[Editor's note: This is the fourth part of an interview series between Science & Sensibility's Walker Karraa, and OBGYN Dr. Michael Lu. To read the interview from the beginning, go here. For a list of resources pertaining to this interview series, go here: resources and bibliography_dr lu interview series.]

Sacred Trust of 24/7

Walker Karraa: Do you use doulas, or do a lot of your patients use doulas?

Dr. Lu: I do, oh absolutely.

Walker Karraa: How is that?

Dr. Lu: It's been good. I think it's been real good. Usually my patients just mention they have doula and I usually say great and I see them on labor and delivery. In some instances they alleviate some of my guilt for not being at the bedside.

Walker Karraa: Is that hard?

Dr. Lu: Yeah. I had a patient that came in Easter Sunday. My own family was going to do an egg hunt. We had hidden the eggs and everything - but she was a VBAC patient. When I came in to check on her she was still maybe around five centimeters or so. I didn't know how fast she was going to go. And then I was torn. Should I stay because she's a VBAC? I knew I should stay, but on the other hand, my two daughters, ages eight and five, they've been waiting for this Easter egg hunt. It's an important moment. A precious moment and I wanted to be home. But on the other hand I know the success of that VBAC very much depends on support.

Walker Karraa: Did she have a doula?

Dr. Lu: No she didn't have a doula. And so I ended up going home. The whole time I was feeling extraordinarily guilty. She forgave me; I mean she understood. But you know that this is not optimal care. I knew in my heart it wasn't optimal care. The way the current system is designed, you're on call 24/7 for your patients. That's something that I haven't reconciled because I know that there's something sacred about that bond with your patient. The way it's actually set up, you're coming in at 3:00 in the morning, and you're distracted. Or if you have another meeting that you have to go to, or if you have an office full of patients that are getting frustrated because you are in delivery - this might actually start to create these sort of instances for you to do the things that may not be in the patient's best interest, such ast be called in on Easter Sunday!

Walker Karraa: But the intention is not malice.

Dr. Lu: No it's not malice; that's why I keep saying it's not just an individual problem. It's a system flaw. It's not just about asking the individual OB to work harder, but it's asking the system to work smarter. So this is where the teamwork approach actually comes into play. I think doulas are much better trained in terms of providing support during labor than obstetricians are. Most of us didn't sign up to stay by the bed side. We signed up for obstetrics. You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc. They're not really trained to provide nurture and support.

And by the way, we had an in-house attending OB, and with my VBAC patient on Easter...

Walker Karraa: Let me guess, the mom said no way?

Dr. Lu: Well I couldn't even say, 'I'm passing you off to the attendee.' The attendee could have easily supported her labor and delivery - just somehow the expectation was that no, you don't pass her off to just the on-call attendee. That's your patient. She's under your watch.

Walker Karraa: That's a lot of pressure.

Dr. Lu: It is a lot of pressure and that's why I think sometimes people are increasingly critical of the doctor's role, like the increase in caesarean, etc. But that's what the system has set them up for. I still believe that most OBs are driven for the right reasons. They really want the best outcomes for moms and babies but sometimes they're just pretty ill-equipped to deliver that. That's where I think it'd be great to get some conversation going in our field, in our world. We're all united for one common purpose, how do we do that better?

Walker Karraa: You talked about the sacred trust of 24/7 between patient and doctor. I wonder if somehow that is the same sacred trust that leads women to agreeing to a c-section?

Dr. Lu: I know I could talk my patient into anything, and most OBs know that. But that's a misuse of that trust. Yet there is that sacred trust. I don't know how to change that culture. Maybe the trust is misplaced. And this is what I haven't figured out, if we replace the OB with a team, can you have trust in a team the same way you have a trust in your OB?

Posted by: Walker Karraa

[Editor's note: In tomorrow's final installment of this series, Walker and Dr. Lu discuss racial gaps in maternal outcomes and the need for future research.]

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