Perhaps this explains why I find blogs about the humor in child raising funny, though I have no children of my own. (Not likely to soon either, but that's another story, boiling down to "got to find the girl." I digress.) I also found this article in Slate hilarious and intriguing, despite only ever having been on the other side of it. I'd like to think the hilarity is just the author's style, but the intrigue is in the point of view I didn't get in my time on OB/Gyn.
He discusses the doctor-doctor interaction, handing off the patient who is his wife with this wonderful passage:"Tabitha's doctor collected information from the doctor on call, in the way doctors do. They spoke for maybe two minutes, in English as intelligible as their handwriting."
And then, in a paragraph I like because it reflects a lot of my own feelings on medicine:
Tabitha's doctor is maybe the least likely obstetrician in Berkeley, Calif. He doesn't believe, for example, in the sanctity of his patients' whims. He has no time for superstition; he is unapologetic about his belief in the power of modern science; he believes that the best way to endure childbirth is not out in the woods surrounded by hooting midwives but in a hospital bed, numb from the waist down. He is, in short, my kind of guy.
As a resident of mine on my obstetrics rotation put it, "there's nothing wonderful about 'natural childbirth.' People died in natural childbirth, that's why there are doctors." I do know more than a few people who are fans of natural childbirth, but while (being bound for internal medicine) I'm a little more understanding of the sometimes inscrutable whims of patients, this is one I don't think I endorse. Life is painful enough sometimes.
The passage I quoted above reminded me of a patient I saw on my obstetrics rotation, who is the reason I don't like doulas. She was pregnant with twins, and had a history of several prior births that had not gone well. Her children had all been born drastically prematurely, and as a result suffered from a variety of congenital ailments. Because of her history, she had a cerclage placed, though when I first saw her, she had finally reached term, and had that particular apparatus taken out. Here is where it got complicated. She had been discussing her situation with a doula, and this non-medically trained individual convinced her it would be a good idea to give birth at home, despite her history of tragic pregnancies, and the fact that she was carrying twins. And to complicate the matter further, the final ultrasound I saw her get showed the twin closest to the cervix was smaller, and the second was breech.
When a woman gives birth to twins of different sizes, the order in which they come out has a powerful influence on the ease of the birth. If the larger twin comes out first, the second delivery is relatively easy, as the cervix and canal have stretched already. If the smaller one comes out first, the second will involve more laboring, and chances for things to go wrong, such as prolapse of the umbilical cord with concomitant asphyxiation of the newborn. This patient was set up for failure.
The next weeks were tense, as every night the patient's story was related, "just in case" she changed her mind, or showed up on the ER door with a kid halfway out of her and in extremis. And about a week and a half later, she did show up, doula in tow.
She had tried to give birth at home, and finally her screaming had gotten to be too much for everyone involved, who dragged her onto the labor and delivery deck at about 2am, probably waking the entire population of the hospital. As I went into the triage room, I was genuinely concerned someone was dying, because of all the noise. My resident was right behind me and it took a total of about 2 seconds to decide to take her to the OR.
We did manage, in the OR, to start an epidural, and then we tried to deliver the kids vaginally while waiting for the staff doc. He arrived minutes later, and began to prep for a C-section, just in case. Through the whole delivery, I heard absolutely the most foul language imaginable coming from the doula and her charge, our patient. Evidently the epidural didn't have time to kick in before the kids were coming. It was positively distracting, and my resident reflected later that it was a pity the first word the kids heard was a vulgar reference to their conception. The second child had to be delivered with forceps, and that wasn't pretty either.
The whole team came out of the delivery pretty exhausted. The doula had disappeared. My attending turned slowly to me and intoned "well I hope you've learned why natural childbirth is overrated."
Oh I have. I most definitely have.