Thursday, March 22, 2012

Same Gender Maternity Care
by Misty Roberts

Many people falsely assume that women don’t care about their modesty during childbirth because they are in too much pain, but that is simply not true. There are many women who feel that their modesty during childbirth is extremely important. Some women and husbands don’t want a male obstetrician / gynecologist (ob/gyn) or any other male medical professional to be present for the birth of their baby. All too often families have their wishes for modesty violated as they gave birth. The birth of your child should be a joyful time and it is tragic how violations of modesty have made birth experiences traumatic. Even female ob/gyns can be insensitive. 

Some female doctors have ignored women's wishes for privacy and allow medical students to be present for all parts of birth even when asked otherwise. At some hospitals, medical students strive to do as many pelvic exams as they can for their requirements and many women are taken off guard because they have medical students coming into their room uninvited doing these invasive exams and other procedures without asking.

A number of hospitals in the United States, especially rural areas, have mostly male ob/gyns and few or no female ob/gyns. This is a very serious problem because many women don’t want a male gynecologist to deliver their baby. Far too many hospitals cannot assure families that their desires for modesty will be met. All hospitals should offer this choice for women, to be able to birth with a woman. There are a number of wonderful all female ob/gyn practices in the United States that work hard to accommodate patients’ wishes for an all female team. Unfortunately, it is hard to find an all female ob/gyn practice in small towns so women who reside in those areas have limited choices unless they are willing to drive to a bigger city. Before 1990, there were not many all female ob/gyn practices so women's choices were very limited. About 80-90% of current ob/gyn residents are female so there will be an increase of hospitals that can guarantee a woman a female OB/GYN for the birth of her baby in the years to come. 

Home or birthing center births with a midwife attending is an excellent choice for healthy women with low risk pregnancies. You choose who is there with you – family, friends, or neighbors. There are no externally-imposed visiting hours in your home, before, during, or after the birth. Women's wishes for modesty in hospital settings are disregarded routinely unless they have worked out arrangements with the hospital to ensure that their wishes are honored.  Unnecessary medical interventions are common. The list is huge, but a few examples are: too many pelvic examinations, episiotomies and unnecessary C-sections. Midwives do fewer pelvic exams and always ask first. With respect for you as a laboring woman, you will reduce your chance of having these unnecessary interventions. 

If you choose an out-of-hospital birth, look for an appropriate back-up plan, preferably with an all female ob/gyn practice to deliver your baby. Always be prepared for complications that could happen that would require you to be transported to the hospital from a birthing center or your home so it is very crucial that you prepare a backup plan ahead of time. Make it clear to your midwife that you don't want a male gynecologist. Many midwives even do breast examinations, pap smears, gynecological examinations, and even some procedures for women who are not pregnant. 

For a planned hospital birth, (or unplanned as in the case of a transport from home or birth center), if a birthing mother wishes for an all female team and maintain that her husband is the only man present, she will need to choose an all-female ob/gyn practice that doesn't rotate with other practices of male doctors. Keep in mind that all doctors in a practice rotate. There are many wonderful female ob/gyns in mixed practices, but you usually cannot be guaranteed a female ob/gyn in a mixed practice. If you use a practice that has two female doctors and two male doctors, you have a 50% chance of having a male doctor deliver your baby unless you have a scheduled C-Section with one of the female doctors. 

Discuss with your ob/gyn your desires for an all female medical team for the birth of your baby. You should also visit the hospital and meet the nurses especially the nursing supervisor to let them know your desires. Remember that the team may consist of the female ob/gyn doctor, nurses, anesthesiologist and/or nurse anesthetists, and surgical scrub technician. If you need an epidural, you will need an anesthesiologist. It's best if your team consists of all females, a female anesthesiologist or nurse anesthetist. Many hospitals employ at least a few nurse anesthetists. Nurse anesthetists are often able to administer anesthesia without an anesthesiologist. If it isn't possible, speak to the doctor and nurses and request that they keep your private parts covered while the anesthesiologist or anesthetist is present to protect your dignity and modesty. If you must have a Cesarean Section, you will be required to have a catheter inserted. You should ask that the male anesthesiologist or anesthetist stay out of the room until all of the prepping for surgery including insertion of the urinary catheter has been done. 

Important Tips For Pregnant Women Concerned About Modesty During Childbirth: 

1.) Choose an all female ob/gyn practice that doesn't rotate with other practices that have male doctors. 

2.) Visit the hospital that the practice delivers at and ask to speak to the nursing supervisor or the manager for the Labor & Delivery unit. Discuss your wishes about who you want to be present and how the nurses can protect your modesty in case a male anesthesiologist or pediatrician is required to be there for some parts of the birth. Make sure you indicate if you don't wish for even female medical students to be there. Some women who want an all female team are open to female medical students observing them giving birth.

3.) Request that the amount of vaginal exams be kept to a minimum. Vaginal exams cannot tell you exactly how close you are to giving birth. They can increase the risks of infection even when done carefully and with sterile gloves. 

4.) Speak up immediately if you feel your wishes are not being honored. 

5.) Create a birth plan. Make sure that you include who you want to have present. If you don't want medical students or male medical professionals to be present, indicate that on your birth plan. Make sure you come up with a plan in case the unexpected happens. One web site that offers a good example of a birth plan is: BirthPlan.com

6.) Consider hiring a doula to provide support during your labor. She is an advocate who can help you to speak up for your wishes about modesty if you are birthing in the hospital.


Misty Roberts is the founder of Medical Patient Modesty (http://www.patientmodesty.org), a non-profit organization that promotes stronger patient modesty.

6 comments:

Joel Sherman MD said...

This article certainly illustrates all the difficulties that face a patient who wants same gender care. It's relatively easy to achieve in an office setting, but difficult in the hospital. If it is a goal, it can only be achieved by much advance planning.
My daughter certainly preferred to obtain maternity care from a woman obstetrician. Ironically when the time came to deliver her obstetrician was on maternity leave and she was delivered by a man. At that point she didn't really care and only wanted to have her baby. I've heard other similar comments and experiences.

Anonymous said...

Women are told to develop a relationship with an obstetrician that they are comfortable with, yet in many, many cases, such as Dr. Sherman's daughter's experience, the delivery is in the hands of a total stranger.

Doctor Watchdog

MarĂ­a said...

Sorry to barge, by I want to comment about the posts of someone that frequently posts in these blogs, PT. I had a really strong clash with him, because he absolutely refuses to believe that there are male NPs working in OB-Gyn floors. There are, and many of them. They're usually medical students that've taken degrees in nursing, and usually work in public facilites controlled by the state, but also in private clinics. To compound the problem, when I wrote "This is Third world" (by this I mean a non-industrialized country, among other things) he snapped at me.

Joel Sherman MD said...

Thanks Maria. What's most common is male student nurses taking a rotation in OB. That happens in every teaching hospital in the country. Most states require an OB rotation for graduation from nursing school. I'm sure what you describe also happens.

Medical Patient Modesty said...

Maria,

Unfortunately, you are right. It is true that some hospitals don't allow male nurses on their OB/GYN or Labor & Delivery floors. Look at the case of Patricia Cohen and her husband who sued a hospital and a male nurse because they had requested no male nurse at http://www.casebriefs.com/blog/law/torts/torts-keyed-to-dobbs/establishing-a-claim-for-intentional-tort-to-person-or-property/cohen-v-smith. The hospital should have worked to accommodate their wishes. It is wrong that they assured her that her wishes would be honored and then they allowed that male nurse.

Anonymous said...

Dr Sherman, you say your daughter didn't really care, but it becomes a big problem for a woman who cares...that's why it's so important to make sure your doctor has female doctors covering her. Having to accept a male doctor because of circumstances (no one else available etc) can lead to lasting psychological issues and cause distress etc.
A c-section is more difficult, I know women who achieved all female care in the private sector. It's not difficult if the hospital and staff actually care - it's just a question of prepping the woman privately or behind a screen or curtain and then once draped...no problem.
I've always felt this is an issue because the system doesn't care and has always preferred to ignore the problem.
I also, wonder whether some of the women who feel they must accept a male doctor because of circumstances, console themselves with, "I didn't really care".
I know women who've said that, but later admit it was their way of dealing with a bad experience.
EEB