My awesome OB missed the first night of her family's vacation for me!
Tuesday, June 15, 2010 at 7:34AM 
By Kathryn
My first child was conceived on the heels of my second (very early) miscarriage – literally, I got the positive pregnancy test five weeks after I lost the previous pregnancy. Because of my history, I spent my entire pregnancy in daily terror; I had no faith in my body’s ability to carry or birth a baby. I asked my family practice doctor, who was also an OB, if she would provide my pregnancy care and deliver my baby, and she was thrilled to do so. At the time, I thought I was getting a pretty standard OB experience – I only found out later how lucky I’d been, really.
The first good sign was when my husband, at our ten week visit, asked what her policy was on inductions and C-sections. “I don’t like to do either,” she said. “People say epidurals cause C-sections; I think inductions cause C-sections. We know so little about the exact methods and processes by which labor begins; I don’t like to sidestep your body unless I have a really good reason to, and the passage of time really isn’t enough for me, not with all the monitoring we have. As for C-sections? There’s a reason why I choose to work in a hospital that has two anesthesiologists on-call 24/7, and the OB/OR right across the hall from the birthing rooms. It means I never have to do one ‘just in case.’ I can wait until I see affirmative evidence that surgical intervention is needed.”
The second really good sign was when I gave her my birth plan at 32 weeks; it had two items on it, because I trusted her. The first was that I wanted to be given all the information available to me, that I would freak out and feel MORE anxious if I thought that people were hiding things from me. And the second was that if I needed an episiotomy, my husband would need some warning about that if we wanted to keep him upright. She said “OK, I’m good with both of these, but you should know that I’ve only cut two episiotomies in my career. I use a delayed pushing technique instead; when the baby is crowning, I hold your perineum up and try to coach you through not pushing for one contraction. Under the pressure of the baby’s head, the perineum usually relaxes plenty and tearing is minimal. It hurts like hell if you’re not medicated, I won’t lie, but the results are really positive overall.”
But the kicker is when I went into latent labor a week before my due date. She saw me at 39 weeks, and then at 39w3d; that visit was when she said “Remember when I said I don’t do inductions? As you are learning, latent labor can go on for some time. Like, really quite a lot of time; I hate to break it to you, but three days is nothing. Your cervix is softening a lot, which is good, and I’ll sweep your membranes for you if you like, but that won’t actually do anything if your body isn’t poised literally on the precipice of labor. Which is why I’ll do it.”
At 39w5d she said “Look, you need to quit fixating on your due date; average term for a primigravida is 41w2d. If you want to fixate on a date, fix on 42w3d, because that is when I will CONSIDER more active induction.”
At 39w6d (I had quite severe SPD, and my physical therapist couldn’t work on me when I was laboring – remember I was in latent labor this whole last week – so I was in really exquisite pain; that’s why I was seeing her so often) I said “I hope you don’t have any plans to go out of town this weekend” and she winced and said “Actually, we, um. My husband and I and our kids have a week booked in a cabin starting, uh, tonight. He and the kids are going without me; I’ll join them if you give birth before the week is up.” I was sort of aghast, but she handwaved me off and said “This is part of the job.” I pointed out that with a cervix 2cm dilated and completely effaced and having irregular (but kind of painful) contractions every 8-15 minutes, I would probably go into labor if she just gave me an unopened vial of pitocin to hold under one arm, and she laughed and said “Probably, but that’s not the road your body is on. Go home and sleep as much as you can.”
My water broke that night, at 1 AM – 40w0d on the spot. My OB came flying through the door pulling scrubs on over her jeans at 5 AM, just as I was feeling pushy even through my epidural. She took one look at my fetal monitoring strip – I’d been having late decels – and flew BACK out the door; I found out a couple weeks later that it was to check the status of the OR, but at the time nobody gave me even the slightest hint that the decels were anything to do anything about other than bump up my oxygen and keep an eye on them. While she was gone, the L&D nurse had me do a test push, and reported to my OB that I was pushing really, really well. “Of course she is!” said my OB. “She’s a trained opera singer! This woman could push out a Mack truck! Come on, Kathryn, let’s have a baby!”
20 minutes of pushing later, I delivered my beautiful, healthy baby girl, with Apgars of 9 and 9 despite the occult cord prolapse that had been the cause of the worrying decels. The prolapse meant that she couldn’t hold me back for a crowning contraction, and I did tear, but only superficially. As she was sewing me up, I said “See? I would have been the easiest induction ever,” and she said “Don’t count on it. Everything can go haywire when you start to mess with nature. Hey, look, it’s only 5:30; with a quad latte, I can be at my cabin by noon!”
(I was so sad to learn, with my [current] second pregnancy, that she was no longer delivering babies. When I started looking for midwives to deliver with instead, I discovered that she had studied extensively with a couple of local midwife practices before she decided to do pregnancy care and delivery. Color me completely unsurprised; she was more like a midwife even than a lot of midwives.)
Reader Comments (6)
Wow! She sounds like an amazing woman, and you had a fantastic experience! Congratulations on your wonderful birth and your precious baby, and also your new little one on the way. I hope you can find (or have found) the perfect caregiver for THIS pregnancy, too!
What an inspiring story! Thanks for sharing, and good luck with #2!
If most OB's were like that, there wouldn't be such a backlash against them!
She was so great. I'm with a wonderful midwife practice this time around, and planning an out-of-hospital birth; realizing just how easily a lot of providers or hospitals would have sectioned me really made me pause. I'm 20 weeks tomorrow, and really excited!
ah, what a sweet, lovely, caring doc. would love to know what her mortality rates are... probably a 10th of the national average...
Bronwyn, at the time I chose her to attend my birth, I asked her if she'd ever had a birth "go south." (My words.) "Yes," she said. "That's when we cut you open and go in and get them." (Yeah, her manner is very brusque, but I find that oddly comforting.)
"OK," I said, "but have you ever had a birth end with Mom or baby not going home?"
She shook her head. "Nope. Not when delivered at term."
Now, she was a family practice OB who largely worked with low and moderate risk women; she referred high risk pregnancies out to the local university's maternal-fetal medicine clinic. But I still found that striking.