A Physician Responds to Claim about OB-GYN Education
As an OBGYN, I can attest that we start doing deliveries very early in our careers, often with varying degrees of supervision. In fact when I was in medical school, the labor floor was so busy that my first delivery was also the first one I had seen, since 2 other women were delivering simultaneously, and the very experienced labor & delivery nurse coached me through it. (I would note that the medicolegal climate has changed since then and this sort of occurrence is now a rarity.) We also had midwives working on the unit which gave me an early exposure to that type of practice, and certainly instilled in me confidence in their skills and abilities.
A vast majority of our training as an OBGYN is not in normal deliveries but in taking care of sick women, either with GYN related disease or women with high risk pregnancies. Therefore, the majority of the laboring patients we care for have been referred to us from other hospitals and practices, due to their degree of risk. We learn a great deal from seeing these kinds of patients in a concentrated environment, surrounded by experienced attending physicians, but it gives a skewed perspective on normal birth.
It was likely not until I practiced in New Zealand, which has midwives as the primary caregivers for pregnant women, and no history of malpractice lawsuits, that I really was able to witness normal childbirth. The obstetricians, of which there were few, only looked after the high risk patients, or came in when there were issues. Many women chose homebirth and few of these required transport to the hospital. I did not witness or hear of any catastrophes, and the statistics for that country for newborn outcomes exceeds that of the US.
I believe Marsden Wagner said that having an OBGYN attend normal deliveries of low risk women is like hiring a pediatrician for a babysitter, in case the child should get sick. The New Zealand model recognizes this and reserves their doctors for the women who truly need them.
I feel strongly that a system which allows deliveries by well trained midwives, who have a collegial relationship with a supportive physician community is a safe one and is far preferable to treating women who opt for homebirth as outsiders and their caregivers as criminals.
The biggest hurdle however is educating the OBGYN community, and I am afraid that once prejudices are established early in one’s career, it is nearly impossible to eradicate them.
So no, we don’t train 12-15 years before delivering babies, and at the end of that training, perhaps only 1-2 years is actually spent attending deliveries, which brings the CNM or CPM’s training in childbirth a lot closer to ours. Knowledge of ovarian cancer staging, or the ability to perform a laparoscopic hysterectomy does not make me a better caregiver for the patient in labor, and yet the midwife’s focus on facilitating the normal birthing process in healthy women does lessen their chance of adverse events, and this mode of care should at the very least be an option for women.