The biggest problem faced by pilots and obstetricians alike is nature

It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.

That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless expanse of the Great Plains, the pilot is busy checking the weather, the readouts on his console and completing the endless routines and subroutines to make sure that the flight is on the correct settings, at the correct altitude and nowhere near other planes.

Most of us appreciate the pilot’s attention to detail. It gives us an opportunity to enjoy the magnificence of our continent without worrying whether we will arrive safely at our destination. Can you imagine people berating the airlines that the biggest problem with flying is that the pilots don’t fully appreciate and give themselves over to the magnificence of the scenery? That the pilots waste time trying to prevent emergencies that rarely happen? That pilots ruin the flying experience by refusing to fly over the most exciting natural wonders if risk factors like fog or high winds are present?

It’s hard to imagine people complaining that pilots worry too much about safety, but natural childbirth advocates might be different. After all, their chief complaint about obstetricians, whom they hire specifically to pilot them through the far more dangerous territory of childbirth, is that they fail to appreciate the wonder of childbirth and waste time trying to prevent emergencies that rarely happen. Even worse, they can’t be persuaded to ignore risk factors merely to get a glimpse of childbirth in all its natural wonder.

Coincidentally, the biggest problem faced by pilots and obstetricians alike is nature. Wind, rain and fog are entirely natural, yet they can wreak havoc on a plane flying at altitude or a plane trying to land. Pre-eclampsia, hemorrhage and breech babies are entirely natural, yet they can turn childbirth from a blessed event to a life threatening disaster without warning.

Flying is not a disease, right? Why waste time worrying about and preparing for things that rarely go wrong? Sure pilots are specialists in flying and landing planes in the most treacherous circumstance, but do we really need experts in disasters to superintend every flight? Wouldn’t it make sense to hire pilots who are “experts in normal flight” for most trips? And if those “experts in normal flight” get into trouble because of an unexpected storm, they can always call the tower for additional help, right?

And what’s up with all those delays for mechanical problems? Airplanes have zillions of moving parts. Is it really worth interfering with an airplane just to make sure that every single one of them is working properly. How likely is a plane crash anyway? Why not take off and “trust flight”?

Think of all the money we could save if we hired “experts in normal flight.” And it’s not just because we could pay them less. We’d use far less expensive technology. Do we really need all those fancy dials and readouts in every cockpit?. They’re only useful in a few dangerous situations and those situations don’t occur in most flights. The “experts in normal flight” could prepare for emergencies: they could carry those funny plastic oxygen masks with them. And you could still use your seat cushion as a flotation device in the rare event of a crash landing in water.

Instead of wasting all their time checking and rechecking for things that probably won’t go wrong, the “experts in normal flight” could use their time more productively. They could act as guides, pointing out the natural wonders during the flight, and supporting people in getting the most enjoyment out of the experience. They’d let passengers dispense with seat belts and move about the cabin at will, finding whatever position was most comfortable for the passengers, not the one most convenient for the pilot. They could provide home cooked food and lavish attention on the decor of the plane, making it feel more like home. And in the event of a crash, they could clean up all the blood from the floor and wash the towels.

When you think about it, it’s difficult to avoid the conclusion that airlines insist on pilots fully trained in preventing and managing emergencies merely as an excuse to raise the price of tickets. You can charge a lot more for a flight with a trained pilot. And you can charge a lot more for those fancy dials and meters in the cockpit. You can get away with all those rules that exist merely for the convenience of the pilots. When you convince people that their safety is at stake, they are willing to wear seat belts even though they are probably not necessary. You can convince them to return their seatbacks to the upright position and stow their tray tables on takeoff and landing even though that’s probably not necessary either.

Consumers need to “educate” themselves and take flights back from the airline industry. Let’s demand “experts in normal flight” for the majority of flights. Let’s do away with the equipment that is only useful in emergencies. Let’s insist on pilots who appreciate the wonders of nature and guide our own appreciation instead of obsessing over possible problems. In the meantime, let’s encourage passengers to make their own flight plans, emphasizing their refusal to wear seat belts, their insistence on better food and specifying the desired routes instead of merely acquiescing to the routes suggested by the pilots.

And after the flight (if we survive) we can boast to others about how we took “responsibility” for our own air travel and proclaim that we are empowered passengers.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

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  • http://doctorsintraining.com Erin

    I think the pilot/OB analogy is flawed to say the least. Airplanes have never flown by themselves, but, as they say, “birds do it, bees do it…” I think a closer analogy would be having air traffic controllers monitor the patterns of birds…a man-made construct forced on a natural occurrence.

    This is not to say that doctors and medical technology haven’t made birth safer. Undoubtedly they both have. But childbirth isn’t served best by intervention at every stage, and it’s not served best by a total hands-off approach. There is a happy medium.

    I don’t know why the different sides of the birth debate feel like stigmatizing the other side is the answer. On your website, you attack natural birth. On other sites, they stigmatize the “unneccesarian.” This makes it increasingly hard for all women to get unbiased information, and that hurts us all. Why should anyone care how anyone else gives birth? Only because most of us fear that someone else’s preferred method will be forced on us, against our will and against our need, and that can be hurtful and frightening.

    Women do have choices in their care. Unfortunately, many women don’t know what those choices are, and they get labeled and treated according to what their provider wants, their families want, what their insurance covers, and feel like they don’t have a voice in their own care.

    Is having a voice in your own care important when the condition is elective and non-life threatening? I believe, under those conditions, it is essential for a successful outcome.

    Maybe that’s where we differ.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    Dr. Tuteur, I just wanted to applaud this well written article before the army of “naturalists” takes over and bluntly silences everybody else.
    And while flying airplanes is not natural, having babies is, and so is dying in childbirth, losing most children to disease before adulthood, plagues of all types (viruses and bacteria are natural too), losing your teeth before the age of 30, dropping dead once your reproductive years are over, being eaten by lions, survival of the fittest, perishing in natural disasters, etc. etc. etc. So let’s just lay back, enjoy the uncertainties, and let it all happen instead of trying to manipulate mother nature for the sake of accumulating wealth….

  • skeptikuc

    Amy, Amy, there you go again. Medical precautions of the sort OBGYNs recommend to prevent “crashes” have costs, which you people do not recognize. Doctors like you impose these precautions without understanding the costs and benefits. Examples? Hmm . . . how about natal monitoring. According to a lot research, it does more harm than good. In most cases, it is better to go low tech when it comes to fetal monitoring during labor. “Empowered” patients should therefore resist fetal monitoring.

  • skeptikuc

    oops. just to be clear, that is electronic fetal monitoring

  • http://sassymd.blogspot.com Sassy

    As a pilot’s daughter who came to med school sure I would do OB/GYN (still love the field, but can’t deal with the ridiculous expectations and constant threat of malpractice)…I think this is great!

  • Med Nerd Extraordinaire

    Excellent essay with a poignant analogy. I’ve never understood why the general public (or at least a very vocal minority) has always been so quick to denigrate the very physicians who have given so much so that they can help heal them.

    And I think every hippie mother who’s set on a “natural birth” should come with me to the NICU and see what “natural” results can really look like. And if they’re still determined after that, then I’ll show them the autopsy photos of the mothers and children who were even less fortunate.

    As a medical student, it’s just so easy to become discouraged. Patients insult us and mock us until something goes horribly wrong, and then they demand our help. They feel entitled and and often pitch fits when the topic of payment is brought up. Yeah, you’re right, why on God’s green earth should you have to pay for your own healthcare? Never mind that I’ve put myself in hundred’s of thousands of dollars in debt and sacrificed my 20′s to learn the medicine that just saved your life! And then, sometimes even our best efforts fail to help a patient and there is a negative “natural” outcome. Then we get sued, often when the lion’s share of blame lies with a non compliant patient or with “natural” forces outside of our control. :-/

    You know what? Let the public replace their family docs with PAs and let midwives completely supplant ob’s. Maybe after enough people die needlessly the general public will come to their senses…

  • Kiani Waters

    Why would you want an oral surgeon to clean your teeth? Sure anything can happen during child birth, and its good to be ready, but we don’t need surgeons delivering babies the ‘normal way’ that’s what midwives are for. I know plenty of doctors who wouldn’t dream of getting on the floor to assist a birthing mom, but real midwives will.
    It’s like having EMT at a high school football game, they don’t coach the game because something could go wrong, they let the game unfold and are ready to take care of the problem when they are needed.
    Midwives are trained to recognize when to transfer care. We need more Normal birth care providers, not more surgeons.

    • A Sarah

      I’m not understanding these analogies. What can go wrong with teeth cleaning that would require an oral surgeon to quickly step in? Don’t high school football teams have a trainer to deal with injuries?

  • doc99

    Murphy was an Obstetrician.