S2E15: History, Present, and Future of OB/GYN

Harjit: Okay.

Leen: One of y'all is not plugged in.

Harjit: Ready, ladies?

Leen: I'm not wearing a head piece.

Harjit: Ready Bundle of Hers?

Bushra: Go.

Harjit: That was very not nice. Gosh, Bushra's back.

Bushra: I got to go to bed soon.

Margaux: She's been working all day.

Harjit: Okay. Yeah. Okay. We're all in the studio today. I'm so excited. So I just started OB-GYN this week with Leen. Me and Leen got our first rotation together. We're doing hair hand five. If Leen will give me a hand five back.

Bushra: A hand five?

Margaux: I was trying not to laugh.

Harjit: Wait is it . . .

Margaux: High five.

Harjit: Oh, a high five. I think Leen's done. Anyways, one thing that I noticed yesterday when I walked into . . . I'm starting with the gynecology portion, and when I walked into the OR, it was so interesting to see so many women on this case. So it was kind of a complicated case. So there were two female surgeons and a gynecologist and a gynecologist-oncologist, and then there was the resident who was also a female, the nurse and also a nursing scrub tech student.

And I was just like, this is a very different environment than I'm used to, because I did surgery before, and I don't know, it was kind of refreshing. But I will tell you, it just felt kind of odd. I think it's because I wasn't used to it, but I really liked it because it was so funny. Like they were having cool conversations in between the case. It was just a sight I haven't seen before in any other field. I know you, Bushra, and you, Margaux have already done it and maybe have -- I've only seen one case so far -- kind of a broader perspective. Would you agree with that?

Bushra: A majority of the time, your time spent in OB-GYN is mostly female providers. On rare occasion, you'll get a male surgeon or a male resident, but I think I've maybe count twice that that's happened. But yeah, it is a different experience because you're used to being probably the only female on surgery, right?

Leen: OB was my second rotation. But I definitely got this air of like, it was like a club of badass women, right? It was so different, and it has still stuck out in my mind as a really cool, unique specialty in that way in that is one of the few or maybe the only female-dominated specialty right now. And it is cool that you can go in the OR and have all women, and it's just a different feeling. And that's something I've been fortunate to experience in the OR as well, which is great, but I think is definitely more common in OB-GYN. But historically, there may be reasons for it being female dominated that are maybe not as great.

So I think a lot of women, when they were first coming into medicine, felt like they either could go only into pediatrics or family planning and OB-GYN because those were women-related specialties, right? And so whether women . . . the field is dominated now because all women, historically women thought that's all they had.

But I think now a lot of women choose to go into it because there's a lot of camaraderie and an understanding between patient and provider, as a woman or as a female. I think that's really cool that it's a specialty where women who need or are seeking help from healthcare providers have very sensitive issues in body parts that are not always easy to talk about, especially with men. And there's a lot of racial and social and religious considerations surrounding this sub-specialty of healthcare. Not that there aren't in all specialties. But I think this one has a unique . . .

Harjit: It's just like a different arena, because I think it's topics that are often, you know, hush, hush back in the day, but I think now they're coming out into the forefront, which I'm excited about, because I think they're necessary educational topics and to be completely healthy, like, that's a very important part of all of our lives.

Bushra: Margaux, just to kind of piggyback off of what you were just saying, it's interesting because the field of medicine originally was male dominated in all aspects, right, and then when you start seeing women entering the profession, you see them kind of gravitating towards Peds, towards Family Medicine, towards OB-GYN, and those historically have been where one would expect a woman to go into.

Now looking into it, you see OB-GYN and it's female dominated. And a lot of the reason why is not because, oh, this is the only thing that I can go into. It's actually pretty competitive to go into OB-GYN, and it's more of that camaraderie aspect that you can be a badass surgeon. In OB-GYN, you can take care of cancer patients, you can take care of sick, sick, sick babies in utero, like new fields have come out of that like maternal-fetal medicine and fetal surgery. So it's interesting to see the growth of the field from its inception to now has been like a stark difference I would say.

Harjit: There's also been this like conversation like at this moment it is, even though historically it was male dominated, it is now female dominated. And I've kind of noticed how interesting it is hearing conversations of fellow classmates, how they perceive OB-GYN. I noticed from the women it's like, "Oh my gosh, it's so cool. There's so many women, like it feels really good. We can mostly go into most cases." And a lot of the men have this kind of like appre- . . . Sorry.

Bushra: Apprehension, I think is a good word.

Harjit: Is it good?

Bushra: Yeah.

Harjit: Okay. So a lot of men have this like apprehension. They're like, "Oh my god," like they're feeling so doomed, like they're going into OB-GYN. But I don't think they directly ever use the words, "I'm apprehensive because it's a woman-dominated field." There's just this like vibe, you know, for them.

Bushra: It's the first time that they've had to be a minority in medicine, which is like interesting because I feel like if you ask most women in the most medical schools, they'll tell you, "Yeah, I felt like that before." But OB-GYN is distinctly different, because of that aspect of like men are going to be . . . most of the all of the patients are women. So the women choose to decide whether they want male medical students in on their cases to learn. And if a woman is not comfortable with that, she can say no, and a lot of the times she does.

The other thing is a lot of the questions that you ask is very sensitive questions. And it's like you get uncomfortable, or as a man, you might be a little bit more uncomfortable asking those questions. And then the third thing is most of your seniors are going to be women. And so that might put them at an awkward position or a position that they never saw themselves having to navigate as Margaux likes to say.

Harjit: I just find it so interesting when I hear like my fellow classmates talking about OB-GYN. There was . . . it was orientation, and there was someone in my class that was like, "Oh, I heard that it's really hard for men to get opportunities to see a lot of the cases. Is that true?" And I was like, "That's so funny that you even ask that question, because there's a lot of denied opportunities that we all get along the way." You know.

Leen: I had several male classmates on my labor and delivery rotation that were denied. And they, you know, instead of coming from a place of understanding and grace or however you want to call it, they got really upset and felt entitled and thought that their education was less, because of this . . .

Bushra: Compromise. Yeah.

Leen: . . . compromise. And then I kind of confronted them and like more of a reason for this sort of denying you an access into this case, than like a female surgeon being denied doing a surgery just because she's a woman. And so I think that when you pose that as a question, they maybe only think about it, at least in this case, it was like, yeah, but still it's annoying. They don't . . . like you're saying, Bushra, they just can't come into a place of understanding and use it as an experience to actually understand what other people may be experiencing across the spectrum of all specialties.

Bushra: And I think this is like where privilege comes into place, right? As a man, you've learned that you expect certain things. And when you don't get those certain things, you react, and sometimes is not a great reaction, let's be honest. But that's because you've been taught that these are your rights. And when something threatens that, it kind of takes you aback.

And then you compare that to, say, one of your female classmates who on a different rotation experienced a similar thing. And for her maybe like, "Oh, that's totally expected." And so you don't get that same reaction because you've been socialized to be like, "Oh, this is to be expected." And so the reaction is different.

For me, that's what privilege is, difference in reaction. One is saying, "Hey, that's my right," and you get angry about not being able to fulfill and take your learning opportunities as they come. And then the other is people who, yes, they do have those rights but don't necessarily exercise them because they've never been taught to.

Leen: Yes. I love how you said that.

Leen: Jumping off of both your thoughts, for our colleagues who are male and have been denied opportunities to see certain procedures or be involved in certain care when it comes to gynecological and OB cases, and then they become subsequently irritated by it, it's for me, I find it ironic because the rules in which women find that women parts are supposed to be kept hidden, or are somewhat shameful are as a result of a patriarchal kind of based society. So it's almost like their rules being flipped back on them, and I think that's very ironic.

In that sense, it's like, yes, I agree. I feel like, as medical students, we all need the skills and opportunity to be able to take care of these patients. I completely agree with that. But on the flip side, you got to realize where did these stigmas come from? You know, you can't just blame a female saying, "Why can't you let me into your operation? Why can't you let me?" Because there's the stigma that she brings to her care, comes from a society run by patriarchal rules. You know, in order to make this a completely even playing field in the sense that we are all here for everybody's care, we need to understand where the cultural and historical contexts are coming from.

And I think that's a huge point that a lot of our colleagues will get irritated and miss this point.

Bushra: I agree, Leen. I think that's so insightful to recognize where a lot of that comes from.

Leen: And then what you brought up the point of historically the field was male-dominated, and women didn't have a choice. These patients didn't have a choice. They had to see a man whether it made them feel uncomfortable or ashamed or whatever.

Harjit: But I think it's so interesting that this is one place where women have the right to speak their choices, and I'm sorry, but I also think that makes people uncomfortable.

Leen: On that note, it actually reminded me of a story that I heard from one of the standardized patients who was involved in a group that come to medical schools and teach medical students how to do pelvic exams on themselves as well their standardized patients, and she was telling me the history of this group. So when they first started, they used to bring in sex workers to have the medical students perform pelvic exams on. However, the sex workers they were not allowed to speak if something was uncomfortable or if a med student was doing something wrong, and, you know, back then the practices were very, not very comfortable.

Harjit: Ethical.

Leen: No, comfortable. They weren't very comfortable. Like if you needed to search the vaginal wall, you'd like move the speculum around and search.

Bushra: Oh, my god.

Leen: Yeah, so she's saying we cut that practice, but old OB-GYNs will still do it.

Harjit: That's scary.

Leen: So they weren't allowed to speak if they felt uncomfortable, until there was a nurse, I believe is what she told me. There was a nurse who said, "Hey, like we understand the anatomy. This is our job. Why don't we teach this to medical students?" So they allowed that, but however, they had to cover their faces with like a bag so that they wouldn't be recognized as well. And then they could speak to the medical students. This is like the history of teaching med students. This is like your first exposure to . . .

Harjit: Male med students.

Leen: Well, male and female in general, like whether you're a conservative society or not, but this is like the introduction to teaching med students, here's OB-GYN. You know, we don't care about her face, we don't care about who she is, but this is your job down here.

Leen: You mentioned that there were some unethical practices within this, namely, you know, using these women and just practicing without allowing them to give feedback on whether it was painful or not. And I think that we must address the elephant of OB-GYN and the deplorable history of these physicians, older physicians using enslaved black women as the original research subjects for C-sections. And they were doing it without anesthesia. And all sorts of other gynecological practices, that are still in use today, have their root in this very unethical, very horrible history.

And so that's an interesting component to the OB-GYN story. But I think now, you know, there's this history of women of color being, you know, used as research subjects in OB-GYN, and now I think that, you know, the field has totally changed and these badass women have totally taken over and are really doing great things in OB-GYN, but there is still a lot of discrepancies in health care. And especially right now in the U.S. it's very prominent data to suggest that women of color, mothers of color giving birth have a much higher mortality rate than white women in the United States. And the level is greater than in developing countries for women of color in the U.S.

Harjit: And specifically black women. There's like a whole study on it.

Leen: Studies.

Harjit: Studies. You're right.

Bushra: I'm so happy that you brought this up, by the way. It's interesting because they control for socioeconomic status, they control for everything, and in every single instance black women are dying at an alarming rate in this country. And then giving the history of the field, I don't think it's that surprising. I don't think it's surprising at all because we have a tendency to ignore the things that black women say in terms of pain, in terms of discomfort, in terms of how they're feeling and how their bodies are feeling. And that shows in the data.

Harjit: Hundred percent. And I think it's kind of brought in this field, you would say like, oh, this is women dominated. But the truth is that even though this field is now dominated by women, a lot of those women are white women. It's not dominated by women of color. And I think that's where this field now needs to go, is it needs to be more diverse. I'm not saying dominated by women of color.

Leen: Why not?

Harjit: Actually, why not? You are right. But I'm saying that's where I think this field needs to go further.

Bushra: I agree with that. And all fields for that matter.

Harjit: Hundred percent.

Leen: So there you go listeners.

Bushra: Urology should not be a male-dominated field either.

Margaux: That's off topic.

Bushra: No, it shouldn't. What I'm saying is . . . No, it is on topic.

Leen: It is a male-dominated field.

Harjit: Wait, tell me.

Bushra: Urology is a male-dominated field.

Leen: Why should it not be?

Bushra: Why is it a male-dominated field? It doesn't have to be.

Harjit: Women have urology issues, don't they?

Margaux: Mm-hmm.

Bushra: But you have urogyn.

Leen: Urgoyn. So I think a really important lesson here is in order to understand how patient reactions in clinic and how some of our male colleagues feel in terms of being denied certain opportunities in OB-GYN, is to truly understand, you know, in order to understand the present, you need to look back at the history, and you can't just blame it all on the incidents of what we're experiencing now, because there's, you know, the history is what shapes the future. And here we are.

Harjit: And I think, Leen, that is the key point that we, as physicians, at least this is my goal as becoming a future doctor, and I don't want to speak for you all, but I think this is a common goal that we all strive for, that we become critical thinkers because not every patient is the same. They're not going to present the same, and we have to figure out what they have, right, like the disease process they're going through. And so when you are critically thinking about a solution of a problem in the terms of health, that also means we need to think broadly. We get their past medical history. We get their past surgical history. It's important that every instance we really see what it's built upon.

And I think that the reason I love this topic today is because there is a field that we can say this is female dominated, and it's different and people think it's different. And that makes them feel apprehensive, right? And for the future, it's also a great opportunity for all of our colleagues to go through a situation that is unlike the others and learn from it, be it they're male-identifying or female-identifying.

I'm really excited that we are all women going into different fields. And I'm happy that we're all going to make our own mark in whichever field we go to. We'll continue to be critical thinkers. We'll continue to try to understand our history as well as we can to kind of move forward with our future, and we're so happy that we can share our thoughts with everyone.

I also want to add that this is one episode that brought up a lot of interesting nuances, and we talked about a lot of different topics that I'm excited to explore in the future. And we are so happy that you guys are joining this journey with us. Please follow us on Instagram and Facebook at Bundle of Hers and leave a comment, subscribe to our podcast and do all those things. You know, the usual. Bye-bye.

Leen: You just ended it really nicely.

Harjit: Did I say good stuff in the end?

Bushra: Yeah.

Harjit: Okay. Okay.

Leen: Thank you all for listening.