Male obstetricians & gynaes

[RevoltingPeasant]

This is just a musing, really.

What do you think about men who work in obstetrics & gynaecology? In my undergraduate women's studies days, I would've bristled and said, 'What? Why does it matter whether the dr is a man?'

But since joining MN I have read so much about assault during childbirth, rude and dismissive HCPs, and it does seem that most of these comments are about male doctors. Recently I have started to wonder if bad treatment of maternity patients is related to the still-preponderance of male HCPs.

Would we be better off with mostly female consultants in this area? Would you go to a hospital/ clinic entirely staffed by women? Do you think women drs listen to women more?

Or is this a non-issue?

Gynae is an odd area. The best gynaecologist I've seen was a late middle-aged, upper middle class man with a booming voice and a close to the bone sense of humour - that was more due to him listening to and acting on my concerns, and discussing my problems in such a way that didn't make me feel stupid.

I have found all physical procedures to be unpleasant in one way or another. Those performed by doctors, regardless of gender, tended to be worse, while those actually carried about by nurses were much less painful and degrading. All of the nurses were female, but it may have been down to their increased experience of hands-on patient "handling". It's an interesting one.

Long ago and far away, I worked for a time as a gynae nurse. Initially, I, too was surprised that there wasn't a significantly different approach taken by male and female gynae/obs surgeons and that even women nurses in the clinical area weren't particularly more sympathetic to the conditions patients were experiencing.

I wondered then, and still wonder, if senior women doctors (as with women in senior positions in other fields,) they experience or feel in themselves a pressure to "not appear too female," as overall, they are a minority within their discipline. For a gynae/obs practitioner, showing too much empathy for patients could be equated with not being "professional enough," and in my view, women doctors are judged more harshly by other doctors within what is a very male-led, male-dominated field.

KRITIQ I think that is more the kind of thing I was groping towards. Clumsily expressed on my part!! More the idea that the profession is so male-dominated that it breeds - possibly - certain kinds of attitudes towards women patients.

What made me begin to think this was a rather upsetting thread a month or two since on Childbirth on non-consensual manual dilation of the cervix during labour. During it, someone posted a thread to an article from a peer-reviewed journal which referred to women who refused VEs in labour as 'highly hysterical' and remarked approvingly that even when drs hurt women, they largely remained 'compliant'.

It made me really feel sick and tbh - I am sure this makes me A Bad Feminist, but - my first thought was 'A woman would never have written that'. The article was admittedly from the late 70s but I wondered how far that culture remains entrenched and whether more female involvement would change it.

exotic thanks for answering - I suppose I was thinking of stats like the ones I believe are available from NICE - don't have to time to Google now as on short lunch break - showing that labouring mothers with female birth partners experience significantly lower rates of intervention. I was wondering if it would be possible to organise a study whereby intervention rates under the care of female v male consultants and midwives, e.g., was compared? This may not be desirable but I think it would be methodologically possible!

I wonder if that is because male birth partners tend to be the father though, and they either can't cope with seeing their partner in pain, or are frightened about the outcome for the mother or baby? If a female birth partner has some experience of childbirth, she might know more about what pain seems 'normal'?

The sex of the doctor or midwife is irrelevant to me too, I really couldn't care as long as they are good at their job and explain things.
I do however think that women should have the choice.
I was very happy to have my DH as a birth partner, I really wouldn't want a female birth partner.
It is all down to personal choice.

Yep, I think fundamentally it is down to being able to choose, particularly in relation to reproductive health care. There may be reasons men would prefer a male urologist as well.

I do think though there is the separate issue which isn't just unique to medicine - the impact of a "male culture" on practice, both for men and women doctors and of course on patients ultimately.

Yes KRITIQ, urology is another good example as well (and hi exotic!).

FWIW urology is the area I have had most experience with recently. I would really have liked a female urologist; I didn't realise until after an op recently that the surgeon was going to insert something into my urethra (and therefore be taking my knickers off whilst I was unconscious) and I also had a male surgeon explain a cystoscopy to me by saying 'I would find it quite embarrassing' . I didn't get a choice of dr: all the consultants who work in that specialty are male, so are all the registrars with one exception.

But yes, I think I was thinking less really of the sex of individual practitioners and more of the cultural climate, as it were. And that this issue might become particularly acute in maternity situations, which involve vulnerable, frightened women having to make split-second decisions and endure invasive procedures under time pressure - not an ordinary 'controlled' medical situation. Tis all!

It is an issue. There's plenty of criticism in feminism about the medical establishment and in particular men's forays into gynaecology and obstetrics.

NICE guidelines recognise that a female birth partner results in better outcomes. Tis true

Even Michel Odent says that men should stay out of the delivery room:

www.guardian.co.uk/lifeandstyle/2009/oct/18/men-birth-labour-baby

Even Michel Odent says that men should stay out of the delivery room:

All he can possibly say is some men should stay out. It is utterly ridiculous to think that all men have the same reaction. Personally I can't think of anyone better than my DH. I wouldn't like a woman who wanted me to have birth plans etc and had opinions on how it should go.

It says a low profile woman not one that wants you to have birth plans or tell you what to do. That's a rather different thing.

They would have to be very low profile-and I doubt if many could-therefore DH muddling along with me was much better-for me.

A nice, approachable, friendly manner is more important than gender.

I refuse to see male gps anymore and preferrably no males at all regarding my mental health problems.

The ones I have seen have been dismissive, patronising and at one point refused to do anything as 'he didn't know what to do' (I was at crisis point which he admitted) and wait till my normal (female) doctor returned and phone the samaritans if it got really bad (I wasn't suicidal). Everything is questionned and then I am told I am wrong or it didn't happen even when they insist on talking to my dh who backs me up (who they have called in as clearly I can't be trusted) because clearly I have tricked him (despite him witnessing enough of it). I have been told that they cannot believe a single word I say as I have a history of paranoid delusions (which is noted that I recognise as delusions while they are happening). And just other complete dismissing of anything I say because clearly I Cannot Be Trusted on anything, ever.

I don't think all men automatically are terrible when it comes to mental health problems but because of my experiences I won't take the risk anymore. If I had relied on the men I have seen over the years I would never have received a diagnosis or any treatment. I was dismissed as just another depressed young mother (which apparently pretty much disqualifies you from any treatment) despite not being depressed. This happened over years and various different male doctors and different doctors surgeries.

And yes I do believe they would have treated a man differently.

Having been sexually assaulted by a male obs/gyn whilst on work experience aged 16, I am rather wary of being in any position of vulnerability with a male doctor. I'm sure the vast majority are fantastic but I do wonder whether the power that they have over women specifically in obs/gynae attracts some nasty types - certainly the most unpleasant surgeon I've ever worked with is a gynaecologist.

I had a male MW for part of my induction with DD.

I tried SO hard to be all liberal, and yes fine, get on with it etc. When it came to it, I couldn't do it. I had to ask for a female MW.

Later that same day, a consultant came in, who was also male. There was no choice, apparently. He did not take no for an answer. Basic forced VE.

Fine, men can be in these roles, no problem. But while rates of rape and abuse of women are as high as they are, I would venture a guess that there are more women than me who have a problem with strange men poking at them. It has absolutely fuck all to do with a nice, rational, egalitarian thought process - what I experienced was a gut reaction, a massive fight or flight response and total panic. Exactly what you need at 42 weeks pg. We need to be allowed to choose.

I was examined in labour by a ham fisted bitch of a female midwife but I don't imagine she was representative of her profession or sex. My male surgeon and male midwife in second delivery were amazing. In fact it was only after I had been in recovery for about an hour that I noticed he was a man.

I think I would struggle massively with a male MW, with my other pregnancies I've spent a huge amount of time in the bath absolutely stark naked, it's not so bad having another woman seeing me like that but I would hate a strange man seeing me naked. I'd feel very self concious and awkward.

I think that there is pressure on women to be good sports about it, rather then being honest with our feelings. We're not supposed to upset other people just for our own comfort.

Crunchy that is interesting. When I woke up from my urology op and realised that I had been catheterised by the surgeon, I had this moment of 'Oh'

Of course I know that he was just doing his job - but yeah, it felt like a violation. I'm sorry for your experience, but it is interesting to see what you wrote about forced VEs........

I think you have hit it spot on KRITIQ. I speak as a young female consultant though not in obs/gynae. The medical profession is amazingly conservative, old fashioned and sexist in its attitude to itself and other HCP. It is now I think rather better in its treatment of patients but if your attitude to your colleagues is off then this will have an impact on patient care.

The overwhelming majority of medical students are now women but certain specialities and the senior posts are still male dominated. It wasn't until I qualified that I realised the full impact of how sexist we are as a profession. As a medical student I was completely oblivious that there was still such a thing as discrimination on the basis of gender. There were a few hints that I didn't take too much notice of such as the nurse at my GP practice placement trying to encourage me to come and work with them as one of their 'lady doctors' or my realisation that every orthopaedic firm in any hospital I went to wore a distinct uniform depending on their place in the heirarchy (PRHO: non-uniform and white coat, SHO: cream chinos, blue shirt, Reg: as SHO but with blazer, Consultant: pin-stripe suit. All men bar one female reg who wore pink wellies in theatre).

When I qualified I was met with comments from my senior colleagues from all sides about which job was or was not suitable for a woman. Tutors told me about how 'when you get to 40 you'll be unhappy you haven't had children' and one female surgeon I knew was told by her tutor that the only possible surgical job for women was breast surgery as you can't combine anything else with having children. Another medical director spoke in a meeting I was at about his frustration that every time he appointed a female registrar they went off on maternity leave and he didn't want any more candidates who would go off sick or have babies. These are only a few examples. Time spent doing things other than following a very narrow career focused ladder was frowned on. It was thought you lacked commitment to your career.

Senior jobs still go on the basis not just of your ability but also whether you'll fit in or not. Whilst there are some good reasons to why the ability to get on with your colleagues is obviously important, this can become a problem when there is such a macho attitude to how we should work, what we should be like and where difference is seen as a bad thing.

My feeling is that one of the key problems is that it is simply not expected in medicine that men will take any significant time off or work part time to look after their children. Therefore to look like a competitive 'serious' candidate in some specialities as a woman, it is best to either have your children in your annual leave, not to have children or to wait until you are already appointed as a consultant before getting pregnant. Fit in with typical male stereotypes or stay out and become a 'lady doctor'. When the most common 'caring' role, ie as a parent is not valued as an important role for men and women then a profession as a whole is always going to struggle with taking a caring attitude with others.

Deep breath and rant over.

RevoltingPeasant

" I am interested as to why so being sued is such a greater risk for ob/ gyns. Do you think it's because it's an emotive area of medicine or because care genuinely is not so good?"

The risk of being sued (and therefore extremely expensive insurance) is more to do with the size of compensation claims rather than their number. The reason is that in O+G when something goes wrong that can often mean that a baby has been affected, and the compensation has to reflect the increased needs of the baby across their lifespan, so payments can be in the millions.

There's a big thread on male MW in AIBU. Nearly every other poster thinks the gender issue is irrelevant. Post after post talking about how not only are male MW OK, they are better than female ones.

And obviously anyone with an issue is sexist/ prudish/ whatever.

Sorry if this is bad form (talking about another thread) but it's an interesting counterpoint.

Nyac Michael Odent is a misogynistic twit in my book, and I don't see how his opinion (for it is opinion, not evidence based fact) should carry any more weight than anyone else's.

I want well-trained HCPs who are good at their job, and don't care about their sex or gender. Or how many children they had themselves by what delivery method. Their personal experiences are anecdote, what counts is their professional experience. Any gender/sex based working ban is ridiculous.