Over at Navelgazing Midwife she talks a bit about a "Dr. Wonderful" in California (aka, Dr. Robert Biter). Those on the birth circuit have probably been following the latest about Dr. Biter. I'm not going to comment about the particular situations that have been going on with Dr. Biter. Instead, I want to talk about the whole concept of a "Dr. Wonderful".
With all of the negativity that permeates on the blogosphere and elsewhere with doctor bashing, we need to focus on the more positives out there. I'm sure we all have run across a "Dr. Wonderful" in our time. Perhaps he/she isn't the extreme of a "Dr. Wonderful", but they are wonderful nonetheless.
Believe it or not, I work with a few doctors that could be considered close to, if not at, the "Dr. Wonderful" status. I call them midwives in disguise. Why? Because first and foremost, they empathize and listen actively to the women and families that they care for, both in and out of the hospital environment.
There is "Dr. Magic Hands" who can successfully perform an external cephalic version with very high success rates. I literally turned my back for 2 seconds one time, when at the bedside for a version once. When I turned back again, he smiled, looked at me and said "done". WAH?!? Done?!? Yep. That was quite the easy version too. Not all go quite as quickly or as successfully. "Dr. Magic Hands" could do my external cephalic version ANY day. (Not that I will ever have another baby, but I'm sure you know what I mean.)
There is my favorite, very mildly mannered and soft spoken "Dr. Midwife". He has the patience of a saint. This man should have been a midwife - he definitely has his entire heart and soul into serving the women and families who come to him for care. I could tell you dozens of fantastic stories about this man. The hypnobirth mom who labored all day, stalled at an advanced dilitation, and he never once put her on the time clock, or even talked about a c-section for failure to progress. She went on to birth her baby over an intact perineum many hours later.
Or the cord prolapse, where "Dr. Midwife" literally calmed down every single person in the OR, made everyone take 5 seconds to breathe in and out, calm down, focus, and then proceed. Successful stat c-section with excellent apgars of a sudden and unexpected cord prolapse.
Or the woman who, because of her religious beliefs, would not allow a male provider to perform sensitive examinations or see/touch her genitalia. We simply traded places for exams (he acted as the nurse at the head of the bed, while I was performing the exams), and I pretty much delivered the baby, except for the very end of the birth when we traded places quickly for him to catch the rest of the baby (this was pre-agreed to by the patient and her husband as an acceptable solution to their gender beliefs regarding medical care and birth).
Or his general calm demeanor and sensitive nature. His belief that women can and do VBAC successfully. His positive comments to women in labor. His laid back management of labor/birth. Liberal fluid and food intake in labor. I really, truly could go on and on. This is a physician I would LOVE to collaborate with when I am a CNM!
Tell me about some positive stories of your own "Dr. Wonderful"s. We need more positive stories out there.
27 comments:
I do have to say that though my OB group is very intervention oriented, with my 6th baby the head of the group came at shift change. The nurse was pushing to have my waters broken for a scalp monitor, and made me stay in bed for hours without bathroom breaks and no position changes...she was addicted to the monitor. Though I'd had at least a check every 20 minutes with that nurse and also a few with the former OB on call, no one knew baby was OP. This OB figured out baby was OP, refused to break my water though I was begging in case it helped baby come faster (after the ridiculous hour and 20 minutes of pushing at that point)...and said, "get her moving, let her squat and whatever to push" instead of flat backed. Baby was born 10 minutes later because this man was at least paying attention and he used evidence based care I think. He didn't break the water because, and I quote, "I may have to use instruments you don't want to help you." He thought baby would likely get stuck OP and knew she could move if I could move. Now, he wasn't perfect as he left me right after that and therefore missed the birth...but just being a smart doctor kept me from more intervention.
Blessings!
Dawn
My Doc Wonderful is Dr. Joseph Tate in Atlanta. He practices evidence-based care and is supportive not only of VBAC, but of vaginal breech delivery, breech VBAC, VBAmC and VBAC of multiples. This year he helped a mom successfully VBAC triplets. He BELIEVES in women's ability to birth. He is responsible for my VBAC and that of many, many women not only in Atlanta, but from other parts of the country and even other countries. It's a shame there aren't more like him!
"skills of a surgeon, heart of a midwife"
I had a more hands off birth with my current OB than I had with most CNM's. (little monitoring, encouraged to stay out of bed, pushing standing next to bed, kneeling, squatting, no broken down bed, no bright light, no drapes, no betadine on perineum, pushing spontaneously, baby straight to me, delayed cord clamping, natural 3rd stage (until I started a PPH-then he intervened-calmly and cooly and I was barely aware there was an issue as I was busy nursing and loving on my baby boy) I've never had such autonomy in my birth and cared for by someone who so deeply believed in the process and in me despite my VBAC status and ob history that would make most OB's want to cut asap.
I had a beautiful birth resulting in a healthy, vigorous newborn in a supportive atmosphere with a bunch of great nurses too!
This particular OB is a quiet, modest man and probably doesn't want anyone singing his praises publicly but in my city he is one in a million.
Peter Kuhl
San Antonio, TX
I posted a comment on my blog, because it was rather long to post here. See: http://antigonos.blogspot.com/2010/06/how-sweet-it-is.html
It's either a doctor with great bed-side manner and high intervention rate, or a doctor who seems rude but just sits back and lets you do whatever you want to get the baby out. It'd be nice to one day get the opportunity to work with someone who has both of those qualities.
Personally I am really glad there are brilliant doctors who are also decent human beings with a sense of humor so those of us who are high risk can have the safest possible pregnancies and births without being treated any less kindly because of it.
My MFM doctors were every single one of them some of the kindest, most generous and caring professionals I have ever encountered in any field. And they are by definition "high intervention" practitioners. The two things need not be mutually exclusive. Thank God.
with my last pregnancy, i had my "dr wonderful". having been an ob nurse, I know that he does rupture membranes, use pitocin, etc etc but that for those who want it natural, he is very supportive.
at 40 weeks 6 days pregnant, when I declined induction, he said "okay". didnt try to convince me. he agreed to come in for me even if he wasn't on call. (turns out he was on call when i came). i wanted to eat when i was 9cm dilated, he said "whatever you want". i've actually called him "Dr Whatever-You-Want". When my labor was stuck at 9.5cm for 5 hours, he never said "c/section".
he had been on call all fri, sat, sun and my labor was concluding on that early monday morning, and he stayed til the baby was born at nearly 9am.
I went on to deliver a 10 1/2 pound baby vaginally.
of course, it wasn't all sunshine and roses, and he did some things i wasn't happy about,(had feet in stirrups) but i felt my wishes were mostly respected, and never blatantly dis respected.
he has also had other patients who vba2c (successfully, with no previous vaginal deliveries) or one who was attempting to hbac and he supported that and was completely kind to her when she transferred to the hospital
Ahem. I am not sure that y'all realize the reality of modern medicine. The reason your midwife sits with you is that they do maybe 2 births a week.......
Stop confusing schmoozing at the bedside with skill. Personally, Biter gives me the creeps. Talk about overly personal interest, bordering on inappropriate. I don't need validation from a care provider. I need medical skill.
Anonymous, perhaps you are assuming that a "schmoozing" bedside manner means the OB lacks the required judgment and medical skills to do a good job? Women have different tastes in OBs - some like personally interested ones, others like ones who just answer relevant questions and turn up for the last 10 minutes of the birth. The only part you are right about is that women should choose care providers who are skilled enough for the job.
Ummmm...you do realize that the "personal attention" you get from your midwives comes from a serious lack of practice? Where the average OB resident has delivered more infants during the first 6 months of his residency than the average midwife has in several years of practice?
If practice makes perfect and gives skill, and complications aren't the norm, one has to attend many births to get the practice and exposure to complications in order to handle them effectively. It takes people several codes to quit freezing up and babbling incoherently, even more to function effectively, and years for them to spot the problems before the patient codes at all. I highly doubt that OB is a much different field...after all, hearts ARE designed to go on pumping and last time I looked, blood really was designed to stay on the inside of the body.
Don't confuse all that fluff with actual skill.
Aw, Anonymous - go ahead and leave your name! it's not like anyone can actually see you on the other side of the screen. Maybe you are the one who should learn a bit more about what midwives actually do - for most it's a tad more than 2 births a week. ;) Of course they also do just a bit more than sit on the edge of the bed (schmooze??? do people actually use that word? ok) I won't get into all of it here, because really all you have to do is open any midwifery textbook to figure it out.
Anyway, the point of AYC's post was to talk about DOCTORS who manage to treat their patients with dignity and respect rather than demanding that they alone be accorded such consideration. It's a 2-way street, you know?
My son is now 11 days old, and out of the 4 doctors in my OB group I had my "Dr. Wonderful" deliver him. I saw this doctor the most out of the 4, and she even had a baby of her own about 2 1/2 months prior to me.
I was induced due to borderline pre-eclampsia, and when my doctor first stopped by my labor room she told me exactly what my levels were as compared to their cutoff. After nearly 8 hours of not much happening the first day she authorized that the induction be stopped so that I could eat dinner before we tried cervidil overnight.
When it came to the actual delivery part (he was born at 8:01pm) my doctor helped to make certain that I didn't tear, which was a big help to me because I was having coughing fits while trying to push. While I did have a lot of interventions during my labor (pit, cervidil, rupture of membranes, epidural) there were no additional ones during the pushing phase, which has amazed several people in my area because I guess a lot of other doctors are very cut happy.
I am still over the moon with how everything happened. And in addition to having my Dr. Wonderful present I had the most fabulous nurses ever present. The nurse I loved the most was the one "counting" for me - all she did was remind me to breathe and to push again. No counting out loud, which would have irritated me. And I didn't even share this preference with the nurses!
Aron said: about what midwives actually do - for most it's a tad more than 2 births a week. ;)
Not homebirth midwives. For one thing, the demand is very small -- less than 1% of deliveries occur in the home in the US. Secondly, especially if the woman is a primip, labor can take a very long time [up to 20 hours for prodromal labor, and 12 or more for active labor] and the midwife stays with her patient for the duration. Even the strongest midwife can't go days without sleep. I've covered for midwives who do home deliveries as well as work in hospital, and 3-5 private births a month is about all they can manage. A hospital midwife in a midsized unit sees twice that number a week, easily, sometimes in a single shift. You simply cannot compare the amount of experience gained between homebirth and hospital midwives, not to mention the much better education a CNM has.
The doctor that was there at the birth of my baby was very hands-off, which I appreciated. I'm not sure if he usually is (I arrived pushing and would not move my hands off of her head while she was being born), or if he just didn't have time to be more interventative since she was born 15 minutes after we got there, but instead of being panicked he just let me push and pull her out myself. He also didn't even flinch when we reminded him that we were delaying the cord clamping. Of the doctors that I had seen at the ob practice, he was one of the ones I liked the most- he took time to talk to me even though I didn't have that many questions.
So I'm not sure that he qualifies as Dr. Wonderful, but he was pretty good under the circumstances :)
And why did the comment section turn into midwife-bashing? I'd rather have a person that is experienced in normal birth than one that has only seen intervention-heavy hospital births if my goal is to have a calm unmedicated birth.
"I'd rather have a person that is experienced in normal birth than one that has only seen intervention-heavy hospital births if my goal is to have a calm unmedicated birth."
What your "goal" is, and what may happen are two different things entirely. In literally the blink of an eye, you can go from 100% normal, needing only the most basic care and almost no technology, to a situation where all the medical expertise and technology in the world may not be enough. When you write something like the above, I hear the voice of optimistic ignorance speaking, but then, you aren't an OB professional, so that's OK, because that's why you have a professional health care provider. What, for example, would your "normal birth only" person do if the placenta completely separated from the uterine wall [abruptio placentae] when you were 6 cm ?
Happens all the time in perfectly normal labors. Remember that one-third your total blood supply goes through your uterine artery EVERY minute, and a baby can last 4 minutes without oxygen before becoming brain-damaged.
Give me the expert, and the facilities, every time. And if they are unneeded, well, I've never claimed on my car insurance either, but I'm glad I've got it.
Thank you for sharing i really enjoyed your blog throughout reading.
I think you see this everywhere. There are Dr Wonderful cardiologists, surgeons, etc. I'm kinda curious, though - how many female OB Dr Wonderfuls are there? What I hear in the field is never very good!
Anonymous - what you mistake for schmoozing in midwifery is the reality that most midwives are forced by the birth industry to practice alone. They don't have the luxury of having partners who can swap out while they play golf. And two of the three midwives we had (the third being relatively new) had assisted at hundreds of births.
At Your Cervix - how come you get anonymous trolls?? Where can I get one?
Antigonos - what is "happens all the time"? Does it really, statistically speaking? And how often does abruptio placentae occur with Pit? That's questions I'd be asking before throwing it out there that normal women just happen to lose their placentas halfway through labor "all the time."
I always love the statement that "birth always turns into something where all the technology in the world isn't enough!!" If hospital technology isn't enough, then that situation can't fairly be used against home birth, can it?
Antigonos - I have to argue with you about abruptions happening "all the time" in perfectly normal labors, when the woman is at an advanced dilatation. You know as well as I do that more often than not, there are warning signs that occur a decent amount of time in advance of a catastrophic placental abruption occurring. A good provider - midwife or physician, as well as well trained L&D nurses - will see those s/s early enough to warrant further assessment and possible intervention.
How often do you see abruptions, true abruptions, when a woman is in labor? If you are seeing "many" as per your previous comment, then there must be a problem with the labor management. Even in the unit where I work, where labors are sometimes managed very aggressively, I have to say that I rarely see an abruption in a laboring woman. Most abruptions that I see are in women who come in from home with heavy vaginal bleeding and/or a hypertonic uterus. Those are usually the more deadly abruptions. The quieter abruptions are the women who are NOT in labor, but present with painless vaginal bleeding.
To everyone: Let's please be a little bit more respectful of everyone here. We all have our own opinions and experiences.
Chris (man-nurse): I do work with several awesome female OBs as well. So yes, there are some good and not so good OBs of the female and male persuasion.
Ugh, why do trolls need to turn this into a referendum on how midwives or natural birth is dangerous?
Anyway, lovely original post. There is a Dr. Wonderful in my area. Dr. Rivera. He attended one of the most beautiful births I have attended, and it was at a hospital in Miami, of all places. He was incredibly patient and respectful. I don't call that shmoozing, I call it good, woman-centered care, whether it was a midwife or a physician. He also didn't threaten a cesarean, even though she was stalled with ruptured membranes. He didn't threaten a cesarean even though she was a gestational diabetic with other medical issues. And, he didn't insinuate that "anything could go wrong at any minute!!11!!" He even allowed us to try the breast pump on her stalled labor instead of pitocin, and it worked beautifully.
What a wonderful role model.
It was probably a bit excessive to write "all the time" in relation to abruptions-- my intent was to write that I see so-called "normal low-risk" labors become much more complicated than expected with a high degree of frequency. Abruption is only one kind of problem. BTW, in my experience, abruption, partial or complete, happens more often in labor than prior to it.[One of the worst cases I ever saw, before fetal monitors were developed, was only diagnosed post delivery: not only a complete abruption at full dilatation but a true knot in the cord. One of the doctors strapped the Doppler onto the woman's abdomen while we all urged her to push--to avoid a crash C/S, back then, regarded as a "failure"--and as she pushed, we heard the FHR get slower and slower until it faded completely just as the head crowned. Resuscitation failed] Painless bleeding is more likely to be due to previa or a very low-lying placenta, and yes, tends to begin well before the onset of labor. It surprises me, AYC, that since you are obviously working in a high-risk, high-intervention unit, you retain your belief that low-risk labors rarely become complicated. While hemorrhage is one of the big problems [prolonged labor can predispose to hemorrhage, btw, and both "natural" and homebirths tend to allow labor to be more prolonged than in the hospital], there are other complications as well. Pre- and true eclampsia can have a sudden, devastating onset until the woman is 24 hours postpartum, for example. I could write an essay.
Perhaps I've been lucky. I've seen so many births that were supposed to be a piece of cake but became complicated, that I've developed a great respect for birth, rather than "trust" it. When you are prepared for the worst scenario, and it doesn't happen, that's great. But the opposite isn't so nice.
I have to say as much as it is nice to see you giving some credit to some of the OBs out there, it is disappointing that the only way you can praise them is to say that they are "almost a midwife"! I think your assumption that midwives somehow have a monopoly on caring, sensitive birthing is deeply flawed.
But my question is this: All of those long labors, etc.....what if something had gone wrong? Those ruptured membranes could easily have become an infected and very ill newborn, that prolonged labor have led to PPH....what then? There is a lawsuit brewing, because any mom can retract her consent by stating that she didn't understand it. And even more important, the lawsuit is brewing because there is an injured mom or infant. What then? Oh, at least you had a REAL birth?
My Dr. Wonderful experience was with 2 Perinatologists and a C-section- that's quite different from the "midwives vs doctors skills" debate but a reality for some mothers who develop a serious problem. And I'm here to say that it IS possible to have a wonderful birth despite high risk, high anxiety, life-threatening conditions... I was given time to hold my baby skin to skin in the OR at delivery even though he needed NICU and again less than 2 hrs later, allowed to put him to the breast even though he was NPO (I guess they thought he wouldn't really drink, they were very surprised I had enough milk to pump 2 oz at a time), they offered unconventional treatments including healing touch and visualizations and all the staff were more compassionate than any other office I've seen. Personal attention, having the high risk doc avail to me 24/7, the hand-holding & attention to detail was the sort of thing moms want from a midwife PLUS I got the skill to save our lives during a crazy medical challenge. I'd love to hear your perspective on how midwives can help smooth the transition for "natural" birth advocate moms who are faced with a sudden need for high tech interventions? Do you know any Dr. Wonderful Perinatologists?
Yes, I do know some Dr Wonderful perinatologists. Perhaps it's just the nature of their high risk patient population, but I see a whole lot of interventions with them as well. Some that appear to me, as the nurse, to be unneeded. A definite overkill of preeclampsia diagnosing going on.
I had an incredible doctor for the births of both my living children. Same doctor, a female family practitioner that was at every appointment, would come to the hospital for me no matter when I went into labor (no switching to the on-call doc, with the exception of going out of town for something for her daughter - but I just told her the baby would wait =) ).
She, and my wonderful nurses, encouraged me to walk around, get in or out of the tub, bounce on the ball, whatever. When I was pushing with my first for (I later found out) 3 hours, she asked if I wanted her to use the vacuum to assist. I said no - I wanted to keep trying, and she said okay. 3:20 he was born, almost 10 at night, no pressure to cut or vacuum or section, no saline locks "just in case," no antibiotics "just in case," wishes for the newborn respected, and just the sweetest doctor ever. Since she was an FP, she was my doctor before and after pregnancy, my kids' "pediatrician," and my husband's doctor the one time I could convince him to go. I think about, and miss, her at least once a week - and we've been gone over 2.5 years!
With two midwife attended homebirths, I haven't had much experience either way with OB's. However, my first baby was breech for a while at the end, and my homebirth midwife won't do a planned breech birth.
I found a birth center doctor who would let me try a vaginal breech birth, even though it was my first baby, even though he'd only seen me once before for a blood test, even though he did point out that there was a chance I'd need a c-section anyway (which he promised that he would do himself, if I needed it, instead of transferring to the hospital surgeon.
It made me so much less stressed. We didn't end up needing him (baby flipped!) but he was definitely a Dr. Wonderful.
Well my "Dr. Wonderful" is Dr. Bradly Stetzer at Metro Health Medical Center in Cleveland. I had him when I was pregnant with my twins (second pregnancy), and he was awesome! Always reassuring me about my pregnancy and not allowing me to freak out about everything (I tend to over-research things a bit too much...) I delivered my twins in about 20 minutes, my first was vertex and my second was a footling breech. He did a great job! Most other doctors don't even want to attempt a delivery of multiples unless both are head down, but Dr. Stetzer said as long as the first one was head down, he was confident that he could successfully deliver the second one vaginally. Loved this man!
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