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.
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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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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If a patient has evidence of an infection, I would certainly bring it up.
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When it comes to circumcision, I can only present the facts, and then the parents have to make their informed decision. The benefits of circumcision include decreased transmission of STDs such as HIV and HPV, and therefore decreased penile cancer; there are also decreased rates of urinary tract infections. However, the American Academy of Pediatrics states that there is no medical indication for circumcision. There are many reasons people choose to have their child circumcised- religious, cultural, and social. It is now standard to use local anesthesia during the procedure, but of course, there will be discomfort associated with the procedure.
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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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