Stop Saying That: Care Provider Generalizations Edition

Stop Saying That: Care Provider Generalizations Edition

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newborn 5My guess is that most of you have heard one or more of the following statements before:

 

Those OBs are just looking for ways to do a cesarean–they’re surgeons, so of course they all want to have your baby be born surgically!

Midwives always do what is best for moms and babies, without fail: they all care more about their patients or clients than physicians do.

All CPMs are unsafe: instead of working to improve CPM education requirements and standards, we should just ban the whole lot of them.

OBs are the only safe birth attendants.

CNMs are all just “medwives”: they’re OBs in disguise and aren’t really practicing the midwifery model of care.

All midwives really want is for you to have a natural birth…in the water…and at home!

All OBs want is to induce you by 38 weeks or schedule your cesarean before their golf game!

Get an OB/GYN! Midwives are terrible!

Hire a midwife! OB/GYNs are terrible!

 

For the love of all that is nuanced and rational:

STOP SAYING THAT!

 

There’s a saying that goes something like, “When you assume, it makes an ass out of you and me.” I like this saying a lot, both because I enjoy a good pun that involves calling someone an ass and because I think that careless assumptions do highlight people’s ass-ish-ness.

But sweeping and/or hasty generalizations have this same effect, I think. In fact, I’d like to coin my own relevant saying regarding these mistakes in rationality:

“Hasty and sweeping generalizations make a general dumbass out of you. But not me, because I try not to make hasty and sweeping generalizations. You dumbass.”

Okay, okay, so maybe I’m a bit harsh when it comes to this matter. And maybe I should be a bit more forthcoming about including myself among the ranks of the dumbasses, for there have certainly been times where I’ve been guilty of skating away on a river of generalizations.

Nonetheless, I think that generalizations about care providers do an especially large disservice to women, particularly to those who are trying to research their options and find a care provider who best suits their individual needs and circumstances. Sweeping generalizations do nothing but obscure the ability to make an informed decision. And in these sorts of scenarios, they obliterate the uniqueness of each care provider, and they potentially set women out on a path that will have them choosing a care provider who is patently not right for them.

For example, what might the aforementioned generalizations be obscuring?

  • In many communities, there are OB/GYNs who have lower-than-average cesarean rates. They might be the ones who support VBACs, or they might be the ones who have never made a habit of scheduling elective births before 39 weeks, and they might even be the ones who attend waterbirths in their hospitals! And remember: even the cesarean rates in a particular state or hospital only describe the rates for a population of practicing OB/GYNs: they do not necessarily indicate how each individual OB/GYN practices.
  • Though midwife-led care has been shown to confer numerous benefits to childbearing women, this does not mean that every midwife practices in a uniform fashion. What’s more, this research in no way indicates that all midwives “care more” about their patients or clients than all OB/GYNs do. There are plenty of midwives–at home and in hospitals–who are poorly suited for their profession, just as there are plenty of OB/GYNs who might have done better to choose a different field of medicine. But more than that–and on a more “touchy feely” level–there are plenty of OB/GYNs who care deeply for their patients and who are wholeheartedly committed to healthy birth, in every sense of the term.
  • Though education requirements and standards for Certified Professional Midwives (CPMs) might vary widely, this does not necessarily mean that CPMs are a “bad fit” for every childbearing woman, nor does it necessitate that every or even most CPMs are poorly educated to attend births.
  • There are subsets of OB/GYNs and midwives who might practice in ways that some would deem to be “unsafe.” This does not entail that all physicians or midwives are unsafe birth attendants.
  • The initials after a person’s name by themselves do nothing to indicate exactly how that care provider practices. Some midwives practice in a way that some might consider to be over-medicalized, especially for low-risk women. But some physicians also practice in a way that either a) is aligned with some of the philosophy behind midwife-led care, or b) defers to midwifery care for lower-risk childbearing women.
  • Not all midwives who attend births at home think that every woman should have a home birth. Not all midwives who practice in hospitals think that women should give birth without epidurals. Believe it or not, many midwives even describe epidurals as wonderful tools for women who find that they need them during labor.
  • Many OB/GYNs are not out to trick women into scheduling their births before their babies are ready. In fact, in many communities, women are able to find OB/GYNs who routinely avoid scheduled births (barring medical indication), who have low cesarean rates, and/or who are willing to collaborate with their patients on a care plan that best suits their patient’s particular needs and circumstances.

But a woman might not know any of these things about the care providers in her community if she just rode the wave of generalizations that tend to flood conversations about pregnancy and childbirth.

So the next time you’re tempted to generalize about certain types of maternity care providers, try to bring some sunshine-y disclaimers and nuance and qualifiers to your statements.

  • Suggest to others that some OB/GYNs or midwives tend to practice in x/y/z fashion, but you can only know for sure if you interview specific care providers and ask knowledgeable people in your community about those care providers’ practice patterns.
  • Help women to formulate questions to ask when interviewing care providers. And don’t just hand over questions that would help them find your favorite care provider: help women ask questions that get them the answers that are best suited to their needs.
  • Remember that not all OBs are bad/good, and not all midwives are bad/good: some have skills and practice patterns that will make them better-suited for some women.

Just don’t make a hasty or sweeping generalization about maternity care providers because, well, you know how the saying goes…



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3 Comments

  1. Anna
    Anna01-29-2013

    Thanks for this post! As much as I try to avoid MAKING the generalizations, I find that I do end up buying into them, at least subconsciously, which means coming to every situation with preconceived notions about how it’s going to go that may end up making problems and conflicts where they just don’t need to be. I think we can all use the reminder that lots of people have positive birth experiences in all sorts of circumstances, with all sorts of care.

  2. Katie
    Katie01-29-2013

    Thank you for yet another brilliant post in a brilliant series!

  3. rebel
    rebel04-16-2013

    I could add, don’t assume that all doctors who attend births are OBs. There are family physicians who provide obstetrical care – more in some areas of the country than others, sure, but who often are ignored in the “midwife or OB” discussions.

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