Tuesday, March 04, 2008

An Interesting Conversation with an OB

Yesterday I had what can only be described as "an interesting conversation with an OB."

I went in to the clinic to get a copy of my prenatal labs so that I could have a copy to give my midwife. The doctor that I saw was the same one that did the u/s last time. He's an older guy (62) and quite funny. He's got what you might call a dry sense of humor-very sarcastic. Sarcasm is just my style so it suits me well.

We had talked briefly last time about twin births. He had mentioned that there was nobody in our town who would allow a vaginal birth, let alone a VBAC, for twins. I smiled and said "that's one of the reasons I had a homebirth."

Yesterday our conversation again turned to birth. The doc and I were discussing the ever-climbing cesarean rates. He told me that it was terrible that so many women are having unnecessary surgery. One of the things that he told me was about a 28-yo primip who had a primary cesarean while he was a resident. She died of a pulmonary embolism. That was enough to convince him that cesareans should be a last resort. (I wonder what his cesarean rate was when he was practicing?) He said that the new doctors these days just don't learn how to use forceps or deliver breech presentations and so they just rely on cesareans. I told him that I couldn't agree more and how I'd had a client who was a primip that drove to Atlanta to have her baby and had a unmedicated frank breech birth in a hospital there. He thought that was great.

Then he said something that literally made my stomach twist into a knot. He said that more residents need to learn how to handle breech presentations and use forceps. When he was a resident, he wanted to learn to use forceps. The doc he was working with that day told him that there was an easy way to learn. He was told to go around L&D and anytime he found a mom at 8cm, to give her a spinal. This would cause a deep transverse arrest which would require the use of high forceps.

This doc admitted openly that he CAUSED harm to women so that he could hone his skills as an OB. He purposefully intervened with the sole intention of causing a complication that would necessitate further intervention. Hearing this was almost enough to make me vomit. I couldn't believe he was actually telling me this to my face and he was proud!

I asked him if he felt guilty for causing pain and complications for these women. His response? "That's how we learn." Well, there you have it! Still trust your fabulous OB?

I told him that this was exactly why I had a homebirth last time. He said that my only chance of having these babies come out my vagina this time is to either have them at home or come in to a prenatal appointment and the first baby is crowning. They don't even do deliveries at this military hospital and this particular doc no longer attends births at all. But if I showed up at his office pushing he says I'd be his only hope for a vaginal hospital birth. He even said that if I had Baby A vaginally at the other hospital downtown they'd still section me for Baby B. All of this just reinforced what I already know-that I am avoiding the hospital unless there is a true emergency which will likely mean that I'm headed off to a cesarean.

Of course I've been planning another homebirth anyway but I didn't tell the doc that.

Nothing this doc said yesterday is shocking to me, but I am really surprised to hear such honesty from him. I'll continue to use him for backup care because my other option is to use the doc I used last time. This won't work for a number of reasons... the main one being that the other doc scheduled me for a ERCS last time and I didn't show up or call to cancel. When they finally called a few days later I told his nurse that I'd had the babies already. She asked where and of course I told her they were born at home. I highly doubt that this doc would believe me if I walked into his office again and pretended to be planning a hospital birth with him!

After the u/s on Thursday I should have a pretty clear picture of what my plan will be for the rest of my pregnancy. If the babies do not share a chorion then I will have very minimal care. if they do share a chorion, I'll have somewhat regular appointments to monitor their growth because of the risk of TTTS. (So much for an uneventful pregnancy this time!)
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