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What Women Want

waldmanDr. Richard Waldman isn’t one to romanticize his reasons for becoming a doctor. “My mother gave me three choices: I could be a doctor, a lawyer or a dentist,” he explains. “I had two older brothers, one was an endodontist and the other was a surgeon.”

Wanting to make his own mark in the medical field, Waldman specialized in gynecological surgery and from there went into obstetrics. The Jamesville resident has been in private practice in Central New York since 1978, and he has established himself as one of the area’s most respected physicians.

“Serendipity brought me in and it was just a wonderful accident,” Waldman, 62, says. “But I found that I was just one of those strange people who loves to deliver babies.”

Waldman, chairman of the Obstetric and Gynecology department at St. Joseph’s Hospital Health Center, is president-elect of the American College of Obstetricians and Gynecologists (ACOG), a private, nonprofit organization with more than 52,000 members. He will become the organization’s president in May. In this role, he is one of the nationally elected officers on the 25-member ACOG executive board, which sets numerous standards and guidelines for women’s health care and maternity care.

“Many former presidents have been academics in teaching centers. But my being in private practice brings a different perspective to the organization,” says Waldman, father of five grown children, and president of local ob-gyn practice Associates for Women’s Medicine. “I bring a sense of what physicians across the country are dealing with every single day.”

“If you want to talk about liability, I know liability from personal experience. I know how unfair the system is. If you want to talk about maternal mortality, I know how painful it is to lose a mother during childbirth. I know the beauty of childbirth. I know the frustrations of coding and billing, I know how wonderful it is to have electronic medical records. I bring experiential knowledge to the organization that is really necessary.

“I can utilize a tremendous amount of resources that are at my fingertips because of ACOG. Through this group, our community knows what is going on in the nation, and I think that is an advantage. It is certainly an advantage for our hospital,” Waldman says.

Locally, Waldman has built a reputation for a progressive approach by working to improve patient-doctor relations, expanding the role of the father during cesarean deliveries, establishing Syracuse’s first hospital-based midwifery practice at St. Joseph’s Hospital Health Center and contributing to the creation of St. Joseph’s Birth Place, a more home-like setting for deliveries that also offers the security of hospital technology and staff.

While Waldman personally would not advise a patient to give birth at home, he respects those who believe the option is right for them. “I’ve always been against home birth, but I’ve never been against anybody who wants to deliver at home,” Waldman says. “At our practice, we’ve always viewed birth as sort of a tightrope walk between nature and safety. If you look at childbirth, you realize this is not an inherently safe biological process. I don’t think we should take for granted all of the technological advances we have today.

“On the other hand, this is the most intimate, personal moment of a woman’s life,” he says. “You can be empowered, or you can be emotionally destroyed. If you don’t have control of your decision-making it can be exceedingly upsetting. So, I’ve always felt that providing a place like the Birth Place was a good compromise.”

“There are many great arguments for home birth,” Waldman admits. “I can say home birth done correctly (such as in England or the Netherlands) can be fairly safe. But a lot of the birth that’s done in the United States is done by what I’d call lay-midwives, some of whom are apprentice-trained. I just cannot accept the fact that a woman would put their life in the hands of someone who is apprentice-trained; that doesn’t make a lot of sense to me. The most important thing is to make sure they know the risks of the birth setting and that they are making their decisions of their own free will. Most of the time it’s going to work out OK.”

Waldman also balks at suggestions that the numbers of women seeking elective cesarean sections is rising dramatically. “In our practice up until July, there was not a large amount of women coming in and requesting elective cesarean section,” he says. “I don’t think it’s a major problem.”

Waldman and many other obstetricians are trained to perform procedures that encourage natural birth. So he does not advocate elective cesareans with no medical basis.

“That has been a very difficult concept for me to accept,” Waldman says. “I think every physician has to decide if they are ethically capable of doing that, and if they are, then make sure patients are well informed about the issue.”

For some women, Waldman says, elective cesarean may well be the best birthing option. For others, particularly young mothers who may want to have several children, it may not be advisable. “I reject the idea that we are waiters taking orders for the birth that women want,” Waldman says. “We should be giving women good, informed consent so they can make intelligent decisions for themselves.”

Some of the problem, Waldman suggests, is that today’s medical norms can be at odds with enabling a woman to have as natural an experience as possible. “When you start having patients being able to demand epidurals, demand pain medication, and do elective cesarean sections, I think the barrier comes down and (justifying) those cesarean sections becomes easier than it was years ago. That’s the bigger problem, I think. Why do we have such a high cesarean rate, and is that the direction we want the country to go? The questions are very complex and the answers are very complex as well.”

Waldman suggests societal expectations have gradually changed women’s notions of what acceptable risk is for procedures that were considered statistically safe decades ago. “VBACs (vaginal delivery after cesarean) have the same rate of uterine rupture and the same rate of childbirth injury. In 1980, when I started doing VBACs, that was an acceptable complication and acceptable prenatal mortality statistic. But the same statistics in 2009 are no longer acceptable. Nothing has really changed, but if you have a 1-in-1,000 chance of child loss or uterine rupture in 1980 and a 1-in-1,000 risk of a child loss in 2009, society has changed.

“I’ve been doing VBAC deliveries for almost 30 years and I’ve never had a mother harmed or a baby harmed,” Waldman says. “I’ve always thought it was a safe and good practice. But fewer hospitals are offering the service, fewer physicians are doing it.”

Waldman’s strong advocacy for certified midwives has only grown during the course of his career. He happens to be married to one—Elaine Mielcarski, a certified nurse midwife and nurse practitioner—and he believes that more midwives will guide births in the future.

Through ACOG, he hopes to encourage more standardized midwife certification, and a collaborative working rapport between midwives and physicians. “I love the profession of the certified nurse midwifery. I love working with them, I love their training, I love their expertise. I love what they bring to the table.”

With the number of physicians specializing in obstetrics going down, Waldman sees a growing need for midwives in the near future. “It wouldn’t alarm me if more midwives were delivering more babies. (Making sure midwives have) college-level education with a background in childbirth and appropriate accreditation—those things are very important to me,” he says.

Along with a more natural birthing experience, Waldman’s practice has always encouraged breastfeeding when possible. But he acknowledges the medical recommendations don’t always help women with their own decisions on this issue.

“Raising a baby today is very difficult. Our society requires two incomes. If mothers or fathers could stay home with their babies and not work, it would be a wonderful, wonderful thing. But when that’s not possible, women should still be encouraged to breastfeed as much as they can, and society needs to support them in that. Pump when you can and go to work.

“Our society needs to change. Women are a powerful force and should advocate for that. Women need to recognize that it’s OK to breastfeed as much as they can for as long as they can, and wherever they can. Some women do feel coerced to breastfeed, and that should never happen, either. We can’t advocate for choice in childbirth and not advocate for choice in breastfeeding.”

Although Waldman continues to be inspired by the intricacies of his field and looks forward to his work with ACOG, family life keeps him grounded. Of his 10 grandchildren, he has delivered four of them and attended the births of four more. Sharing those moments with his own children helped him appreciate how truly special his work has really been.

“The most rewarding part is that moment you are involved in a birth. Dad is looking at the baby and Mom is having a beautiful, powerful birthing process. The experienced labor and delivery nurses are crying because of what they see—then you know you’ve had a good day. Making a difference in women’s lives is so incredibly powerful. I am so in awe of birth and what it can be. It’s really an honor.”                        
Award-winning writer Tammy DiDomenico lives in DeWitt with her husband and two sons.

© Family Times: The Parenting Guide of Central New York