This article was originally written by Dr Gauri Lowe on December 4th 2012 on FaceBook. She currently resides in India. This article is shared with her permission.
Often I hear and see mothers as consumers comment on their own experiences with doctors or birth professionals comment on their interactions or others experiences with doctors managing birth. So I thought it worthwhile to write about the training of a medical doctor in relation to birth to give a bit of context and perhaps challenge our expectations.
In my 4th year of medical school we did our perinatal block. Now remember we study disease – pathology, aberrant physiology and how to diagnose, manage and treat these harmful states. Now we were studying birth and pregnancy – physiological states in healthy women!
In our clinical time, we spent 2 weeks at a MOU (maternity and obstetric unit). This is a unit run by midwives and designed for low-risk births and pregnancies, any risk factors in pregnancy or labour are immediately transferred to a higher level hospital with doctors.
There my exposure devastated my spirit. The midwives generally used harsh words, called the labouring patients names, evoked guilt for becoming pregnant, for not pushing “right”, when distressed babies were delivered and controlled by shouting. They pushed on the fundus of a contracting uterus, panicked at every step from full dilatation, rushed to cut the cord, contorted the lady to promote pushing (in lithotomy position), often sent out the birth partner. Oh and cut episiotomies without giving local anaesthetic.
But these were the precious 2 weeks of my NORMAL birth training. And it was a relief to find a midwife who was calm, mature and “nice”. We needed them to sign off our logbook and could not risk getting on their “bad side”.
The rest of the time from then our exposure continued in hospitals. Women seen there generally had a risk factor like anaemia, previous caesarian, blood pressure problems, previous intra-uterine death or current twins. Women were monitored by CTG, mostly laboured on the bed and had regular vaginal examinations according to the partogram. Care was mixed with doctor and midwife. Sometimes labours progressed according to the book and other times the intervention according to the protocol was carried out. Ward rounds took place at handover times – and 7-12 doctors and students would briefly crowd around the bed of the labouring lady to discuss her “problems” and progress. And appropriate decisions would be made like “cut, synto, review in 2 hours and then…” Labour wards were full and always busy.
I remember presenting one case on a ward round and I included the social history (her home situation, did she have water, inside toilet and would she breastfeed). I was openly laughed at and ridiculed for taking up the round with this information.
As a doctor – I work currently in a busy district level hospital. A day at the outpatient clinic 2 of us can see in between 40-60 patients a day. When we walk out the office to pee, never mind get a drink or have lunch – we are met with faces that say “Don’t go, I haven’t been seen yet and I have been waiting for SO long now.”
Alternatively we may be seeing inpatients in the wards with different problems that have to be managed…ante, peri or postpartum.
Then we may start our night call….after a full days work – now managing all obstetric and gynae wards including labour and other emergency admissions and theatre. Keeping pace on the possibly 8-10 labouring ladies you have admitted, before and after you cut an emergency caesarian or an unstable ectopic pregnancy…or evaluating one of the 3-5 miscarriages that present at the emergency unit.
The home births that cross our path and vocabulary are most often the BBA’s (born before arrival). That is they are not planned home births. They are often unbooked (have not attended any clinic) moms or have other social problems. The exposure of the genuine homebirth in this context is the transferral in or after labour for some “problem” needing an intervention.
In this set up we see medical complications, risks, problems and deaths. We are on alert for diagnosing and managing these problems quickly and effectively. Our continued training is made up of “skills managing obstetric emergencies” like dystocia, haemorrhage, ecclampsia.
So…When expecting your medical doctor to really support, understand and become your attendant at your desired natural birth….remember what has built his experience, exposure and practice. There is definitely the exception who has been pulled and exposed to natural birth. But this is the exception.
Simply – If you want a natural birth chose someone who has had experience in natural birth.
Myself? My next note will be called – “Why I chose a homebirth again.”
(Personally, I look forward to participating in more natural births in a more suitable environment for this expectation.)
For more information on Gauri and her work visit womens-health.co.za