50 years of ob.gyn.: Embracing the ‘voice of the woman’


I hadn’t originally planned to be an obstetrician-gynecologist; in fact, I trained as an internist for 2 years. But as I became more exposed to the real-life experience of medical care, I realized that ob.gyn. would allow me to take care of women in all facets of their lives, from family planning to childbirth to endocrine problems and even depression.

Having joined the American College of Obstetricians and Gynecologists in 1965, my tenure as an ob.gyn. has spanned almost the exact length of this 50th anniversary retrospective of Ob.Gyn.News. But in my experience, those early days of my practice were actually the turning point for our specialty.

I’m an observer, not a historian. But I can’t imagine that any other specialty was more impacted by societal change in the mid-1960s than ours.

Dr. Ronald J. Pion Courtesy Rivermend Health

Dr. Ronald J. Pion

For one thing, when I was training, we were an overwhelmingly male group of residents who were learning about how to take care of women. Our commitment was not in question, but our ability to truly connect with women was certainly underdeveloped.

I’m gratified now to see that the demographics of ob.gyn. have changed, because they should. Without disrespecting my male ob.gyn. brethren, I was pleased to see that more than 80% of ob.gyn. trainees are now women. Importantly, many of them are learning now from female ob.gyns. This foretells a future in which connections between patient and physician are as strong as they should be.

Moreover, ob.gyn. trainees today have the highest proportions of African American and Hispanic trainees compared with any other specialty. We are doing a better job of representing, within our ranks, the women whom we treat. This continues to bolster our relationships, and in no other field is a trusting, intimate relationship as important as in ours.

Of course, the mid-1960s also heralded dramatic changes within reproductive health. Women were beginning to dip their toes into being able to control their own fertility and, in so doing, to prevent pregnancy. This also gave us the opportunity to focus on a woman’s greater well-being, helping her to address her own health before becoming pregnant. It pivoted the role of the ob.gyn. and charted us on a course to being, for many women, their primary point of care. And it gave women educational, professional, and economic opportunities the likes of which had never existed before.

Outside of fertility planning, we also began to make inroads in obstetric care – and to make some mistakes. The 1960s heralded some developments that we still embrace, but we also began a path toward dependence on technology and overinvasive care that we are trying to step away from today.

And, we had difficult conversations then that we have now. The more things change, the more they stay the same.

One of the most exciting, and essential, changes that I have seen since I began my career is the voice of the woman in ob.gyn. care. We speak with our patients. We screen them for depression and for intimate partner violence. We discuss their lives and whether they are using the birth control that is best for them. We try to reflect their own preferences in our approach to their labor and delivery. We missed an opportunity to do this in the past, to discuss a woman’s social history. We know now that there is more to a woman’s well-being than whether she smokes and drinks.

It makes sense that our specialty has changed, because we are the only specialty dedicated to women, and the last 50 years have brought about intense societal change for women.

We still have further to go. We can be slow to evolve, and we constantly face challenges that other specialties don’t confront. But I believe that the same dedication to women that inspired me to go into ob.gyn. 50 years ago is the same inspiration that is leading today’s trainees to do the same.

Dr. Pion is a clinical professor at the UCLA School of Medicine. He has served on the faculty of the University of Washington and the University of Hawaii, and worked for more than 25 years in the development and production of TV and radio programming on health care. He is a fellow of the American College of Obstetricians and Gynecologists.

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