We live in a society that demands unquestioning obedience to authority. There is a rather extensive list of authority figures, and doctors are right there near the top of it. Unfortunately a large number of obstetricians aren’t working particularly hard to earn that respect, and it clearly isn’t working well for women and babies.
Women assume that if a doctor gives them information or makes a recommendation, it is necessary, and scientifically based, however with a one in three caesarean rate, something is amiss. The birth outcomes in industrialised countries such as Australia and the US are showing the cracks in obstetric led care.
As Marsden Wagner neatly explained once, scientists must assume that they do not know the answer, whereas obstetric surgeons must assume that they know the answer, with a high degree of accuracy. Clearly this is a complicated aspect of obstetric practice, but the greatest problem is in the lack of transparency that comes with that, not with the reality of practice.
Women believe that they are being given sound, scientifically based recommendations for the safety of their babies, but quite a number of studies have shown that very few recommendations are based on high quality evidence.
Doctors are humans, not gods. What we forget when we see a doctor is that, although they have the qualifications, some of them finished bottom of their class. That doesn’t mean they failed their final exams, it means that they weren’t the TOP of the class. Not all doctors are geniuses, but they are all human.
Another problem is that we often fail to discriminate between a good doctor, and a nice person. A doctor who greets you with a smile at each appointment, cracks a few jokes, remembers your name and asks how your mother is, might just be the one who came last in their class.
Doctors have families they like to spend time with, their jobs are dependent on performance – practicing within the protocols of the hospital they work at – their priorities might not be the same as yours. In an ideal world there would be a perfect meeting of the minds between each woman and her maternity care provider, in the real world this is rarely the case.
Some women seek the services of a midwife, however friends and family are often doubtful of the safety of midwifery. They perceive doctors to be experts, and midwives to be dangerous and poorly trained. The respect granted to a qualified midwife is often far less than that given to a doctor. Husbands frequently grill midwives about their practices, and yet never raise a single question when in the company of an obstetrician.
In an Australian study of medical misconduct, obstetricians and gynaecologists topped the list of complaints and disciplinary measures. American obstetricians are sued an average of 2.7 times in their career, with one third facing legal action as many as four times. Yet we still view obstetricians as authority figures over our bodies and our births.
Despite the soaring caesarean rates, despite the obvious safety issues that are becoming more apparent as the years of obstetric led maternity care continue, we still place them in a position of power, deferring to them on all matters relating to birth, ignoring the voices of birthing women and midwives.
This is not to suggest that we should be disrespectful towards doctors because ALL human beings deserve our respect, however in their professional capacity we should not blindly award it to them simply for completing medical school. There comes a point in time where we have to remember that respect is earned, it should not be simply given freely. Unscrupulous practitioners must be mindful of the fact that just as easily as respect can be given, it can be lost. Respect is a two way street, and care providers who wish to remain in business should be mindful of that.