Sunday, August 06, 2006


I am struck by the inability of DEMs and their advocates to understand anyone's point of view except their own. This is quite notable in their unwillingness to follow established rules of professionalism; in fact, it is most clearly illustrated by their bewilderment that they should even be subjected to the same rules as everyone else.

One area of this deficiency is especially glaring. That's because it unites almost all practitioners who care for women in childbirth. It also is a red flag that DEMs and their supporters have an incredibly narrow knowledge base, a knowledge base that is so limited that it calls into question the ability of DEMs to be professional partners to anyone in the field. I am referring to the fact that DEMs apparently cannot understand the heavy weight of responsibility that is carried by most doctors, CNMs and nurses who care for women in childbirth.

One of the luxuries of having deficient knowledge about the reality of childbirth is that you don't have to worry. If you are deluded into thinking that nothing is going to go wrong because "childbirth is natural", there is very little reason to feel the weight of responsibility for the lives entrusted into your hands.

Unfortunately, obstetricians to don't have the luxury of living in a dream world when it comes to the risks and complications of childbirth. Each obstetrician knows that she has responsibility for the lives of two patients in her hands when she cares for a pregnant woman. She can't dump off her patient in the local emergency room and feel confident that someone with much more knowledge and skill will fix the problem that the DEM created, or that she didn't originally recognize or that she has no ability to treat.

Most DEMs have such limited experience that they have never had to tell a mother that her baby is dead. It is excruciating for any obstetrician, even if she has the comfort of knowing that she did all she could. It is far worse, if the obstetrician is plagued by doubt that perhaps the baby could have been saved by earlier action.

Even worse, if such a thing is possible, is losing a mother. I have lost two patients to non-obstetric complications that were completely unforeseen. Both were healthy young women with no risks factors of any kind.

Obstetricians are acutely conscious that an apparently normal situation can turn deadly in a relatively short time. It makes them especially careful about whom they choose to work with. They only want trusted colleagues to care for their patients, and they only want to work with colleagues they can trust not to dump life threatening emergencies into their laps.

You may agree with this point of view, or you may disagree with it. Either way, you cannot understand what obstetricians do and why they do it, without understanding the existence of this sense of responsibility and the weight of it on every obstetrician's shoulders.

That's why DEMs blithe denunciations of obstetricians mark them as limited in knowledge AND as insensitive to others. Ascribing the high C-section rate to greed, or to "not understanding normal birth", as DEMs and their advocates often do, marks DEMs as completely unacceptable candidates for collaboration.


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