Center for Bioethics and Medical Humanities at Northwestern University, 420 E Superior St, Suite 628, Chicago, IL, 60611, USA.
Feinberg School of Medicine at Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA.
Soc Sci Med. 2022 Nov;312:115365. doi: 10.1016/j.socscimed.2022.115365. Epub 2022 Sep 14.
We explore the work labor pain does in cultivating obstetrics and gynecology (OB/GYN) resident physicians' conceptualization of the "ideal" obstetrical patient - replete with moral, pharmacological, classed, and racialized dimensions. Our data is derived from a single-site, qualitative study conducted at an urban academic OB/GYN residency program in the midwestern U.S. between 2018 and 2019. 36 residents, 9 from each post-graduate year, were randomly selected to complete a semi-structured interview on their perceptions of patient pain surrounding OB/GYN procedures. Grounded theory analysis of the OB/GYN residents' interviews revealed the idealized obstetrical patient is quiet and easily controlled. Residents praised women whom they believed were suppressing their labor pain, a racialized and classed concept that furthers misconceptions about the "obstetric hardiness" of Black women and the hypersensitivity of wealthy White women. Participants' conceptions of "bad" patients included those with less cultural health capital due to low health literacy and socioeconomic status, which impeded the patients' ability to participate in shared decision-making. Despite acknowledging the importance of patient autonomy regarding pain control during labor, the interviewed residents positioned themselves as the ultimate authority. Their subjective assessment of patients' pain inherently invoked their personal biases, such as conflating low socioeconomic status and race. Some participants posited an inverse relationship between hardship and pain, while others questioned whether those with low health literacy exaggerate their pain due to fear of the clinical encounter or to secure medical attention. Both framings have concerning implications for inadequate pain control and the unintentional perpetuation of obstetric violence and obstetric racism within the profession.
我们探讨了分娩疼痛在培养妇产科住院医师对“理想”产妇概念化方面所起的作用——这种概念化充满了道德、药理学、阶级和种族维度。我们的数据来自于 2018 年至 2019 年在美国中西部一所城市学术妇产科住院医师项目中进行的一项单站点定性研究。36 名住院医师，每个研究生年级 9 名，随机选择完成了一项关于他们对妇产科手术周围患者疼痛看法的半结构化访谈。对妇产科住院医师访谈的扎根理论分析揭示了理想化的产妇是安静且易于控制的。住院医师赞扬了他们认为正在抑制分娩疼痛的女性，这种种族和阶级的概念进一步误解了黑人女性的“生育坚韧”和富裕白人女性的过度敏感。参与者对“坏”患者的概念包括那些由于文化健康素养和社会经济地位较低而文化健康资本较少的患者，这阻碍了患者参与共同决策的能力。尽管受访者承认在分娩过程中控制疼痛方面患者自主权的重要性，但他们将自己定位为最终权威。他们对患者疼痛的主观评估不可避免地引发了他们的个人偏见，例如将低社会经济地位和种族混为一谈。一些参与者假设困难与疼痛之间存在反比关系，而另一些人则质疑那些文化健康素养较低的人是否因为害怕临床接触或寻求医疗关注而夸大自己的疼痛。这两种框架都对疼痛控制不足以及该行业内无意延续产科暴力和产科种族主义产生了令人担忧的影响。
