“Sorry Ms. Jackson” – A Pregnant Physician’s Perspective Part V, By Ilene Goldstein, MD

Pregnancy PlanningMy entire life has been a series of planned behaviors broken down into four year increments. Here’s how I see it:  during four years of high school, I planned how to get into a good college. And the next four years of college focused on attaining access to medical school. Next, four year of medical school planning for the appropriate residency. And residency was four years of training and planning for the career to follow. By definition, I am a planner.

Most people plan major life events: a wedding is planned over the course of a year for some folks; couples are sometimes able to plan when they conceive and experience pregnancies. Even smaller events like family vacations, birthday parties are generally planned ahead of time.

Let’s consider childbirth, potentially one of the biggest life-altering events of all; and for most patients including myself, we cannot plan! We have no say on the date, the time, the mode, the birth attendant, even the outcome! How frightening to feel as though you cannot plan such a pivotal moment in your life!

Having said that, I completely understand the temptation to plan the birth experience. For many patients, it can be a means to regain control over the unknown and a potentially scary set of circumstances. However, in what could be my last pregnancy blog, I think it’s only fair that I divulge what may no longer be a secret, and is not likely a popular opinion, but an important consideration of the birth experience nonetheless:

You don’t have control, you cannot plan it, and the more you try, the more you are likely to be disappointed!

I’m sorry, I hate to be the bearer of what may be perceived as bad news. Sigh, but there’s more: your obstetric provider has little control either! The health and wellbeing of the mother and baby dictates when, where, who, why and how. Outkast nailed it when he melodically taught us “you can plan a pretty picnic, but you can’t predict the weather.”

So, to all the planners out there, we are all for dim lights and mood music. But we cannot delay cord clamping or do immediate skin to skin if your infant needs resuscitation by the pediatric team. I want you to breastfeed too, but I was also taught in the same class that vaccinations are best for the infant, so would recommend your newest addition receive hepatitis B and vitamin K as advised.  I think your partner should cut the cord.  But when he’s shaking with excitement and his vision is blurred with happy tears (and the lights are already dim), I don’t feel entirely comfortable with the machete he brought to commemorate the occasion.  If you are more comfortable in downward facing dog than a traditional birth position, first, I’m impressed and second, I’m all for it, as long as I can guarantee the baby is enjoying and tolerating the flow sequence too.  Encapsulate the placenta, roast the cord, serve it with kale chips at your infants first birthday! Go crazy! Whatever floats your boat!

In all seriousness, rather than fixate on the details of the birth process and the experience more than the outcome, lets move away from “planning” the birth and head towards “preparation” for birth and communicating birth “preferences”.  Childbirth classes, hospital tours, prenatal yoga, selecting a pediatrician are all excellent ways to prepare for the birth of a child.  And we will do our very best to accommodate your birth preferences, but most importantly, we will work our hardest to ensure you and your baby are safe and healthy.

I have attended thousands of deliveries, thankfully the vast majority of which have involved healthy patients and babies. I have then visited with those new families in the hospital and in the office weeks after. The word on the street is that all parts leading up to the birth pale in comparison to the lifetime of experiences ahead.

Everyone assumes since I work in the biz that perhaps I have more control than the average bear, but I don’t! I am (painfully) not planning. Everyday I wake up not knowing if it is my last day of work for a while, my last leisurely hot chocolate at the local coffee shop, my last pregnancy blog! So I try to enjoy these potential “lasts”, knowing that I have many exciting (and scary) “firsts” on the horizon, most of which, I cannot plan!

Maybe more to come, who knows :)

ilene

Ilene Goldstein, M.D. is an ob/gyn physician with Virginia Beach Obstetrics and Gynecology, PC.  She practices in Virginia Beach and Norfolk, VA.  She and her husband, Len Futerman, DDS, are expecting their first daughter in November, 2015.