Cultivating the ideal obstetrical patient: How physicians-in-training describe pain associated with childbirth

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.