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.
While I am certainly not a therapist or psychiatrist, postpartum depression and other mood disorders are absolutely something I diagnose and treat on a daily basis. Although I don't know that we can prevent postpartum mood disorders, I certainly think we can prepare ourselves for and lessen the severity of postpartum mood disorders. Firstly, its important that you take care of your physical health- healthy diet, exercise and healthy sleep habits are the first line treatment for depression at any stage of life. Secondly, its important to utilize all of the social supports available- when a friend, neighbor or family member offers to help so that you can take a break from your newborn, then by all means, accept. Being cooped up with a fussy newborn while suffering from extreme sleep deprivation will lower anyone's threshold for a mood disorder. Lastly, but certainly not least, we need to be educated and informed on the signs and symptoms of postpartum mood disorders. Many times the earliest warning signs are attributed to "hormones" or "baby blues" when, in fact, they are a red flag for something much more serious. As an OBGYN, it is my job to educate my patients so that they can recognize the symptoms should they develop.
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Of women who know they are pregnant, the miscarriage rate is approximately 20%. However, miscarriages can also occur so early that a woman might not even know she was pregnant. Thus, we believe that the overall miscarriage rate may actually be closer to 25-33%. Sadly, miscarriages are very common, but that certainly does not make it easier to come to terms with. I find the best way to approach this is by being direct and honest. I always try to be empathetic and express my sympathy for their loss. Many women have already emotionally and spiritually formed a relationship with the fetus they are carrying, and will experience grief and mourning with the loss of their potential child. Some women will even experience depression after their loss and may require counseling. Everyone responds differently to the news, but my job is to remain empathetic and available for questions and support.
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The cesarean section rate is at an all time high right now, and while cesarean section is usually a very safe surgery, there are risks to performing any major surgery. Having a vaginal birth after cesarean section (VBAC) is one way to reduce the cesarean section rate. Benefits to having a VBAC include less bleeding, a shorter and less painful recovery, and lower overall cost. However VBACs also come with significant risk. The uterine scar, through which the baby was delivered at the time of cesarean section, may be weak, and may not tolerate the stress of repetitive uterine contractions. If this is the case, the scar could open up, or rupture. Although rare, uterine rupture can potentially result in hemorrhage, loss of blood flow to the fetus, and ultimately fetal and/or maternal death. When we discuss the possibility of VBAC, we want to make sure that the patient is a good candidate for a successful VBAC- we aren't willing to take this risk unless there is a high likelihood of success. Therefore, patients who had their cesarean sections performed for poor labor progression or because the size of her pelvis was too small for the baby to pass through may not be ideal candidates. If you are considering VBAC, you need to have a discussion with your physician to see if you are a good candidate. If you decide to attempt VBAC, you will be monitored very closely during your labor, and if anything out of the norm occurs, your doctor will likely recommend a cesarean section. It's very important that you understand that at any time during the labor, if there are worrisome signs for uterine rupture or the baby not tolerating contractions, you will likely undergo a cesarean section.
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I believe the ratio is probably similar to the general population. Whether we consider them to be ethical, religious or personal beliefs, we all come into this profession with our own beliefs, and one's area of medical expertise doesn't tend to change those.
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The joys of bringing new life into this world are countered by the devastation when a delivery does not go smoothly. Regardless of how advanced our fetal monitoring techniques are, we will never be able to prevent all bad outcomes such as stillbirth or birth injury. Not only is this responsibility emotionally strenuous, but there is also the stress that we could be sued over these bad outcomes that are typically not under our control. Unfortunately, we live in a litigious society, and most ObGyns will experience a lawsuit at some point in their career. This can be morally, emotionally, and financially devastating. The work hours of an ObGyn can be physically challenging, and takes away from family and home life. While I feel extremely fulfilled by my job, there are certainly times when I feel the emotional, physical and mental burnout from being an ObGyn.
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During my training, I often worked for 48 hour shifts without sleep between, only to return 12 hours later for another shift. This was the traditional way of training residents. Nowadays, there a strict rules in place that limit the number of hours one can work at a time. In real practice however, we continue to work 24-36 hour shifts simply because we don't have the person-power to take shorter shifts. In addition, in our field, there is a need to keep continuity of care- we prefer to follow a patient in labor through delivery, and shorter shifts would mean more frequent turnovers in patient care. If I feel I am ever overtired or impaired, I would certainly call on my colleagues for help.
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Trained midwives are skilled clinicians who are fully capable of providing care throughout an uncomplicated pregnancy and delivery. I have worked with some outstanding midwives, and I do think they can offer a different approach to pregnancies for patients who desire a more non-interventional approach. When choosing a midwife, be sure that he or she is a Certified Nurse Midwife (in some cultures, the term 'midwife' is applied to a lay person who participates in deliveries but who may not have official training and certification). I would always be sure that your midwife has an affiliation with a physician who will provide emergency coverage in the event that things do not go as expected. For a healthy woman without any major complications during the pregnancy, labor and delivery, a midwife is absolutely capable of providing prenatal care, performing deliveries, and caring for you in your postpartum period. If there are concerns for preterm labor, gestational diabetes, hypertension, multiple gestation or other complicating factors, I would recommend consulting with, and perhaps transferring care to, a physician. Finally, I would always recommend delivering your baby in a hospital or birthing center affiliated with a hospital. I do not support the concept of home births with a midwife.
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