Thursday, October 25, 2012

THINGS YOUR OB/GYN MAY NOT TELL YOU

I recently came across an article in Reader's Digest titled, 50 SECRETS SURGEONS WON'T TELL YOU. It got me thinking of the issues that pertain to my own practice and the field of Obstetrics and Gynecology. Here is a stab at my own short version, applicable to pregnancy and gynecology care.

THINGS YOUR OB/GYN MAY NOT TELL YOU...

1.To know which doctor is good, ask hospital employees- specifically the nurses or scrub techs. They are the ones who work closely with the doctors- they see them in action, with patients at their bedside, during deliveries, procedures, and surgeries. Their word, based off of what they see and their own interactions, trump any prestigious title or affiliation.

2.Ask about their rates- all of them...their complication rate, induction rate, episiotomy rate, and c-section rate. If they don't know, they're either hiding something or playing dumb because they simply don't want to be bothered.

3.Some surgeons won't mention procedures that they don't do or don't like to do. Some Gynecologists cannot do laparoscopic surgery, and some can do laparoscopic surgery but are not trained in the newest method of robotic surgery. If you need a hysterectomy and a surgeon is not trained in da Vinci robotic surgery, do you think he or she will mention it as an option? The answer is probably not. To do so may very well be sending you out the door...and your money with you.

4.A lot of thought may have gone into finding the right surgeon, but very few people even consider who their anesthesia provider will be. My hospital currently does not offer routine consultations with the anesthesia providers. And no patients actually even think to ask about it.

5.Doctors are human beings, not perfect and not all-knowing. I am constantly learning something new, each day, with my interactions and experiences with each unique patient. I do not always know the answers and I am not always right. As is the same with any doctor. A good doctor doesn't necessarily have all of the answers at hand, or pretend to- they listen, learn, and attempt to solve the problem. And listen some more.

6.When seeking OB care, don't be afraid to ask the doctor what their philosophy on birth is. If he or she looks at you like you just spoke in Latin, then take that as a sign. Even an Obstetrician should view birth as the important event that it is and should have some thoughts to share that will leave you with a better idea of what to expect from their care.

7.It's never too late to transfer care. Unless the baby has been born. THEN it's too late. If you have gone through the discussions above about intervention rates and philosophy of birth and it's just not sitting right with you- or if you just in general are not feeling cared for or supported in the way that feels right, listen to your instincts. Transfer care and don't look back. Just as my wife always says- if you don't feel you're being listened to and supported during your pregnancy, then why would it be any different during your birth? She's exactly right. That's why I have been known to accept transfers at 36, 37, and even 38 weeks.                                                          

This is only just the beginning of things that come to mind that your OB/Gyn may not tell you. Have you experienced any situation like any of the above? Are there any others you can think of to add?

Glen Elrod, OB/Gyn

Friday, September 28, 2012

Homebirth through the eyes of an OB


Being an Obstetrician married to another birth professional, you would guess that this wouldn't be the average pregnancy and certainly wouldn't be a mainstream delivery. And if you guessed that, you'd be right. From the first text message with a picture of a positive pregnancy test, I knew that we would be doing things a bit differently.

We did our visits ourselves, together- in the comfort and intimacy of our own office or home, with the convenience of whatever time we desired. We never really settled on a midwife. I guess Tara at her core always felt like we could do this on our own. She is knowledgeable and intuitive, and trusted in our knowledge, skill, and abilities. I always held a little skepticism. Homebirth was something new for me. But, I really believed that my work with midwives over the last three years had put me in a very good place in my life and my career, to see my first homebirth.

I had read the books, witnessed raw, natural birth and watched our local midwives in action. I knew it could be done. I knew it was safe...but yet I worried. I had no rational reason to think it wouldn't go well. Tara was young and healthy and had no risk factors. She had had two previous uncomplicated births.

I wish I could describe what exactly my fears were. I guess I feared what I was least familiar with...the newborn resuscitation. I could not get it out of my head. I would fall asleep and picture our birth. The labor would be smooth and easy, the delivery would be textbook and then I would inevitably see Adria in the bed...pale, limp and lifeless. I would panic and try to logically get through the steps, walk through my NRP algorithms. How would I live with that hurt? How would I know that I had done the best that could be done, not just the best that I could do. I knew that I would do the best I could do...but our baby deserved the best. So I worried. I don't think I ever talked to Tara about my fears. I knew in my gut that they were irrational. Yes, I had read the Wax study about homebirth and ACOGs stance on homebirth and the Skeptical OB's blog trashing homebirth, but I had read countless articles that picked apart the Wax data and called into question the methods and results, showing the flaws and pointing to that homebirth truly was safe. But even beyond the published data, I pulled on what I knew to be true... Healthy women with healthy pregnancies... If not messed with, they do very well. I had traveled with Ina May and listened to her stories of birth on the Farm and the very low intervention rate and complication rate over years and years of homebirth. I had talked with Dr. Fischbein about his experience as an OB, who does homebirth. But what I knew more than all of that was my own personal experience. I have been the backup for our local midwives for nearly three years. I roughly know how many deliveries are done locally and I know certainly how many hospital transports are done. Out of that I know how few have any complications in labor. The number is very very small and there are warnings before hand. So I kept telling myself...pay attention Glen, pay attention.

We had made every effort to make sure nothing would cause me to miss our birth. We had limited patients and postponed surgery. But Tuesday, September 13th I had a c-section and a hysterectomy. Our due date had passed on the 12th and I knew it could be any time, but that morning was like any other. Tara felt and looked good and was headed to a conference at the birth center.

The c-section came and went without a hitch. Then I got a text. Tara wasn't feeling well and had started throwing up and she was headed home. I was just about to start the hysterectomy. What should have been an easy surgery quickly turned more difficult that I had expected. Then another call. 'Can you hand off the surgery?' My gut told me that this was the real deal. But I couldn't leave right then. Would I make it in time? Would all this planning and care be for nothing? I was going to miss my own daughter's birth...I just knew it! I began the case and when I finally finished, she hadn't delivered yet. Thank goodness.

Hustled home to find my wife in the tub, still sick as can be. I change and get in there to help. Then my introduction to homebirth. She hands me the full puke bucket, which I promptly proceed to drop and spill. The bucket hits the floor and now I am wearing vomit! Great! I'm glad I'm a doctor usually.

Tara finally gets out of the bath, working hard with her contractions and obviously overheated. Worried doesn't quite cover it. She looks flushed and sickly. Her temperature is over 101 and the baby's heart rate is 180. (She doesn't think I can count that high, but trust me, it was that high.) Where were we going with this? Was it infection, dehydration, infection...I was very worried that our perfect plan for a homebirth was suddenly going to become a medicated, monitored hospital birth because of a fever! So we watched and worked. We started an IV fluid bolus and gave a round of Ampicillin.


Slowly, over the next few hours she started to look and feel better. The baby seemed to rotate from posterior to anterior and voila, the contractions that had been horrendously painful and in her back, dissipated. As Tara cooled off from her much too hot bath, her temperature went down and the baby's heart rate was normal. Maybe tonight wasn't the night after all. And probably a better thing it wasn't with all those problems.

We gave all our Facebook fans the news that there was not going to be a baby on this watch and to all lay down and go to sleep, because that's what we were to do.


Thursday rolls around. No work, no rounds, no patients on the horizon. This seemed to be a good day to have a baby. And what do you know... By 5pm the contractions were regular. I knew it was coming. I was excited, terrified, nervous, happy and I couldn't wait to share so everyone knew it was the real deal. But we waited to make it known.


In our every day life, Tara and I are always very close, very affectionate. Our long standing plan for labor had of course been one of closeness. We would rock together during contractions. She would stand or lay and I would rub and caress her. Regardless, I would be close and there would be physical contact through the whole process. I guess the best laid plans...as they say. However, labor wasn't anything like our ideal.


At 7pm contractions were every 2-3 minutes. Remarkably, she was still putting on her makeup for what would surely be a photo op in the near future. I suggested we call our midwife and after many repetitive refusals, ultimately Tara relented and let me text her. At 7:45 Tara got in the bath. Other than a few trips to pee, this would be the last time she was out of the tub until we delivered.

It soon became apparent that the only physical contact between her and I was going to be with my pinkie. During contractions she would grab my pinkie and pull it underwater with her hand. No touching, no rubbing and certainly no caressing. But that was her way of dealing with the contractions.

It also became apparent that all of us should have had a script. What do you tell someone that continuously asks you to say something nice? I didn't know. Jennifer didn't know. So I tried humor. Oops...not the best idea. It will now certainly be a long standing joke in our house, but she asked for something nice and I told her that her Escalade would be ready to be picked up tomorrow. They had called today. It WAS nice for her after all...no more rental minivan. That would be the same minivan that I would later clean up a front console of puke before giving it back.


At times I felt that the labor was surreal...that time was standing still and there wasn't anything happening. At times I wondered what I would be doing if this were in the hospital. But, I knew... I KNEW that everything was going well and that it was in fact going to be OK. There wasn't a monitor ticking away in the background. Pandora was there instead. There wasn't the beep of the blood pressure cuff or the IV bag finishing. Cal Worthington Ford's annoying commercial was about all that wasn't calm and soothing. The bathroom lights were dim. The tub was lined with fragrant candles. It was nothing at all what my hospital experiences were like...minimal resemblance to the births I have the honor of attending. I thought this to myself and felt a fleeting wave of sadness, as that's not the way it should be.


I knew Tara had no desire to be checked in labor. She felt as if there was no need. And honestly, I never once felt the need to check her. I could hear it in her voice. I could see it in her face. I knew that she was making change. Amazing, the value of observation and intuition. Funny that she didn't trust us to pick up on it though. We all were trying to give her encouragement. You're doing great. You're almost there! “How do you know I'm almost there...no body has checked me. I could very easily be 4!” Jennifer and I glanced at each other...8cm was our guess.


Before long her tone took on a different tenor. Lower, deeper, longer. It was coming and it was coming soon.

Pop...gush. There it was, her water had finally broken. Having been the start of her other two labors, this time it waited until the very end. Once it broke, things went quickly.


I find it amusing to watch the video at this point. I reached into the water, desperately wanting to do something, but each time pulling back my hand. I didn't NEED to do anything. I fumbled and accidentally turned on the water. I grabbed for a towel to provide support. Really? In the water? So I reached down and gave pressure on her bottom. No gloves. But even that wasn't needed. The baby's head was crowning and with a grunt her head was out.

Delivery of the shoulders. Hmmmm. I was trained to just get on and get it over. Tara wanted none of that. In fact, she had been adament about it. I had to make an absolute conscious effort to do as little as possible. I did check for a cord and then beyond that, just waited. According to the video, her head was out nearly a full minute before the rest of her was born. That seemed like an eternity to an obstetrician! But, once again, I had to pull on what I knew to be true...it wasn't an eternity. It was just fine and everything was going the way it should. Voila...just like that, another hard push and she was out. Tara reached down and grabbed her and Adria was screaming on the way up to her chest. Relief!!!!

I turned into a dad...and Tara turned into a midwife. I kissed on Adria, rubbed her head and just listened to her. Tara asked how her bleeding was, did someone want to listen to her-there's a stethoscope in the other room, she said. How was her bleeding now. How was it NOW? Does she need to get out of the tub? She wanted to let the cord stop pulsating...but she doesn't want to bleed too much. The perked consciousness and awareness of a midwife. Meanwhile...I'm still admiring our baby daughter.

She gets out...gets to the bed...delivers the placenta, and I all of a sudden I become an obstetrician again! HOLY SHIT!!! I was mortified to say the least. The placenta! OMG, the placenta. It was the scariest looking placenta I ever remember seeing.

Velamentous insertion. The vessels of the cord start dividing in the membranes. Big, honking vessels unprotected and vulnerable. Plus, a vessel running through the membranes. Yes, anything could have happened. So what did I do? I took pictures. Loads and loads of pictures of our crazy scary placenta.

A flurry of things then happened quickly. A few stitches, a quick drive to Tesoro for Motrin and a drink...Motrin for her, drink for me. Adria got weighed in a hanging fish scale, she got her newborn exam, a few pictures with the little ones and Candice and then the best.....silence. Everyone left. At that point it was Tara, I and Adria, in our bed. It was 2am by this point and the world outside was quiet. We pulled up the covers, turned on the TV and relaxed. After about 20 minutes, we turned off the TV and went to sleep...in OUR bed, in OUR house. Comfortable, relaxing and peaceful.

In the end, I'm glad we did what we did. Being the 'midwife OB doctor' and the backup to the local midwives, I would have had a hard time doing it any other way. I truly believe- as well as research shows- that home birth for low-risk women with healthy, low-risk pregnancies is safe. It's where we felt was the best and safest for US. Of course, I had my fears, my 'what ifs', my 'worst-case-scenario' moments, but they were all erased the moment I saw her and knew that we had made the right choice.

Just like we did that night, I'll pull up the covers and say 'Goodnight' or 'until next time.' I look forward to the day that our experience is what is the norm for birth in our society. I look forward to being a doctor and instrument of change as a doctor who sees and acknowledges that we are not treating birth in the manner that it needs and deserves to be treated. I look forward to giving mothers, babies and families births they deserve. And of course, I look forward to doing this again. Now, to get Tara on board...


Glen


Wednesday, August 29, 2012

*I* am a midwife


I began my journey into birth work with my own personal journey into motherhood- the birth of my first baby. I emerged from the experience as a mother- the repeated cliche of false assurance of a 'healthy mom and healthy baby' that I oh so cringe when I hear-  but with little feelings of positivity and empowerment. I took a look back at the events and my experience as a whole and realized that I had not been an educated, active participant in the birth of my baby and the birth of myself as a mother. I thought to myself, “That was not the way it could have been or SHOULD have been. There has to be a better way!” I vowed that I would do things differently the next time around.
In seeking my own knowledge and wanting to pass it on to support other women, I became a Childbirth Educator and Doula. I went on to have my second baby- an unrestricted, unmedicated, empowering birth within a hospital. Wanting to have a larger scope of support and care, I went on to complete an intensive 2 1/2 year apprenticeship at a busy freestanding birth center, Mat-Su Midwifery- under the guidance and wisdom of some of the best midwives. During the time of my intensive training, so much life happened...settling into life in Alaska- a place I never in my wildest dreams thought I would ever live, the pregnancy and birth of my 3rd baby- born into the water, in the comfort and safety of my home- and so much knowledge, experience, and insight gained from the countless births I was a part of.
Today I found out that I passed the NARM exam. I am now a midwife. All of the sadness I had felt before about the end of my training has now been replaced by pure excitement and happiness, and some relief that my training is behind me. I know, of course, that my training and learning will never end, for as long as I am working and serving women and families...but it will be different now. Good different.
I have been doing birth work for over 6 years now- either as a Childbirth Educator, Doula, or Apprentice Midwife. I have been a part of so many pregnancies- so many births- so many lives. Most of the births I have been a part of, I can remember with clarity, better than my own births. Cumulatively, they have been just as profound as my own births.
So I want to say thank you for the many ladies I still have contact with... Thank you for allowing me to play a role in your story. For trusting me and confiding in me, for learning from me but also simultaneously teaching me. With every pregnancy or every birth I have attended, I have walked away as a better teacher, supporter, or midwife. You have claim to the midwife I am and will continue to grow into and I hope you realize the importance of that.
So with that said...
WOOOO HOOOOOOOO! THERE IS SOME CELEBRATING TO BE DONE!!!!!!!
Love to all,
Tara

Wednesday, August 8, 2012

Goodbye, Apprentice

I expected my feelings to be different from what they are. I walked away today, and had the feeling as though I was walking away from life as I knew it...I had, and still have, this feeling of unknown and excitement...apprehension...uneasiness...nervousness...gratefulness, and yet more unknown, inside my heart and inside my mind. I began my apprenticeship journey the same way I suppose- tangled inside all of those emotions and not knowing what I was getting myself into and what the future held. For the past two and half years I have been emerged inside two worlds- midwifery and obstetrics- straddling them, juggling them, and taking from each whatever experience and knowledge I could, and trying to put together the pieces to make up a better whole within me. I have seen birth by candlelight, silent except for the soft breath of the laboring woman, and the sight of her reaching down- unscathed, untouched, unbothered and uninterrupted, to birth and catch her baby with her own hands- as well as highly-intervened birth ending in cesarean section. I have seen shoulder dystocias, hemorrhages, and neonatal resuscitations, as well as calm and normalcy, peace and beauty. I have caught first babies and I have caught 10th babies. There was nothing lacking.


I should be happy and relieved that my apprenticeship is over. I look back at the past 2 and a half years and most of it is a blur. With the experience and gained knowledge came huge personal and family sacrifices. But for some reason I am not feeling happiness, nor relief. I'm standing here looking back at a time that was monumental for me, seeing that the door has gradually been closing and the dynamics shifting. I am wondering what comes next...and how and why and when. The flavor of change seems to be bittersweet. Sadness for the termination of what once was, and excitement of what is coming.

I am so, so grateful for the midwife who gave me a chance. She didn't have to, and I have always known that and respected that. I've learned through the eyes of my own training and the training of others that to have an apprentice is no easy feat. With it comes self-limitation, self-sacrifice, and the burden of the weight of true patience. I am grateful for the patience and the service and the dedication that each midwife has given in passing on their knowledge and experiences to me.

And to my husband- the epitome of what an Obstetrician should be- Thank you...for being you, for sharing your knowledge with me, for learning along with me, and for allowing me to share my knowledge with you and actually valuing it and applying it within your own practice and how you care for women and birth. We have so much to learn and share with each other...and so much to give to the world. We are truly Integrated.

The NARM exam awaits me in 6 days. Here's to the future.

Wednesday, June 13, 2012

Holy Births and Howling Babies

As a mom labored down the hall tonight, I quietly opened up Varney’s Midwifery. For the first time ever, I noticed the poem that discreetly lies at the very beginning of the text. It resonated with me. So very much.

Holy Births and Howling Babies

In my backyard there are nuns who live in a shaded brick building
next to the St. Stanislaus church and elementary school.

Together we rise before the sun is in the sky.
Behind the kitchen curtain, in the damp haze of morning,
I watch them walk in shades of blue robe.
They glide in white sneakers across the parking lot.
They are cool, calm, brisk.

Some day, I’ll go see them
I’ll ask for some lesson on prayer.
Because the thing is…I pray now.
Not Dear God Almighty!
Just low, easy, quiet thoughts.

I pray when my patience is worn.
When my shoulders ache.
When my own voice becomes tiring to my ears.

I pray when my heart sits heavy with stories and faces of women.
A prayer for the 32 week babe.
A prayer for the lady with the skinny, squawking twins.
A prayer for the woman without a mother, or a lover, or a friend.
I pray when my cold hands run across a pregnant belly
and I feel a kick from inside.

I pray for all my babies, Be good to your mama.
I pray for all my mothers, Be strong, be good to this baby.
I pray secretly and I pray slowly.

I pray for us, the midwives and almost-midwives.
I pray that we make the right decisions.
And I pray for those of us who make bad decisions.
Decisions we regret with outcomes we can’t change.

I pray that we learn from our mistakes.
That with age comes wisdom.
I pray deeply and I pray completely.
For all of the hands and all of the bellies.
I pray for holy births and howling babies.

By Dana Quealy, CNM, MSN

Tuesday, April 3, 2012

Professional Juggler

I recently watched the movie, “I Don't Know How She Does It.” I sat there and, through the emotional tugs at my heart from sadness and sentiment and blended in laughs, with my tears and laughter I nodded my head in pure understanding. Not only could I relate to Kate- the professional mother and her struggles and antics that this movie revolved around, but I WAS, AM, this character. Professional mother? Mother of profession? I am certainly not either, but every day I strive to balance it all- some days I succeed in my balance, and some days fall nothing short of epic failures.

Kate is a motivated, self-driven, sexy vixen of a professional woman. In one of the best scenes, she sits in front of a business big wig, trying to close a huge business deal, and while at a glance she appears to be well put together and the epitome of a professional, every time her business counterpart looks away, she is frantically scratching her severely tossled mane of hair due to an aggressive infestation of head lice that she gotten from her preschooler. He looks up. She immediately stops scratching and gives a smile and a seemingly attentive nod of understanding. He glances back down to his documents. She scratches with fury for relief.

Wow…That sucks…That’s hilarious…That’s totally me.

Yesterday, running ever so slightly behind schedule (something I cannot honestly say is not my norm), I walk into Ethan’s classroom to drop him off. As we are saying goodbye, one of his classmates- a teeny petite little red-head girl, comes up to me, says, “Hi Ethan’s mom,” and wraps her arms around my leg, burying her face into my leg to give me a big squeeze. I smile and then hurriedly rush off. Minutes later, as I walk into work, Adria in her infant carrier slung on one arm and my iPad and iPhone in the other hand, I happen to glance down and notice a green, quarter-sized glob of snot on my brand new, gray dress pants. I flash back to that cute little ginger, burying her face into my leg to give me love, and I cringe knowing that some kid’s snot is dangling from my pants. Bleh. Gag. Yucky, Honey. And so, not wanting to walk into the office with such bedazzlement, not having any tissue or extra hands to properly clean myself up, I bend down and flick the ginormous gooey booger onto the ground. Mental note to self: go wash hands. I walk to the sink, wash my hands and scurry about my day.

Fast forward through the day: paperwork, phone calls, client/patient appointments, midwifery schoolwork, picking kids up from school, and being the ultimate ring master- I am, once again, running late for a very important dinner meeting. I’m driving, attempting to put on my lip gloss, and I’m wondering to myself, “What the HELL is that smell? I seriously have the permanent smell of baby crap on me.” I park, check my teeth in the mirror, adjust my boobs, and jump out of the car, all but running into the restaurant. As I’m approaching the door I look down to my pants and see that while I did indeed get the glob of booger from earlier, I seemed to have missed cleaning up the trailing snot smear that was left behind. Crap. Dammit. I lick my fingers to get them wet and try to rub it off as I walk through the door. I get a waft of air and simultaneously think to myself again, “What IS that smell?!!” I look down into my $1,000 leather Louis Vuitton and see the answer. A dirty cloth diaper that I tied in a grocery bag and stuck in my purse the previous day. Oh nice. I am on a roll. I am a sensuous, aromatic wave of Flora by Gucci a la baby crap. But I don’t skip a beat. I smile and introduce myself to the OB recruiter we are dining with. As I shake his hand I contemplate vocalizing the words in my head, “Oh hello, nice to meet you. Don’t mind the breastmilk on my shirt, the mucous on my dress pants, and the aroma of baby poop that I brought in with me. It’s just the dirty diaper I’m carrying around in my purse. No worries. This is normal. All normal. I promise.”

My point? I’m honestly not sure. Maybe just to tell all you women- stay at home or working- that perhaps “I Don't Know How She Does It” is right…are we just women? Just mothers? Midwives? Teachers? Students? Whatever titles or roles you may hold. No, perhaps the description most fitting is ‘Juggler.’ I am a juggler. Not the most skilled, and certainly not perfect, but I do try. And, if anything, I am usually quite entertaining.