Absurdity of the End Game with Hospital Birth

I don’t know how else to title it.  Perhaps “Being Left at the Altar”  Or “Some OBs Value Weekends More Than Moms & Babies.”  Or “Left to the Tribe: Who Will Catch or Cut?”  Yeah, those are good ones, apt titles.  But I’ll stick with my initial title.

I’m not an OB hater, really I’m not.  There are some awesome docs out there who do wonderful things for women and their babies.  When pregnancies are truly complicated, OBs and perinatologists may be necessary.  When natural birth goes awry and babies need to be delivered by cesarean, OBs are necessary.  Most of the time, though, it’s overkill.

And then there’s someone like me who needs RE assistance for pre-conception (or an OB who’s willing to test progesterone and treat low progesterone) and regular monitoring in early pregnancy to be sure that the babies have a chance at life.  But just because I need interventions in pre-conception and pregnancy does not justify the need for interventions at birth.  I’m deemed high risk for many reasons this time – I’m old, my scarred uterus, twins.

My OB and I have agreed . . . no induction, no augmentation.  That increases my risk of uterine rupture.  My OB and I do not agree . . . I don’t believe that having twins puts my scar at greater risk during labor, mostly because I haven’t found any evidence that supports the claim.  If the risk is there in labor then it’s there just being pregnant.  I reminded him that the composition of the lower uterine segment (mostly fibrous, less contraction) is different from the contracting portions of the uterus.  He had to agree.

But most simply stated: I don’t feel high risk.

So why the title of this blog.  Yes, perhaps I digressed.

I am not assured of getting my OB after hours or especially on weekends.  The call group in this town is large and shared among many practices.  Excuse me . . . but I chose my OB specifically for his track record with lower-interventive birth and “natural” delivery of twins.  I didn’t choose him and the rest of the tribe here in town.

Additionally, if it were to turn surgical . . . I may not know who my surgeon is?  What???  In any other medical specialty this is NOT how it’s done.  This is what is absurd – you spend 30 or so weeks cultivating a relationship with a particular provider only to be left at the altar at week 40?  Only to be cut open by a complete stranger?  Only to be cut open by a complete stranger whose surgical skills are completely unknown to you?  Whereas if you need hand surgery you meet with a surgeon a couple of times, be sure that this is the right surgeon for you, and that surgeon does the surgery!

Why is this acceptable?  How do we put pressure on the tribe to be accountable to their patients.  How do we convince docs to break up into smaller call groups of similar-minded similarly-practicing docs and be sure that women know and have interfaced with these docs at least once during pregnancy?

Tribal obstetrics is selfish.  It’s lazy.  It’s unjustifiable.  Docs, if you didn’t want to serve your patients, you should have chosen another field.

Caution: You may not need a myomectomy

I just talked with my regular OB.  He was under the impress that I had a Mullerian Anomaly (such as a septate uterus) and a major contributor to my recurrent pregnancy loss.  I’ve seen a Reproductive Endocrinologist recently who came up with his own recommendation.  He suggested that my 1-1/2 inch fibroid was distorting my uterine cavity and causing the recurrent pregnancy loss.  He said that he would be “very concerned” about that fibroid.

I double-checked my obstetric records from my 2004 pregnancy.  The fibroid was discovered during a 10-11 week ultrasound (a first-time mom, I was nervous that the midwife didn’t find my baby’s heartbeat).  The fibroid was roughly 4.5 cm then and is therefore about the same size now.  However, I don’t believe it to be a cause of my recurrent losses.  Rather, it is a symptom.  It is a symptom of imbalanced hormones, usually too much estrogen.

Anyway, my OB’s nurse called me today to say that he (my OB) would NOT recommend a myomectomy for a non-symptomatic small fibroid.  I don’t bleed without stopping; I don’t have unmanageable pain.  Since I already have a cesarean scar, he sees no reason to add to that.  Phew!

So, if anyone tells you that you definitely need a myomectomy, please do seek other opinions.  Your uterus may just say “thank you.”  In my case, it should be thankful that I’m saving it from at least two more uterine surgeries.

Norman Morris, OB & Advocate

I just read a fascinating story about Norman Morris, a professor and obstetrician in the UK.  He died last month so his career was chronicled briefly in the Telegraph.

Throughout his life Morris was guided by a deep humanism. He felt that the way in which women were traditionally treated by the health service was inhumane, and that the psychological stress involved often militated against the best possible outcomes and tended to increase demand for artificial pain relief.

If that doesn’t pique your interest . . .