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Monday, April 25, 2011

A loving (form) letter from my OB

After a few days' vacation I returned to find a couple of craptastic things in the mail. Besides the summons for jury duty, I also received a nice, warm robotic form letter from one of the OB's in my practice.

As I looked at the return address on the envelope my stomach sort of went sour. I immediately thought it was a bill. Upon opening it, I realized it was nothing like that - but rather a plea for me to follow her in her new venture as she branched out into a private practice of her own.

Considering my feelings for her, I read her letter with amusement. Equal parts fake concern mixed with complete arrogance, I immediately began crafting a response in my head before I even got to the "I look forward to seeing you again" that mocked me at the bottom of the page.

She writes:
I would like to thank you for the trust you have given me as your OB/GYN physician during the last three years. Your health and wellness have always been and will continue to be my top priority.
Unfortunately, your convenience is obviously top priority, too. As is your "just forget your quaint little plan to have a VBAC and let's just get this birth over with" mentality.

A little back story: when I gave birth to my youngest, I was in the throes of late-pregnancy hypertension. I never had any protein in my urine or other symptoms except for elevated blood pressure, and her attitude certainly wasn't helping, that was for sure. I was trying for a VBAC, and of course it seemed towards the end I got the heavy rotation of not-so-supportive care givers in the last weeks and days of my pregnancy. I called her "Dr. Congeniality" because of her perfectly coifed hair, trendiest clothes and slim figure - did this woman have kids? - she swept in and out of the room like a human Barbie doll and barely spent more than the allotted 4 1/2 minutes with me. At one point, she said I was measuring small, and I'm not even sure how she could tell because she barely took any time to whip that tape measure out. (In hindsight I'm sure that was a ploy to get me to consent to a cesarean and skip the VBAC, but the ultrasound tech confirmed my suspicion that the baby was perfectly fine.)

With less than ten days from my due date, my blood pressure was still a concern and now the baby had flipped into a transverse position. The head OB in the practice decided to admit me for observation for several hours, so I sat in a hospital bed being grilled by various residents, including Dr. Congeniality herself, who was on-call. Before I left for the hospital, I stole glances at the on-call schedule at the clerk's desk at my OB (as if I somehow felt I was not entitled to know that basic information of who would be available to deliver my baby) and found out that Dr. Congeniality would be on-call on my due date (as if that mattered). I memorized the schedule and silently prayed, Do not go into labor on not go into labor on Wednesday...

Since I was just there for observation, no one except my mother knew I was there (and of course my husband was with me the entire time). The phone kept ringing in the room, and in my confusion, I didn't answer it - after all, I didn't consider myself a real patient. Who the heck knew I was there? And crap, where was the phone? I felt like I had to twist myself like a pretzel, somehow maneuvering around all the monitors and my huge belly, to even find it, and by the time I decided I should probably answer it and find out who the heck it was and what they wanted, it stopped ringing.

It must have rung twice, I can't even remember, and still we didn't answer it. In my mind, I was still trying to come up with a plan of action, and really didn't want to be there or talk to anyone anyway. So I ignored it. It rang a third time. This time I picked it up.

"Do I have to come down there?" a voice demanded. My brain turned as I tried to put pieces of the puzzle together and figure out just who the (!@&% this was, talking to me like I was a six-year-old child. I immediately went on the defensive.

Of course it was my "doctor," who felt that "oh, it's too bad you wanted a VBAC, but now I think you should just have the cesarean." As if she really cared for my plans - but I thought, I have to stand up for myself. I cannot just let this chick walk all over me and I have to be the advocate I'm always encouraging others to be. I told her I felt the doctors in the practice were being alarmist (after all, I had been through this before with my second pregnancy and there was nowhere near the fervor and intensity over it) and told her I wanted to give my baby time to turn on its own. "I am not having this cesarean for no reason," I said, which she did not like. She sighed audibly and said, "Well, okay then. 'First, do no harm,'" as she flippantly cited the Hippocratic oath. Yeah, as if, I thought.

Soon after a nurse (a wonderful one, I might add!) came into the room and said how she too had fielded a call from the OB, who didn't even identify herself. Wonderful Marilyn firmly said (before she knew who it was on the other end of the line) that she wouldn't put Dr. Congeniality through to me because I had been through a lot today, and was upset and confused about what to do next. Apparently Dr. C was furious, but Wonderful Marilyn stood her ground, bless her heart.

Five days later I had gone into labor on my own but the baby was now breech. Thankfully even though I had gone into labor on a Wednesday, the head OB was still on-call from the night before, and he did the cesarean. Whew. 

Of course, she did come in to examine (rather, what felt like punch me in the guts) my uterus, and made a snide remark about the baby's position and not wanting "feet coming out of my vagina." As if to scold me for my rash decision to avoid a cesarean sooner. I wanted to take down that Pitocin drip (you know, the one I didn't need because I was successfully breastfeeding) and strangle her with the tubing. I forget what I said, but I wish I could have come up with something in my typical smart ass fashion if it were not for the Percocet-induced haze.

...I have exciting news: I'm starting my own private medical practice, a comprehensive women-centered practice, where the patient comes first.
Unless she wants an atypical birth, right? You know, the ones that don't involve being coerced into induction or made to feel stupid for her decisions. And if she doesn't follow your advice, you'll just berate her and treat her like a child, I presume? Yeah, that sounds very "women-centered."
I will be offering a variety of hours to accommodate your busy schedules...
Yeah, we all know what a laugh this is. And that we'd probably be sitting there for at least an hour to be seen for a five-minute appointment, just like with your former employer.
As you transfer your care to my new practice ... 
Ha! This one made me laugh. How about, 'As I transfer my care far, far away from you and your former colleagues, whom the very thought of makes me want to vomit uncontrollably and reminds me of how completely crappy my last birth was'? It also struck me how forward this sounded, and I wondered if she left the old place on good terms. But then again, being this presumptive is right up her alley, I have found.
My highly qualified and dedicated team is committed to providing you with the outstanding care and service you deserve..
Oh yeah? How about supporting more mothers who want to have VBACs or normal, natural births?
Compassionate care has always been my focus, and along with my knowledgeable staff and state of the art technology, I will provide you with the most up-to-date medical treatments available. 
Except if you are delivering vaginally, in which case I'll likely tell you, based on outdated information, that you can't eat or drink while laboring; that you must lie down at all times to be examined and hooked up to monitors, and you won't be allowed to get out of bed for any reason. You'll also be subjected to monitoring that has been proven to raise the cesarean rate and failed to detect the very condition in babies that it's designed to prevent. You will also need repeated vaginal exams - even though you are GBS+ - although your body could just as easily tell you when you're hitting transition and it's time to push. And by the way, when it is time to push, we'll tell you how and when - even though in the average woman the urge to push is like an unstoppable freight train. And if you don't have the urge to push, we'll tell you to, anyway. And if you show up with a breech-presenting baby (which you seem to like to do), we'll insist on an instant cesarean, even though recent, up-to-date studies suggest otherwise.

Yes, that all sounds very compassionate and "women-centered." Never mind that even with all our "superior" state-of-the-art technology and care, we still have abysmally high rates of neonatal and maternal death.
I look forward to (never seeing) you again.
 I hope all your patients up and decide to hire a midwife.