice for the doctor even though s/he would be missing out on "everyone else."

but because these doctors are often have too many clients anyway, it would make sense to start telling people to go to other kinds of caregivers so that their speciality is available to those women who need it most.

part of this, too, though requires the individual person to go out and figure out that these people are specialists. there are times for specialists--that is certain--but we can determine whether or not we need one.

as an example, i went to an opthemologist for years due to my specialized eye conditions. the opthemologist is there for my surgerical and specialized needs which now no longer exist due t o the work of the opthemologist when i was a child. therefore, i can go to an optometrist instead.

it is upsetting that people--whether doctors or not--become enamored with a particular procedure such that everything is a nail to their hammer. of course, we're all guilty of this sort of practice, i would say, but it's particularly difficult when you're sitting in a completely different perspective AND it's a minority perspective AND the other person is hammering away!

i'm very weird to my family too. i've been encouraged to do all sorts of things that they think is best. i've been as open as i could with information--which they either accept as real or they don't. it's fine if they don't; but i expect them to be respectful and decent when around me and discussing my process.

and i'm fine to discuss their process (my mother loves to talk about her natural hospital births--which in the 70s were natural hospital births) as well, as long as there is no implication that i must follow suit.

[doctorjen]

Doing my OB rotation convinced me right out of doing OB. In fact, I came home after my first shift and cried and cried because I went to med school because I was interested in women's health/maternity care and by the end of that first shift I knew I could never do THAT. I didn't realize before I went to medical school what it meant that OB/Gyne was a surgical speciality. The training is heavily surgically focused - in most programs it is only in the first year that you even do a lot of vaginal births (I won't say "normal")

Fortunately, I figured out in time that I could be a family doc and still attend births, and bring a different perspective. I practice in a small town and do about a third of the births in my hospital (around 70 a year.) I am frequently asked why I didn't pursue OB because don't I wish I could do my own surgeries and the answer is a resounding NO. I feel the majority of births should be attended by non-surgical birth attendants. Preferably midwives, but I think generalist physicians can do a good job as well. I tell my clients that being a non-surgeon means that no one in my practice ever has a cesarean because I have dinner plans - I have to consult for surgery, and I have to have a reason that a consultant agrees is valid.

I think it is quite hard for the average person to overcome their surgical training as an OB and attend a birth wihtout seeing pathology at every turn. Not impossible, as their are great OBs out there who have the skill of attending a normal birth, but really hard.

[Belia]

Originally Posted by RoxyJas

My best friend's little sister is in her last semester of RN schooling to be a labor and delivery nurse, and she actually makes fun and imitates noises mothers make when laboring naturally.

This made me cry. What a cruel thing to do... even if those moms have no idea that they're being made fun of. I'm a very modest person, and I'll admit that, right or wrong, I have fears about what I will sound like and/or look like during labor. Reading this confirmed my worst fears.

[serenbat]

I had a 100% natural birth in a hops. - my OB was an old MALE (who also still teaches - in his 60's) the intern who observed and my nurse were in SHOCK!!! Both had NEVER seen a natural birth! The DS went right to my boob and the cord was not cut until it was done pulsing and my placenta naturally came out. By the way my Dr. did acupuncture and did it on me during labor and after. At my post-op check up I told him what all the nurses said that made a special point to come talk to us (I didn't have much time, he released me an hour after the birth)-he told me, I would LOVE to do births like this but NO ONE wants them! I didn't scream because I hardly had pain, this was my second and with the AC it was less than 50% of the pain I had with the first, besides using AC my labor was super short. I have yet to meet ANYONE outside of this message board that wants a "NATURAL" birth, I just had a cousin proudly tell me how she didn't scream because she got the ep she wanted, and the pot. drip and all the other drugs- and just because the kid came out of her without a "c", she claims she had a natural birth!

[La Limena]

Hi doctorjen. Did you do an OB fellowship? Hopefully not.

At my clerkship hospital we had 1 or 2 FPs doing OB fellowships, and the result was that they just got swept up into the surgical realm too, so that any non-surgical perspective they may have originally brought to medicine was soon reduced or erased by the same c section training and highly interventive labor management education that the OB residents experienced.

The interesting thing to me is that IME many of the OB track students and later residents that I knew LOVED the surgical aspect of OB/GYN and would even prefer to have a GYN only surgical practice so as to avoid the lifestyle inconvenience of "boring" "normal" deliveries in the middle of the night. I just don't get it...if these folks don't even like or want to "catch babies" why not support midwives efforts to provide the much needed service to low risk women. (Or if not actively support, then at least not actively resist the efforts.)

I also agree with the example zoebird gives. I am an ophthalmologist and though I am trained to refract and prescribe glasses and fit contacts, and I do provide this service to some patients, I am a surgeon and prefer my more challenging medical cases and surgeries. I am (and most ophthalmologists agree with me) totally okay with optometrists handling the very routine cases because it lets me concentrate on the things I like best. If ophthalmology as a whole can "let go" of routine healthy eye exams to optometrists I just can't see why OB as a whole can't "let go" of the low risk women to midwives instead of actively turning their births into potential surgical births by interfering so much.

[DBZ]

I think we ought to just start refering to OB/GYNs are obsterical surgeons or gyn surgeons.

[applejuice]

i would rather that surgeries be safe as possible with good training, then have an untrained or inexperienced surgeon handling any surgical procedures.

Could it be that OBs have done so many unnecessary surgeries on healthy women, i.e., women who really do not NEED the surgery, that the OBs have plenty of training and experience and are therefore excellent at what they do? Just asking. That is probably how they have the good outcomes that they do get most of the time.

But then most women prefer to think that their surgery was necessary; few women want to think of themselves as teaching/learning material.

[crazy_eights]

She saw one natural delivery in FOUR YEARS????? That's nuts.

[applejuice]

I guess maybe we should almost cut doctors some slack for being so ignorant, they are only acting as they've been taught.

This is true. They are heavily indoctrinated that their services are going to be necessary for 90% of births

But this indoctrination is done unnecessarily and costs people money and causes unnecessary pain and trauma to people who really do not need it. And doctors act as if the patient has no choice in the matter.

[sapphire_chan]

Originally Posted by applejuice

Could it be that OBs have done so many unnecessary surgeries on healthy women, i.e., women who really do not NEED the surgery, that the OBs have plenty of training and experience and are therefore excellent at what they do? Just asking. That is probably how they have the good outcomes that they do get most of the time.

Do heart surgeons often have bad outcomes? Brain surgeons? Ophthalmologists (: La Limena)?
Presumably they don't do a bunch of unnecessary surgeries.

[sapphire_chan]

Originally Posted by mom2seven

She saw one natural delivery in FOUR YEARS????? That's nuts.

No, according to the OP, she saw one vaginal delivery in four years. That was induced with pit.

[applejuice]

Originally Posted by sapphire_chan

Presumably they don't do a bunch of unnecessary surgeries.

I hope not. That is not a good comparison. Childbirth is a healthy, normal, natural condition of a healthy women. Brain tumors, heart problems, and eye conditions are diseases that can be corrected by surgery. Pregnancy and childbirth are not diseases routinely needed to be corrected by surgery.

Pediatricians used to do a tonsilectomy on every child they could get their hands on. I was the only member of my first grade class that had her own tonsils, in a class of 57. Neither of my parents had their tonsils. Now pediatricians do routine ear tubes and circumcisions. There is plenty of unnecessary surgery happening.

Read Confessions Of A Medical Heretic, by a member of the State Of Illinois Medical Licensing Board and a Professor Of Medical Ethics. Little has changed since that book was written.

[mamaverdi]

Most surgeons (outside of OB) these days don't have TIME for unnecessary surgeries. At least most GOOD surgeons.

[accountclosed3]

Could it be that OBs have done so many unnecessary surgeries on healthy women, i.e., women who really do not NEED the surgery, that the OBs have plenty of training and experience and are therefore excellent at what they do?

for the average ob who is out of school at every level (residencies etc), and who continues to do unnecessary surgery? yes.

for the student who is hoping to become a gyn/ob surgeon and work on those special cases--i would say no, simply because they have NO training prior to getting training.

and, they need to train.

what is unforunate is that because of the way the system is currently, the obs who are training the newbies are demonstrating the procedures on women for whom it is unnecessary, which then perpetuates this idea that it is necessary.

if it could go back to it's original process, that is that OBs who train new OBs now would step back and only work on those cases where it is necessary, then the OBs-in-training would get a better education (about when the need applies, as well as how to do the technique) and the needs of women would be met.

but, there are a lot of factors in this--social and political--that need to be worked through. part of it involves doctors stepping up and discussing the ethics of unnecessary procedures and another part of it involves women stepping up and educating themselves about these issues.

[sapphire_chan]

Originally Posted by applejuice

I hope not. That is not a good comparison. Childbirth is a healthy, normal, natural condition of a healthy women. Brain tumors, heart problems, and eye conditions are diseases that can be corrected by surgery. Pregnancy and childbirth are not diseases routinely needed to be corrected by surgery.

Um, yes, that's my point. The other surgeons only do surgeries when necessary and still have good outcomes. Therefore, OBs should be able to do only the necessary 10 to 50% of c-sections (i.e. 3-15% of all births) and still get in plenty of experience.

They don't have any grounds for arguing "we need to do all these c-sections so we can stay skilled."

[applejuice]

Frankly, again, I do not want to be teaching material for anyone, thank you very much.

In terms of childbirth, the human body recovers remarkably quickly and well, an evolutionary adjustment, perhaps, so that the mother can survive and care for her the life.

OBs use this fact to their advantage to show how well their skills work for mothers and babies.

[LemonPie]

She saw one natural delivery in FOUR YEARS????? That's nuts.

When I had my hospital NCB, the nurses were all amazed and kept going on about how good I'd done. Random nurses would pop in and say "I heard you did it ALL without medication!" My labor nurse, who's been in the field for 25 yrs and is an instructor at the local nursing college, said, "I haven't done a delivery like that in YEARS!" It was like I'd pulled off some amazing medical feat.

No, according to the OP, she saw one vaginal delivery in four years. That was induced with pit.

I think the OP meant that she considered it "natural" because the mom had gone without an epidural. I can't hardly believe she'd only have seen one vag. delivery in 4 yrs. That would put the hospital c-section rate at 100% and as far as I know, nobody's earned THAT distinction yet. Correct me if I'm wrong!

[sapphire_chan]

Ah, you're right, sorry about that everyone. She'd attended one delivery without an epidural. Okay, so my point about her having never attended a natural delivery still holds, but it's not as bad as I managed to freak myself out with. :