Who is the modern woman? What constitutes the modern gynaecologist/obstetrician?

One’s views would depend on a number of factors including age, experience, lifetime experiences, social/family environment, perceived needs and where one is living/working. As a urogynaecologist in Australia, my understanding of the modern woman here is quite different to my view as a fistula surgeon (for over 20 years) working in low income countries. 

We now live in the age with the desire to be ‘perfect’ in our body-image and instantaneous gratification. This is evident from the boom in cosmetic surgery including the genital area. Dr Google tells us we can get fit and lose weight in 2 weeks without too much effort and there are always ‘super’ foods to assist us. Dr Google tells us what we should look like. And upgrades are always better. 

In terms of pregnancy and childbirth, perfection is now the aim, with a beautiful baby and body after delivery. Young women are now unhappy, that in spite of a normal spontaneous vaginal delivery with a healthy baby, she feels that ‘things down below’ are not the same and she is unable to attain her pre-pregnancy body shape and weight. In the not so modern world, the woman is expected to rest after delivery (between 30-60 days – depending on the culture e.g. Chinese, Indian, Turkish). In these traditional cultures, she is not expected to return to the gym and do heavy lifting etc. She does not expect to return to her pre-pregnancy body shape and weight within 2 weeks! However, our modern mother often believes she can and has to, with pressure from family/friends and media. 

In terms of medical practice around the world, many doctors in low income countries have the perception that what is done in high income countries is always better. This is often done without consideration of what is actually available (or not available) in the local health care system. In many parts of the world, there is no reliable mains electricity, no adequately trained health professionals especially in rural areas, and medical equipment including sutures are suboptimal. 

In many parts of Africa, there is now a high cesarean section rate without a corresponding improvement in maternal mortality/morbidity and perinatal outcomes. An instrumental delivery is not performed as it is ‘bad’ because it  ‘damages the mother and baby’ – Dr Google says so. Even for women with obstetric fistulas, there is a high cesarean section rate – to deliver a stillborn baby low in the maternal pelvis. With pressure necrosis of maternal tissues from the prolonged obstructed labour, an impacted fetal presenting part very low in the maternal pelvis causes significant morbidity and has a significant impact on the woman’s future fertility. 

In our modern woman/mother, media plays a large role in her perceptions of her desired outcomes. However, the obstetrician/gynaecologist/urogynaecologist is also influencing her views. If we give the impression that something has ‘gone wrong’ when an instrumental delivery has occurred or the delivery resulted in a perineal tear or haemorrhoids or some pelvic floor dysfunction or levator muscle tear, then we may be not better than the media. 

We also often forget that as the ‘world is getting smaller’ with easier access to communications etc, we need to be more responsible about what we say and do as it does impact on women around the world. Most women around the world do not have access to antenatal care or a trained health care provider to assist her at time of delivery. About 1 in 16 women in sub-Saharan Africa still die from complications in pregnancy and childbirth. In some areas it may be as high as 1 in 6. In Uganda, maternal mortality accounts for 18% of all deaths in women between 15-49 years of age. In many parts of the world, cesarean section causes significant maternal morbidity and mortality with no perinatal benefits. 

In other words, we need to be mindful about what we say and do as we are being watched. 

As a fistula surgeon working in many low-income countries, my desire for the modern woman in these areas, after a delivery, is for someone to say “mother and baby are well.” I hope this is not too old fashioned.