4.2.09

Confessions of a Neurotic Pregnant Obstetrician

Today marks the first day of my third (and last) trimester. As an OB, I feel like this is a very important milestone (mostly in terms of fetal status--long term outcomes are much better for the baby if they are delivered after this point). It's been an interesting time, being pregnant and in my last year of OB-GYN training, like a double edged sword. Most people think it must be great, since I would know everything that's going on. Maybe my obstetrician thinks it's great, because I never have to ask any questions at my OB appointments. :)

The flip side is of course that I also know of all the potential complications that can occur during a pregnancy, and I've thought of them all over these past six months. Medicine is a superstitious profession, and many think that doctors and nurses are usually subject to the most medical complications, the weird diagnoses, the rare problems. Starting with my positive pregnancy test at 4 1/2 weeks (yeah, yeah), I thought about the risk of miscarriage. And bleeding. And molar pregnancies, which can lead to cancer. I saw the first heartbeat on an ultrasound that I did myself around seven weeks, which was somewhat reassuring, but I knew there was still a chance of miscarriage. You'd think I would have relaxed at 12 weeks then, the end of the first trimester. But no...several weeks later there was a string of patients coming in to labor and delivery with an "IUFD" (intrauterine fetal demise, or pregnancy loss) between 14-17 weeks. One day in clinic, my first patient was due 2 days before me. She came in at 17 weeks, still unable to feel the baby move. I told her that was normal, thinking to myself, I haven't felt my baby move, either. But then I couldn't find the baby's heartbeat on the ultrasound, and had to tell her that her baby had died. I left the room, shaken, and immediately grabbed a monitor to reassure myself that my little one still had a heartbeat.

Starting at 23 weeks, the good news would have been that the baby was now "peri-viable," or technically able to survive outside the womb. The bad news is that there's a better than 50% chance of death, and an 80-90% chance of long term disability. What if I'd deliver now? That might be the worst possible scenario! But I didn't. And now, week by week goes by and every week is a little better for the baby's long term outcome. But still--IUFDs, preterm labor, rising blood pressures, so many things could still go wrong! Honestly, my pregnancy has been as smooth as possible so far. Minimal morning sickness, no contractions, normal weight gain, minimal discomfort. I'm grateful for that! And I am glad to know that when I do come in in labor, I'll know what to expect, who's taking care of me, what the baby's heartrate patterns mean, what happens if I need an epidural, or a C-section, or whatever.

I haven't been losing sleep over any of the above issues, either, but I have had time to reflect on what it means when a doctor turns into a patient. I'm sure there are correlations to other professions, but doctors have a unique place in all of this. Going through this experience gives me some insight into what my patients talk about every day. Granted, it's not like I'm going through a diagnosis of cancer and a chemotherapy regimen, it's a much happier and more common occurrence. But still. Now that my patients can see that I'm obviously pregnant, I feel like there is an easier bond there. They trust my reassurance more (I have that same pain sometimes...it's normal!). I have some extra personal insights. Sometimes I inwardly roll my eyes at their complaints. The glucola test didn't taste that bad. You can't be all that uncomfortable since I'm not. I need to recognize that every pregnancy is different, and increase my compassion accordingly.

And finally, there is a special kind of joy in being pregnant that has been fun to experience as well. The first movement. All the subsequent movements, in the middle of a surgery or during rounds, that no one else knows about, that bring a smile to my face. Seeing my little girl on ultrasound for the first time. And the second, and third, and....(and all the benefits of being able to do as many ultrasounds as I want). Wondering what she'll look like, and what she's act like, and what name we'll finally pick for her, and if she'll really grow up to marry one of our friends' little boys who have all been born recently (probably not, but it's a fun thought!). So I know that in the end, things will probably be fine. And unless an incredibly rare complication occurs, which is unlikely, no matter how my labor goes, I will go home in the end and be a mommy for the first time, with a beautiful new life to take care of. Shock and awe. And gratitude. And wonder, that though I may have learned many things over the years, some thing are still wonderful and mysterious and defy comprehension.

3 comments:

Teresa said...

You really are a very good writer, and I enjoyed reading it. Thanks for sharing. Although, I'm glad that I have had my baby already, or maybe I would start worrying! We can't wait to see pictures of (and possibly meet?) your little girl soon! Congrats on the 3rd trimester. And maybe the other little baby boys are fighting over spots in an arranged marriage scheme, but we are vying for Autumn to be the best friend.

Anonymous said...

Thanks for sharing. It has to be a completely different experience for you watching your patients go through it also on a daily basis. You also need to post another picture of you and your cute belly for the rest of us to see and experience the pregnancy with you:) Much love! Mariah

Anonymous said...

Rachel,
This reminds me that my OB was pregnant at the same time I was,(twice), and still delivered all three of my babies. Two C-sections and a VBAC. To this day I consider her the person who got me through my three most physically trying, vulnerable, moments in life with the three most precious outcomes. And for that reason, I look forward to my annual exams and feel a bond with her unlike any other doctor I've ever had. From a patient's perspective, it probably reassures your patients that you are pregnant as well. I hope the last few weeks go well for you. We pray for the three of you daily. Love, "Nana"