Should we be angry at obstetricians for mocking Meghan Markle?

A surgeon in gown and mask.

With the wonderful news of the royal baby (congrats to Meghan and Harry by the way!), there was a news story I came across about how Meghan was openly mocked by Dr Timothy Draycott at a conference of obstetricians. He said “Meghan Markle has decided she’s going to have a doula and a willow tree – let’s see how that goes… She’s 37, first birth. I don’t know. We’ll have to see.”

And the thing is… it’s easy to feel angered and outraged at the clear lack of faith in normal birth, the misogyny, indeed, the sheer lack of respect.

HOWEVER, why is it that obstetricians generally have this lack of faith? Why do many seem to believe that normal birth is a mythical event, only found in fairy tales? Is it because they are terrible, awful human beings? Minions of the patriarchy out there to beat women down?

NO!

It’s simply because you have to see normal birth to believe it. We live in a society that has portrayed birth as a scary, medicalised, dangerous event. If you never have the life-changing experience of seeing birth happen physiologically, then it’s no wonder you don’t believe it can happen. You were brought up in a society that almost denies its very existence and judging obstetricians for the very same thing is unfair and unprogressive.

Now, put yourself in the shoes of an obstetrician. At Medical School you spent some time in maternity. You saw clinics and ward rounds and, yes, a few births. But most of those births were likely to have been c-sections and instrumental births. A number of those births would have been ‘vaginal births’ but most of those would have occurred after an induction or with an epidural or in lithotomy position. None of this is truly representative of physiological birth. And even if you did get to see one or two physiological births, these are so far outweighed by the medicalised births, that they almost become null and void.

Your next step on the ladder is as a junior doctor but now there’s no time for observing midwives on the Birthing Unit or at home. You’ve got a job to do, you join the rest of the team on ward rounds, you document the discussions had, you write up prescriptions and discharge letters and take part in some of the clinical care. There is no time whatsoever for observing physiological birth, the system simply doesn’t allow it.

As you progress in your career, you quickly learn how to apply forceps to a baby’s head, you learn how to perform an episiotomy and suture it back together, you learn about interpreting a CTG and what doses of medications to give. Is any of this focussed on physiological birth? No. And not because you don’t want it to be, not because you don’t want to normalise things as much as possible but because the politics of the system and the chronic understaffing means that you simply can’t.

Perhaps, one day you are counselling a woman or birthing person about induction for post-dates pregnancy. They decline the induction and go on to have straightforward birth at home at 42+3 weeks. You hear nothing about it and never know what happened. The following week, the same thing, but this time the baby is born with meconium aspiration- you get notified about it and have to submit a statement about your discussion. The woman from the week before is forgotten about, but the woman who’s baby becomes unwell- she is in the forefront of your mind. So, what happens next time you go to counsel someone about induction? How can you honestly have an unbiased discussion? It’s impossible, you’re a human being, you have emotions and you care about the people you are looking after.

Finally, you make it to consultant level. And by now you don’t even get involved in many straightforward instrumental births, by now you are only attending the really complicated births. And there is no doubt- your actions have saved the lives of many mums and babies. So, any memories from your days as a medical student are long gone. You have a whole career behind you, a whole host of memories of birth going wrong, of medically assisting mothers to birth their children. A memory bank of proof that babies aren’t born without medical intervention. True, physiological birth is a myth to you. It simply cannot exist in your reality.

I get it. I thoroughly understand why obstetricians don’t believe in normal birth. If you don’t see it, you can’t believe it. This can become true of anyone. A mother that hasn’t experienced physiological birth can become blind to its existence. Midwives that only work on the Labour Ward and take part in medicalised births can forget about physiological birth. It is human nature and to become angry in anyway at anyone for merely being human is simply outrageous.

So, should we be mad at obstetricians? No, they work bloody hard, day in and day out, doing their best within a system set up to see them fail. Should we be angry that they have lived in a society and worked in a system that shields them from physiological birth? Yes. We should be angry at society and angry at the system. It’s these things that have led to the crisis in birth we see today, it’s not the individual men and women desperately trying to make birth better.

As Michel Odent says, we are at the edge of the precipice when it comes to birth. We can choose to have these difficult conversations, we can choose to change the way things are… or we can carry on blindly until we reach the point of no return. 

I want to take this opportunity to ask- what do you think we should do about this situation? Do you think we should campaign for better training in physiological birth? Do you think there should allocated time for obstetricians to spend in midwife-led units observing physiological birth? Do you think there should be better decision making tools out there (like this one) that can help when it comes to difficult conversations? Obstetricians- what do you think? What would you like to see change? Let’s really begin to set the wheels in motion, let’s really begin to be a part of the change- together.

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