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INTRODUCTION

The obstacles preventing natural birth practices from becoming part of the routine options presented to women are numerous and complex, but they are important to understand, both for medical providers working with patients who desire a natural birth and for women themselves who may be meeting resistance toward their natural birth plan. One of the harder to define barriers is the general culture of labor and delivery units that often stands in opposition to the natural birth plan. That culture can be a product of the stressful, dynamic, and fast-paced working environment nurses and doctors find themselves within, but it is also a result of the way in which nurses and resident doctors are trained and their own life experiences. An obstetrical residency is one of the most challenging and often demoralizing residencies a physician may undergo and this impacts both their relationship with patients and their approach to labor management. Obstetrical residencies also rarely include formal training in low-intervention techniques. This is because most training tends to occur within busy, high-risk centers which provide the opportunity for residents to be exposed to a large volume of delivery and surgical experiences, as well as a wide range of complications and unusual pathology, but little time for the actual one-on-one work with laboring women that really promotes understanding of the labor process.

Much of the other impediments to the natural birth approach are, unattractively, all business. Birthing babies takes considerable time and our medical system is based mainly on procedural reimbursements, meaning obstetricians earn the same amount of money for a procedure, or delivery, that takes 10 minutes as one that takes 10 hours. The risk of litigation for performing that procedure also continues to rise, with physicians assuming large costs for malpractice and living under the constant threat of a lawsuit that would increase those costs further or even threaten their personal property and their ability to continue to practice medicine in their specialty. It is a complicated set of challenges that often pit the interests of physicians against the interests of their own patients.

RESIDENCY: THE BARRIER OF THE MACHINE

An Obstetrics and Gynecology residency is an intense four year training program that competes only with surgical residencies in terms of its reputation of suffering among the residents completing it. While all residents work hard, it is only in OB/GYN that a resident can go an entire twenty-four hour shift without sitting down or eating. In my hospital, there was always a patient in need and it was always urgent. We divided our time between delivering babies and triaging pregnant patients on labor and delivery, learning to perform gynecologic surgery with up to fourteen hour stints in the operating room, managing all the postpartum and postoperative patients recovering on the hospital floors, caring for patients with gynecologic issues in the emergency room, and seeing patients in the hospital’s outpatient clinic. A ...

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