The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, October 10, 2007

Eleventh Hour Panic

So as much as I’ve tried to deny what comes next, my pregnancy is quickly nearing an end. I am well into the third trimester—my hands are constantly puffy, I don’t remember what my feet look like, putting on socks leaves me panting for breath, and I have only 17 more days of work until my maternity leave starts.

I haven’t been a good pregnant woman. I haven’t eaten as well as I should. My well-balanced, healthy diet went out the window in the first trimester with nausea and food aversions, and I haven’t managed to regain control over it. I rarely remember to take my prenatal vitamins. My exercise routine now consists of walking for an hour 2-3 times a week. I haven’t been swimming, which I intended to do. The prenatal yoga that I managed a few times on out-of-town rotations is a distant memory. Mr. Couz and I haven’t attended any prenatal classes, or even toured the labour and delivery floor of the hospital where I’ll be giving birth. I don’t think I’ve managed to do anything to prepare myself for what lies ahead.

Even my prenatal care has been sporadic. My midwife is very nice, and because I’ve been out of town so often I’ve only attended 3 appointments since my care was transferred to her when I was 20 weeks pregnant. I declined my gestational diabetes test, as my weight gain has been appropriate and I have no family history of diabetes (gestational or otherwise) so I figured it was unnecessary. I enquired about the banking of cord blood vs. delayed cord clamping at my last appointment only to learn that I was far too far along for cord blood banking to be an option. So delayed cord clamping it is.

And now I’m starting to second guess everything I’ve done so far.

Initially when I opted for midwifery care I was very confident in my decision. In the town where I left the midwives had a great relationship with the obstetricians—they were well trained and respected, and the hospital where they delivered was very progressive and baby-friendly. This meant immediate skin-to-skin contact after delivery (unless resuscitation was indicated), no episiotomies, birthing tubs available, lovely birthing rooms that looked less like hospitals and more like living rooms, followed all breastfeeding friendly guidelines (so no well-intended nurse would pressure you to supplement baby with formula because your milk hadn’t come in by post-partum day #2—gah!)… Generally a place where I’d be comfortable to deliver.

In my new town, I’m not so certain. I’ve heard a few cautionary tales about making sure the midwife doesn’t wait too long to consult obstetrics in the case of complications, the relationship between the midwives and the obstetricians isn’t quite as friendly, and the birthing practices seem right out of the 1950’s. And I’m getting nervous.

My midwife is aware of our preferences. We’ve gone over every aspect of the delivery and immediate post-partum period and she is aware of my wishes pertaining to every step along the way. She even seemed okay with the fact that I’d prefer a c-section over an operative vaginal delivery (get those forceps away from me!). I think that between her and my husband they’ll be advocating for me if I’m not able to. But still I’m starting to wonder if I’ve done the right thing.

Should I have just gone with an obstetrician? There is one in town who seems to be universally loved by other physicians and patients alike. Of course, I still wouldn’t have been able to guarantee that I’d go into labour while she was on call. As ashamed as I am to admit it I’d still prefer a scheduled c-section over the unpredictability of a vaginal birth, but I am also well aware that no obstetrician in town would agree to that. And since the Bean has been vertex (head down) for weeks already, it looks like my semi-subconscious wishes that he would be breech have gone unheeded. So it looks like I’m doing this the old school way.

What about a family doctor? The one that was recommended so highly by a number of people refuses to accept my family into her practice, even as a professional courtesy. Her practice is closed, and she isn’t accepting new patients regardless of who they are. So much for the perks of being a physician. Having her deliver my baby would have been a back door into her practice, and it would have secured my family a primary care provider.

I don’t know why I’m starting to question all of this now when I’ve been perfectly comfortable with my choice since the beginning. As with all of my other neuroses lately, I’m going to assume it’s hormonal.


Anonymous sherry said...

I can't believe that you can't choose to have a c-section. It's done here in the States all of the time. Having had two children,1 without the CB classes the 2nd one with them, I highly recommend taking them. Sounds like you're to late :) Also,while a mid-wife was a great idea for me as well, the last minute panic set in and I gave birth at the hosp. (just in case) All was fine. Good luck!

11:30 PM

Blogger MedStudentGod (MSG) said...

Sounds like you're having anticipational anxiety. Not knowing anything about giving birth, I'm assuming it's normal - Wife had something like it as well. I'm sure you've done more than enough to ensure you're midwife will take good care of you and the Bean.

7:32 AM

Blogger Couz said...

Just to clarify, although I'm having a midwife attended birth it will DEFINITELY be in a hospital.

And Mr. Couz and I are scheduled to take a mini-childbirth class at the hospital this weekend. I'll let you know how it goes!

7:40 AM

Blogger scalpel said...

I recommend an epidural.

Good luck!

9:03 AM

Anonymous Anonymous said...

OK first of all these feelings are completely normal. Are you kidding me? All pregnant women, especially physicians, worry like this all the time. I get *more* worried when women I see prenatally aren't nervous (i'm a family doctor). Seriously.

The midwife thing is a tough call. I totally understand your nervousness around transfer politics. But overall, I think you are better off under their care. You will especially love them postpartum when the real challenges of breastfeeding, moodiness & freaking out seriously kick in--I find the midwives totally rock this stage. Have you considered finding a doula? It's never too late. We had one with our first--we found one who was a former RN, very down to earth and not freaked out to have MDs as patients. She was great and took away a lot of our anxiety.

If you're a book person I highly recommend the book "Birthing From Within". You can order it from Amazon. The art therapy sections are not so helpful to you I suspect, but the prepping for labour, dealing with pain chapters are excellent and have appealed to many doctor pregnant couples I know. (good for your partner as well).

Finally, sorry "scalpel", but recommending an epidural is not particularly helpful, reassuring or evidence based. Lots of us--yes, even us doctors--deliver without epidurals for many reasons and are totally happy with our outcomes. From the evidence we know that an epidural is an intervention, not just a simple painkiller,which definitely has its place but is not without some pretty solid side effects as well.

Hang in there Couz. You're going to be totally fine.

12:12 PM

Anonymous Anonymous said...

Why is it too late for Cord Blood Banking?!?! I'm a L & D nurse here in the States, and people have all the way up until delivery time to decide if they want it, since we have some of the kits in the hospital. The baby's cord blood is saved right after the cord is cut, and the maternal portion of the labs can always be drawn right after delvery if need be. You'll need to find out the reason why it is too late for you.

1:05 PM

Anonymous Anonymous said...

I am curious: If the mother's milk doesn't come in until, say, pp day 3, then what exactly does the infant consume, if not formula?


4:55 PM

Blogger mm said...

The doula in me is SCREAMINGGGGGGG!!!!!!!!
Please hit up DONA or CAPPA... they have listings of doulas in your area.
As a woman who has had a primary c/s and homebirths attended by midwives.... Cesareans have their place in the world... not because you are a control freak. Do you want to have major abdominal surgery, for fun? Nah... didn't think so...
Stick with the midwives. Don't believe everything you hear from other people about them either... Every birthing woman has a different view on things.
I'm sure you'll do just fine. A doula might just be the ticket for you! Please just try the thought on for a bit! I figured I wouldn't need one with my last birth, figured I did after all three weeks before I had my 3rd child....
Never regretted it.
*HUGS AND KISSES to anon 12:12 family doc! You sound so lovely!!!!!!!
and Felix... babies suck back that stuff called collostrum. It is liquid gold... moms milk comes in when it comes in! Don't screw with nature, and it shows up. Ask a certified lactation consultant.

10:43 PM

Blogger Dr. Ramprekash Varma, M.D. said...

This comment has been removed by a blog administrator.

9:09 AM

Blogger scalpel said...

Don't say I didn't warn you. Epidurals are one of modern healthcare's greatest interventions, turning a horrendously agonizing experience into something beautiful that you can enjoy.

If you want to relive the olden days, then take a horse-drawn carriage ride through town on the way to the hospital. Then when it's time, get the epidural.

You'll be begging for one roundabout 4 cm anyway, so don't let anyone shame you into thinking you are a failure if you decide to go that route.

10:54 PM

Anonymous saskatoon said...

I think it's pretty much bad luck to go in with a detailed birth plan. I've heard almost no stories of cases where the plan was actually followed, and not necessarily the providers' fault - there are so many ways things can go, so many unanticipated decisions to make. I'm just saying, don't be too set on the plan. About all you can plan is what you'll take with you to the hospital.

And it's great that you're firmly set on breastfeeding but please don't let it become a big bugaboo. More people than you might think just cannot make enough milk, even though the lactivists deny it vigorously, and it's not good for the mom or the baby to keep trying past the point where it's been a few days and the baby's still losing weight. Again, breastfeeding is usually pleasant, cheap, sanitary, all those good things...but don't let it become the end-all-be-all of your experience as a new mother. There is so much more to it than feeding.

1:12 AM

Blogger Lisa b said...

Couz I hope all goes well for you.
I had my GP deliver my first baby and a midwife for my second.
With the first I arrived at the hosptial fully dilated and deliverd the baby within three hours. I was the girl in the pre-natal class voted most likely to get the drugs. Seriously I almost cried in the class when the teacher said they might turn off the epidural so I could push. I was convinced there was no way I could do it but when the time came it was no problem. Honest to god I have no memory of being in pain.
With the second I had a midwife but complications, tranfer to high risk OB group and an epidural puncture.
all to say - you never know.
like saskatoon says, and I am sure you know, a plan can go right out the window.
best of luck

6:04 PM

Anonymous jojomd said...

You'll be okay Couz. As you know, the vast majority of deliveries go really smoothly, and you know enough to ask for help if there are any concerns.

(Felix, newborns don't need much in the first few days-a couple of teaspoons of colostrum (the clear liquid that is present before the milk comes

9:34 PM

Blogger grass said...

I just had a birth with midwives. I got freaked out about the choices we were making too (we had a home birth.) In the end I calmed down and everything went even better than I'd hoped. But aside from the birth itself, what someone else said here - the postpartum midwife care is AMAZING. Although we chose midwifery because of the home birth option, have to say that the really important stuff happens when the baby is here, and they've been great.

9:55 PM

Blogger frectis said...

I'm a midwife and had my babies with midwives before I was ever one myself so I'm thinking that's a nice way to go ;)

I'm also curious as to why it's too late to bank cord blood, seeing as how the baby is still using its cord currently? As long as our clients have the kit from their choice of bank handy at birth we do it there.

1:55 AM

Blogger medstudentitis said...

My sister couldn't get into any prenatal classes or anything and she did fine... I'm glad you managed to get in though. And I'm glad you're using a hospital midwife instead of a home birth! (I always have this nightmare of a placental abruption at home...). I think I'd probably be nervous about pushing something that big out of something so small too... and what the hell are you supposed to do with the thing once it's out!

11:34 AM

Anonymous Miss S said...

Hum ... Not sure why its too late for cord blood banking. Sometimes hospitals have kits on hand, ask. I'm using a midwife in an OB practice and delivering at an urban ciy hosptial. I'm 31 weeks - sounds like you are closer to the big day. The cord blood banks might be very willing to rush you a kit and get you entered into the system, after all, they want your money, er, business.

I also haven't eaten as well as I had wanted to or exercised as much as I wanted to. I wanted to swim but now I count 20 minutes walks with the dog as "exercise".

Oh, and haven't done a class either.

11:49 AM

Anonymous Anonymous said...

Scapel, everyone is different. You may have begged for an epi at 4cm, but it doesn't mean that couz will.

Couz, you'll do fine. I agree with trying NOT to plan it so much. And trust me, you don't want a C-section if you can avoid it. While I've been told to opt for another for the next babe, I'm seriously considering a VBAC and I had a GREAT C-section experience.

I wouldn't worry about the classes so much either, I mean, you ARE a doctor, so it is not like you have no idea what goes on.

4:32 PM

Blogger frectis said...

I think I'd probably be nervous about pushing something that big out of something so small too... and what the hell are you supposed to do with the thing once it's out!

Uh, the baby or the placenta? ;) ;) Babies go into arms and placentas go into disposal bags. :)

12:14 PM

Anonymous Anonymous said...

Not all are related to this, but please check out Grand Rounds today at Some moving and insightful stories about experiences in hospitals. Thanks.

6:06 AM

Anonymous Anonymous said...

Nonthing is well verse than the nature.

People in the hospital can take care of you, after all they are mean to do so.

Best of luck,

9:27 PM

Blogger Midwife with a Knife said...

judging from the absence, I'm wondering if a "blessed event" has occurred?

5:12 PM

Anonymous Anonymous said...

I don't think couz has had the baby yet... I know her from elsewhere.

11:07 AM


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