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.
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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Without becoming too political with this question, I'll simply say no. My responsibility to my patients is to provide them with counseling and the resources available to them when faced with a difficult decision about continuing or terminating a pregnancy. I always support my patients in their decisions. For every pregnant patient, I present the options for genetic screening available. Some people choose to be tested because they are looking for peace of mind, others choose to be tested because they would prefer to be prepared in the event that they are having a child with special needs. Others choose to be tested because they would terminate the pregnancy if there was an abnormality. All are valid options, and I want my patients to feel empowered to make their own decisions based on the education I provide and based on their own personal beliefs.
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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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I can't imagine how one could do a pap smear on oneself. That being said, I think it is difficult for all physicians to choose the provider for themselves and their family. But, doctors are patients too, and we look for exactly the same traits that everyone else does- intelligence, a good beside manner, and empathy.
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Obstetrician Gynecologist
Has being an OBGYN affected your own beliefs about when "life" begins?
Plenty of physicans realize mid-career that they have chosen the wrong profession. It is a challenging road to change course because by the time you've finished your training, you are well into adulthood. ObGyn training requires 4 years of college, 4 years of medical school and 4 years of residency. In order to retrain in a different field, you would need at least 3 additional years of residency (long hours, inflexible schedule). But I can't imagine what it would be like to practice OBGyn and be unhappy with my decision- the work hours, the call, and the stress would be pretty hard to tolerate if I didn't love what I do!
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I have never had to break the news to someone that she is HIV positive. I have told someone that she has hepatitis C, which in many ways, is a very similar chronic disease. Fortunately, the treatments for HIV and hepatitis C have advanced to the point where people have the potential to live healthy, normal lives despite having the virus. I have taken care of patients with HIV and hepatitis C in pregnancy. If the viral loads are suppressed enough, and if they take their medications as instructed, these patients can go on to have healthy pregnancies without transmitting the infection to their babies.
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Approximately half of c-sections are scheduled, mainly for indictions such as a previous cesarean section or breech presentation. The other half consist of unscheduled cesarean sections, for protracted labor, fetal intolerance to labor (fetal distress) or other unpredictable circumstances. So much about labor and delivery is unpredictable, and therefore the mode of delivery is often decided upon after a trial of labor that can last for minutes to hours to days. Because there is often an emergent nature to cesarean sections, I am very thankful for the advances in modern medicine that allow us to perform these lifesaving procedures immediately and safely.
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