“I want everything to be natural.”

Well, we are in a building with electricity and high-speed internet, neither of which are gifts from Mother Earth.

Yes, that’s really how I responded to a patient. We laughed, but her comment allowed me to reflect. I interpret this statement to be the patient’s wish to minimize intervention or achieve a vaginal delivery. I understand this position. However, it may stem from the cultural mythology we share. We have this story that pregnancy and childbirth are physiologically normal, benign phenomena and that women have undergone this phenomenon since the dawn of time. (The ultimate destiny for all those with uteri to become mothers is a conversation for another time.) But the ugly truth is this: obstetrics isn’t simple. As a population, we are dealing with more medical comorbidities and huge gaps in health care access and equity. Therefore, there are cases where medical interventions are necessary and even essential. It behooves us as medical professionals to have honest, clear discussions with the patients who have entrusted their care to our hands.

Secondly, there is an inordinate and unnecessary amount of pressure on women to complete a vaginal delivery. Honestly, most obstetricians would prefer this route as well. However, the factors that can result in a Cesarean delivery are not always controllable during the pregnancy. The labor course and emergency situations may dictate the need for a Cesarean. It is never the patient’s fault. In fact, considering “fault” isn’t a useful framework. How about we stop pointing fingers that shame women and label a Cesarean delivery as the “easy way out.” Let us instead lend a hand of support to all parents. Support all parents, birthing and otherwise.

“So, who will deliver the baby? So you’ll be here the whole time, right?”

Well, sometimes I go home.

It is an incredible honor to hear that a patient would like me to deliver her child. Regardless of the prenatal packet every OB patient receives, there is still a lot left to review and re-review. I explained our call schedule and which physicians she may see while in the hospital. I clarify that a labor induction can often take more than 24 hours and that I won’t be sitting in her labor room the entire time. Sometimes there may be more than one patient in labor. Some physicians have office hours on hospital days. There are several rotating logistics to consider. However, I share reassurance that her care will be managed safely. Remember, obstetrics isn’t simple.

This is another area where communication helps manage expectations and can create a positive experience. Cultural messaging and social media don’t often help answer questions but can identify areas where patients need education. When a patient comes to an antenatal visit with a birth plan, I see this as a patient’s plea for support. She’s done some legwork and wants to go into this experience with some knowledge and agency. I will review her plan in detail to dispel any misinformation and alleviate fears. This is a place where women are trying to advocate for themselves. It’s a privilege to partner with them on that journey.

“How do you manage? But what about your kids?”

Oh, there are actually two of me; the other one doesn’t leave the house.

I appreciate the interest in my life. This tells me that I am approachable and real enough for my patients to consider me human. Ahh, refreshing. Here is a great segue where I counsel patients about the fourth trimester and creating a village. This village needs to account for the needs of the mother while supporting her recovery. The real work starts upon discharge home.

I get granular with patients. There are some books and podcasts I recommend that may help with the transition into parenthood. I share my own experiences with daycare, juggling schedules, and setting up boundaries with families. I had my first child during the summer of 2020. The global pandemic brought incredible focus but limited the village I had hoped for.

I also use this as an opportunity to remind myself that I am a human with multiple fulfilling responsibilities. I chose this specialty, and I chose to have children. There is an art to juggling, and I am always practicing this craft. The juggling can look different for different families. I share my struggles and triumphs with patients. But here is where the old mythology reels in again. Patients are so eager to achieve a pregnancy but are often underprepared and unsupported in the rawness of parenthood. I believe this is one of the most overlooked periods in obstetric care. Let’s do better; we don’t need to juggle.

“You should work more. You should work less.”

(Awkward laugh.)

I once had a patient’s male spouse demand that I perform his wife’s repeat Cesarean delivery even after I had left the practice. He even named a sum he would offer me if I were to perform the delivery. I went from flattered to scared.

There are unrealistic demands in our profession from our employers and our patients. It seems they always want more of us—more calls, more office hours, more RVUs. But there are only twenty-four hours in a day, and I do not want to see a doctor seven days a week. Physicians need to reclaim the value of their time if the medical profession is interested in remaining effective and sustainable.

Sometimes we’re pressured into doing less. A medical assistant once told me, “Children do better when their mothers raise them.” There’s a lot to unpack there. I am raising my children. I completed years of training, and now I am privileged to practice the art of medicine. Through this, I can earn an income and provide them with clothing, food, and an education. I am raising my children with the time and skills that I have.

Our trajectory sometimes feels like two steps forward and one step back. Our profession can demand us to work as if we don’t have children or families but parents as if we don’t need to generate income. When we’re trapped in this pattern, we will never be satisfied. I want something different. I suggest that we take a firm grip on the steering wheel and drive off the premade path.

Roshni D. Patel is an obstetrician-gynecologist.