Friday, August 04, 2006


Homebirth advocates routinely vilify obstetricians and then express surprise that obstetricians do not want to back up DEMs. DEMs would do well to think about how other professionals behave toward one another, and ask themselves if their own behavior is even remotely professional.

Obstetricians have professional relationships with each other, with anesthesiologists, with neonatologists, with CNMs and with nurses. Whatever they may privately think about how the anesthesiologists and neonatalogists practice at their own institutions, they address controversies through professional channels or they keep their opinions to themselves. An obstetrician's practice can be dramatically affected by the way anesthesia is administered in their hospital. Yet even if they don't approve, they do not publicly vilify the anesthesiologists. That would be counterproductive for their patients and themselves. They must work together for the good of the patients.

Obstetricians do not routinely back each other up. They form groups of obstetricians who rely on common philosphies and mutual respect for the members' professional skills. No obstetrician would willingly agree to cover for another obstetrician whose judgement was questionable.

So why on earth should DEMs demand that obstetricians cover them? In the first place, DEMs behavior is completely unprofessional. They routinely vilify obstetricians. They attempt to deny their professional achievements. They question their motivations. They resort to personal insults. If they will not act like professionals, no one is going to take them seriously. DEMs need to look in the mirror for the primary reason why they cannot obtain back up coverage.

Second, no obstetrician agrees to cover another unless he feels reasonably sure that the other obstetrician has good judgment and will not be routinely handing off disasters. So individual DEMs should expect the same treatment. They need to be able to demonstrate their professional competence through mutually agreed upon methods before anyone will agree to share care with them.

DEMs simply cannot deliver safe care without obstetricians. They would do well to recognize that reality and behave accordingly, in other words, like the medical professionals they claim to be.


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