Wednesday, July 30, 2008

The Ob/Gyn, on the other side of the Stirrups

In the summer of 2003, my husband and I finally decided to dip our toes into the pool of being potential parents. A thought, that had up until that time been more terrifying and unpalatable to both of us than we would care to admit today. You see, I was one of *those* people. I had oft proclaimed, loudly, that I was *never* going to have children. Kids were too much work, I was too selfish, and to be quite honest, it was too scary for me, the perfectionist, to comprehend messing up another human being's life. Some of that changed when I met Mr. Whoo. We were so happy and he was so awesome, he made me want to give him the chance at being the great dad I knew he was going to be. The rest of the transformation occurred as I rose through the ranks of my Ob/Gyn residency. It was babies, babies, babies, day and night. I saw the great joys and the every day miracle that was childbirth. I was also devastated with the losses, and frightened to see how badly birth can go in a blink of an eye. Perhaps, most of all, my heart ached along with the infertility patients that I followed along the way. Women and men who wanted nothing in the world more than a healthy, happy pregnancy and take home baby. I saw the struggles, and as I saw their fight for a family, I knew that I wanted a family more than I had realized. In many ways, it was my profession that made me want to have children.

We were fortunate that we didn't have to try very long to conceive. The pregnancy was fraught with complications, some of which I have alluded to in previous posts and comments. To put it succinctly, hyperemesis (puking every day until 37 weeks, living on Zofran), symphysis pubis diastasis (hobbling around as though someone had kicked me in the crotch with a steel toed boot), pre-term contractions (which got me pulled from work, made a pariah amongst my peers, and changed my whole residency experience), depression (a side effect of how horribly I was treated by my fellow residents), and last, but certainly not least, preeclampsia. The last on the list was the reason that my physician made the decision to induce labor. We went to the office on Tuesday with no expectations or concerns, but were greeted with a BP of 160/90, 2 + protein on urine dip. "They are going to induce me," I told my husband. I knew they would, because that's what they would have told me to do for any of my patients presenting the same way. Induction was set for midnight that evening, and away we went to make preparations.

Luckily for me, I was only a mild preeclamptic, so I didn't have to experience the joy that was Magnesium Sulfate. I also was a healthy 39 plus weeks, so not a lot of worry about my baby girl's maturity. I did worry about what every pregnant woman at term worries about...how am I going to get that baby out?? Unlike many mothers, however, I had free access to an ultrasound machine, which I used often. I had been doing fetal growth measurements during down times on our triage ultrasound, and was consistently getting an estimated weight of 8 pounds. Despite my, er, generous "birthing hips," this freaked me out, just a little, because I am all of 5 feet 2 inches, and at term, was as big around as I was tall. There had been several times that I had contemplated having an elective cesarean section, but had finally decided against it due to the small amount of recuperation time that I would have afterwards. My physician was concerned because I was only fingertip, thick, and high (unfavorable cervix for induction) and said that I might be heading for a C-section regardless. I was at peace with that, and went into the whole process almost expecting it.

That evening we took my last belly pictures out in the yard amongst the flowers, packed up the car, and drove in, listening to Gavin Degraw, knowing the next time we were in the car together, we'd be a whole different family. It was weird to deliver in the hospital in which you work. We parked our car in the employee parking garage, and I walked the familiar path to the hospital as I had for the last 2.5 years as a resident, only this time I was the patient and not the doctor. I had already picked out the room that I wanted (lucky number 11) and the nurses had reserved it for me. I know that for other midnight inductions, they would make them sit out in the waiting room until the stroke of midnight, but Mr. Whoo and I walked right in and got sent straight back at a quarter to midnight. One of my favorite night nurses, Julie, had me, and we made nervous chit chat as she did my assessment, drew blood, and started the IV. None of the night residents came to visit (they were the chiefs that were pissed off that they had to cover extra nights of call since I had the audacity to become pregnant), nor did I expect them to. Julie gave me an Ambien, and placed misoprostol around 12:30, turned down the lights and suggested that I sleep. I didn't sleep, though. It was just bizarre and twisted to be the one in the bed instead of the doctor at the nurses station. I could see my monitor comfortably from the bed, and instead of sleeping I passed the time watching for contractions and CindyLou's happy, reactive tracing.

Another misoprostol was placed at 3:30 am, and another at 7:30 am, this time by my physician, who informed me that for all the medicine overnight, I was still only 1cm, and my pressure had been steadily climbing throughout the night. I later learned he was debating magnesium at that point, but was afraid that I would never reach a labor pattern if he added it (magnesium is also a tocolytic, a medicine used to stop contractions) and hinting at a surgical heading to the nurses.

I was already steeling myself for a surgery, but I also knew that I really wasn't hurting all that badly, despite contractions every 2-3 minutes per the toco. Just before noon, I had to use the bathroom, and I knew my nurse was on lunch break. So, rather than bother anybody and be another whiny, needy patient, I unhooked myself from the monitor, stopped the tracing, and hauled myself and IV pole to the bathroom. After using the bathroom, I was surprised that there was still a constant trickling, well after I knew my bladder was empty. It seemed to stop, so I stood up, and proceeded to flood my slippers and the bathroom floor. I schlep-squished my way back to the bed, turned on the monitors, and reluctantly used the call button to let them know about the SROM. They were, of course, thrilled, and started pitocin right away. I was still 1 cm, but now 80 percent effaced (woo, a half a centimeter in 12 hours!).

Almost instantaneously, the contractions felt different, more intense, once the membranes were ruptured. I found that I had to breathe through them, and I started to feel like a big baby because I was only 1 cm and hurting way more than I thought I should. I had heard great things about "the Stadol" from patients and residents alike, so I told Rebecca, my day nurse, "I'd like to try the Stadol." Much like ordering a drink from a bartender, Mr. Whoo later informed me. Obviously, that was a pretty close estimation, because the evolution of feelings went something like this, following the infusion of Stadol: "I don't feel anything." 30 seconds later "Ooooh, now I feel it." 30 seconds later "Ok, now I'm starting to get a buzz." 2 minutes later "Yep, I am hammered, woo hoo!" 5 minutes later "Oh, I don't feel so good. The room is spinning." 5 minutes later "I have a headache." So, yes, I went from buzzed to drunk to hungover in a matter of 10-15 minutes, but the pain wasn't any better, I was just less in control of it than I had been. Around this point, I found myself closing my eyes and focusing my energy inward. Mr. Whoo says there was also a lot of moaning, but I don't remember it that way. Next was the comedy of errors that was getting my epidural. The residents were in a day conference, so the attendings were (unfortunately for me) placing the epidurals. Long story short, my back was kyphotic (very curved) and 2 different attendings tried, and failed, to get a complete block.

My cervix decided that this was the time to get the hang of dilating and I went from 1 cm to 4 cm in one hour, then from 4 to 9 cm in the next 4 hours. Despite the anesthesiologists' best efforts, I. Felt. Everything. Me, the person who signed up for the epidural at 1cm, and never ever wanted to do childbirth without the aid of drugs, was feeling everything. Then, for extra fun, I stalled out at 9 cm for about 1.5 hours. All I wanted to do was push, but I couldn't. By this time, Mr. Whoo's mother was in the room, and I had several different visitors. I don't think I even opened my eyes to look at them. Around 6 o'clock, the anesthesia residents got out of conference, and one of the first years came in and tried to rebolus the epidural for me since I was so miserable...and it worked! I loved that man, and told him so every time I saw him thereafter. After that sweet relief, all I wanted to do was sleep, and, for 20 minutes, I did (likely relaxing enough to let my body completely dilate and for CindyLou to descend).

At 6:30 pm (near shift change, of course) my OB checked and told me it was time to push now. (HA! I wanted to push for 2 hours! Now I want to sleep and it is time to freaking push!) I grudgingly complied, and found that pushing can be the very best part of labor. Due to many days and nights of "pushing with" patients (and giving myself hemorrhoids in the process) I knew exactly how to push. CindyLou was born after just 20 minutes of pushing and a 2nd degree laceration, at 6:56 pm. She weighed a whopping 7 pounds, 4 oz, and she was 19 inches long. She was every bit as perfect as I hoped she would be.

There must have been 30 people in that room, and I didn't care. Two of my OB doctors (day shift and night shift) were there, 2 scrub techs were there, a couple of residents and nursing students were there, the whole peds team was there, and 2 nurses were at my side. Everyone that I worked with and their mother (including Mr. Whoo's mother) was in there, staring at my business, and I didn't care one little bit. It was another surreal moment as they placed that slippery, writhing being on my chest. She was mine. She was ok. She was pink, wriggly, and breathing. (I gave her a one minute APGAR of 9 in my head.) I knew that things would never be the same. And they weren't. They were better.

So, what did I learn as a physician going through pregnancy, labor, and delivery?

1. Knowledge is power. The more you know, the more you may worry, but ultimately it is better to be knowledgeable about your body.

2. Ultrasounds are not incredibly accurate in the 3rd trimester

3. "The Stadol" is good for exactly 5 minutes, otherwise it sucks for pain control

4. Epidurals don't always work, so you better have another coping mechanism in mind as a backup.

5. Contractions can hurt, even if you aren't very dilated.

6. Contractions hurt more after the water breaks, so be kind and don't break water early if you don't have to do it.

7. People can be really mean to pregnant women for a myriad of reasons. Ignore them.

8. Long inductions can be successful vaginal deliveries.

9. Never underestimate the female body's ability to overcome obstacles in labor.

10. At the moment of birth, you won't care who's looking at you.

I use these caveats in my OB practice every single day. I'd like to think it makes me a more aware physician, but I guess you'd have to ask my patients. Thanks for letting me share my (very long) story with you. I'd love to hear what lessons you learned going through pregnancy, labor, and delivery.

4 comments:

  1. Thanks for sharing your story. I'm currently pregnant with my first (and delaying the start of my fellowship). I'm trying not to stress out about the delivery (not to mention the anxiety of having to take my anesthesia boards one day before my due date) and reading your story has helped.

    ReplyDelete
  2. ""The Stadol" is good for exactly 5 minutes, otherwise it sucks for pain control."

    I found that it might not be good for pain control, but the amnestic effects were great! I don't remember much of it at all - my husband says that I laughed for 4 hours. My only memory is that my hand flopped into the lab coat pocket of the nurse who was fiddling with something by my bed, and that was, indeed, the funniest thing that has ever happened to me. (Fortunately, I didn't deliver at the hospital where I worked....)

    Dr. Nic, I sympathize with your board exam "issue." I was studying for my FP Boards while pregnant, and that was an awful, awful thing! Every possible pediatric disorder - minor and major - was growing inside of me - hypospadias to hermaphroditism to hydrocephalus - I was a mess - not to mention I had to pee about every 10 minutes during the exam - the proctors probably thought I had answers in the stalls or something! Good luck on your boards - I imagine you'll do JUST FINE - just make sure you sit near the door if possible :)!

    ReplyDelete
  3. Your induction sounds a bit like mine. I came in at 9pm, got 3 doses of misoprostol (sp) and finally dilated to 1cm. I then had my membranes ruptured and WOW there is a difference in contractions after that. I agree, IV pain medication only makes you less in control of the pain/contractions. I would not have it again.

    Pushing is a relief!

    I didn't have my first until I was in practice and my partner certainly was very supportive. Taking call throughout my maternity leave (I was able to take 8 weeks off, very nice).

    I am a general surgeon. I've heard many stories that Obstetricians are harder on partners/residents than other specialites when they take off during pregnancy. Sad, isn't it?

    Kellie

    ReplyDelete
  4. You know, it's funny. Just the way OB residents might be harder on their workmates for being pregnant, I've noticed that health professionals in the OB field are often harder on their OB patients than professionals in other medial fields are. I think without realizing it, they sometimes further the stereotype that women in labor are whiny, selfish, and child like. Even this post has a couple references to that.

    Yes, sad indeed.

    ReplyDelete

Comments on posts older than 14 days are moderated as a spam precaution. There may be a delay between submitting your comment and its publishing. Thanks for commenting!