Friday, October 29, 2010

Will We Ever Reach Peace in the OB v. NCB war?

I'm considering removing my RSS subscription to MyOBsaidWhat?!? I used to read all the comments and sometimes comment myself, but lately I've realized that it is steeped in negativity, and I'd rather focus on the positive. Reading there, it becomes easy to assume that all doctors are unhuman douchebag stabby-hands. Of course, the "Thoughtful Thursdays" are wonderful examples of what to say to a woman, but because they are featured once a week, they come across as the rare exception in a world of horribleness. If any doctors show up and make efforts to defend their profession, they are almost always met with hostility by people who know nothing about how they practice medicine or treat their own patients.

I was recently surfing a blog called OB/Gyn Kenobi, because I thought the name was really clever, written by an anonymous obstetrician who calls herself Dr. Whoo? I haven't read a lot on her blog, but I can tell that she believes in individualized patient care and recognizes that the issue of liability in the American legal system is a huge problem for her profession. I came across one post where she expressed a lot of frustration about how the natural birth community views obstetricians, automatically assuming that they are all the same horrible stereotype. She points out that in her current practice, there is a split in philosophy between the older generation and her own younger generation.

My personal experiences corroborate her observations, as the OB I saw during my first pregnancy before switching to a midwife group, was an older doctor, and he had a "my way or the high way" attitude, complete with continuous EFM, mandatory IV infusion, NPO, and pushing on your back only. He believed that episiotomy is necessary for about a third to half of all women and that all women change their minds about wanting a natural birth when they are in labor. The OB/Gyn I saw in my second pregnancy was younger and was nothing like this--she was supportive of low-intervention birth if all was going well, and had attended many unmediated labors. She almost never did episiotomies, and actually encouraged me to write a birth plan.

It is wrong to define obstetrics by extreme negative examples. There are great OB/Gyns out there. I'd like to hope that there are a lot of them.

One of Dr. Whoo?'s most compelling points is this:
Perhaps the most disheartening thing, is that there can be no real dialogue between the two philosophies, so jaded are our particular perspectives.
I appreciate that she acknowledges that the obstetric side has a jaded perspective, too. This is evidenced by some of the comments on the post:
The fan page looks good so far. You might want to include links to things like: Mothers in Medicine, pages where people can get real information about Ob/Gyn services (other than the doctor hating, "busness of being born" websites)
Condescending, much? Here is another
go to I went there trying to figure out what a doula was. They are very anti-OB and also are giving very bad advice to pregnant women.
That almost makes me ashamed to call myself a doula. And this one
Do any of these doctor bashing twits realize that just a few generations ago women DIED from "natural" at-home childbirth (the only kind going, back then) on a regular basis?
I would be remiss if I didn't address the fallacy of the "women used to die and now they don't" argument. You can not compare statistics from different time periods and assume that one change in that time is the determining factor in the change in statistics. Natural birth advocates know that hosptials and interventions have benefits and save lives in certain situations. That is why women who plan to birth at home have a plan for transfer to the hospital if complications arise. The burden of reaching out the olive branch of peace is really on us because we need obstetricians. Modern homebirth, though significantly safer than homebirth in antiquity (due to sanitation and better midwifery knowledge and emergency medications that can be given in the home), can never really be safe without hospital back up. All too often, women who transfer to the hospital from a planned homebirth are met with hostility for choosing not to use the hospital and then needing it after all. The truth is she needed you all along, just in a different way than you wanted her to need you.

We need to focus on what we have in common--a desire to improve birth for everyone. We may have different opinions about how that can be done, but we will never get anywhere if we keep making this a war. Division is hurting us, and hurting mothers and babies. We cannot afford to alienate all of the the obstetricians our there who care deeply about mothers and babies and make birth their life's work! Just as there are various types of natural birth advocates, each obstetrician is an individual person. Many of these people are caring and sensitive and we push them away with our belief in an extreme stereotype. It is bigotry, and I am done with it. I am committing now to make my blog a doctor-friendly zone. I want better care for pregnant women and their babies and that is only going to come about with peace and collaboration.


  1. Great post Brittany! I wholeheartedly agree. I felt very comfortable under the care of my OB with my daughter and had a great NCB experience. I always felt funny when people would comment on how crazy I was to consider a NCB with an OB -- and in a hospital nonetheless.

    I like the point Henci Goer makes in The Thinking Woman's Guide on how some OB's are more like midwives and how some midwives are really just like OB's. (I wish I had it here so I could quote.) The blanket assumptions (either way) don't really help; it's about learning about a particular practitioner's philosophy.

    I think if both sides would work together birth could be improved for everyone.

  2. I agree! I had a wonderful OB who was very much into NCB! He was excited that I wanted one, asked if I was "getting educated" in my Bradley classes, and had taught NFP classes. My Bradley instructor told me several of her students had had successful NCB's with him and I had "nothing to worry about" with him as my OB. At my first appt when I asked how often he performed episiotomies, he chuckled and told me they were "old school" and he couldn't remember the last time he had done one. I found his comment amusing since he's in his 50s ;-) When I had to have a c-section due to a failing placenta, he was extremely disappointed. At my first appt my second pregnancy, I told him I wanted a VBAC. He grinned and told me he knew I would and that was why he had taken extra care with how he had stitched me up after my c-section. Definitely not a stereotypical OB! Especially not an older one...

  3. I agree, I agree, I agree!!!! I have been meaning to write that exact post, and I too am considering bowing out of MyOBSaidWhat simply because it encourages the hatred and the OB/NCB war rather than actually working toward any collaboration or positive change. Thank you for writing this.

  4. Don't forget the family practice physicians who still catch babies! I actually called mine a MD for Midwife in Disguise. She was wonderful.

    Personally, I think the midwifery has its place and medical maternity care/obstetrics has its place. Midwifery is concerned with the normal, physiological birth, and obstetrics is concerned with pathology in pregnancy and birth. Really, there doesn't need to be a war...not if everyone would stick to what they know and give props to the "other side" for their own contributions to maternity care.

  5. I agree, Amber. Unfortunately most of the Obstetric community doesn't see their role that way, and I think this is where most of the problems originate. I just sometimes see a zeal in natural childbirth advocacy and support that is usually misunderstood by the medical community as meaning we are against all medical intervention and hate all doctors. In some cases, the attitude is actually extended to midwifery as well. I think sometimes both sides are guilty of judging the other by polarized extremes, while most of us are actually rational people.

  6. I know that this is an old post but I had to comment that many of us who have been harmed in the past by obstetric "care", or seen births where our relatives/friends/doula clients were harmed, naturally find it hard to trust OBs and medicine as a whole. Hopefully as time goes by and more OBs become receptive to the idea of respectful care, we who lack trust will be able to regain our positive attitudes as well.

  7. I chose a family practice doctor for my first pregnancy, hoping he would be more "natural childbirth tolerant/supportive" than an OB. I didn't have any way to ask around ahead of time to find a supportive provider b/c I didn't really want all my acquaintances to know we were trying for a baby.

    He wasn't awful, and I did end up with a drug-free birth, but we had a lot of conflict about various things from what my due date was (he didn't believe my charting-based due date), him wanting to induce labor for a "too small" baby (ended up being 7 lbs. 11 oz), etc. He gave me a bunch of misinformation about breastfeeding, made fun of my use of natural family planning, and retracted my son's foreskin (causing him great pain). So yes, I have a distrust of doctors. I assume that they are not knowledgeable, supportive, or respectful until I see otherwise...I have to do this so myself and my kids don't get hurt (physically and emotionally) again.

    I try hard to say things to friends like "choose a provider carefully", and "find a provider that will respect your wishes/plans" instead of "doctors are ignorant" or "you'll have to fight hard to have a natural birth in a hospital / with an OB".

    The second time I had a home birth with a midwife and it was much better...

    I wish there was a way to know a provider's philosophy before signing up for an appointment with them.