OBGYNDoc
Minneapolis, MN
Female, 36
I am a practicing Obstetrician and Gynecologist, providing care for women in all stages of life. Approximately half of my practice consists of pregnancy-related care, including routine prenatal care, high risk obstetrics, and delivering babies at all hours of the day. The other half consists of gynecologic care, which ranges from routine annual check-ups to contraception and menopause. I perform many surgeries, including laparoscopies and hysterectomies.
As women age, risks of complications such as infertility, miscarriage, chromosomal abnormalities such as Down Syndrome, preterm labor, diabetes, hypertensive disorders and stillbirth increase. There is no black and white cutoff at which one reaches a "high risk" age. We choose the age of 35 as our designation of Advanced Maternal Age because this is the age at which we see a sharp rise in the risk of chromosomal abnormalities such as Down Syndrome, as well as an increase in the medical problems listed above. Although the risks are much higher at 35 than at 25, they are still relatively low. The risk of having a baby with Down Syndrome at age 35 is still <1%. But I don't think the risks are exaggerated- they are certainly real and should be taken seriously. If you have underlying medical problems such as obesity, hypertension, diabetes or pre-diabetes, then your risk of having a complication in pregnancy is much higher. However, if you are in good health and have the approval from your physician, then you are statistically likely go on to have a normal, healthy pregnancy.
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Yes. The active ingredient in marijuana, THC, crosses the placenta and enters the circulation of the baby. Use of marijuana in pregnancy can result in poor blood flow and growth of the baby. In addition, there have been studies that have shown cognitive delays, hyperactivity and behavioral disorders in babies born to mothers who abused marijuana.
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It is absolutely true that the risk of complications in pregnancy increase as maternal age increases. In particular, the risk of genetic disorders such as Down Syndrome, miscarriages, preterm labor, gestational diabetes, stillbirth and cesarean section rises with maternal age. However, if a patient is in good health and does not have a significant history of obstetric complications, then I support her in pursuing her pregnancy goals. As our society continues to delay childbearing to later ages, we see more and more patients beginning their families in their 40's. Advances in treatment of infertility have made it possible for these individuals to aggressively pursue childbearing. There certainly are examples of misuse of this technology- for example pregnancies that result in high order multiples, or pregnancies in patients with serious chronic medical problems. However, in general, this technology has allowed for countless women to conceive babies in the face of a heartbreaking struggle with infertility.
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The amazing thing about my job is that every day is a different challenge. I take care of women from their adolescent or teen years all the way through menopause and beyond. For most women, I am seeing them once a year for their annual exam, with an occasional visit in between for problem visits. Over the years, I get to know my patients, and really feel that I am a part of their lives. I see them through graduations, relationships, marriages, pregnancies, career changes,etc. When my patients get pregnant, I have the privilege of participating in perhaps the most memorable and emotional 9 months of their lives, culminating in the most life-changing experience possible when I am attending the delivery. Every day when I leave work, I can reassure myself that I have done my best to make the world a better place. While a career in OBGYN is immensely fulfilling, it obviously has its down sides as well. For one, the job requires taking call, which means that there are times when I have to be available at all hours of the night. I have had many 36+ hour stints during which I am constantly on the go. In addition, there is an immense amount of stress that comes with the knowledge that the actions I take can be life-or-death determining actions. I can't imagine doing anything else right now, but there are certainly moments after a long night of call when I wish I had considered a career in dermatology. But then I remind myself... rashes give me the willies!
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The practice of obstetrics is almost always a gratifying, life-affirming, joyous career. When things go badly, however, it can be devastating. Regardless of how meticulously and skillfully we perform deliveries, there will continue to be complications. Any time there is a complication, I feel the loss, grief and disappointment in a very personal way. I don't think "guilty" is the appropriate word- I always do my absolute best to "do no harm". But I think it is natural for any physician to replay any difficult delivery over and over again in his or her mind to see if there is anything that could have been done differently. While the answer is inevitably no, I hope that each challenging delivery can broaden the depth of my experience.
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We screen all newly pregnant patients for HIV, and early detection is the key to a healthy pregnancy. If an HIV infected mother has a very low viral load, then she has a very good chance of delivering an HIV uninfected baby. Recent studies show that the risk of transmission is <2% if the mother is appropriately treated. The medical advances in treating HIV in pregnancy have made incredible progress such that HIV infected women have an excellent chance of having a healthy baby.
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Most couples do relax a bit with their second and subsequent pregnancies because most of the anxiety is related to the fear of the unknown. Just having had the experience of knowing what a labor room looks like, what it feels like to have an IV, what to expect when it is time to push, and how to cope with the sleepless nights of caring for a newborn can alleviate the stress that a first-time parent experiences.
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