Sunday, February 19, 2012

The 5 Trimesters Clinic

The 5 Trimesters Clinic

When I started in medicine, I thought it might make me a better mother, were I lucky enough to marry and have children. And it has, sort of. But I never expected that being a mother would make me a better doctor.

Six months ago, I organized the 5 Trimesters Clinic, offering psychiatric evaluations to women with problems related to fertility, pregnancy, and childbirth. My co-founder has three young children, the chief resident is pregnant, and the resident who does the work is about to get married. Together our decades of mothering experience have given us a perspective on the whole range of issues that the medical literature on women’s health covers in little Balkanized buckets. (Are you imagining leather buckets with gypsy embroidered covers? I am). Seeing pregnancy and childbirth within the context of an adult life, not as a medical/mechanical problem, seems quite novel to my obgyn colleagues. Seeing psychiatric difficulty as a normal element of pregnancy has been equally intriguing to my psychiatry peers.

Having been there, done that, bought the tee shirt and had to wash baby fluids out of it, I have an interest in many problems that are simply off the medical radar. I am, for example, interested in “Motherbrain,” the transient cognitive impairment some women experience after childbirth. The medical literature pooh-poohs this, but I believe it is real, because I had it. More importantly, it needs to be acknowledged so that we don’t expect new mothers to pass high stakes exams or the equivalent before their babies sleep more than 2 hours at a time. (The scientific studies of this problem excluded mothers who were depressed, the population most at risk for sleeplessness and poor concentration—duh.)

Our clinic pays attention to many matters—the role of fathers and grandmothers, women’s anxieties about bonding during pregnancy, new mothers’ loneliness—that come directly from the experience of those who run it. To integrate mothering with doctoring brings me enormous satisfaction. The greatest joy is passing this wisdom on to the resident embarking on the same journey. My kids are grown, but I am and will be until retirement, a mother in medicine.

13 comments:

  1. Do you think that "Motherbrain" exists beyond what would be the expected degree of cognitive impairment in a person who doesn't sleep for more than 2 hours a night for several months, or do you think it's mostly due to sleep deprivation?

    I just ask because 4 weeks into my maternity leave, I don't feel especially cognitively impaired beyond being really sleepy and/or out of the loop vis a vis what is going on with my research group at school. Of course I have no idea how others perceive me, but that's a completely different story.

    :-)

    ReplyDelete
  2. I think that at least sometimes it is different. The loss of sense of time and general disorganization that goes along with it seems a little different from ordinary sleep deprivation. And it may persist beyond the point when the baby sleeps more. It isn't universal by any means. Some of the women in the premenstrual dysphoria studies also had transient, but unmistakable, cognitive problems, suggesting that some women are markedly more sensitive to hormonal flux than others.

    ReplyDelete
  3. What an awesome and important endeavor. This is great! Best wishes, One of your (proud) Former Students

    ReplyDelete
  4. Good work. Hope this becomes a model for others. ... I live in a rural community and experienced baby blues. When I asked about resources I got nothing but blank stares (from both my OB and my pediatrician!) and then finally a referral to a psychiatric nurse ... Um, not what I was looking for.

    ReplyDelete
  5. What a terrific idea for a sorely needed program - hoping you'll share updates with us as time goes on!

    ReplyDelete
  6. Awesome. This will probably provide a more useful explanation than mine... which is that I am positive my short-term memory left with the placenta. : )

    It sounds wonderful.

    ReplyDelete
  7. I should note (and don't shoot me) - I wasn't sleep deprived, beyond the first 4 weeks or so, since the Dude was good enough to enjoy sleep, and at 3.5 years later, I really can't blame sleep, but the decrease in my working memory still stuns me.

    ReplyDelete
  8. It is so nice to know that you have become better doctor after becoming mom.
    Good for you and your patients

    ReplyDelete
  9. It is comforting to see this issue discussed.
    Unaware of mother brain idea, while trying my best to save my career, i ended up flunking many times on step 2 CK. Not sure how I will fill that gap, but looking back, I only have pride, despite the many failures.

    ReplyDelete
  10. I think that your clinic sounds extraordinary, and shows the advantages of using lived experience to inform your work, both clinically and scholarly. I was wondering (since it's the field I'm looking to go into, so I'm thinking about it a lot), whether spiritual care is something that your clinic addresses? We make this big push to address spiritual needs around death, but other transition points in our lives are also "locations" for spiritual stress and shifting.

    Sorry- I don't mean to sound like I'm proselytizing for the inclusion of spiritual/pastoral care, but I guess I kind of am doing so.

    ReplyDelete
  11. It is a good question. Certainly, we encourage families to turn to their faith communities for support, which is often forthcoming. But there is so much guilt associated with being a depressed or ambivalent mother that we have to be careful, since we have no idea what a woman will find if she seeks pastoral counselling. We do encourage people to participate in rituals of faith, including baptisms or namings and those related to grief. As a whole, our department does more than many to teach residents to think about spirituality as a part of a full life, while also being clear about some of the ways religion can harm as well as heal. Our chairman, James Griffith, has written extensively on the subject. Since we are basically a free service, there are big class differences between us and the women we see, and that can,I think, contribute to some constraint about discussing matters of faith. I once had a patient look at my wall of psychology texts and comment that I had a lot of spiritual books. I feel like making a real emotional connection with women who are in serious distress related to their desires for love and connection has an intrinsically spiritual aspect. If a chaplain happened to want to be part of our regular discussions, or the case conferences we hold with the ob dept, we would welcome it. I actually don't know of any outpatient based chaplaincy services--they tend to be sponsored by hospitals, and we are quite separate in that regard.

    ReplyDelete
  12. What a brilliant idea! Love it. You have very lucky patients. :)

    ReplyDelete
  13. I love the idea of a Five Trimesters clinic!

    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!