TOUGH LOVE: A Valentine for the Guys of OBGYN

By Katharine Hikel, MD, Contributing Editor, Vermont Woman Newspaper

I’m having flashbacks.

I’m in an operating room at UVM Medical Center. A woman, anesthetized, out cold, lies on her back on the table, legs apart, feet strapped into metal stirrups. A surgeon (in my experience, invariably a man) invites a lineup of residents and medical students (in my experience, invariably men) - half a dozen or so - to take turns practicing vaginal exams on her, to 'feel the pathology.'

That form of sexual assault was, and is, practiced at teaching hospitals everywhere. It was the perfect situation for inexperienced, ham-handed, or predatory guys. They had support and approval. There was no feedback from the patient. They did their thing, then got out of the way for the next guy.

The words ‘rape culture on college campuses’ brought these memories back, with this question: is anyone looking at the culture of medical schools, with regard to women patients in obstetrics and gynecology departments?

I mentioned this to a med-school classmate, now an emergency doc in Boston. He knows trauma. He said, “I’ve never forgotten what it was like to see that. It was something I refused to do."

I also refused. I regret not yelling “Stop!”

A gynecologist friend provided an update on the ‘exam under anesthesia’ at the University of Vermont Medical Center: ‘Women are introduced to the students who would perform the exam. A patient can talk with them before she signs the consent form.”

Where does this meeting occur?

“In the pre-op holding area,” she said.

Experts in bias and discrimination would call this micro-aggression: putting a woman in setting that appears friendly, but is set up for submission.

Woman-centered care would have OBGYN surgeons propose these unnecessary procedures in the office visit before surgery, with the patient fully clothed, when she might take the paperwork home and think about agreeing to serial vaginal exams by strangers. But that’s not the culture.

Men in women’s health do things 'to' women – not 'with' us.

Crimes Against Nature

Along with the ‘exam under anesthesia’, I observed births with an obstetrician who manually dilated laboring women’s cervixes – ripping the sides open with his fingers to get the baby out faster, then repairing the ‘lacerations.’ Incident reports were collected about this (I know; I wrote one). This guy had great bedside manner: “Patients love him,” said the nurses. Residents voted him ‘Teacher of the Year.’ He’s now director of a division. Is this the ‘trusted clergyman’ model of abuse? Is that why he keeps getting promoted, instead of being put, oh, I don’t know, say, on the sex offender registry where he belongs?

When I told my boss that I wanted to write about the man problem in women’s health, she said, “And can you make it funny?” Holy Mother, help me here.

The culture of OBGYN developed like any men's club or frat which defines women as ‘other.’ Because of the pressure to conform, it’s not unusual to hear women patients and providers – nurses, midwives – say, half-kiddingly, “The women in OBGYN are as bad as the men.”

Meanwhile, UVM Medical Center, through all of its name changes, has never had a woman in charge of women’s health.

It’s not just us. This is a nationwide problem.

Though obstetrics and gynecology now has the largest proportion of women residents of any specialty – 81 percent -- only 20.4 percent of academic OBGYN department chairs are women. The American Congress of Obstetricians and Gynecologists (ACOG) – the national governing organization – is also dominated by men. It’s a fraternity. You don’t play, you don’t stay.

Men running OBGYN is why we have a 30% surgical-birth rate in Vermont and in the USA; why uterectomy – ‘hysterectomy’ – and surgical birth are the two most common surgical procedures performed on women.

The guys of OBGYN promote 'active management' – pushing birth to occur in 12 hours or less, and eliminating natural childbirth as the norm.

This is a classic Raging Hormone problem. Childbirth is regulated by oxytocin – the hormone of love, connection, and bliss. Guys are regulated by testosterone – the hormone of aggression, dominance, and My Way Or The Highway.

As in, who’d you rather have in the birthing room – Artemis, the Goddess of Light and Compassion, or Attila The Hun?

OBGYN surgeons now want to be our ‘primary care providers. This is the main obstacle to woman-centered, patient-centered care. The problem is that we’re not dealing with the profession of medicine; we're dealing with corporate culture – another fraternity. Women use more health services than men; we’re charged more for coverage; and we earn less. So not only are they raping us; they’re bleeding us dry.

Katherine Hikel, MD is a contributing Editor to Vermont Woman Newspaper.

Please read the rest of her OP-Ed with a subscription to the paper.

Selected References

Exam under anesthesia:

http://www.ourbodiesourselves.org/2012/09/conversations-we-shouldnt-still-be-having-pelvic-exams-under-anesthesia/

Microaggression and gender bias:

http://www.oa.uottawa.ca/journals/aporia/articles/2014_10/Caplan_Ford.pdf

http://www.huffingtonpost.com/2015/01/12/microaggressions-college-racism-sexism_n_6457106.html

Low numbers of women in OBGYN leadership:

http://journals.lww.com/greenjournal/Abstract/publishahead/Subspecialty_and_Gender_of_Obstetrics_and.99228.aspx

Active management of labor:

http://www.midwiferytoday.com/enews/enews0316.asp#main