Clients, Not Patients

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Pregnant women are not sick!Why do we call pregnant women patients?

A healthy woman is not sick simply because she now has a baby in her belly.

In fact, the Dutch call their healthy pregnant women clients. Of course, in The Netherlands, almost 50% of births are attended by midwives.

Dutch pregnant women are called clients because they only see doctors if they experience complications. They are midwifery clients first and doctors’ patients second. Midwives have an incentive to keep their pregnant women healthy (so they get paid) but also to refer high risk pregnancies to the doctors who work with them (so they keep their license). Thereby, healthy Dutch pregnant women simply go about their pregnancies and have their baby the same way that I go have my annual teeth cleaning.

So why do we call American pregnant women patients? Are they sick? Are they poorly built? In America, less than 1% of babies are born at home and less than 8% of births are attended by midwives. In turn, the epidural rate in the US is about 75% with over 30% of babies by C-section. How can a country of over a quarter billion women have so many broken uteruses while Dutch uteruses work perfectly well?

(And yes, I know the plural of uterus is uteri but it just sounds better)

It’s unfortunate that, as a nation, we don’t appreciate pregnancy and birth for the physiologically normal event that it is. What I mean is that having a baby is as normal for a woman to do as sitting on the toilet and pooping. A lot harder, granted. But no less normal.

You don’t believe me? Read this: Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM

Basically, a healthy pregnant woman goes into labor and births a baby when all the conditions are right. That means maternal hormone levels are right, fetal hormone levels are right, the mother feels safe and comfortable, etc. This has been happening successfully for tens of thousands of years, folks.



So, back to my question: why do we call pregnant women patients if they’re not sick?

I’ll keep it short.

Late eighteenth century male doctors needed more business than they could drum up just by treating sick people. So they put on their salesmanship hats and sold their services to the upper and middle classes, claiming their care of these rich gentlemen’s pregnant wives would be far superior to the care of a dirty, uneducated midwife. The rich gentlemen bought this lock, stock and barrel and prenatal care at the hands of a medical doctor became a status symbol. And, as with all status symbols whether cars, iPods or Nike sneakers, this spread like wildfire even though there was no evidence to suggest births at the hands of doctors or in a hospital setting had better outcomes than births with a midwife and in the home. Quite the contrary. But never mind about that.

So, after over a century of medicalized birth, we call healthy American pregnant women patients because, after all, doctors only treat sick people, right?

We should stop that. I know that I, for one, was healthier during my pregnancy than prior and found it anxiety producing to be called a patient. It made me feel like there was a ticking time bomb in my belly, waiting to go off at any moment unless the expert medical doctor fiddled with my internal wiring and dearmed the fuse.

Pregnancy and birth just aren’t like that. It is not a catastrophe waiting to happen. Being pregnant is actually a normal state for a woman to be in (for a man, not so much). That doesn’t mean pregnant women should go run ultramarathons or go binge drinking in the name of being normal. Things are different for a woman when she’s pregnant. Her body is busy growing a human being and that takes a lot of energy and attention. But that doesn’t mean she’s sick. And we, as a society, shouldn’t treat her like a patient.

To read more about the Dutch: The Place of Birth: The Dutch Midwifery System

To read more about epidural rates: Epidural Rates in the US and Around the World

For more about how doctors took over birth in America: The History of Midwifery and Childbirth in America: A Time Line



Monica Profile Photo FooterMonica is a Certified HypnoBirthing® practitioner serving the Northern Virginia area, DC and some parts of Maryland. Her practice is called NoVA HypnoBirthing® LLC and she provides group as well as private classes.