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Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu (Part Four)

[Editor's note:  This is the fourth part of an interview series between Science & Sensibility's Walker Karraa, and OBGYN Dr. Michael Lu.  To read the interview from the beginning, go here.  For a list of resources pertaining to this interview series, go here: resources and bibliography_dr lu interview series.]

 

 

Sacred Trust of 24/7

 

Walker Karraa: Do you use doulas, or do a lot of your patients use doulas?

 

Dr. Lu: I do, oh absolutely.

 

Walker Karraa: How is that?

 

Dr. Lu: It’s been good.  I think it’s been real good.  Usually my patients just mention they have doula and I usually say great and I see them on labor and delivery.  In some instances they alleviate some of my guilt for not being at the bedside.

 

Walker Karraa: Is that hard?

 

Dr. Lu: Yeah. I had a patient that came in Easter Sunday.  My own family was going to do an egg hunt.  We had hidden the eggs and everything–but she was a VBAC patient.   When I came in to check on her she was still maybe around five centimeters or so.  I didn’t know how fast she was going to go.  And then I was torn.  Should I stay because she’s a VBAC?  I knew I should stay, but on the other hand, my two daughters, ages eight and five, they’ve been waiting for this Easter egg hunt.  It’s an important moment.  A precious moment and I wanted to be home.  But on the other hand I know the success of that VBAC very much depends on support.

 

Walker Karraa: Did she have a doula?

 

Dr. Lu: No she didn’t have a doula.  And so I ended up going home.  The whole time I was feeling extraordinarily guilty.  She forgave me; I mean she understood.  But you know that this is not optimal care. I knew in my heart it wasn’t optimal care.  The way the current system is designed, you’re on call 24/7 for your patients.  That’s something that I haven’t reconciled because I know that there’s something sacred about that bond with your patient.  The way it’s actually set up, you’re coming in at 3:00 in the morning, and you’re distracted.  Or if you have another meeting that you have to go to, or if you have an office full of patients that are getting frustrated because you are in delivery–this might actually start to create these sort of instances for you to do the things that may not be in the patient’s best interest, such as talking them in to do a scheduled c-section instead of VBAC so that you can actually free up your schedule–so you wouldn’t be called in on Easter Sunday!

 

Walker Karraa: But the intention is not malice.

 

Dr. Lu: No it’s not malice; that’s why I keep saying it’s not just an individual problem.  It’s a system flaw.  It’s not just about asking the individual OB to work harder, but it’s asking the system to work smarter.  So this is where the teamwork approach actually comes into play.  I think doulas are much better trained in terms of providing support during labor than obstetricians are.  Most of us didn’t sign up to stay by the bed side.  We signed up for obstetrics.  You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc.  They’re not really trained to provide nurture and support.

 

And by the way, we had an in-house attending OB, and with my VBAC patient on Easter…

 

Walker Karraa: Let me guess, the mom said no way?

 

Dr. Lu:  Well I couldn’t even say, “I’m passing you off to the attendee.”  The attendee could have easily supported her labor and delivery–just somehow the expectation was that no, you don’t pass her off to just the on-call attendee.  That’s your patient.  She’s under your watch.

 

Walker Karraa: That’s a lot of pressure.

 

Dr. Lu: It is a lot of pressure and that’s why I think sometimes people are increasingly critical of the doctor’s role, like the increase in caesarean, etc.  But that’s what the system has set them up for.  I still believe that most OBs are driven for the right reasons.  They really want the best outcomes for moms and babies but sometimes they’re just pretty ill-equipped to deliver that.  That’s where I think it’d be great to get some conversation going in our field, in our world.  We’re all united for one common purpose, how do we do that better?

 

Walker Karraa: You talked about the sacred trust of 24/7 between patient and doctor.  I wonder if somehow that is the same sacred trust that leads women to agreeing to a c-section?

 

Dr. Lu: I know I could talk my patient into anything, and most OBs know that.  But that’s a misuse of that trust.  Yet there is that sacred trust.  I don’t know how to change that culture.  Maybe the trust is misplaced.  And this is what I haven’t figured out, if we replace the OB with a team, can you have trust in a team the same way you have a trust in your OB?

 

Posted by:  Walker Karraa

 

[Editor's note:  In tomorrow's final installment of this series, Walker and Dr. Lu discuss racial gaps in maternal outcomes and the need for future research.]

Doula Care, Preconception Care, Research, Series: Preconception Care , , , , , , ,

  1. avatar
    Walker Karraa, MFA, MA, CD
    July 21st, 2011 at 11:42 | #1

    An additional note to this installment. In the interview, Dr. Lu shared that he originally encouraged his VBAC patient to follow his referral to a midwife–and she still chose him. This subtle layer of trust was one of the most compelling revelations for me–as it speaks to unpacking the mechanisms that continue to drive women to birth in hospitals, with medically based care. Some questions arose:

    What is the nature of that sacred trust?
    How does it develop?
    Is it universal?

    Is it symptomatic of a deeper psychological, if not transcendantal need to have a trusted guide in birth, and during this zeitgeist, and this country, that guide has been collectively chosen to be an OB/GYN?

    Dr. Lu shares this Albert Einstein quote in many of his presentations: “The definition of insanity: doing the same thing over and over again and expecting different results.” Are our current methods of advocacy, education, etc. working as well as they could? Or are there elements of our organizations and “movement” that do the same thing over and over and expect different results–and vilify everyone else for the lack of progress? Are we sustainable for future childbirth educators and doulas–say 20 years from now? Do we know how to remain relevant?

    Can we begin

  2. July 21st, 2011 at 15:53 | #2

    Walker,
    Thank you for helping our readers put this segment of the interview into context with the components of your conversation with Dr. Lu that didn’t make it into the transcript. And, yes: when we are so quick to select one side of a heated issue–vilifying any and everyone we perceive to be “on the other side” with little to no exception, we not only risk our credibility and position within that system, but our potential to effect the change we so desperately want to make.

  3. July 21st, 2011 at 16:29 | #3

    Great interview. He says a lot of things that every OB feels, and illustrates a point of view that many people are unaware of. His point that there is no malice involved in an OB’s decisions is important. There are times that factors outside of an individual woman’s labor lead one to a path that is not optimal for that individual woman. Some would call that malicious or dereliction of duty, but in reality it is a product of a system that almost mandates such activity from time to time.

  4. avatar
    Walker Karraa, MFA, MA, CD
    July 21st, 2011 at 17:52 | #4

    Yes! And I look forward to seeing how we might all benefit from taking a stab at the systems that keep us doing the same things, and expecting change. For years I have felt a bit isolated in trying to share that individual OB’s are not the problem, and not evil incarnate. And that we can make a tremendous stride toward changing the things we know are wrong (infant/mternal mortality; C-section rates, etc.) if we get in the sandbox with the system and play nice. Otherwise, we will remain on the sidelines, complaining, and pointing fingers, and as Kimmelin pointed out–risking our own credibility.

    Dr. Lu’s vision offers an invitation to childbirth professionals to become a part of the national dialogue on maternal care reform. And the ironic thing is that organizations would profit if they got on board. Certified preconception counselor? Brand it. And help others along the way!

    @Nicholas Fogelson, MD

  5. July 25th, 2011 at 08:49 | #5

    Hi
    what I think society expect that doctor ob/g should work 24/7 and during his working hours he should offer his or her services happily.and during this if something which he or she decides is not going in favour of a particular patient as per they think is wrong how can they think like this .A person is there 24/7 and without enjoying his personal life with his or her family serves patients unconditioned then why his design is doubted .It is too much of expectation from doctor.In my opinion he or she can take decision and it should be respected.

  1. October 22nd, 2011 at 17:20 | #1