Monday, January 31, 2011

Obstetrician

I got to meet my OB today. Woohoo. He was actually pretty nice. Kind of grandfatherly with Riley, and nice to me. He didn't say or do anything that offended me, and when he saw I had been to see the endocrinologist at Surrey he got a twinkle in his eye and asked, "Did he bring out his whip?" I guess this endo has a reputation.
;)
I laughed and said, "Oh yes, he did!"

I was able to communicate that my goal is a natural birth, provided there is no placenta previa. And he said that sounds great to him.

He thought I was nuts for requesting the fetoscope. He couldn't actually hear the heartbeat through the fetoscope (he blamed his age), and seemed a bit exasperated with me, but said my baby is moving lots so it's just fine.
He only wants to see me once or twice more, depending on when I go into labour, and he said as long as I go into labour on my own and my baby is head down, he doesn't have to be there for the birth itself at all. Which I appreciate: I can still have a midwife attended birth this way, just with an OB who happens to know I'm there and know me and know my history. Maybe that's kinda nice, just in case, you know?

But of course we discussed at length my previous birth, including the fact that Riley had 'some degree' of dystocia and was born flat: my midwife attributed cord compression because he handled labour so well right up til the last two minutes, and because she saw his cord behind his shoulder blade. I also pointed out there was some discussion as to *how* flat he was, because the compressions that were done were not agreed upon as necessary. We don't know in retrospect whether he needed them or not, because the nurse running the resuscitation called out, "Heart rate less than 100, start compressions," which is incorrect. If an infant's heart rate is less than 100 they need oxygen and a bag valve mask, and if their heart rate is less than 60, they need compressions. So either the nurse misspoke, or he didn't need compressions. He also recovered quickly and completely, which speaks more to cord compression than dystocia. It also indicates he wasn't as flat as was possibly thought. Anyways, we talked about it for awhile. We also talked about rupture, VBAC, long term obstetrical health, whether I want more children, why I want to avoid a cesarean (I stuck to health facts and didn't mention the emotional side), why I think a drug free birth is important, and diabetic management, research, outcomes, and issues around the globe.

He wasn't a midwife, and it wasn't an empowering visit per se. But it wasn't overtly negative, or bullyish, or even interventive. He didn't order more tests, he didn't mention induction, and he didn't seem opposed to physiological or natural birth. It was evident he believes in physiological birth, but he's also a 'worst case scenario' thinker. We also talked about the difference between the midwifery approach and the obstetrical approach: midwifery looks at the statistical probability and says, "this is safe," whereas obstetrics looks at the worst case scenario and says, "this or this or this could happen." And he responded that this is because the buck stops with obstetricians. They're the ones ultimately looked to for expertise and answers in worst case scenarios. This makes sense to me, like the captain of a ship. No matter if s/he's sleeping off watch; if the ship crashes, s/he's responsible.
But it's hard to know that worst case scenario thinking actually causes problems when it inspires more fiddling with the physiological process than is absolutely necessary, and fully trust this type of thinking. If there were a way to believe in and trust birth and yet still be an expert surgeon for worst case scenarios, THAT would be the ideal obstetrician.

Now I need some more help from you guys.
#1, suddenly I'm petrified of my ability to give birth to this baby. Suddenly, I've lost my belief in myself. Suddenly, I'm thinking the baby's too big, I'm too small, it can't be done, my uterus will rupture and explode and we'll both die, I can't, I can't, I can't...

#2, I have my intrusive ultrasound tomorrow to determine the position of the placenta. PRAY. We need a 2 cm margin. Please, please, please, please....

7 comments:

Tania Grim said...

my prayers are with you. with ob did you get? i had a great one with my first

Caryn Ouwehand said...

Oh Melly Pants. You know I have been there with ya on your #1 issue. ACK.

I'm going to email you...

SANDRA said...

The endocrinologist was very unprofessional and rude so I am so glad that your OB was nice to you!
We are praying! I wish we lived closer so I could give you a big hug. <3

Tonya said...

We will be praying for you!!!! I think the whole fear is fairly normal - at least it was for me! And then I just got SOOOO miserable I didn't care if they did give me a c-section, just as long as they got the baby out!!! :-)

tamie said...

Mel, a comment on your feelings of fear that this can't be done. It makes a ton of sense that you're feeling this way, given how insane your last few weeks and months have been. Now is the time to re-build that self-confidence, girl! Maybe now is the time to watch some really empowering videos of birth, or to do visualization, or maybe even just the time to take yourself to the spa or something. You can completely do this, and maybe a lot of it is just letting yourself relax back into that belief.

melissa said...

You guys are awesome.

@Tania; I have Dr Price. I'm delivering at Surrey and he's the head of obstetrics there. My first cesarean was done by Dr Busletta, whom I LOVELOVELOVED, she encouraged me to VBAC and did an amazing job on my surgery. She works out of Langley. I've heard from TWO sources now that Langley is no longer doing VBACs, which makes me angry....anyways, that's my OB's name. What was yours?

@Caryn, I love your emails. xo.

@Sandra; you know exactly what it's like to run into medical professionals who aren't so *professional*!! I'm going to write a letter....

@Tonya, I hear you! The whole previa scare helped me narrow down what's REALLY important to me this time around, so that was the small silver lining to the whole damn thing. It helped me to completely relinquish the whole home birth thing. I don't care anymore, I just want a natural birth (there have been I don't care if they c-section me moments too!!! Esp. when I'm scared to give birth!!!)

@Tamie; I think you're totally right. I read more of my Hypnobirthing book last night to help me get back into a believing frame of mind =) But I think watching some of my movies is a FANTASTIC idea, thank you for that one! I'll start tonight when the kids go to bed. Yoga will help. Most of all, you guys will help. Keep praying.
xo

Asheya said...

I'm soooo happy you don't have placenta previa! So happy!

What an interesting conversation with the OB. Sounds like you really advocated for yourself and what you want, and that while he thinks a little differently he will be able to respect that (especially if he's not there!). I am so going to want to pick your brain about that conversation for the educational tools I will be developing on advocacy and informed choice for the Maternity Care Research Group. How can we equip women to have the sort of conversation with an OB that you did?

You birthed Riley. You know your body is capable of this. It's hard to be fighting ALL THE TIME just to try to have a healthy pregnancy so you can try to have a non-interventive birth. It has been really, really hard. No wonder you are feeling like you can't do it, because the pregnancy has been such a marathon.

But your body has been doing an AMAZING job of growing this baby, just right, and you, body and mind, will do an amazing job of birthing this baby. I second Tamie's suggestions!

Love you lots. xo