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Hey, Doc, There's a Brain Attached to That Uterus

In, “Listen up, doctors: Here’s how to talk to your patients,” Salon contributor Mary Elizabeth Williams, offers some blunt advice to doctors about their bedside manners. Williams is coming from the perspective of someone who has recently navigated “Cancer Town” but her observations can easily be applied to Obstetric City:

“…what is far too often lost in our grueling, impersonal and cost-driven healthcare system is the basic fact that a human being in the chaotic and scary world of injury or illness deserves sensitivity and compassion. That a shivering person in a paper dress deserves dignity.”

A pregnant woman in labor is often that person shivering in a paper dress. And she deserves dignity: Surveys indicate that a positive birth experience is based less on how it was done (epidural, no epidural, etc) and more on whether mom was treated with respect at a time of intense vulnerability. We also know that the fight-or-flight hormone can inhibit the labor hormone oxytocin. Don’t even get me started on the benefits of good mental health for a new mom and new baby.

I’ve encountered doctors who absolutely get this. They explain what’s going on in an honest and balanced way. They ask mom how she is doing and listen to her and watch her and respect what she’s feeling whether it’s fear, hope or disappointment. When possible, she will tell the mother when she’s going to do something to her body before she does it. She won’t say, “I’m sweeping your membranes,” but, “I’d like to sweep your membranes, this is what it is, why we do it, what it feels like.”  She will tell mom what her choices are and be clear about the benefits and risks of various procedures.

For example, she would not say an epidural has no risks. She would not say synthetic pitocin is exactly the same as oxytocin, the hormone your pituitary gland releases. These are things I’ve heard in the labor and delivery room out of the mouths of doctors and they are not true.  This is not to say that an epidural has lots of horrible risks or that pitocin is not very similar to the hormone produced by your body. These medications may be the perfect choice for the mom in her labor at that moment. But let’s be more specific.

Here are three tips Williams has for the doctors who are not getting it (read her other ones here):

1. “Take your hand off the goddamn doorknob already.”

“Conveying information while you’re walking out the door may work if you’re a character on ‘Revenge,’ but it’s a crummy way to have a conversation with a person about his or her health,” she writes.

In order to cover the cost of massive insurance premiums, ob/gyns need to see too many patients in a day. To be fair, the system exerts a ton of pressure on these doctors. Still, there are physicians who can whip through a perfunctory check up in an efficient and reassuring way, answering vital questions and knowing when to slow down. And then there are others who are short, dismissive and speak in a way that actively discourages inquiry and openness. If your provider is always already out the door, get another one, or consider a midwife– midwives are trained to “treat the whole woman” and therefore spend more time with a woman prenatally and in labor.

2. “Remember that this random collection of faulty parts is a person.”

Williams: “Early in my treatment, I had a doctor on my clinical trial bring in a team of research fellows to look at ‘the tumor.’ That the tumor had a sentient human host seemed utterly irrelevant to him. And when my friend Ariel had a miscarriage, the sonogram technician confirmed it by briskly announcing, ‘Yup, no heartbeat,’ and walking out of the room. This is what is known, in medical terms, as a nightmare.”

I have too often seen doctors literally talk over the laboring mom as if she were not there at all. It’s not a matter of being cheery or “nice” (though that helps) but simply recognizing that somewhere above that aching, stretching uterus is a brain and a pair of ears.

Williams is particularly angry on this point and if you’ve ever been in her situation you are too:

“You may deal in tumors and miscarriages in a revolving door of horrible things all day long, but your patients live in a very different world. Their tumors and miscarriages and dying parents are pretty important to them. The moment they become trivial to you, seriously rethink why you ever wanted to do this for a living.”

3. “Consider that the patient is telling you something the charts don’t.”

Since electronic fetal monitors have replaced human labor support in hospitals, we now have hospital staff checking “the tracings” more than the actual laboring woman. These tracings can be valuable, but they don’t tell the whole story.

I once asked residents in triage to get a first time mom into a delivery room because her labor was picking up fast. They condescendingly explained that a first time labor takes a long time, take a walk.

They would not even call her personal doctor to come look at her. If they had, the doctor would have seen amniotic fluid pooling around the feet of a moaning, actively laboring woman who was progressing extremely fast. Finally I convinced a doctor to come and check her and lo, she had gone from 2- 6 cm dilation in under couple of hours. This is not a common occurrence but here it was, happening.

If the residents had really seen her (heard her, smelled her, talked to her) they would have noticed it, too.

***

The sociologist Barbara Katz Rothman has written, “the profession of medicine would have us see a dichotomy between safety and emotional needs.” But just to turn this topic on its side a little:  I’ve often heard people say, “She’s got no bedside manner, but that kind of person is definitely going to deliver a healthy baby.” I wonder if, on some level, we– the healthcare consumers– aren’t suspicious of nice care-providers? Maybe we think someone who is decent and kind will be too big of a softy to deal with a true medical emergency, that emotions cloud logic. I’d like to hear your comments on this. The more I live and learn I find that asshole care-providers do not deliver superior care.

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