obgyn | Expecting the Unexpected | Page 2	
I stared at the couple across the desk from me. It is their first pregnancy. Cheerful. Ignorant of what lay ahead.
They want to know when the first ultrasound is going to be. Seeing the little blob will confirm that the baby is real. That the little blob will turn into different kind of a blob, one that looks like a baby. The heart will beat, the legs and arms will form, a face will appear. Never will they think that the feet could be clubbed or the heart might be motionless. Make it to that first ultrasound and all will be well.
Who am I kidding? What blissful ignorance! I envy them.
I smile and schedule them for an ultrasound this week. They don’t know that everything could be taken away. Taking a baby home at the end of this is not a given. But they don’t need to know this. For now, they look forward to seeing that little blob and all the promise it holds.
Posted in Uncategorized	| Tagged grief, midwife, midwifery, neonatal loss, obgyn, Pregnancy	| 10 Replies
What’s it like to deliver babies?
“Do you deliver babies too?” I nodded and gave a quiet “yes.” It’s a hard question to answer these days. Yes, it’s part of my job. No, I am not doing right at this moment. Yes, I do want to someday. No, I don’t know when I’ll be ready.
“Does that mean you could deliver my baby?”
“You have a one in five chance, it’ll be me” I told her. It was my standard line- there are five of us midwives who do call and though on occasion our docs end up being the one catching their babies, we midwives attend almost all of the vaginal deliveries.
“What’s it like?” she asked. “To deliver babies?”
I paused. I haven’t been at anyone’s birth except my own since December. What’s it like now? I have no idea what it’s like to be present at one of the most intimate, life changing, joyous moments of someone’s life. What it’s like to hold a warm squirming, crying baby up and place that baby on her mother’s abdomen, presuming that’s where she’ll stay until the mom is ready to let her be weighed. What it’s like to hold a baby that will likely live. I don’t know what it’s like to do that without being reminded of how none of those things were true with my baby. My best guess is that delivering a baby now would be painful, heartbreaking and soul shattering. Handing a woman the baby she will likely take home will be grief inducing. Just the thought of it, the mere writing of these words causes my throat to clench and my heart to beat more wildly. I have to breathe deeply to calm myself down.
Up to 5% of women experience PTSD after childbirth with a much larger percentage experiencing some symptoms. Traumatic birth is the most common precipitator of PTSD in these women. What defines traumatic birth? Some definitions are obvious- an emergency c-section, problems with the baby, feeling violated- and some might be less obvious. Some women can feel traumatized while their providers could think everything were perfectly. My birth was beautiful and traumatic at the same time. I found what beauty I could in it, but I did not want to actually birth her. My baby was whisked away from me a moment after birth. My baby died. Whether or not I have PTSD is unimportant to me- but I definitely have some symptoms- avoiding, intrusive thoughts, hypervigilance at times, detachment at other times. Right now, the idea of returning to attending births honestly feels like reliving the nightmare part of my experience.
I do want to do births…eventually. It is the most amazing thing to be the first hands to welcome a baby into the world and to be a part of that intimate life changing moment for a family. I want to help make births positive, not traumatic experiences, for women. That is my goal. For now I am on the schedule to return to births in September. I am unsure if I will be ready. If I’m not, I hope I can make it work with my job. But in the long run, in the future, I really do want to return to birth, when it’s less traumatic for me. Because it is truly amazing.
“It’s the coolest thing in the world.”
Posted in Uncategorized	| Tagged baby loss, babyloss, birth, childbirth, complicated grief, grief, Grief Loss and Bereavement, midwife, midwifery, obgyn, obstetrics, PTSD, traumatic birth	| 3 Replies
“Oh my daughter was in the NICU!” I said, sort of cheerily, finding something in common with my patient who has worked in a NICU. The moment the words were out of my mouth, I knew they were a mistake. She didn’t respond- I don’t know if she had read the sign and felt it was inappropriate for me to be bringing it up, looking for pity. My instinct was just to find some common ground, but I realized after I said it, if we elaborated any more, I would have to say my baby died, which wasn’t fair to the patient. The visit was about her and her pregnancy- not about me and my daughter. Recognizing her unease, I quickly changed the subject and went on to the next order of business. She asked about exercise in pregnancy– something I have strong opinions about.
A patient once told me how one of my colleagues told her to stop crossfit in pregnancy. I told her the exact opposite. In the absence of complications, most exercise routines can be continued with some modifications. I encourage my pregnant patients to exercise- continue their regimen or start a new one. I had a patient who ran half marathons while pregnant. I, myself, was very active in pregnancy. Again, I wanted to bond with this patient sitting across from me and mentioned I did bootcamp through the end of my pregnancy. This time I quickly transitioned away from me, not giving her a chance to respond, focusing the attention back on her. She asked about deep squats in the third trimester. I wanted to say so much more- about how I would exercise in the hospital while hooked up to the monitor. And if a baby with no fluid could tolerate it well, an uncomplicated pregnancy should have no issue. My high-risk doc thought I’d make a great study- showing the lack of any fetal distress in the presence of exercise and oligohydramnios. These thoughts whizzed through my head, but I kept them to myself. I just thought they’d hammer home the point of just how OK exercise is in pregnancy, but I also knew saying them out loud could lead to more questioning.
It did make me wonder what would I have said if I had a baby at home. Would I have talked more easily about my pregnancy because it wouldn’t cause discomfort to others? What do other providers say to patients, if they themselves have had a baby? Before Mabel I could only talk in generalities or tell other people’s stories, but now I have personal experience. I recognize over time, as the memories of my pregnancy and labor fade, I’ll be able to speak in more generalities again. But how do others do- those who have just had babies. Do they bring in their own experience? And do patients find it helpful? I can see how in some ways it might not help at all- providers who say- well this is how it was for me so this is how it should be for you– might come off as insensitive. But in that exercise example, I thought it would support her. In the future, someone dealing with loss- would it help her to know her provider had a loss too? I wouldn’t want to take away the attention from her, only show her I can understand on a different level. I think it would have helped me when I was a patient, but would it help others? For the future, I wonder if when I want to reference my pregnancy, I could say “I know someone who…,” [meaning me, but not actually saying it’s me]?
To everyone in general, how do you feel when/if your provider to brings in a little personal experience sometimes?
To those who have experienced loss, have any of you had an experience with your providers (nurse, doctor, midwife, etc) who have had a loss and shared about it? If you haven’t, would it have been helpful?
Posted in Uncategorized	| Tagged baby loss, babyloss, boundaries, crossfit, exercise, exercise in pregnancy, fetal heart rate monitoring, FHR, midwife, midwifery, neonatal loss, NICU, obgyn, obstetrics, oligohydramnios, prenatal patient	| 14 Replies