Keeping mothers out of medicine (And my ongoing career crisis!)
I’m coming to the end of the final module of my MBA. I started on that path ten years ago as a bright-eyed 21 year old software developer with vague notions of one day being a powerdressing consultant. It’s been a long, long process with several pauses during which I had two babies, completed a BA in theatre at a bricks and mortar university then moved across the world and had a third baby.
I accelerated the MBA over the last two years and decided to pick a specialism in healthcare and the life sciences. It turned out to be a serendipitous choice. My home birth revitalised a rabid interest in birth matters and the life science specialism allowed me to combine my birth and management studies into a dissertation on how the NHS might cope with managing doulas.
So now I find myself at a crossroads. Home-educating and breastfeeding are part of my life and I’m more t-shirts and piercings than shoulderpads. But I want to keep studying, keep going, keep learning and I want to be challenged. I also want to be in a position to make positive changes in the world.
Here’s the thing.. my impression is that the only qualification which counts is MD. (Please, PLEASE challenge me on this. I’d welcome a debate!)
Personally, I adore midwives. I’ve met several over the last year or so who are among the wisest people I have ever met. They are on top of the latest evidence, constantly learning, reading, gaining experience and absorbing knowledge. They have the emotional intelligence, spiritual intuition AND the science.
Yet if we’re playing ‘birth top trumps’ the midwife always loses out to the doctor.
And in American society, the doctor is king. They can deliver babies, cut people open, prescribe medicine, make diagnoses and declare deaths. They get a cracking salary. They can also make all sorts of pronouncements that are often ‘the voice of experience’ rather than coming from any kind of evidence.
And many will say fair enough, they went to medical school for a long time.
And this is where I hit a snag.
I would quite like to go to medical school. I would love to learn about cell biology and anatomy and all that stuff. I’m a good student. I’ve juggled motherhood and studying in various fields for years.
Yet the barriers are massive. They’re almost insurmountable if you have young children. “It’s about stamina.” I hear. You have to go full time. You can’t do med school part time. You have to be dedicated. It has to be your number one priority. Your spouse will have to deal with the funny hours. You won’t see your children. You need to do it early in life or you’ll never pay off the debts etc. etc. etc.
I ask why? Why can’t you learn more slowly? Why all the macho stamina stuff? Why is it a study course tailored to young, childless people? Why is the med-school recruitment target audience made up of people who have not yet had a baby or even much life experience out of academia? At my school, the ‘clever girls’ were groomed to be doctors following a straight, clear path from school. And well done to them. It’s not an easy path. They were smart figuring out what they wanted to do before children. But some of us needed a little more time to figure out what we want to do – then find it’s too late.
Things are changing slowly in the UK – St George’s for example offers a fast track course aimed at getting older students in and trained. There are post-bacc courses in the US too. But there are no part time med schools. You have to dedicate yourself to it entirely. You can do law or business part time. You can do a PhD part time. But medicine is different. Why?
Now I’m not suggesting that doulas or midwives are second best. They’re a different thing entirely. And there are some massively influential ones – Peggy Simkin, Ina May Gaskin etc. etc. But they don’t carry as much weight in the medical world as they should. Hospitals NEED more doctors like Dr Biter who is rightly all over the news at the moment. Doctors who have PERSPECTIVE and are aware of why natural birth is important and when they should let it take its course. Doctors who carry weight with their peers. Who have the same level of education and authority.
But that education is not easily available to women with children. Especially women who are reluctant to put their children into full time day care.
There’s a feminist issue here. Why should wanting to care for your children preclude you from accessing that education? Why shouldn’t women with children study and gain the experience to become peers with doctors? So many mothers become doulas or even midwives yet for a hands-on mother to become an OB/GYN is difficult to the point of near-impossibility.
And doulas and midwives will always be ‘put in their place’ beneath the OB/GYNs. The patriarchy is stifling.
How can mothers get their voice and experience heard when we’re always told we’re ‘not as good’ or ‘not as clever’ or ‘not as educated’ or ‘don’t carry as much authority’ as the wise doctor and we don’t even have a chance to access the education?
May 13th, 2010 at 12:41 am
Being unfamiliar with life in the USA I can only comment from a UK perspective – and mostly I agree with you. However, I believe that things here are changing with nurses roles expanding into specialist roles, such as nurse consultants and nurse prescribers. Also, the NHS now advocates midwife led ante and post natal care for normal, uncomplicated pregnacies and births.
What saddens me a little about your post is that you don’t consider the implications of an intelligent, motivated and strong woman like yourself joining the midwifery profession and the difference you could make. The idea that you must be a MD to make a difference is, in my view, outdated in the UK, but maybe accurate on your side of the pond. If that is still the case over there then they need you even more!
May 13th, 2010 at 12:55 am
Thanks for the comment, Tamara! I do keep feeling a nudge towards midwifery. But I see incredible midwives here struggling to make a difference outside home birth territory. The role of the midwife in the US is becoming increasingly marginalised, they make a fraction of the money doctors make, they’re constantly defending their profession and midwife-led care in a hospital setting is a rarity.
I think perhaps in combination with a doctorate or a very strong career strategy with lots of speaking, publishing and research, a midwife can gain credibility and authority. But it’s tough going. They don’t get the instant kudos a doctor has.
The American situation frustrates me greatly. And I’m more frustrated with how these barriers have been erected and no-one questions the discrimination against mothers when pretty much every other field including law and business have online, flexi and part time study options.
May 13th, 2010 at 4:51 am
I think there are several reasons you don’t see many part-time MD programs, some sensible and some not so sensible. Law and business are both essentially cognitive professions. Medicine includes both cognitive aspects (including a knowledge base that changes very rapidly) and a fairly large set of procedural skills that easily decay if not reinforced fairly continuously and that are not effectively taught online. That might be a more sensible reason. A less sensible one is that it would be much harder for medical school faculty to assess and evaluate part-time students, and many faculty worry about graduating docs that they have observed extensively.
If you want to be in “health care top trumps”, though, a PhD (in public health, health policy, etc) + MBA would be a pretty powerful combination if you wanted a career where you try to set the policies, regulations, incentive structures, and other systems that control how the doctors get to practice. But that’s not direct patient care, of course.
(We have midwife-led care in hospitals here – have for years – but I think the midwives need to be nurses or nurse practitioners to have the credibility/authority in the hospital setting).
May 13th, 2010 at 7:33 pm
Alan! Hi! Thank you for this.
Yeah… I’ll concede that an online course wouldn’t work, no matter how many virtual patients or dissections you threw in.
But it strikes me that there could be a lot more flexibility and a lot more encouragement for non-trad candidates. Every other field has seemed to realise that mature candidates bring a huge amount to the table yet there is heavy discrimination in medicine which seems to favour tradition over progress.
A PhD is a definite possibility (and thank you for the encouragement!). I met a nurse with a doctorate in infant feeding recently who has worked all round the world and for bodies like UNICEF. She was fascinating. There are other pathways open for me (and probably more sensible ones as I would have to do some serious work to bring my science up to scratch).
But in the big picture, I do think there is discrimination in access to medical education for mothers and the knock-on effect I see is that the vast majority of obstetric wards are not woman-friendly. One of the very few pro-VBAC doctors in the county has been witch-hunted out of his hospital. The range of birth choices open to women is narrowing all the time. Empathy seems to have gone out of the window in favour of minute and flawed risk analysis.
May 17th, 2010 at 7:35 pm
Katharyne… I can’t thank you enough for this post. As a mother of two young girls and someone who has the burden for birth, I couldn’t agree with you more. I’m in the process of being certified with DONA… and someday think I’ll take the midwife path… but SO WISH that i could take the medical school path, but agree with you 100% in that it seems next to impossible.
Also, to give you one more reason to respect Dr. Biter- when he and I were discussing a birth that I attended and I was processing through how things had gone very different from what was seeming to be the course (mom at 9 cm, stuck, got to 10, pushed 3 hours and ended in a c-section)- referred to me, as a doula, “his colleague.” I already respected the man immensely, having birthed with him myself… but my respect and appreciation grew ten-fold with that comment.
Thanks for your postings as of late…
May 17th, 2010 at 7:53 pm
Thanks Jenna! What a lovely, respectful thing for him to say. It’s a shame that it’s not the norm.
I was uncertain about doulas until one ’showed up’ for my home birth. She was incredible and I have so much respect for women who dedicate themselves to this profession. It’s not an easy one.