Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “labor”

The Cynic’s Stages Of Pregnancy

1)  Thinking About Having a Baby:  has no effect on whether or not you will actually have one.  The universe will pregger you pretty much as it chooses,  (or not) any time that it chooses.  A general rule of thumb:  your chances of conceiving a pregnancy are inversely proportionate to how much you want to be pregnant.

2)  Conceiving a Pregnancy:  Did you really think I was going to give you instructions here?  I will say, standing on your head may be helpful.  If you need to have conception explained to you, call your mom.  And then enjoy watching her freak out.  Especially if you are older than forty.  The internet is jam full of very interesting videos (OK, porn) which will offer you limitless ideas for different approaches to conception.  Or gonorrhea.  You’re more likely to get gonorrhea.  Fact:  pregnancy IS a sexually transmitted disease.

3)  Finding Out:  First, you have to deal with the baffling intricacies of the pregnancy test.  Most people choose to pee on an average of at least 6 sticks before they accept the verdict.  The home pregnancy tests available over the counter are exactly as accurate as the much more expensive Doctor Ones.  I’d do them at home unless you are having problems.  You may get the dreaded “kinda pregnant” result with the little faint pale fuzzy line.  Just repeat in a week.  If still fuzzy, call your doc to get sorted out.

4)  The Response:  divides more or less into three camps, although they may intersect somewhat.  You will either be Team Ohhhhh Noooo, or you will be Team Yessssss, with Team Ambivalent hovering in between.

5) Telling Everyone:  may be as follows: The OMG So Excited Twitter FB LinkedIn Email Text Phone Call Billboard strategy, also affectionately known as The Drama Approach, b) telling your partner, your family and your close friends, also known as the Moderate Approach or c) telling only your partner until you hit 12 weeks and your risk of miscarriage is pretty much gone – which is a very smart approach.  Up to 1 in 3 early pregnancies may end in miscarriage – if something happens, do you really want to face the painful questions and watch your friends fumble to think of the right thing to say?  This is the Cautious Approach, and as an OB, I must say I recommend it.
6) Early Pregnancy: you will look like you are getting fat and letting yourself go instead of looking pregnant. It is possible that you may barf up your toenails your entire first trimester. Maybe longer. Your boobs will hurt really bad and you will want to assassinate your partner for merely dragging the bed sheet across your chest. Your refrigerator and your trash will smell so bad you will vomit, because your sense of smell becomes so acute.
7) Your OB: by now, you’ve probably found one. Your first visit will be interminable, you will be asked all sorts of embarrassing questions, and they will remove approximately half of your blood from your body for labs. The ultrasound is really cool, though.
8) Second trimester: you will actually start to show, and get a baby bump, thank goodness. Your raging hormones will chill out a little. You may actually feel almost normal. I will warn you, the “glow of pregnancy” is actually grease.
This is when strangers will start to touch your belly and ask questions. Because the national pastime is scaring pregnant women to death, they will give you wrong and scary advice, tell you horrible stories, and you will call your OB in tears multiple times. One major plus: you get to feel the baby moving. Sometimes your partner can’t feel it yet and gets really jealous. Another bonus: you get to find out the sex of the baby. Or you may argue vigorously with your partner about whether you are going to find out the sex of the baby.
9) Planning For Delivery: you will be terrified of the impending delivery until you are so uncomfortable near your due date that you no longer care – you just want that baby OUT. If you are gung-ho, you will most likely have read at least 8 books about pregnancy and delivery, all of which made you more terrified than you already were. If you are really intrepid, you may have created a birth plan, or you may have gotten a doula or a midwife to attend your delivery. This is all OK with us, but OBs have a cynical expression:  “Birth plan + doula = C-section.”. This is not because we want you to have one; we want you to be happy with your birth, but it seems that the universe always conspires to make those who really want a natural birth need a C-section, which sucks for us and for you.
10) Delivery: I won’t delve into this much because everyone’s experience is different. This is a good time to give yourself a pep talk about control. As in, you don’t have any. We happily try to accommodate you, but what we need to do in labor is completely dictated by the baby’s well-being and by what your body does, and you can’t control either. This will help you to accept that you will have no control over most of your parenting either, because kids are little people and they often have other ideas about how any given day may proceed. Also, during your delivery, your partner may or may not pass out.
11) Bringing baby home: a properly installed car seat is a must. Then there is that moment where you pull up your driveway with a whole new person and you look at each other and think, ” Holy crap, what did we just do?!? “. And so it begins…

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Birth A La Mode; No Cherry On Top

I miss the good old days. I admit, it’s hard to miss something you never actually witnessed, although that’s how things were when I was an infant.

No one who had a baby in the early sixties remembers giving birth. When women arrived in labor, their husbands were promptly dispatched to the waiting room, and the mothers were taken to a labor room.

They would not have signed a consent to give birth. The lawyers had not yet mucked up the entire medical system. What a laughable thing, signing a consent to give birth. What the hell happens if you refuse to sign the consent? That thing is coming out anyway; I can assure you of that.

On admission, they were administered a cocktail of at least two medicines: Demerol, a powerful painkiller, in doses calculated to make one gutter drunk, and scopolamine, also called the zombie drug, because if you give enough of it to someone, they are in a trance-like state and will almost certainly be suggestible and compliant with any orders. Scopolamine also has a powerful amnestic effect: given in sufficient doses, the recipient will remember virtually nothing from the time the drug was given.

Doctors back in the day tell me that those women were still awake; they still felt pain and yelled, but they did as they were told and didn’t remember a BIT of it. My mother remembers nothing about giving birth to me. And she doesn’t seem to regret that one bit. She told me, “Well, I had some contractions, so I did the laundry and vacuumed the house, and went in to the hospital. When I woke up 2 days later, I had a baby.”

That would be AWESOME. And I say this not because I am a narrow-minded misogynistic control freak, but because the pendulum has swung WAY too far in the other direction. The change began in the late 1960’s when the hippies decided that childbirth was a beautiful and natural experience and they wanted to live every bit of it. Grudgingly, the physicians agreed to allow the husbands to be present at the delivery. That meant no more doping the patient, so now they were dealing with a wide-awake very scared little person in massive pain, because they didn’t really do epidurals back then. And then they had to deal with the baby’s FATHER (I don’t say husband, because that was around the time of free love and marriage while procreating was optional at best).

I can just imagine the ambiance. The physicians at that time would still be all male, serious as all get out, and doing things the way they were done in the 1950’s: clinical and sterile and blue gowns and drapes and sterile instruments and obedient nurses all doing things very, very seriously.

And in the middle of all this would be the father of the baby (which we heretofore will refer to as the FOB, which is what we call the biological paternal unit, even on the chart, because it gets rid of all need to establish whether or not the patient is married, or if the guy in the room is indeed even the one who donated the DNA, or just some new guy). The FOB would be intoning things like, “Just stay groovy, baby. We want the little dude to have a peaced out aura. Like, so, you probably shouldn’t be screaming and stuff.” At which point, the woman in labor would probably do what all women in labor do at this point, and scream, “Shut the hell up, and get this damn thing out of me!” Hispanic women in labor scream this in Spanish. It is universal.

And then IT happened. After the major adjustment made by the obstetrical community, and the drastic move of allowing fathers in the birthing room, the slippery slope began. The logic being, well, if my FOB can’t be here, can my mom be in here? Which then extended to, well, if my husband or my mom can be in here, can they BOTH be in here?

And that is when stuff just fell all apart. It became anarchy. Allow me to describe a common scene when I enter a labor room: the patient is in the bed, hanging out comfortably with her epidural. Her boyfriend is in the bed with her. The mom and the mother-in-law are both there, because if HER mom can be there, then why can’t mine? Grandma is there too, over in the corner, reeking of gin. There is some young girl with low rise jeans and her thong hanging out sprawled in the recliner meant for the FOB, and her boyfriend is sitting on the armrest. We are not sure who she is but we think she might be the patient’s half-sister. It is explained with some giggling that the boyfriend in the bed is, well, not the FOB, because the FOB is in jail right now, but he didn’t do anything. There is someone’s toddler on the floor. No one is watching him; his diaper is dirty, and he is fondling the patient’s foley catheter bag.

When I enter the room, there are cries of, “Who’s that?” from the imbeciles who arrived late, and from those in the know, cries of “Hey doc, has she done dilated yet? Can we have this baby now? We done waited a long time!” I announce that I am going to examine the patient. Nobody moves. I pointedly say to the patient, “I am going to uncover you and check your cervix. Would you like anyone to step out?” The patient shakes her head. Over from the corner, where it emerges that the patient’s own father is lying on a sleeping bag on the floor, the father yells, “Naw, I done seen it before! Done changed her diapers all these years!” Again, no one steps out. There is a mass craning of necks (from the ones NOT passed out) and they all wait eagerly for the verdict. This is better than reality TV for them. We get more visitors yet on days when there is nothing good on cable, and they’ve already seen that episode of Duck Dynasty.

Now you may ask, why do you put up with this? The answers are multiple. First, this is now part of the birth culture. These people have already attended multiple other labors and would not understand why they were not allowed to hang out for this one too. Second, most of the time, they aren’t really hurting anything; they are just being picturesque and inappropriate. If they are really in the way. I will boot them out. If they are upsetting the patient in any way, we will boot them out, with the help of Security (or the police, if need be), and yes, I cannot begin to enumerate the number of times cops have been called to drag out feuding potential FOBs or belligerent family members.

The other reason for the tolerance is this. All these clowns seem to reduce the anxiety level of the patient and FOB by distracting them, and they are not staring at the baby monitors and pushing the nurse call button multiple times and yelling down the hall, “Hey, the baby’s heart beat done went down!”

Also, we are not nearly as tolerant at the births. After all, birth requires focus. And there can be complications of a birth, certainly, and you don’t want a room full of panicky bystanders with camcorders getting down every second of it. Most hospitals allow two guests at pushing time, usually the FOB and one of the moms. If the patient and family are well behaved, I may allow one more, so we have, say, the FOB, his mom, and the patient’s mom. I reserve the right, at any time to boot everyone out.

Everyone who has been shooed out into the hall for the pushing phase now gathers in the hall. Despite multiple warnings from the nurses, they ooze back out of the waiting room and materialize right outside the door. From out in the hall, we hear audible speculation on what is happening with each scream that is heard. Usually, there is a pool for the weight of the baby or the time of birth. Wagers are cast. I have literally exited the labor room to get something during the pushing process and had people who were pressed up against the door actually fall halfway into the room.

The plague of locusts is rousted one more time, hopefully timed so that the poor girl gets some privacy during the birth and her creative swearing and screaming may not be heard. I hand over the baby, give my congratulations, and head out to the desk to do the paperwork.

After the paperwork is done, I usually swing by the room to make sure everything is stable and mother and baby are well. At this point, all the starlings have come back to roost and are perched on every available semi-horizontal surface and playing Pass the Baby. The TV is blaring. Multiple cell phones are in use. Pictures of the baby and the bleary-eyed mother are being uploaded to every single social media site known to man. I can barely see or speak with my patient because the room is so full of family, friends, and random acquaintances who may have just wandered in.

So this is where we are. It is a far cry from the calm, controlled circumstances in the 1960’s, and all dignity pretty much seems gone from the process of birth. So, I feel I can hardly blamed for being nostalgic for the good old days, where the dads were out pacing the waiting room with cigars, and the moms were pliant and drugged to the gills. There is a happy medium somewhere between where we are now and where we were then. But since when does mob mentality settle for happy medium? We’re just another reality show.

Things That Men Say

Let me preface this for those who do not know my by saying that I am an OB/Gyn – a doctor that takes care of women, doing, you know, women stuff like baby birthing, hysterectomies, icky periods… yeah, that stuff. Because I care for women for a living, I get to spend a lot of time with their men, frequently under bizarre circumstances like childbirth, or a really icky pubic rash. Shhhh… I’ll tell you a secret. OB/Gyns have a saying: “All women are different, but all husbands look alike.” Their men are a constant source of amazement, embarassment, stereotypical behavior, sweetness, and hilarity, planned or not.

I made a previous post about things that patients say that amuse me. This one’s just for the guys! Here’s to you and thanks for all the laughs (and muffled sobs)!

1. When you do her hysterectomy, can you get the mean out of her too, doc?

2. Hey doc, while you’re sewin’ that up, can you throw in a couple extra stitches, just for me?

3. You mean that thing’s an extra nipple? Babe, you’re a FREAK!!!

4. Only YOU would ask the doctor for something like that, Princess.

5. I thought she’d go back to normal after the baby came out.

6. We both dug around and looked for it, doc. Just can’t figure out where the damn thing went!

7. Are you gonna stick that duck thing in ‘er?

8. I’m leavin’ the room. I don’t wanna see this.

9. Oh, my God, what’s THAT?

10. What’s that brown stripe in the middle of her belly for?

11. Hey, if you’re gonna do that to her, you oughta at least buy her dinner first!

12. I dunno, doc. She got off your scale and just started cryin’.

13. What do you mean, she got pregnant in April? I wasn’t here in April!

14. What’s THIS for?

15. Is it OK if we keep the litter box in the kitchen?

16. Don’t worry, doc. I ain’t gonna pass out. It’s just like guttin’ a deer, right?

17. If it’s a girl can you put it back?

18. If it’s a boy, you only got one dick you gotta worry about. If it’s a girl, you’ve gotta worry about ’em ALL!

19. She caught that somewhere else.

20. I AM payin’ attention, hon. You just keep pushin’!

21. I’m just gonna sit over here.

22. I feel a little…. THUNK!

23. There ain’t another un in there, is it?

24. You swear it ain’t twins?

25. Does that hurt, babe? That looks like it hurts! What do you mean, shut up??

26. OW! You’re gonna rip my fingers off!

27. What do you mean, this is all my fault? You was there too!

28. My wife is hurtin’! Fix that Goddamn epidural thing, NOW!

29. She done broke her water all over my truck upholstery!

30. What do I do? What do I do?

31. Damn, Babe! You’re big as a frickin’ HOUSE!

32. Is she gonna be OK?

33. I am NOT drunk!

34. Can’t you just grab its ears and pull?

35. Why’s his head all pointy? Is that gonna go away?

36. What do you mean, you don’t want my mom in here?

37. Some things a man just shouldn’t have to see.

38. What do you mean, she can’t just have it now?

39. Can you just spay her?

40. Damn, I can’t even look at her but she gets knocked up with another one!

41. What do you mean, we can’t have sex til the baby comes?

42. Seriously, what do you mean, we can’t have sex until the baby comes?

43. How long do we have to wait to have sex?

44. Tie her tubes? Cut ’em the hell out, set fire to ’em and STOMP ’em!

45. Semen analysis? Hell no, doc, I know it ain’t ME! Ain’t nothin’ wrong with ME!

46. How soon can you do a paternity test?

47. Where’d the red hair come from?

48. She said it was a alien probe! That’s funny Babe! Ain’t that funny?

49. I can’t wear one ‘a them things! Like taking a shower with a raincoat on!

50. It can’t just get lost up in there, can it?

51. Damn, looks like you’re stickin’ your whole HAND up in there!

52. Oh my God! I shouldn’t’a looked down there! Oh, CRAP!

53. What’s that stuff comin’ out of her now?

54. That is just so GROSS!

55. Gawd, doc! How’m I gonna compete with THAT thing?

56. She told me she couldn’t get pregnant.

57. Can you give her somethin’ to make her wanna, well, you know… ?

58. Why’s she squallin’ like that?

59. Damn, her boobs got BIG!

60. Her nipples look like dinner plates!

61. Her boobs are bigger than my kid’s HEAD!

62. That thing makes her look like she’s on a milkin’ machine! OW, Babe!

63. I can’t pick him up. I don’t know how to hold his head.

64. COOL! He blew poop out his diaper right up his back! THAT’S my boy!

65. What do you mean, I get to have the next one?

66. I swear I didn’t think that thing’d get stuck up there.

67. Oh my God! Why’s that woman next door SCREAMIN’?

68. Did you really have to go into labor right in the middle of the Iron Bowl?

69. Do some jumping jacks, Babe. We need to have that thing this year – we need the deduction.

70. Can’t tell if she’s walkin’ or rollin’.

71. Why does she still look pregnant?

72. She can’t have the baby Thursday. I can’t get off work then.

73. She cain’t have the baby on Halloween – he might be a WITCH!

74. What the hell’s a onesie?

75. If her mom don’t leave I’m gonna go nuts.

76. No, you can’t buy all new shoes if your feet spread.

77. How come you need your toenails painted? You can’t even SEE ’em!

78. Stirrups? You mean like on a horse?

79. Why’s she so grouchy when she’s on the rag?

80. Oh my God! That needle is huge!

81. Don’t worry. I’ll make her take her pills.

82. Damn, girl! Your Tweety Bird tattoo’s done turned into Big Bird!

83. Is she gonna have to take that piercing out?

84. Looks like he’s a little alien tryin’ to crawl out your belly.

85. What’s that cut for her c-section gonna look like?

86. She doesn’t want an epidural. You don’t want an epidural, hon. We want an all natural birth.

87. Just breathe, hon. You’re not breathing the way we practiced. What do you mean, shut the hell up?

88. What the hell do you want me to do??

89. Why are all the magazines in here for women?

90. She’s a MILF in training.

91. I forgot the camera.

92. This wasn’t in the birth plan.

93. You’re not the doctor we’ve been seeing.

94. How can you stand looking at this stuff all day? Why’d you decide to do this?

95. Don’t you feel weird looking at women’s crotches all day?

96. Will she still be a woman if she has a hysterectomy?

97. Will she still be mean when her periods go away?

98. You gotta do something, doc. She’s rippin’ the covers off and freezin’ my ass off every night.

99. I told her I was coming in with her to make sure she addresses this issue.

100.Thank God I’m a man. That’s all I’m gonna say.

Wild Cat Birthing

Every once in a while you enter a delivery room and just know that you are doomed.  Something about seeing a pregnant naked teenager hunkered wild-eyed up against the wall at the top of the bed just tips you off.  I entered such a room today and the goat rodeo was in full swing.  The baby daddy and the girl’s mom were yelling “Push!  PUUUUUSSHH!” and trying all manner of ineffectual pushing urgings which the feral girl did not even register.  They had had her pulling on a towel in an attempt to get her to bear down in the appropriate place, which was in her bottom and not in her head as she imagined.

When I walked in, she was yelling, “GIVE ME SOME MORE SPRIIIITE!”  which struck me as an odd thing to say when a baby’s head is half out.  There were two nurses in the room trying to help each other through this awful mess.  Each one held a leg.  Instead of gracefully dropping her legs back and open as the girl had been asked, she was shoving her legs straight out and threatening to crush the baby’s head between them.  She was pushing so hard, intermittently, that her naked bottom with half a hairy baby head protruding from it was waving up and down in the air.  Alternately, she would bring her knees together and threaten to slam them on the baby’s head again.  The two nurses were fighting her with everything they had.

The girl’s momma was yelling, “You got to get it out, baby, you gonna hurt him!” and the baby daddy was hollering, “Get yore LEGS back!  Pull on this TOWEL!”  The nursery nurse was hollering at her to get off the baby’s head.  The nurses were hollering at her to get her legs back and PUSH.  And the poor ward clerk was actually in there attempting to give her some more Sprite in hopes that that might calm her down.

She finally managed, despite her wild-eyed bucking, to get the baby’s head out.  Then of course the baby’s shoulders stuck.  A shoulder dystocia is a possible emergency even in a calm environment and we REALLY had to get her legs back, no fooling.  I had a nurse pushing just above her pelvic bone to try to get the shoulders to rotate.  The girl was screaming, hollering, fighting.  To my relief the shoulders rotated and came on out.  THANK GOD the baby was out!  After a little rubbing and stimulation he started to scream, having survived the squeezing and pushing fairly unperturbed.

“Now I want Sprite,” my patient said.  “Was I bad, Doctor?”  I told her with as much sense of humor as I could muster that she was quite the wildcat and I wouldn’t want to meet her in a dark alley.  Fortunately, she needed very few stitches and she actually submitted to them without too much fuss.  “Did I hurt the baby?” she wanted to know.  We reassured her that the baby seemed to be fine.  We got her cleaned up and united with her baby,  and I escaped from the room.

Outside at the nurse’s station, the nurse who had been in the room helping was shaking her head.  “I haven’t had a wild delivery like that in YEARS,” she said.  “I think I actually hurt my back trying to get her legs in position.  WOW is she strong!”  I shook my head.  “Well,” she said.  “I’m off to get her some SPRIIIIITE!”

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