Editor’s note: This op-ed is by Katharine Hikel, MD, a member of the Vermont Birth Network and a contributing editor for Vermont Woman.
Women’s health care reform is sadly neglected in the larger reform debate, even though women are major players in the market. The single biggest obstacle to progress is never addressed: the fact that men are still in charge.
You could say it’s the 900-pound gorilla in the delivery room.
“Obstetrics and gynecology,” as the guys have named it, is a surgical specialty. Most OBGYN programs are chaired by men. Even though most OBGYN trainees are women, their practice styles retain the flavor of their training. They’ve drunk the Kool-Aid. They’re trained to perform procedures, not to prevent them.
One index of poor performance in maternity care is a high surgical-birth (cesarean) rate. Fletcher Allen Health Care’s is 27 percent — though the hospital posts a misleading “primary” (first pregnancy only) cesarean rate of 14 percent.
The acting CEO of FAHC is John Brumsted, an OBGYN.
Vermont’s overall surgical-birth rate is 27 percent — up from 16 percent in 1996. The World Health Organization says that the surgical-birth rate should be no higher than 15 percent.
Vermont alone produces 30-plus new obstetrician-gynecologists every 10 years.
How do you get to be a surgeon? Practice, practice, practice. The dozen or more residents in the UVM program expect to perform as many surgical births as possible in the four years of their training. Surely they are not interested in reducing the number of practice cesareans.
They enter the market with high debt loads and high income expectations. The oversupply of OBGYNs is the real reason why Vermont, and the nation’s, surgical-birth rates are so high; why hysterectomy is the second most common major procedure for women; and why urogynecology is now the hottest surgical subspecialty – even as the FDA has issued alerts about one of its best-sellers, the “sling” device for urinary problems.
We won’t even go into the overuse problem with procedures like the “vaginal probe” ultrasound. According to BISCHA, Vermont hospitals perform nearly 4,000 ultrasounds on a pregnant population of about 5,200. The average cost is $600 a pop. There are no long-term outcome studies on the effects of high-frequency sonograms on children, and little evidence that the widespread use of prenatal ultrasound has improved outcomes in maternity care.
Many women now expect sonograms throughout pregnancy, even though they hate the “vaginal probe” part of the deal. They post the images on their refrigerators and Facebook pages. But it wasn’t the patients who drove the market for this profitable procedure.
Since the advent of “actively managed” pregnancy and childbirth, with ultrasound, epidurals, Pitocin and skyrocketing rates of surgical birth, we’ve also seen an increase in childhood brain disorders: autism spectrum and attention-deficit problems. Obstetricians will say that there are no studies showing that autism spectrum disorder and ADD/ADHD are caused by any procedures or drugs used in pregnancy and birth. They certainly aren’t doing the research. Perhaps they should.
The prevailing myth is that there aren’t enough obstetricians. In fact, the guys of OBGYN are fighting to take over as “primary care” providers. That’s nonsense. They are surgical specialists. We need fewer of them, not more.
What we need is OBGYN reform.
UVM OBGYN Roger Young is the Vermont section chief of ACOG, the American Congress of Obstetricians and Gynecologists – the political-action trade group of OBGYNs. Three out of four Vermont ACOG officers are men.
At the University of Vermont, Dr. Mark Phillippe is the chair of OBGYN — as he was during the hospital’s recent attempt to close its beloved midwifery service. Women took to the streets to prevent that move.
Even though women’s preference for out-of-hospital birth is rising, nationally and in Vermont, support for home-birthing women has vanished under Dr. Phillippe’s regime. Instead of a “back-up” plan with a provider she knows, a laboring woman who needs to transfer from home now gets a random OB trainee, whom she’s never met, and who has no prior knowledge of the course of her pregnancy. So much for continuity of care.
In more enlightened areas, women and their midwives can make “transport” agreements with family docs or OBs, so if transfer to hospital is needed, a woman will be met by someone familiar to her and to her midwife.
In some places, maternity staff will write the names of women who are laboring at home on their white board, so that if someone needs transport, they’re ready to receive her. Otherwise,
the hospital sends a “Welcome Baby” card.
When asked about this, Dr. Phillippe said, “Oh, we couldn’t do that here.”
Vermont is one of two New England states that still lack a freestanding birth center, largely due to decades of opposition by the guys of OBGYN.
Dr. Phillippe was recently named to the Fletcher Allen board of trustees.
These docs are personally very nice guys whom we know and love. But they’re terribly misguided and mis-trained. They’re doctor-centered, not patient-centered. They now see us as a market to be experimented on, and exploited, not a population to be served.
It’s kind of like having the Qadaffis in charge of civil rights. Is it time for regime change?
And the guys in charge still ignore The Most Important Question In Life: What do women want?
We want more midwives and family docs — and fewer surgeons — providing our care. We want a voice in designing that care. We want better outcomes. We want more relationships — and less corporate hype — from our providers. We want more cooperation — and fewer turf wars — among our practitioners.
And we want more women in charge.
