Responding to Patients' Requests for Female Obstetric Providers

Summary and Comment |
April 20, 2017

Responding to Patients' Requests for Female Obstetric Providers

  1. Diane E. Judge, APN/CNP

Being supportive of patients' wishes must be balanced against concerns about gender discrimination.

  1. Diane E. Judge, APN/CNP

Women from many cultures request female clinicians for intrapartum care. Investigators interviewed 10 obstetric residents (mean age, 29; 7 female) and 10 general obstetricians (mean age, 46; 6 female) at a Canadian hospital with a large immigrant clientele. Structured questions addressed clinicians' sex as a barrier during labor and delivery, antenatal discussions with patients, and suggestions for addressing the issue.

All respondents expressed a desire to be supportive of women who request female providers, but none supported always accommodating this request. Reasons included gender discrimination against clinicians that superseded the principle of patient-centered care, request made by male partner or family member rather than the patient herself, and practical issues (in Canada's publicly funded health system, on-call clinicians provide after-hours and weekend care). In addition, excluding male residents and supervising clinicians from deliveries would compromise the quality of medical education. Respondents advocated for clear guidelines, perhaps based on the Canadian Society of Obstetricians and Gynecologists' position that services “cannot and should not ever be based” on patient or provider characteristics (i.e., sex, race, sexual orientation, age, practice patterns, or religious affiliations).

Comment

These findings (although subject to the limitations of qualitative research and differences between the Canadian and U.S. health care systems) suggest that responding to gender-based preferences for intrapartum care is not simple. Although younger obstetricians and residents in the U.S. and Canada are likely to be women — as are 99% of U.S. nurse midwives — the on-call or back-up obstetrician may not be female. The respondents' concerns about acknowledging patients' preferences while avoiding gender discrimination raise issues worthy of discussion (and policy formulation) by obstetric practices and healthcare systems.

Editor Disclosures at Time of Publication

  • Disclosures for Diane E. Judge, APN/CNP at time of publication Equity Stryker Corporation

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