Showing posts with label pregnancy. Show all posts
Showing posts with label pregnancy. Show all posts

Saturday, August 16, 2008

The Evolution of a Pregnancy (a conglomerate of myths and multiple patients, seen through the years)

Pregnancy is supposed to be a sort of "golden time" in a woman's life. The media tells us this in softly muted images of unblemished bellies and serene smiles. Our own family members knowingly wink and talk about how grand their pregnancies were and how "you don't remember the pain" of labor once you are holding your little (angelic and sleeping) bundle of joy in your arms. Before you become pregnant, the state of gestating a life seems almost mystical, magical, and other-worldly. It seems like somewhere you really really want to be.

Then, you take the plunge, and if you are lucky, you become pregnant. It is then and only then that you realize you've been duped! All the blissful, sighing moments you imagine in your pre-pregnant state are replaced with the bitter reality of puking your toenails up morning, noon, and night, or breasts so sore that it hurts when someone dares to *look* at them. The heartburn burns a path from stomach to esophagus so fiery, you are certain that the 9th circle of hell is cooler, and the mind numbing fatigue turns you into a zombie.

Then, your family and friends, so encouraging prior to your pregnancy, suddenly morph into this raging band of harpies...right before your very eyes! Then, the "advice" and the subtle "judgement" from all sides. Oh, I *never* got sick with *my* pregnancy. Not one time! Are you sure everything is ok? Wow, are you sure you are pregnant? You just look chubby! You don't look like you are gaining enough weight. Oh, no, no, no! You are gaining *way too much* weight! You should always... You should never... You are going to eat *that?* My husband's sister's cousin's best friend's aunt had a miscarriage because she ate too many hot dogs, you know. What was the heartrate? Oh, then it is definitely a boy/girl/fire monster. Face it, people are mean to pregnant women.

Dutifully, you make lists, and bring them to your obstetrician, who spends a good 10 minutes each session systematically de-bunking the myths and reassuring you that the soft serve ice cream that you had last week will not, indeed, turn your child into a four-headed fire monster. As for the heartbeat, naturally it is faster when the baby is smaller, and slower as the baby grows. NO, you cannot tell by the rate whether it is a boy or a girl. Truly, you cannot. You go away feeling somewhat assured, but uneasy. After all, every one you know has an opinion about your pregnancy.

Then, you reach in the second trimester, and you must endure unwanted belly rubs from strangers in the grocery line, accompanied by clucking "you are *how* far along, dear? Oh my, you are (way too big, way to small, carrying *high,* not carrying high *enough*, OMG are you sure you aren't having twins???) Then, these expert eyewitnesses will attempt to divine the sex of your child, simply by looking at the curve of your belly or the, er, thickness, of your derriere. It doesn't matter what the ultrasound says, honey, look at how big your ass is getting! That is a sure sign of a girl/boy (take your pick)! Fifty percent of the time, it works, every time, you know?

Rolling on to the third trimester, you start to fear how you will ever, ever get this growing baby out of your uterus, and your friends and family are now ready to regale you with the *horror* stories they've been keeping secret from you until you have reached the point of no return. Your already sleepless nights, filled with multiple bathroom visits as your precious bundle plays trampoline on your bladder, are now punctuated with fitful imaginings of epidurals that don't work, babies that get "stuck," episiotomies gone bad, and emergency cesarean sections. You turn to the internet for comfort, but instead only find more horror stories about Ob/Gyns that are only out to cut every woman that they have ever met, the evils of hospital births, and about how you should have had a midwife and a doula all along.

Alarmed, you present to your next visit, and try to determine whether or not your OB is one that will cut your belly in favor of getting home in time for dinner that night. Surprisingly, your OB seems reasonable about birthing plans and open to questions about cesarean rates and episiotomies, but you never know, the internets say to beware of medical professionals. Ultimately, you get to the final four weeks of your pregnancy, and you realize that perhaps you really don't care how the baby gets out as long as it does it soon. Your sister suggests that you should just "tell the doctor" to induce you, so you can have a Leo baby instead of a Virgo. You entertain the fantasy of asking the doctor to just "go ahead and cut it out, already," previous worries of cesarean section be damned. Your physician isn't swayed by your pleas for induction at 37 weeks. Heartless bitch.

The final week before your due date drags on. Your feet are swollen. You move like a 89 year old arthritic woman. You have the occasional contraction that makes you excited that the end of the pregnancy may be near, but nothing ever gets close enough. You visit triage once or twice, just to make sure you aren't in labor, and you get turned away, ashamed. You are tired of the "sure fire" ways to induce your labor. You've eaten enough Mexican, Chinese, and Eggplant Parmesan to induce 10 labors, but all it did for you was give you more heartburn (this kid better have some freaking hair!) You've walked the malls, rubbed your nipples raw, and had the most uncomfortable sex of your life, but there are no contractions to show for it. The due date comes and goes, and your OB tries to explain that the due date is more like a "4 week window" of when the baby is likely to come out, and not the day that you magically burst into spontaneous labor as you had been hoping. You are certain that you will be pregnant forever.

Then, one fateful night, you start to have regular, and (oh my lord) painful contractions. You begin to realize that all of the time you thought you were contracting, your uterus was just doing some minor stretching. These contractions? Hurt like hell. You arrive on Labor and Delivery with the bag you packed 5 weeks ago when you were hopeful that you were going to go early (because Aunt Melanie said she "just knew" you weren't going to make it to your due date). You are certain that you are already 8 cm dilated, because, holy hell, these contractions hurt. You are both dismayed to find that you are "only 4 cm," and relieved because you know you have reached the magical cervical dilation for admission. Your determination for a medication-free delivery wavers with each body-wracking contraction that you have. Finally, you just can't take it any more, and you "break down" and ask for the evil epidural. Only, it's too late. You are fully dilated and there is no time to do anything but push. Nothing ever felt so great and so horrible all at once. It is truly like your instincts just take over and your body works with you to finally push your baby out into the world. There's burning, stretching, tearing, grunting, and screaming, and then, relief...followed by a small cry and a warm, slippery body being laid upon your belly.

As you look down at your baby, and they look up at you, white with vernix, covered in goo, certainly not quiet or sleeping or serene, and hairless (heartburn be damned!) you know (despite what everyone else told you) with every ounce of your being that you will never, ever forget the *pain* that it took to get them here. You also know that it was worth it....all of it.

Sunday, July 08, 2007

The Home Stretch

It seems as though, in these last few weeks of pregnancy, I should be surging toward the finish line with my last burst of energy...stretching forward and extending further than ever I have before. In actuality, I find myself barely limping (literally, stupid sciatic nerve pain) along, dragging my feet, and procrastinating the whole way. I haven't packed my hospital bag. The nursery really isn't ready. I'm really not mentally prepared for this new arrival, and yet I find myself hoping that he's getting here sooner than later!

Sorry for the long silence, but as per usual, I've been busier than ever at work and at home. I am covering call for my partner, as he is taking his annual 2 week long vacation (if this doesn't put me into labor, I'm not sure what will). We've had visitors for the last 3 weekends in a row, and while wonderful, it has been exhausting. I wanted to thank each and every one of you for all of your helpful comments, well wishes, and hints about flipping my stubborn breech baby! I promise, I've not been holding these comments hostage, rather, I've just not had a chance to get them all published until today. First of all, I did check the website to find it to be the same one I've directed patients toward in the past, I did do the knee-chest reposition manueuvers, the inclines were just too much blood rushing to my face, and I didn't have immediate access to a swimming pool deep enough in which to do handstands (without embarrassing myself at the public pool by having my stubbly legs waving about in the air, that is), but I did suspend my belly between two rafts in my daughter's oversized wading pool. I did not do moxibustion. I wasn't really sure where to get the candles and wasn't certain enough about the technique to order them from the internet. I barely have time to make my own OB appointments, so seeing a chiropractor was not a real possiblity, although I do have patients that have had success in this arena. As far as visualization/hypnosis stuff, I think it ended up more like begging, pleading, and cajoling the Bean...pleeeeaaaassssseeee turn around, c'mon, I'll buy you a pony, etc. The fact of the matter is, I don't think any of the traditional techniques had one iota of influence on my stubborn child. The evening before my second ultrasound, I could palpate his hard head right below my ribcage, and I had resigned myself to making the decision for version or elective section (because I am too a'skeered of the risks associated with vaginal breech births). Then, my 20 pound girlcat took matters into her own paws. She leaped upon my belly, positioning herself directly over the caput of my stubborn son, and proceeded to activate her very loud purrbox. She hatched my belly and purred for about an hour, and boy, did the baby respond! He wriggled and kicked like crazy, it was, at times, almost painful, but after that hour, I could no longer feel his head in my upper belly. The ultrasound the following day confirmed that I had, indeed, had a successful cephalic version via kitty, and vertex he has remained ever since. So much for traditional methods of flipping breech babies! If I were to try to rationalize why this worked when nothing else did, I guess I could say that it is close to vibroacoustic stimulation like we use to "wake up" sleeping babies on non-stress tests. Who knows? All I know is that he is now vertex, and getting way too chubbly (hopefully) to turn back around now.

As for his estimated weight, a good 7 pounds as of a little over a week ago, of course I'm taking it with a grain of salt. The limitations of ultrasound in predicting weight accurately in the third trimester are not lost on me, but what woman doesn't cringe a bit thinking about the possibility that, indeed, the measurement is closer to correct than not, or, worse still, is off by a pound in the positive direction? I'm trying not to think about it too much and trying to trust that I don't feel like I'm carrying an almost 8 pound kid at this point. We shall see. My BP has been holding steady 140s/80s, no protein, normal labs. I even lost a pound this week. (Whee!) This next week, we are going to try to take professional belly/family photos, so I must find some inoffensive similarly colored shirts for Mr. Whoo, CindyLou, and me. We have a to-do list a mile long. I thank you all once again for checking in on me and all of the encouragement. Now I must get into the hospital to round (I've started to deliver some patients whose due dates are *after* mine, and there is very little in my life as an OB/GYN that is more discouraging than that!), continue to wash baby clothes, and maybe, just maybe, pack my own hospital bag. Just like a real pregnant person.

Saturday, June 02, 2007

Still alive, still pregnant, still whiny

Is it really June already? I'm not ready for it to be summer! The last few weeks have been (SSDD, I know) a whirlwind of work, catching babies, visiting family, and minor freak outs about the status of the medical blogging community in general and about my blog in particular. It is difficult for me to even see hits from the same *state* on my stat counter without getting antsy about being "found out." I debated stopping altogether, but I miss blogging and talking to you all out in blogland. I guess that I was never organized enough about blogging to figure out what I wanted this blog to be, a mommy blog? A doctor blog? Educational? Entertainment? To tell the truth, more than anything I approached it like my own personal journal, an outlet for all of the jumbled thoughts in my brain that I need to spill and sort out in black and white. A journal that talks back ! (The coolest part of all.) So, I think that is what it will continue to be, with major alteration of details surrounding the particulars of my job. I think I can live with that. We shall see.

So let's catch up. On a personal note, I am 32 weeks and 2 days. The Bean has hiccups regularly, and I am convinced that he is still in transverse lie. I've been measuring almost 2 weeks ahead for the last few appointments, and I am dying to know how much this kid is going to weigh. (Did I mention that I don't have free access to an ultrasound machine, so I am at the mercy of the insurance/physician order just like every other pregnant woman? Shameful. I'm dying over here.) The "due any day now" comments are coming fast and furious, along with the shock and mock horror when I tell them that I still have at least 8 weeks to go. People can be so jerky to pregnant women, it's unreal. It continues to be a real test to patiently listen and empathize with my whiny pregnant patients, being a whiny pregnant person, myself. More than once, when asked when their maternity leave should start, I've stifled the urge to quip "You can't stop working until *I* stop working." Ha. I would never say this out loud, but it's fun to fantasize about. I had a very busy delivery month in May, and I am looking forward to having only half as many patients due in June. Pregnancy symptoms include lots of contractions (but a negative fetal fibronectin, so all is well), sciatic pain, mild pubic symphysis diastasis discomfort, cankles, borderline elevated BP (130-140s/80s), and killer heartburn. I am happy to report that I am no longer puking, even on a weekly basis.

Remember the less than stellar med student that I posted about a while back as an example of what not to do? Not too long ago, that very same student cornered me in the Doctor's Lounge and proceeded to tell me how "shocked" they were at the grade that I had given them. (For the record, it was in the ballpark of an 85 percent. I felt that I was more than generous for the work the student did!) I got treated to a talk of woe, that they had really, really wanted to do OB/GYN and my grade didn't place them at the top, where they believed they should be. I also heard about how the grade I gave them was the worst grade they had ever received. (Which shocked the hell out of me, leading me to believe that this student must have been allowed to slide by with being "cute" and "sassy" because their clinical knowledge and work ethic was sub par, as far as I could see.) I was as gracious as I could possibly be, and stated that it was possible that I was a stricter grader than the student's prior preceptors, and I encouraged them to pursue recommendations and work hard in their 4th year electives in OB/GYN. Then I politely excused myself before their audacity completely caused me to lose all composure and give them a real piece of my mind. Now I wonder if it would have been better to just lay it all out for them, because, really, I am not doing them any favors, allowing them to think that they were the best student around, and I am just a mean, hard-grading jerk of a preceptor. (No, it isn't me, it's *you.*) I just suck at unexpected confrontation. I need time to formulate coherent arguments, otherwise, I tend to just make off the cuff, not so nice, and certainly not constructive comments. Ah well, just thought it would amuse y'all to hear the update.

I am off this weekend, and Mr. Whoo and I are about to tackle the master closet. A project a long time coming, accelerated by the fact that an entire rack of clothes fell off the wall this past week, requiring immediate attention. Sigh. Home improvement sucks.

Saturday, April 28, 2007

2 Weeks Post Call and Whiny

(I know I've posted a similar whine in the past, but humor me, this is on my mind.) Yes, it is just as it sounds, I have been on call, 24/7, for the last 19 days. Granted, I haven't been in the hospital/office the whole time, but it takes such a mental toll! Call as a private practice doc isn't anything like call when I was a resident. In residency, being "on call" means being in the hospital for 24 hours (and, prior to the 80 hour restrictions, up to 36 hours) at a time, working with a team of other residents/attendings, and caring for multiple patients, including surgical, laboring, antepartum, and post-partum. It was grueling, but the time was finite. Even on the worst of days, there was a definite time when I could turn the pager off, and take time only for myself. On days that I was not on call, I was generally out of the hospital around 5-6 pm, with no fear of having to return to the hospital until the following morning, as another resident team was shouldering the workload.

Now when I am on call, it is all me, and only me, on call for all of the patients that I have ever seen, and, over the weekends, on call for all of OtherDoc's patients, as well. Most of the time the calls I get can be handled from home with a phone call, and I can go about the rest of my day. Of course for deliveries and surgical emergencies, I need to be in the hospital ASAP. The hardest thing for me is that I can never quite mentally disengage, as at any time, I have to be ready to race to the hospital. I can't ever go further away than 30 minutes from the hospital, and if I am doing something with my family, we often take separate cars, "just in case" I get called. The pager can go off at any time, and you just never know what is going to be on the other end of the line.

When I was looking for positions post-residency, this was not what I had in mind. I was somewhat mislead into believing that call was split Q 3, and weekend call was to be every third weekend. What actually happened was that I was on solo call for a whole year until I could beg, cajole, and finally convince OtherDoc to at least split weekend calls. The other hospital OB has no interest in sharing call whatsoever, and only wants call coverage for vacations. Now there are some perks for being on call so frequently. I do get to deliver most of my own patients, and when I get calls for problems, I know my patients' histories and personalities fairly well, and can advise them accordingly. I also have fewer patients to cover than a group OB would, so that means less trips to the hospital/phone calls/ etc. while on call. I think that in the next 2-3 years the hospital is looking to hire another OB/GYN, and I am desperately hoping that this person wants more of a life and will go for sharing weekend call, and possibly sharing weekday call, as well. As CindyLou and the Bean grow up, I want to be available for sport games, recitals, and school activities without fear of having to leave to the hospital. I knew what I was getting into as an OB/GYN, and honestly, I don't mind being on call for my patients, because I know that they need me and trust me. I just need to strike a better balance of being available, mentally and physically, to my family and friends as much as I am for my patients.

I am now 27 and 2/7 weeks pregnant, and I am starting to physically slow down. Some days I feel just like a little old lady, whining about my "sciatica." Ha! I am rather short in stature, so the belly is quite "out there" and it is already inviting "due any day now" comments, which is maddening. My office has actually started to pare my schedule, and now, instead of 40-50 patients on my full days, I am averaging closer to 30-35 patients on a full day. This is infinitely more manageable, especially when it comes to charting, but now that I am moving slower and a little more tired it still takes all I have to get through those full days in clinic. My "half-days" are still averaging upwards of 20-28 patients, which is also difficult, but so far I am making it work.

It's funny (read kinda sad), because my patients are always commenting that it must be "so much easier" for me to be empathetic to my pregnant patients, as I am pregnant, myself. I am finding the exact opposite. It is hard for me to commiserate with the patients angling for time off work, complaining about common discomforts, and lounging about muttering about how *tired* they feel. Some days it takes all that I have not to tell them to "suck it up and deal!" It isn't a fair attitude to have, because I *do* know how miserable pregnancy can be, and misery is relative. Just because I feel like I am *more* miserable than they, doesn't mean that my patient isn't experiencing more misery than she ever has before. I do find it interesting that the majority of my patients that are having an "easy" pregnancy do not work, and those that are having the most complications are the working mothers.

For now I am going to close this post, because the whining is starting to annoy *me* so I know it must be most unpleasant for all 6 of *you* still checking back to see if I am still alive. I have some really good cases to discuss as soon as appropriate time has lapsed, so I will try to get around to updating in less than 2 weeks time. Happy weekend to all!