Why Men in Maternity Matter.

In Australia, as in many other parts of the world, male doctors are becoming a threatened species in the field of obstetrics and gynaecology. Women now make up the overwhelming majority of trainees – roughly 80% across the country – and the numbers are increasing.  Our very own RANZCOG president, Dr Steve Robson, is a great advocate for women in medicine, and proudly highlights this evolving gender imbalance in his tweets and photographs. It is fast becoming the new normal.

But, as a feminist, I have some concerns.

This issue has garnered a fair bit of discussion in the international media of late, with an article published in the LA times last week stirring up some heated discussion. A number of blog posts have followed (including this, from my personal hero, Dr Jen Gunter and this), plus hundreds of comments, and some pretty robust debate on social media.

To be honest, I’ve been pretty dismayed by the tone of some of these discussions. The suggestion that men should just stop whining because medicine is still so much harder for women. That it’s ok if men disappear from gynaecology because women prefer female doctors. That male doctors are being selfish by caring about their own career opportunities and aren’t entitled to feel upset by discrimination.

I know for sure that some of my male OB/GYN friends and colleagues have felt incredibly wounded by these comments and have been feeling decidedly unwelcome in their own speciality. If the genders were reversed, we would NOT be ok with this.

If we truly care about gender equality in medicine, we really have to look at both sides of this story.

On the one hand, my heart rejoices with the increasing number of women in the field. It’s absolutely fantastic to see that, finally, women are not overwhelmingly disadvantaged, and that the system celebrates, rather than excludes women from its ranks. Heck, I’ve been proud as punch of my own little #ilooklikeasurgeon caesarean teams.

I know, too, that women still struggle in medicine in ways that men never will, even in OB/GYN. We have to prove ourselves over and above our male colleagues to be considered equally as competent. It’s exhausting to continuously need to convince patients that we ARE actually doctors and have the skills to help them. We have to walk that fine line between being too passive and too bitchy and get penalised either way. We suffer career consequences to have a family and still do the lion’s share of domestic duties. We suffer a stubbornly enduring pay gap.

For all the gains we’ve made, we still lag behind our male colleagues in the highest levels of leadership: Women occupy only 26% of RANZCOG leadership positions, compared to 46% of specialist memberships and 80% of trainee positions. I really, really hope the new wave of women OB/GYNs can overflow into the positions of power and influence.

But. I do not think that this exempts us from standing up for the inequities that young men face in our speciality. I do not think we can support a culture which behaves as if men don’t belong in OB/GYN. And I certainly do not buy in to the idea that it’s ok for men to suffer systemic bias because it’s “their turn”. To my mind, feminism is the belief that all people are given equal opportunities regardless of gender, and I do not believe that we are there yet in OB/GYN.

This is not the first time I’ve thought about this. I’ve observed for years the way that young men, particularly our medical students and junior doctors, are subject to bias in the maternity wards, birth suites and gynaecology clinics across this country.

I frequently hear from the medical students that for the blokes, it is nearly impossible to gain the necessary experience with speculum examinations, vaginal exams and witnessing births. I have seen the way that a female medical student has been warmly included in the birth suite team, while in the room next door another patient is subtly encouraged to say “no” the the medical student, because “it’s a boy”.

They also accept the inevitability of being “kicked out” of gynaecology consultations as often as they’re allowed to stay. I’ve worked with excellent male doctors who have managed an entire labour and delivery with skill and sensitivity, only to be asked to leave the room so that a female doctor can complete the perineal repair. These guys understand, they don’t argue, they respectfully withdraw. But it’s hurtful.

And here-in lies the problem. Because, above all, I absolutely support patients’ right to feel comfortable with their doctor. Throughout history, men have inflicted oppression and control on women, and we still suffer the consequences of patriarchy in our day-to-day lives. And with women the overwhelming victims of intimate partner violence, sexual assault and abuse, we must protect women’s rights to choice and psychological safety when they are at their most vulnerable. This goes 100% without question. Furthermore, it’s imperative that as a system we support patients’ access to culturally appropriate healthcare, including gender congruent care for certain cultural groups where it’s important, such as Indigenous and Muslim women.

So, I don’t know how to overcome these two seemingly irreconcilable facts. One; that wherever possible, women should have the right to choose a healthcare provider they feel comfortable with. And two; that students and colleagues should not suffer systemic bias, and should have equal opportunities to learn, regardless of their gender. After all, isn’t that the fundamental basis of feminism?

However, I think all of us, staff AND patients, need to consider the consequences that arise when our young men don’t get the same clinical opportunities as the women.

Firstly, we will lose good people who would have become brilliant OB/GYNs. Some may be turned off by the barriers they encounter, and some may never have had the chance to experience the joys of the speciality. And yes, I know we will have plenty of brilliant women doctors, but that’s not the point. We all know incredibly competent and beloved male OBGYNs so please can we STOP talking like women make inherently better doctors? We need to attract the best, brightest, most passionate and dedicated doctors of any gender. (See here for a fine example…)

No, I don’t accept that you have to have experienced pregnancy and birth to be able to be a compassionate obstetrician. Childless female obstetricians and midwives are not excluded in the same way as the men. Further more, you don’t have to have cancer to be a great oncologist, or to be old to be a great geriatrician, so why should you have to have a uterus to be a great gynaecologist?

Secondly, doctors from EVERY speciality who care for female patients need skills in obstetrics and gynaecology. Particularly, those who end up as GPs, emergency physicians and rural doctors who will need to deal with gynaecological presentations in their day-to-day work. It’s female patients who will suffer if their male doctor’s skills with a speculum aren’t as honed as they could be. It’s the female doctors who will suffer if they need to take on extra women’s health work in addition to their regular workloads.

Thirdly, a lack of diversity in any group is detrimental. Boards, academic institutions, departments, clinical groups… all sorts of teams perform better when there is greater diversity. Yes it’s wonderful that women are finally starting to make their mark. Let’s not let the pendulum swing too far the other way.

This is a tricky issue, and I certainly don’t have the answers. But I think we can all start to help by making sure that the language we use includes rather than excludes, by trying that little bit harder to overcome the biases against male students and colleagues, and by acknowledging their rightful place as an important part of the care team.

How about a little #sheforhe?

I don’t know about you, but I practice OB/GYN in the same way I practice all aspects of medicine; with my mind, ears and eyes, hands and heart. NOT with my vagina. I can’t wait for the day when colleagues both male and female are given equal opportunities to enter the birth suites, clinic rooms, operating theatres, academic posts, board rooms and presidential offices, regardless of what’s between their legs. Then the future of this great speciality will be bright indeed.


4 thoughts on “Why Men in Maternity Matter.

  1. yes, well written, balanced piece, thoughtful article. In my view, however, on this particular matter you’ve got to be bias! You’ve got to be able to say as a patient that you don’t want a male doctor to examine you. I have a lousy memory of a lousy feeling when a male doctor sat in front of my genitals to examine me when I was pregnant. Never again. I only had one child.

  2. Well written Penny.

    My strategy for my undergraduate practical examination should I be asked to perform a pap smear would be to take a step backwards, draw the curtains and wait for 5 minutes. Up until then that was my exposure to this procedure in women’s health. Thankfully my experience is now broadened having obtained my DRANZOG advanced and worked in remote areas providing obstetric and gynaecology care. Working in Aboriginal health, I felt I did have to break through the women’s business construct that some midwives surround their patient’s with.

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