My clinic sees a lot of prenatal patients, especially this year after another local prenatal clinic closed and most of their patients transferred care to us. The other practice was staffed with women providers, whereas our practice is staffed with both men and women (four FPs, 2 midwives). As I meet more of the expectant mothers from the other practice, I find myself being asked more often if one of the midwives or I can attend a birth, because the patient prefers to have a woman delivery her baby.
I used to be quite sympathetic with this request. Like many women, I have had both good and bad experiences with GYN exams and I feel more comfortable being examined by another woman. I suspect there is a degree of understanding about the female pelvic anatomy that can only be understood by healthcare providers who share the same anatomy. I am also aware of some strong cultural traditions prohibiting a man from attending to a woman's OB/GYN care--Muslims, for example--but most of our requests come from US born Caucasian women.
This month, because we have gone from an average 20 birth per month to an expected 40 births in July alone, I have had to rethink my position on these requests. Certainly, a woman may ask the Labor & Delivery nurses to call me or one of the midwives when she arrives in labor, but I am careful not to make any promises. In Birth Story #437 I mentioned the pitfalls of committing to a woman's birth, especially during a busy month such as we are having now. I do not believe a woman is well-served by a provider--female or not--who is exhausted from having been up the night before. Furthermore, I warn them that the two midwives spend half the week about 55 miles south of Rural, in the warmer communities of Very Rural, CA. This additional distance makes it even harder for them to contemplate attending a birth when they are not on call.
Other than overtaxing female birth attendants, more and more I realize that this request does a disservice to the men in our practice. All are family doctors and very supportive of minimal interventions in labor. Most women who initially preferred a woman but ended up having one of the men attend them are usually very happy with the care they've received from their XY attendant. When I think about the OB/GYN attendings I have worked with, I have to say I would rather have the men attend me than the women, although this is obviously based on a limited sample.
Finally, since living in Rural I have found there are other reasons for committing to a woman's birth than the desire to maintain a woman-to-woman connection. We see most of the Spanish-speaking prenatal patients in the region, because none of the OB/GYNs speak Spanish and two of our providers do. I have often opted to labor with a Spanish-speaker on my day off or post-call, because very few of the L&D nurses speak Spanish and Spanish-speaking doulas are in short supply. I feel my presence at these women's births is needed much more than at the birth of a woman who can advocate for herself without barriers of language and culture tto get in the way. I also try to be at the birth of women whose prenatal course was complicated in some way--gestational diabetes or hypertension, preeclampsia--because I feel comfortable managing those conditions and can try to optimize the birth experience for those women, despite the medical interventions necessary to prevent complications.
Ultimately this is a variation on a common theme: Not enough healthcare providers to meet everyone's needs, much less everyone's wants. When the month is busy like this one is, I remind myself that I must first take care of all patients safely, then provide extra support for those women whose individual cases need my particular set of skills. Only then may I consider the very understandable but less urgent preference for a woman provider. I only wish there were a good way to communicate this to women, without sounding dismissive of their concerns.