males applying for obgyn

[Mr. McDuck]

O.K. So now I am curious why this burning desire to go into OB/GYN you have...Can you share some of the fascination you have?* Or is it salary? Thanks (in all sincerity)

*I have none for this area- It was the only area in nursing school I couldn't wait to get over with-- med/surg (although this is a sub-specialty area of that) has been way more interesting-- just me though. I am curious...

1) I have no problem with your preference. It's your body; you should be comfortable with your doctor.

2) However, I think it is a bit over the top to say that all male Gyns are out there to abuse women or molest them or something.

3) My reasons for liking Gyn and potentially going into the field are multiple:

a) I enjoy learning about and treating the pathology. Women have a
LOT of issues they have to worry about, and I just would like to
focus on that for my career

b) Catching babies is cool.

c) Honestly, I enjoy the anatomy. I think the whole
reproductive system is fascinating--the uterus, all of it. I think I
probably got hooked when I first learned that a woman in a coma
can deliver a baby.

So, yeah. Basically, I don't mind that you have a preference; if you are more comfortable with a female doc, you should request one. I just think it's wrong to assume all men are in the field to molest women or something. I'm sure there have been a few lesbians that conveniently found it "more appealing to work with women".

---

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[jocg27]

Hmmmmm....ALL the female PEOPLE I KNOW prefer female OB/GYN. I have NEVER heard one state the contrary.

I've actually also heard some women say they prefer males...They've been mostly older, and I haven't met many, but a few... and I've noticed two main ideas they have-

1. There are just still some people who simply feel that doctors are men. We all know this is true, especially females, because I always hear them (females) commenting on how they are called nurse, or people don't believe they are in med school or are a doctor, or whatever. This is, of course, sexist in our current mindset. But as we have to remember when dealing with older people whenever they start spouting things that are ridiculous, they didn't grow up with our current mindset, these things are awfully hard to change, and even if the person is willing to and wants to change them, it takes time to change your own view of the world. The idea that doctors are men and nurses are women isn't just the product of old, sexist men. Is it outdated? Sure....but it's there, and it may be there in women who deserve to feel at ease with the doctor examining them. There really are just women who feel a little more comfortable with a male, because it fits into their paradigm of a medical doctor.

2. I've heard a later-middle aged women make an interesting point. Is there something to it? I dunno, I'm not a woman or ob/gyn. It sounds kind of unusual to me, I can't quite decide what I think of it, and some people may not take it well, but if it's an opinion a woman has regarding her personal experiences with her ob/gyns, then at least on some level it's valid...

She has has both male and female ob/gyns. She said people who prefer females make the assumption that just because they've got what you've got, they'll be gentler, or able to make you feel more comfortable, or whatever. But there's nothing that says thats necessarily true...Her experience seems to have indicated that males, (not talking all male ob/gyns, she means the genuinely good ones, the ones who do understand the vulnerability of the situation for a woman etc etc) may actually be *more* likely to take the extra effort to make sure the patient is comfortable and understands whats happening, contrasted with females who in the worst case scenario, may go as far as to feel a sense of entitlement - I've got all the same parts as my patient, I have to go to the ob/gyn too, we've all got to do it so I'mma do my thing and you just deal with it - and actually not make quite the same attempt at comfort or show as great a sense of empathy.

I think what she was saying at the most basic level was that the best male ob/gyn is better than a mediocre female one...(this, I would hope, is undeniably true to everyone on here) And since she has found a great male one, who makes her feel totally comfortable, at ease, and informed (her current one) she felt no need to return to female ob/gyns. And as long as there are patients out there who feel this way for whatever reason, there is a place for males in ob.

 

[Carbo/Taxol]

Cardsnurse...

You use a lot of commas in your sentences...it is getting really annoying.

 

[Cardsnurse]

Cardsnurse...

You use a lot of commas in your sentences...it is getting really annoying.

hahahahahahahahaha

Was that supposed to hurt my feelings?

 

[UCLAMAN]

2. I've heard a later-middle aged women make an interesting point. Is there something to it? I dunno, I'm not a woman or ob/gyn. It sounds kind of unusual to me, I can't quite decide what I think of it, and some people may not take it well, but if it's an opinion a woman has regarding her personal experiences with her ob/gyns, then at least on some level it's valid...

She has has both male and female ob/gyns. She said people who prefer females make the assumption that just because they've got what you've got, they'll be gentler, or able to make you feel more comfortable, or whatever. But there's nothing that says thats necessarily true...Her experience seems to have indicated that males, (not talking all male ob/gyns, she means the genuinely good ones, the ones who do understand the vulnerability of the situation for a woman etc etc) may actually be *more* likely to take the extra effort to make sure the patient is comfortable and understands whats happening, contrasted with females who in the worst case scenario, may go as far as to feel a sense of entitlement - I've got all the same parts as my patient, I have to go to the ob/gyn too, we've all got to do it so I'mma do my thing and you just deal with it - and actually not make quite the same attempt at comfort or show as great a sense of empathy.

I think what she was saying at the most basic level was that the best male ob/gyn is better than a mediocre female one...(this, I would hope, is undeniably true to everyone on here) And since she has found a great male one, who makes her feel totally comfortable, at ease, and informed (her current one) she felt no need to return to female ob/gyns. And as long as there are patients out there who feel this way for whatever reason, there is a place for males in ob.

for what its worth, i have heard this from many women.

 

[Carbo/Taxol]

hahahahahahahahaha

Was that supposed to hurt my feelings?

No

 

[Cardsnurse]

No

Was it intended to show my lack of grammatical skill? Can you cite a reference as to my inappropriate use of commas? Or was my annoyance to you on another level, and this was something you felt you could complain about without actually touching upon your real feelings and the subject matter that made you feel this way.

 

[juddson]

JocG27's second reason for a male preference in OB gyn patients is what I hear from most female patients who prefer male OB/Gyn's. Invariably (if they prefer males) it is because they feel that the male doctor has been more empathetic and, for lack of a better term, "gentler" both in terms of bed-side manner as well as in terms of doing procedures.

I suspect (and it has been suggested to me by those with a male preference) that this is because female docs have the same anatomy as their patients and, therefore, (it is suggested) think they "know" how the patient is feeling or should be feeling under particular circumstances. For the women I have talked to who express a male preference, this is the primary reason they prefer not to see female OB/GYN's. THough, I should add, they have not expressed a similar preference when it comes to primary care docs or pediatricians for their babies.

On the other hand, those women I have spoken to who express a preference for female docs boil the issue down to one thing - anatomical modesty. That's fine too.

Judd

 

[Carbo/Taxol]

Was it intended to show my lack of grammatical skill?

No

Can you cite a reference as to my inappropriate use of commas?

No

Or was my annoyance to you on another level, and this was something you felt you could complain about without actually touching upon your real feelings and the subject matter that made you feel this way.

No

...i was just annoyed. That is all.

 

[Cardsnurse]

No


No


No

...i was just annoyed. That is all.

Well, I highly doubt it, (comma) but, in any event, it goes to show what a fine, compassionate, and tolerant person you are, especially in your line of, shall we say, work.

 

[Carbo/Taxol]

Well, I highly doubt it, (comma) but, in any event, it goes to show what a fine, compassionate, and tolerant person you are, especially in your line of, shall we say, work.

Yes. Thank you.

 

[Cardsnurse]

Yes. Thank you.

You're quite welcome, I'm sure.

 

[3dtp]

Hmmm, a lot of this discussion has been tangential to the OP's question.
He didn't ask about who preferred what so this debate and posturing, while entertaining isn't helping him.

I have a very good friend who is male, who went into OBG, because he wanted a field that had a healthy mix of primary care, interesting surgery, loved obstetrics and he could work in an area where he wanted to work, and was compatible with periodic sabaticals to do missionary work in developing/underdeveloped countries. He decided on OBG because it met that criteria and he could make a reasonable living at the same time.

He set up is practice in a rural area at a community hospital as a solo OB/GYN. The community was happy to have him. At first his OB practice was slow to pick up because the only other docs who did OB in town were
partners (female FPs) and pretty much had the whole area. His gyn practice started off quickly and grew. Once the word got around the community his OB practice picked up and he did very well to the point where he limits his new patients to referrals by present patients only. He's a good doc, and his patients all love him. He has finally decided to try to recruit a partner because he says he's delivering too many babies and he needs at least a little sleep.

There will always be women who want a female because of irrational ideas or thoughts, just as there will always be men with irrational ideas or thoughts. Can't change 'em, but I'd pick the doc who would do an exam and arrive at the proper diagnosis (in the colpo clinic, the OR, the exam room) and not miss the mass in the pelvis that later kills me.

I think if someone wanted a female doc, no matter what, hey that's fine, I'd rather them go to a nearby town than be "stuck with me" and unhappy because I was born with the wrong parts. And I have watched female (and male) residents and attendings brutalize patients with a speculum. Lack of tenderness and finesse knows no genderness.

So, short answer, if you love the field, love the primary care and advanced surgical aspects and really like getting called at 0305 saying Ms. Smith is 5 cm and 80%, can you come deliver her now? then go for it. Your reputation will build and you'll have a practice of open-minded patients who want the best in a doctor.

And, yes, many programs want qualified boy ob's, if for no other reason than to balance the herd. But, last year was a tad more competitive than others so study hard, do well and get the residency of your dreams.

 

[eddieberetta]

A practical question: Do male OBGYNs normally have a female chaperone in the room during exams in the US?

 

[3dtp]

A practical question: Do male OBGYNs normally have a female chaperone in the room during exams in the US?

Depends on the exam and the patient. TAU, usually not, but TVU, woudn't even consider it without one. Most females I know wouldn't do one without a chaparone either. One trick I learned in diagnostic radiology is to show the patient the transducer, goop it up and explain to her how to insert it under the sheet. Then give her privacy, and come back when it's done and manipulate the transducer from above the sheet. Made a lot of sense to me. Radiologist was female, so she didn't use a chaparone. Male radiologists I know that use that technique go 50/50

 

[Cardsnurse]

Depends on the exam and the patient. TAU, usually not, but TVU, woudn't even consider it without one. Most females I know wouldn't do one without a chaparone either. One trick I learned in diagnostic radiology is to show the patient the transducer, goop it up and explain to her how to insert it under the sheet. Then give her privacy, and come back when it's done and manipulate the transducer from above the sheet. Made a lot of sense to me. Radiologist was female, so she didn't use a chaparone. Male radiologists I know that use that technique go 50/50

Did he mean United States or Ultra Sound, me thinks it was United States, could be wrong...

 

[UCLAMAN]

Depends on the exam and the patient. TAU, usually not, but TVU, woudn't even consider it without one. Most females I know wouldn't do one without a chaparone either. One trick I learned in diagnostic radiology is to show the patient the transducer, goop it up and explain to her how to insert it under the sheet. Then give her privacy, and come back when it's done and manipulate the transducer from above the sheet. Made a lot of sense to me. Radiologist was female, so she didn't use a chaparone. Male radiologists I know that use that technique go 50/50

he meant in the united states most likely.

depends on the doc. sometimes they grab the nurse, sometimes they don't. either that or perhaps they considered me, the medical student at the time, the chaperone.

 

[Faebinder]

Was it intended to show my lack of grammatical skill? Can you cite a reference as to my inappropriate use of commas? Or was my annoyance to you on another level, and this was something you felt you could complain about without actually touching upon your real feelings and the subject matter that made you feel this way.

I think he ment this one...

Sorry, Ohbee, just thought this was a place for people to share their opinions. You sound upset-- didn't mean to do that. Sure, anyone can do what they like-- more power to them!! But I was just stating my opinion, which I have a right to do. And I respectfully explained my opinion, when asked.

I didn't ask for a provider (as I am a woman, as stated in your post) from you, I can figure that out myself. Thanks, though.

Have a GREAT night!!

PS- dont think this is much of a yawn subject- maybe you just dont like it.

 

[3dtp]

A practical question: Do male OBGYNs normally have a female chaperone in the room during exams in the US?

Sorry, it was late and I'd had a very long day in the OR. Personally, I would prefer not do any exam without a chaperone.

Most gynecologists, male or female that I have worked with would not either. I do almost all gyn-onc now, and doing pelvic procedures I have a chaparone. The chaparone is for your protection and there are some people in the clinic that I won't use as a chaparone. I don't trust them, and since the chaparone is for my medico-legal protection as much as anything, I'm particular about having a chaparone that I can trust and feel comfortable with.

I have, on occasion been surprised by a patient who who just drops her gown for a breast exam before a chaparone arrives, and some who have told me to just get on with it. I still call for the chaparone, but generally abide by the patient's wishes, particularly if I've had a long term care relationship with them.

 

[3dtp]

hahahahahahahahaha

Was that supposed to hurt my feelings?

TROLL ALERT: Newbie -> 20 Posts 1 day. TROLL ALERT

 

[Cardsnurse]

TROLL ALERT: Newbie -> 20 Posts 1 day. TROLL ALERT

Sorry, just a newbie, not a troll. Why are you so offended?

 

[OBJen]

As a female to be physician applying in ob/gyn this year--I support males applying in this field and have no doubt that if you are nice/competent you will have plenty of patients. I think it is harmful for any field to get too unbalanced b/c both sexes have wonderful opinions, thoughts, and skills to bring to the field. I have no problem with patients that prefer either gender but from what I have seen there are plenty of both.

 

[ceg]

Hmm, this thread has gone horribly wrong. But I'll play anyway.

I am a doula and CNM student so here's my perspective. As a doula I mainly support clients who want a natural intervention-free childbirth. But the other day I had a client whose hospital was fairly NCB friendly but whose doctor gave me that not so fresh feeling. When she was ready to push the doc was called. When he came in he brought with him a resident and told the pt that the resident would be observing with him (not ASKED). They put the patient's feet in stirrups, cleaned her perineum with betadine (I have NEVER seen this before) and cranked the bed all the way up. The doctor, resident, and nurses stood at the foot of the bed, no kidding, with their arms crossed and yelled at the patient to push. The patient, high in the air, exposed, and being stared at, was very uncomfortable and wanted some of the people to leave. Had the resident come in and held her hand, talked with her, been comforting, etc, it would have been a totally different situation.

Now as a NCB advocate, I have never been exposed to this (pt had no epidural, no need for stirrups, the betadine was like whoa!, and cranking the bed up rather than doc sitting on a stool was weird, also not a fan of directed pushing esp in a multip with no epi). Anyhoo, the residents' actions in this case got him the boot, rather than his penis.

GL to you. A compassionate male will always have a place in OB. Keep in mind, it's a memory for you and a life altering event for the women in your care.

 

[Carbo/Taxol]

Hmm, this thread has gone horribly wrong. But I'll play anyway.

I am a doula and CNM student so here's my perspective. As a doula I mainly support clients who want a natural intervention-free childbirth. But the other day I had a client whose hospital was fairly NCB friendly but whose doctor gave me that not so fresh feeling. When she was ready to push the doc was called. When he came in he brought with him a resident and told the pt that the resident would be observing with him (not ASKED). They put the patient's feet in stirrups, cleaned her perineum with betadine (I have NEVER seen this before) and cranked the bed all the way up. The doctor, resident, and nurses stood at the foot of the bed, no kidding, with their arms crossed and yelled at the patient to push. The patient, high in the air, exposed, and being stared at, was very uncomfortable and wanted some of the people to leave. Had the resident come in and held her hand, talked with her, been comforting, etc, it would have been a totally different situation.

Now as a NCB advocate, I have never been exposed to this (pt had no epidural, no need for stirrups, the betadine was like whoa!, and cranking the bed up rather than doc sitting on a stool was weird, also not a fan of directed pushing esp in a multip with no epi). Anyhoo, the residents' actions in this case got him the boot, rather than his penis.

GL to you. A compassionate male will always have a place in OB. Keep in mind, it's a memory for you and a life altering event for the women in your care.

I am entirely for making the patient as comfortable as possible and maintaining privacy and decency. Although I can see how the event that you witnessed may be a little over the top, let me play devil's advocate for a second.

First, it is very common in teaching hospital delivery room to have at least one resident and medical student (occas. an attending physician will be present if the situation calls for it). These providers are there for one of two principal purposes (i.e., to teach how to deliver a baby or learn how to deliver a baby). That said, they should also make every effort to keep the patient comfortable. In your scenario, more than likely the resident was at the foot of the bed either learning a technique or assisting with the delivery...something that could not be accomplished at the head of the bed holding the patient's hand. The resident should, however, acknowledge the patient and family members and remember that the patient is a human being and not just the "34 weeker with PPROM and PTL"

Second, some programs teach to deliver a baby standing. This position provides the physician with more leverage and mobility if there were to be a problem such as a shoulder dystocia and firm downward traction on the fetal head were needed. This does not mean that you need to elevate the bed to eye level, just to a point that your not killing your back either.

Third, I am not a fan of directed pushing either....in fact, I hate it. If I were the one giving birth (which, as a I male, I will never be...thankfully) I would be entirely annoyed by people counting to 10 and telling me to push (as if I haven't been doing that for the last hour). On occasion, it is of some value to at least emphasize the need to give maximal effort. If the baby is having worrisome fetal heart rate tracings, a little increase and urgency in your voice may convey the need to maximize the pushing effort.

Lastly, I havent seen the betadine thing either...maybe the physician was trying to steralize the area (although this is not the most appropriate time or place).

I am not trying to down-play the scenario that you presented, just trying rationalize and offer explanations for some of the actions taken. Make of this what you will.

 

[Faebinder]

I am entirely for making the patient as comfortable as possible and maintaining privacy and decency. Although I can see how the event that you witnessed may be a little over the top, let me play devil's advocate for a second.

First, it is very common in teaching hospital delivery room to have at least one resident and medical student (occas. an attending physician will be present if the situation calls for it). These providers are there for one of two principal purposes (i.e., to teach how to deliver a baby or learn how to deliver a baby). That said, they should also make every effort to keep the patient comfortable. In your scenario, more than likely the resident was at the foot of the bed either learning a technique or assisting with the delivery...something that could not be accomplished at the head of the bed holding the patient's hand. The resident should, however, acknowledge the patient and family members and remember that the patient is a human being and not just the "34 weeker with PPROM and PTL"

Second, some programs teach to deliver a baby standing. This position provides the physician with more leverage and mobility if there were to be a problem such as a shoulder dystocia and firm downward traction on the fetal head were needed. This does not mean that you need to elevate the bed to eye level, just to a point that your not killing your back either.

Third, I am not a fan of directed pushing either....in fact, I hate it. If I were the one giving birth (which, as a I male, I will never be...thankfully) I would be entirely annoyed by people counting to 10 and telling me to push (as if I haven't been doing that for the last hour). On occasion, it is of some value to at least emphasize the need to give maximal effort. If the baby is having worrisome fetal heart rate tracings, a little increase and urgency in your voice may convey the need to maximize the pushing effort.

Lastly, I havent seen the betadine thing either...maybe the physician was trying to steralize the area (although this is not the most appropriate time or place).

I am not trying to down-play the scenario that you presented, just trying rationalize and offer explanations for some of the actions taken. Make of this what you will.

Not an OBGYN person here but could it have been that the resident thought she might have to do an episiotomy. (Although I know enough about surgery to realize betadine at that point wont do crap.)

 

[tiredmom]

Back home - everybody got betadine preps - that's just what the kits had. But we usually prepped with the Betadine then rinsed most of it off with sterile water, so it didn't really do much good since the betadine kills bugs with drying. Here in med school - they do Hibicleans preps, but everybody still gets one (even if they have to hold the head in to do it - )

Carbo/Taxol - glad to see you back - how's intern year treating ya?

 

[Carbo/Taxol]

Carbo/Taxol - glad to see you back - how's intern year treating ya?

Tiredmom..nice to see you again. I recently finished my night float rotation and just started getting used to seeing the sun again. It has been good so far...I have had a good amount of deliveries, but the chronic pelvic pain and dysmenorrhea patients in my continuity clinic are killing me. How have you been?

 

[tiredmom]

How have you been?

Doing well. Finishing up my ob externship... I really loved it. I was a little bummed about not getting many deliveries, but I've done nearly as many as some of the interns on the rotation if you count lifetime. Doing the scary stuff - finishing up ERAS, interviewing with the dept chair for my letter, etc. Welcome back from mole-ville!

 

[ceg]

I am entirely for making the patient as comfortable as possible and maintaining privacy and decency. Although I can see how the event that you witnessed may be a little over the top, let me play devil's advocate for a second.

First, it is very common in teaching hospital delivery room to have at least one resident and medical student (occas. an attending physician will be present if the situation calls for it). These providers are there for one of two principal purposes (i.e., to teach how to deliver a baby or learn how to deliver a baby). That said, they should also make every effort to keep the patient comfortable. In your scenario, more than likely the resident was at the foot of the bed either learning a technique or assisting with the delivery...something that could not be accomplished at the head of the bed holding the patient's hand. The resident should, however, acknowledge the patient and family members and remember that the patient is a human being and not just the "34 weeker with PPROM and PTL"

Second, some programs teach to deliver a baby standing. This position provides the physician with more leverage and mobility if there were to be a problem such as a shoulder dystocia and firm downward traction on the fetal head were needed. This does not mean that you need to elevate the bed to eye level, just to a point that your not killing your back either.

Third, I am not a fan of directed pushing either....in fact, I hate it. If I were the one giving birth (which, as a I male, I will never be...thankfully) I would be entirely annoyed by people counting to 10 and telling me to push (as if I haven't been doing that for the last hour). On occasion, it is of some value to at least emphasize the need to give maximal effort. If the baby is having worrisome fetal heart rate tracings, a little increase and urgency in your voice may convey the need to maximize the pushing effort.

Lastly, I havent seen the betadine thing either...maybe the physician was trying to steralize the area (although this is not the most appropriate time or place).

I am not trying to down-play the scenario that you presented, just trying rationalize and offer explanations for some of the actions taken. Make of this what you will.

`

I can appreciate that there is a routine in the hospital but we are talking about a woman who had managed to labor without pain meds despite a scalp electrode and pitocin augmentation after AROM. She had a few wishes for her birth and they flew out the window at the moment of pushing.

I got what the resident was doing... I just didn't like the way he was doing it. Or the doctor, for that matter. I didn't really expect him to hold her hands but to actually cross his arms and stand there like he was waiting for the bus was rude and disrespectful to the patient.

I wasn't wondering why betadine specifically was used, just why the perineum was cleansed. I thought that had gone the way of sterile drapes and enemas. It has in my area, anyway.

I got a bad vibe from this doc in general when he refused an alternate pushing position and instead cut an epis and got out the vacuum. So maybe I am coming away with a bad outlook because of this but I feel those last few minutes marred an otherwise lovely birth.

Thanks for the reply.

 

[juddson]

One trick I learned in diagnostic radiology is to show the patient the transducer, goop it up and explain to her how to insert it under the sheet. Then give her privacy, and come back when it's done and manipulate the transducer from above the sheet. Made a lot of sense to me. Radiologist was female, so she didn't use a chaparone. Male radiologists I know that use that technique go 50/50

This strikes me as wierd and overly cautious. It seems to me that the message being sent here is that the male doctor cannot be trusted to manipulated the transducer and behave himself if the female anatomy is visible to him. This is an insult to his professionalism. To my way of thinking, the patient either trusts the doctor and her sense of modesty permits a normal examination or she does not. In the latter case, she should simply request a female doc and dispense with this other stuff.

Judd

 

[juddson]

Second, some programs teach to deliver a baby standing. This position provides the physician with more leverage and mobility if there were to be a problem such as a shoulder dystocia and firm downward traction on the fetal head were needed.

A bit off topic, I know, but I have a question about this. I cannot fathom a situation where it would be appropriate to have to apply more traction on the head of a delivering baby than would be comfortably possible from the seated position. Don't you worry about head dislocation?

Third, I am not a fan of directed pushing either....in fact, I hate it. If I were the one giving birth (which, as a I male, I will never be...thankfully) I would be entirely annoyed by people counting to 10 and telling me to push (as if I haven't been doing that for the last hour). On occasion, it is of some value to at least emphasize the need to give maximal effort. If the baby is having worrisome fetal heart rate tracings, a little increase and urgency in your voice may convey the need to maximize the pushing effort.

The nurses at the last place I was at told me that a technique than has worked well for them is encouraging the patient to "resist" the urge to push for at least 30 minutes after the urge makes itself known to them. It is insisted that this speeds actual delivery considerably. Does this technique have a name?

Finally, I see posters all over my hospital concering the benefits of squatting to deliver YET, I've never seen it done or encouraged in practice. What gives?

Judd

 

[Carbo/Taxol]

A bit off topic, I know, but I have a question about this. I cannot fathom a situation where it would be appropriate to have to apply more traction on the head of a delivering baby than would be comfortably possible from the seated position. Don't you worry about head dislocation?

I am not talking about ripping the kids head off (because if you're having that much trouble you should be doing some other maneuver instead). I actually used to do all my deliveries sitting down as I thought it was more comfortable as well as provided a safe place for the baby to land should it slip (which fortunately never happened). However, now I do a mix of both sitting and standing depending on the situation. I have found that standing allows me to have better mobility not only for downward traction, but to also reach back and grab my clamps, scissors, and other instruments that I may need during the delivery.

The nurses at the last place I was at told me that a technique than has worked well for them is encouraging the patient to "resist" the urge to push for at least 30 minutes after the urge makes itself known to them. It is insisted that this speeds actual delivery considerably. Does this technique have a name?

I am not aware of that technique. You should always tell the patient not to push if their cervix is not completely dilated (to avoid cervical lacerations), but most women with a fully dilated and fully effaced cervix would think your crazy if you tell them to resist the urge to push.

Finally, I see posters all over my hospital concering the benefits of squatting to deliver YET, I've never seen it done or encouraged in practice. What gives?

Some patients have different views as far as the method of their delivery and what they want their delivery to be like and we try to always respect their wishes when possible and not medically contraindicated. I have had several patients ask me about delivering in squatting position and I even questioned other residents and attendings about it as well. I have been told that the effect of squatting (i.e. gravity) does not have any bearing on speeding up the progression of labor, dilation or effacement of the cervix, or speeding up second stage. It is the force of the contraction and the mothers expulsive effort that have the most effect. Squatting often times also causes the onset of fatigue at an earlier time than if they were laying down. However, I have not personally looked up any studies about this.

 

[3dtp]

This strikes me as wierd and overly cautious. It seems to me that the message being sent here is that the male doctor cannot be trusted to manipulated the transducer and behave himself if the female anatomy is visible to him. This is an insult to his professionalism. To my way of thinking, the patient either trusts the doctor and her sense of modesty permits a normal examination or she does not. In the latter case, she should simply request a female doc and dispense with this other stuff.

Judd

The radiologist who used this technique was a professor emeritus of radiology. She decided that retirement didn't suit her and came back to work part time, mainly to work with residents and to teach.

The professor in question is in her early 70s. So, perhaps it is weird and overly cautious, but it would, at least in this case be the female doctor who showed extra respect to the patient. Once the transducer was inserted, she took control exclusively of the transducer. So, perhaps the patient should request a male doctor in this particular case?

Medicine is in general highly invasive of patient privacy and perhaps anything we can do to help restore dignity and some measure of control of the process might not be a bad idea. I really don't know what is best. It certainly does no harm as far as I can see. Women: What do you think?

 

[Cardsnurse]

I'm not even going to attempt to go there.

 

[tiredmom]

The nurses at the last place I was at told me that a technique than has worked well for them is encouraging the patient to "resist" the urge to push for at least 30 minutes after the urge makes itself known to them. It is insisted that this speeds actual delivery considerably. Does this technique have a name?

Finally, I see posters all over my hospital concering the benefits of squatting to deliver YET, I've never seen it done or encouraged in practice. What gives?

Judd

I'm guessing the patients being told to resist pushing have epidurals? If so, we use this often - we call it passive descent - where you let the uterus do the work and let mom save her energy for when it really helps. I'm not sure if that's what you are referring to or not.
I've circulated a few deliveries where we tried squatting while pushing. I wasn't too impressed with it, but it was also in primigravidas who we were pulling out most of the tricks in the book to try to achieve a vaginal delivery. Haven't delivered one squatting myself (though nearly did in the triage bathroom once ) All the deliveries that tried squatting were staffed by CNMs.

 

[ceg]

A bit off topic, I know, but I have a question about this. I cannot fathom a situation where it would be appropriate to have to apply more traction on the head of a delivering baby than would be comfortably possible from the seated position. Don't you worry about head dislocation?



The nurses at the last place I was at told me that a technique than has worked well for them is encouraging the patient to "resist" the urge to push for at least 30 minutes after the urge makes itself known to them. It is insisted that this speeds actual delivery considerably. Does this technique have a name?

Finally, I see posters all over my hospital concering the benefits of squatting to deliver YET, I've never seen it done or encouraged in practice. What gives?

Judd

Yeah, "passive descent" or "laboring down" this would be a patient with an epidural. A woman with a true urge to push would probably not have the option of "resisting" the urge. It's overwhelming and uncontrollable. Laboring down does cut down on exhaustion. Rather than expeding the effort pushing, resting and allowing baby to move down prevents maternal exhaustion.

One of the reported benefits of squatting is opening the pelvic outlet. Lying on your back in the bed actually narrows the pelvic outlet where squatting opens it. As a woman I can feel this when I squat (putting my hands on the symphysis pubis). It in theory reduces dystocias and tearing. More commonly used in areas like Denmark where natural childbirth is the norm. Obviously a squat bar or other support is most effective with this method. Most pushing positions are going to be more effective than laying on your back. ETA: Maybe "effective" is not the word I am looking for... physiologically appropriate maybe? Would work better but not necessarily in a hospital setting that isn't prepared to deal with it, but as a general idea.

 

[eandasmom]

Hi,

I just wanted to tell you from a patient perspective that the practice I see has 8 doctors- only 2 female. The males rocked. I'd take a male over female ob/gyn any day......and I'm only 31.

I say go for it!

 

[Stingla]

Cardnurse,

Having been an OBGYN for many years, and having seen hundreds and thousands of patients, I just want to give my input on why males go into OBGYN.

There are many reasons why a male might go into OBGYN. I personally, along with many other male doctors that work with me, cherish the fact that we bring in new life into this world every day. It's a precious moment for my patients, and it's an honor to be part of that moment. Furthermore, it's one of the few fields where you see mostly positive outcome cases. Families are always happy to bring a new child into this world; I too feel that air of joy. Deaths, trauma, and injuries are few and far in between, unlike many other fields. OBGYN is also one fo the few fields that truly combine primary care and surgery. You care for patients throughout their pregnancy, and you get to operate on them when the time comes. I personally love covering both spectrums, as it gives me a greater scope of medicine in general.

Vagina is an anatomical part. After seeing your first few patients, you become desensitized to the fact that it's a sexual organ. Seeing thousands of women, I can honestly tell you a woman's vagina is no more special than any other organ. It becomes just like looking at a finger, or a nose. If all males walked around naked, you too would be desensitized to the male penis.

I am sorry for your experiences as a youth, but with the system we have today in place to protect women, such as having a chaperone, hopefully those risks are minimalized in the future. I hope this answers your question as to why males enter the field of OBGYN.

 

[TY06]

Cardnurse,


Vagina is an anatomical part. After seeing your first few patients, you become desensitized to the fact that it's a sexual organ. Seeing thousands of women, I can honestly tell you a woman's vagina is no more special than any other organ. It becomes just like looking at a finger, or a nose. If all males walked around naked, you too would be desensitized to the male penis.

QUOTE]

great input dr. i have a serious question. time after time people tell me, how will you go home to your wife? are you married or have gf? do you find this being a problem??

 

[Llenroc]

I have no vested interest in OB/GYN, this thread just caught my interest.

From what I've seen, many of the guys going into OB/GYN these days are often interested in the surgical aspect of it. My guess is they may not have had high enough board scores for orthopedic surgery or even general surgery, and that this is the only way for them to satisfy their need to put stitches in people and tie knots. Some of them are really into delivering babies, but my guess is that the vast majority of young chaps doing OB/GYN these days will be gynecology-oncology or urology-gynecology surgeons.

The differences are most pronounced when working on an OB ward vs. going down to the surgery and seeing gynecology surgeries: lots of women delivering babies and lots of men doing surgeries.

 

[UCLAMAN]

I have no vested interest in OB/GYN, this thread just caught my interest.

From what I've seen, many of the guys going into OB/GYN these days are often interested in the surgical aspect of it. My guess is they may not have had high enough board scores for orthopedic surgery or even general surgery, and that this is the only way for them to satisfy their need to put stitches in people and tie knots. Some of them are really into delivering babies, but my guess is that the vast majority of young chaps doing OB/GYN these days will be gynecology-oncology or urology-gynecology surgeons.

The differences are most pronounced when working on an OB ward vs. going down to the surgery and seeing gynecology surgeries: lots of women delivering babies and lots of men doing surgeries.

what institution are you at? here at northwestern there are essentially equal numbers of male and female gyne oncs. we also have one female urogyne and a male urogyne. furthermore, not all the boys from my class who are going into OB/gyn are necessarily surgery hungry. in fact, i'd like to go into MFM. i see the point you are trying to make...but in my opinion...the guys who want to do surgery usually go into surgery rather than going the ob/gyn route to get time in the operating room.

 

[bluebonnet07]

O.K. So now I am curious why this burning desire to go into OB/GYN you have...Can you share some of the fascination you have?* Or is it salary? Thanks (in all sincerity)

*I have none for this area- It was the only area in nursing school I couldn't wait to get over with-- med/surg (although this is a sub-specialty area of that) has been way more interesting-- just me though. I am curious...

Well, pretty wierd Q. Why do we all have THIS burning desire to go into medicine? Sado/ masochist fascinations?

 

[Brickhouse]

Ok, bickering amongst personalities here aside, I am a woman, always had male ob/gyns, and loved them - point being that for every woman who thinks a man wants to view her anatomy for pleasure or perversion, there is a woman who respects a man who goes into a field that is trying to squeeze men out. I think it takes real conviction of character and a strong sense of knowing why you're going into this field as a man, and those are valuable qualities, and ultimately those that I'd want in a doctor.

Men, if you want to do ob/gyn, go for it, and don't be discouraged by women out there who doubt your motives. I think women can be as deceiving and malicious as men, and I really wouldn't discount a male doctor on his sex alone, and there are plenty of others out there like me.

From an MSIII point of view, ob/gyn is number one on my list, and I look forward to having a diverse group of colleagues with whom to train. I hope the field stays balanced.

 

[MacGyver]

The problem with male ob/gyns is not that they cant hold on to patients once they have the initial visit. I think that once females see a good male ob/gyn for the first time,t hey will have no problem using them from then on as their ob.

HOWEVER, the problem is the "pre screening" aspect of ob/gyn doctor selection. How many women scheduling an initial appointment will say "I want a female ob" on the phone before they even get a chance to meet the male ob?

I think this figure is quite substantial. I dont have any hard data to back it up, but just from overhearing phone calls at an FP clinic of women trying to schedule ob exams, I hear the nurses constantly telling them that they can schedule a female.

This is the real problem. ONce male ob/gyns get patients, they will hold onto them. But they are at at serious disadvantage at the initial consult because they are being screened out before they even meet the patient for the first time.

 

[Good Mountain]

What about the SURGERY? Isnt it the other way round in the surgical field of gynecology? Who does the female patient preffer as her gyn surgeon, a male or a female?

 

[lateness]

Ok, bickering amongst personalities here aside, I am a woman, always had male ob/gyns, and loved them - point being that for every woman who thinks a man wants to view her anatomy for pleasure or perversion, there is a woman who respects a man who goes into a field that is trying to squeeze men out. I think it takes real conviction of character and a strong sense of knowing why you're going into this field as a man, and those are valuable qualities, and ultimately those that I'd want in a doctor.

Men, if you want to do ob/gyn, go for it, and don't be discouraged by women out there who doubt your motives. I think women can be as deceiving and malicious as men, and I really wouldn't discount a male doctor on his sex alone, and there are plenty of others out there like me.

From an MSIII point of view, ob/gyn is number one on my list, and I look forward to having a diverse group of colleagues with whom to train. I hope the field stays balanced.

nicely said.. I agree and think males need more women like you in ob/gyn..

 

[JulianCrane]

For those that are applying or have applied already, are there any programs out there in which you see more of a balance between men and women?

 

[SoSoDefJeff]

On my interview trail, Parkland/UTSW-Dallas and Cedars-Sinai were both relatively good in terms of the XX-XY balance.

For those that are applying or have applied already, are there any programs out there in which you see more of a balance between men and women?

 

[chrisisinnocent]

I wonder why a man would specialize in women's genitalia/reproductive systems.

OB/Gyn is a great field, I am not sure why you would even ask that.