Are Physicians Too Involved
Updated: Jun 27, 2024
Written by Jodi Graves, Elite Certified Doula Trainer
Jodi Graves, CEO of Michigan Family Doulas and an Elite Certified Doula Trainer, is a passionate advocate for modern birth and postpartum care. With degrees in nursing, nutrition, functional medicine, and psychology, she’s dedicated to empowering mothers and improving America’s maternal healthcare.
I think physicians are too involved in maternity and postpartum care. Wait, what? I know, I know. But, just hear me out with this. There’s a growing debate surrounding the extent of physicians' involvement in prenatal and postpartum care. We have horrible maternal outcomes in America, and they’re only getting worse. Our system is absolutely failing women so something has to give.
Maternal and infant outcomes in America
Is it possible that physicians are too involved? Is their presence helpful for optimal maternal and infant outcomes, or is Western Medicine the reason why our system is failing us so miserably? The CDC's Vital Signs Maternity Care Experiences report from April 2023 shows maternal deaths in the United States from 2018 to 2021, increased from 17.4 to 32.9 (per 100,000 live births). (Mohamoud, et al., 2023) In 2022, over 380,000 babies were born preterm—10.4% of all births—earning our nation a D+ for the second year in a row. (March of Dimes, 2022). According to new a new study by the World Health Organization, more than a third of women experience lasting health problems.
Long-term health problems post-childbirth
A new study published in Lancet Global Health reports that every year, at least 40 million women are likely to experience long-term health problems caused by childbirth. Vogel, et al., (2024) performed a systematic review of all research on the burden of postpartum conditions that persist for women and birthing people for months or years post birth. Some of these long-term conditions include dyspareunia (>35%), low back pain (32%), incontinence (19%), urinary incontinence (8-13%), perineal pain (11%), fear of childbirth (6-15%) and secondary infertility (11%). This doesn’t include all of the potential PMAD’s that women and birthing people suffer from. For reference, PMAD’s are postpartum mood and anxiety disorders including PTSD, OCD & Psychosis. In addition, the Mayo clinic reports a whole host of potential postpartum complications that women in the US suffer from including diseases of the cardiovascular system, hemorrhage, hypertension, adverse reactions to the medications given in labor, pulmonary embolism and death. That’s right. Death.
Disparities in maternal health outcomes
According to the March of Dimes, there has been a significant rise in pregnancy-related deaths. Black, American Indian & Alaska Native people are 2 to 3 times more likely to die of pregnancy related complications than white people. By any other measure, a D – is still failing. I would be embarrassed as a student if I got a D…why is the USA not embarrassed?
Disparities in maternal health outcomes
A quick rundown of the role of physicians over time. Historically, obstetricians have been central figures in monitoring the health of pregnant women, conducting regular check-ups, and overseeing the progression of pregnancy. Their expertise is supposed to ensure that potential complications are identified early, interventions are timely, and both mother and baby receive appropriate care.
Traditional vs. modern postpartum care practices
Postpartum care traditionally involves follow-up visits with physicians to assess the mother's physical recovery, mental well-being, and the newborn's health. In theory, at least. These visits are crucial for addressing any lingering issues from childbirth, providing guidance on breastfeeding and infant care, and offering support during the challenging postpartum period. No offense to anyone, but women are not getting these things in their postpartum recovery care. But, more on this later.
The medicalization of pregnancy and childbirth
Many argue that the medicalization of pregnancy and childbirth has led to an over-reliance on physicians, potentially overshadowing the role of midwives, doulas, and other holistic care providers. These alternative practitioners raise concerns about unnecessary interventions, such as excessive medical interventions in labor, over-prescription of medications, early induction before term and the medicalization of natural processes like labor. Some women feel that the focus on medical interventions detracts from the emotional and psychological aspects of pregnancy and childbirth. The pressure to adhere to medical protocols and timelines can create anxiety and diminish the sense of empowerment that should accompany these transformative experiences. This, of course, is midwives and doulas trying not to argue but realizing the system is so badly flawed that it needs a complete overhaul. I mean, come on, all one has to do is look at the facts in the beginning of this article to see proof that the system needs an overhaul.
Arguments for physician involvement
I am going to put on my non-biased doula hat and say that proponents of physician involvement emphasize the critical role that medical expertise plays in ensuring maternal and infant safety. They argue that advances in medical science have significantly reduced maternal and infant mortality rates, with early detection and intervention being key contributors to these improvements. We are still waiting for the proof that this is working. I will agree that the complex nature of pregnancy and childbirth necessitates a multidisciplinary approach, where physicians work alongside midwives, nurses, doulas and other healthcare professionals to provide comprehensive care. Each member of the care team brings unique skills and perspectives, contributing to a holistic and patient-centered approach to maternal health.
Physicians' receptiveness to doulas and patient advocacy
The thing is, physicians are quite receptive to the idea of a doula being in the room to help a patient advocate for themselves, but when push comes to shove-they would rather we are seen and not heard. No, this isn’t all physicians. But over the breadth of my 25-year career as a doula, I would say that it’s the majority. I’m sorry, but it’s true.
The need for personalized, patient-centered care
Finding the right balance is essential. While physicians bring valuable medical knowledge and skills to the table, it's crucial to recognize the importance of personalized, patient-centered care that respects women's choices, preferences, and autonomy. You know what that means-if a woman says no, it means no. Collaboration among healthcare providers, clear communication with patients, and shared decision-making can help achieve this balance. No, physicians, you don’t get to make decisions for me or bully me into decisions any longer.
Integrative models of care: Combining medical and holistic approaches
In recent years, there has been a growing movement towards integrative models of care that combine the best of medical expertise with holistic approaches. This includes incorporating practices like mindfulness, nutrition counseling, and emotional support into prenatal and postpartum care plans. This is a great step in the right direction!
Empowering women and transforming maternal healthcare
My mission is to empower women and birthing people to make informed decisions about their care, ensuring that they receive the support they need while physicians and nurses respect their autonomy and preferences. I am taking a loud stand against how women are treated in birth and in postpartum recovery and I am demanding we stop killing women and then blaming them for it. It has to stop and it’s clear that nothing will change until we unite and demand that it does. The involvement of physicians in prenatal and postpartum care is vital in the cases of true high-risk situations, but it must be balanced with a holistic and patient-centered, listening approach that values women's choices and autonomy. It’s time we took a bulldozer to the current model of care and rebuild it from the ground up in a modern, respectful, safe way that spoils women with choices. And then, we need to consider it may be time to take birth out of the hospital and put it fully back into alternative birthing centers that are staffed by midwives and support doulas and overseen by physicians. Other countries do it safely & successfully with significantly better outcomes that they can be proud of, why on earth can’t we?
Join the movement for better maternal healthcare
It's time for change, and it starts with us. If you're passionate about transforming maternal care, join us in advocating for a system that truly supports women and birthing people. Share your story, support holistic care models, and demand respect and autonomy in childbirth. Together, we can make a difference. Visit Michigan Family Doulas to learn more and get involved.
Read more from Jodi Graves
Jodi Graves, Elite Certified Doula Trainer
Jodi Graves is an accomplished professional with a profound commitment to modernizing the approach to birth and postpartum care. With her extensive education in nursing, nutrition, functional medicine, and psychology, she leads Michigan Family Doulas as CEO and serves as an Elite Certified Doula Trainer. Her personal experiences have fueled her passion for empowering birthing individuals, advocating for informed consent, and fostering a sense of agency and education in the birthing process. Jodi’s dedication extends beyond her family in Brighton, Michigan, including her two daughters and dogs, to her love for Hawaii and her dream of saving the whales!
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