by: Hillary Jarnagin, MD
I have been providing obstetrical care to patients for eight years but only recently became a parent myself. My husband and I welcomed the birth of our son last month, and the journey of planning to conceive, our pregnancy, and the ultimate delivery of our baby was a wonderful and enlightening one. While I do not subscribe to the notion that as a physician you need to have personally experienced each symptom, ailment, or condition a patient has experienced in order to provide knowledgeable and compassionate care, I certainly believe my recent role reversal from doctor to patient has given me an opportunity to grow as a provider.
Firstly, I developed a greater appreciation of the sense of privilege and responsibility that comes with carrying a child and, with that, the strong desire to protect the pregnancy from potential harm. Many patients and parents have expressed similar sentiments to me over the years. I thought my ability to empathize with others would have given me a more than adequate capacity to understand these feelings, but going through it myself gave me a deeper understanding. As the mom, you are the first and main line of defense to protect your little one from danger. You evaluate everything you put in your body from food, environmental contaminants, and pharmaceuticals with a new incredulity. Feeding into this protective instinct, strangers, family, friends, and the internet are a well-spring of oftentimes conflicting advice about what is safe and what is not. I had never fully understood the need some patients had to ask for additional confirmation that what I was recommending was safe. In my own pregnancy, I was surprised to discover my own hesitancy about taking over-the-counter medications that I have advised my patients that they could take without concern. This internal dialogue would proceed about whether I really needed a Tylenol or Zyrtec before making the decision to take something for my ailments or just tough it out. And while nothing about my medical opinion has not changed, I feel like I “get it” now in a way I previously did not. I had friends, family, and patients ask me if it was nerve racking to be pregnant while knowing what all could go wrong. Fortunately, I was not plagued by anxiety about the well-being of my pregnancy despite having a high risk pregnancy and being aware of the potential complications. However, I have more sensitivity as to why some patients do struggle with anxiety during their pregnancy. Pregnancy presents a unique convergence of being out of control at a time when you feel an intense desire to do anything you can to protect this precious gift you have been entrusted with.
Pregnancy feels just plain weird sometimes. From changes to bladder and bowel function, aversion to certain foods, feeling full all the time to pressure, random fleeting pains, swelling, and broken sleep, your body and its functions are completely different. Add to these physical changes, harboring a living being and trying to decipher his or her movements and positions. It can be bizarre and seem as though your body is no longer your own. Cognitively, I knew all these things before, and now I know them through experience. I had the benefit of my experience as an obstetrician to not be alarmed by the occasionally strange things I was feeling, but I am sure that interpreting these changes can be difficult for moms-to-be.
The complications of my pregnancy required me to see a Maternal Fetal Medicine specialist and another medical sub-specialist. During my practice as an obstetrician, I have had many patients in similar circumstances. Being on the other side was a valuable experience. It was a lot of doctor’s visits and a lot of time away from work. I felt a need, likely self-imposed, to have my prenatal care and appointments have as little impact on my office staff, my patients, and my partners as possible. That was stressful, and I imagine that many of my pregnant patients who work outside of the home have silently borne the conflict of competing desires to comply with my recommendations about referrals and visits while wanting to avoid disappointing employers and co-workers by taking time away from the office. Similarly, patients who have to find childcare for their other children to make all their visits may experience an angst about imposing on others. Again, this experience as a patient will not change my recommendations about prenatal care or co-management of complicated pregnancies with other physicians, as needed, but it has given me an unspoken understanding of a struggle I was previously not attuned to.
Throughout my pregnancy, I was hoping for a vaginal birth for many reasons…shorter recovery, quicker return to activity, fewer complications, less blood loss, reduced risk of infection, etc. It’s not important to everyone, and it was not crucial to me but, if I’m honest, it was what I wanted. My general opinion on birth plans is that it is okay to have preferences and I try accommodate those wishes to the best of my ability as a provider so long as they are safe. However, labor and delivery is an unpredictable process and circumstances can change that necessitate adjusting the plan. The bottom line to any birth plan should be “healthy mom and healthy baby”. I approached my own delivery with this attitude. I underwent a medically indicated induction of my labor. Long story short, I had a Cesarean delivery after a failed attempt induce my labor for 24 hours because my son was not tolerating the contractions. We ultimately discovered that his umbilical cord was wrapped around his neck and shoulders and would not let him make his way down towards the exit and was causing his heart rate to go down intermittently when he tried to descend. I didn’t get the type of birth I envisioned for myself, but, my son arrived. He is healthy, and in my biased opinion, perfect, and I could not be more thankful for that. When birth plans go awry, it’s disappointing. I felt like my feelings and concerns were heard and addressed. By the time, my obstetrician recommended an operative delivery, I felt that we had made a more than sufficient effort to try for the vaginal birth that I wanted. Retrospectively, my situation would not have allowed me to have a vaginal birth for this delivery due to the specific circumstances. That is not something we could have known beforehand. The relationship between an obstetrician and his/her patient requires trust especially when things do not go according to plan. My obstetrician had mine, and I hope to earn the trust of each of my patients who do me honor of allowing me to care for them during their pregnancy. I think my delivery experience, and specifically having things now go according to my plan was an important one. It did not diminished my experience to not have a vaginal birth, and I feel like it was somewhat poetic for my labor and delivery to be as unpredictable and unscripted as I know it can be.
In what can only be the divine plan of making me a better provider, breast-feeding has not been textbook for us either. I am grateful that latch, nipple trauma, and mastitis have not been part of my experience, but we have struggled with my son not being an effective breast feeder. The implications of this are two fold…he does not get all the nutrition he needs from a typical breast feeding session and my supply has been stifled because he was not emptying my breasts fully before he became fatigued. At his first follow up visit once he left the hospital, he had not regained the weight he lost in the first few days postpartum despite getting some supplemental formula after his feeds. Since then he has been breast feeding, supplementing, and I have been pumping to stimulate my supply. I don’t think I could have fully understood how tiring feeding and pumping for an hour to an hour and a half out of every three hour period was without going through the gauntlet. I have comforted many new moms that have been in similar frustrating circumstance, but the emotional toll is not insignificant particularly when coupled with changing hormones and lack of sleep. I appreciate the advice and assistance the lactation specialists at my pediatrician’s office were able to give us. They are an invaluable asset to a parent wanting to breast feed but having difficulty. It has been reassuring and things have definitely been getting better. I know that had I been going back to work sooner, it would have been a greater source of anxiety and I might not have felt like I could stick with the schedule. I’m unexpectedly happy to have this experience because I know I will continue to have patients who need support and encouragement if they struggle like my son and I did to get breast feeding down.
Becoming a parent has been a tremendously challenging and incredibly joyful experience. Despite the struggles that come to all parents of newborns and infants, I feel like I have been given the greatest gift. Not the least of these gifts is the ability to relate to my patients who are pregnant or who have children in a fuller and very meaningful way. I look forward to the opportunity to care for my new and existing obstetrical patients and apply the multitude of lessons I have received from being a patient and a new parent.