Tag Archives: My Cousin Susan

In which I try not to overthink blogging and share some funny stories

I had a few stories I wanted to share, and I resisted writing on here until they reached some sort of critical mass. I felt a little weird suddenly posting over and over again. I think getting into ob/gyn residency has jazzed me up in a way that cannot be ignored. I’m trying to look at it as a rejuvenation of my spirit for blogging and medicine, and not overthink what it meant about my spirit and confidence over the last two years. Anyhooooo….

Plus, I have worked ob/gyn clinic for two straight blocks recently, simply a complete coincidence, because neither of these two blocks are going to count at my new site. Ob/gyn just lends itself to a bunch of hilarious stories. I have a serious delve-into-the-evidence-because-something-is-stuck-in-my-craw kind of post a brewin’, but I won’t mix that in with the fun stuff from today.

Needless to say, no names are used, no specific descriptors are used (except for tattoos, I guess), not all stories are recent, and details are bent to obscure the innocent. None of these are my real patients, they are all stories about my cousin Susan’s adventures in health care, rewritten as my own patients to make it easier. And, needless to say, this is ob/gyn related stuff, so if discussion of private parts and fluids gets you discombobulated, you may want to go look at some lolcatz or something.

Story # 1

A patient and her husband were explaining a recent trip to the patient’s gynecologist (I was seeing her as a family practice resident). She was having an irritation down below. Her husband’s helpful explanation of the diagnosis: “My sperm, when it comes out, it’s so hot it BURNS her.” Emphasis emphatically his. I bit down a giggle and asked, “Sir, if this isn’t too personal, may I ask if your sperm has ever touched your own skin? Say, on your hand? It didn’t burn you, right? I don’t think that’s the issue here.”

Story # 2

This one is an in-the-biz special.

Electronic fetal monitor

Electronic fetal monitor

Heard on the labor floor: “I know! The pink one is for the girls, and the blue one is for the boys, right?” I kind of thought the pastel colored binary gender straps were a bit silly, but I didn’t think they’d be confusing. Maybe I should have.

(For those not in the birth biz, that is an external fetal monitor. Both of those get used on everybody, regardless of the gender of the in-utero passenger.)

Story # 3

Maybe I should have realized it could be confusing or important to patients. At a two week postpartum follow up, a mother’s biggest complaint: “Everyone keeps getting him confused with a girl.” I eyed the 13 day old wrinkled baby in a blue hat, blue clothes, blue car seat covered with a blue blanket suspiciously as he slept in a very non-gender specific way. “I don’t think he’s very worried about that right now.” What I wanted to say was, “Now I think it’s a bit early to start imposing roles on it, don’t you?” in my best Graham Chapman voice, but I restrained myself.

Story # 4

I see a lot of interesting tattoos in my line of work. I have two tattoos, and I am not judging people who have them. In fact, having a tattoo in certain age groups is actually more common that not having one. Some of the people I hung out with when I was younger had some highly questionable tattoos. A friend of mine dated someone who had a tattoo on his leg of a manatee with an erection. That was only one of the list of questions I had about her choice of this guy, but hey, poor dating choices happen to the best of us.

I was triaging a young woman in labor, and when I raised her gown to attach the eternal fetal monitors (as seen above) to her burgeoning belly, I saw two dolphins dancing on either side of her navel. I said “Oh, look! Dolphins!” Then I glanced at the cursive writing underneath her navel. It read “Wet Pussy”. And they say the kids aren’t learning cursive these days. Wait, maybe that’s a good thing for her offspring.

Not judging. Not judging.

I also saw “Respect My Mind” tattooed on a patient’s hand, which I kind of liked. It was next to a 305, which is our area code here in Miami-Dade, for the reader who is not a local, or isn’t familiar with Pitbull. (Ironically, also my birthday. OG, here. Ironic because the longest I’ve ever listened to the song was just now to copy the link.) It’s a common tattoo, on that always makes me sarcastically wonder if they’re afraid they’ll forget the area code. Maybe they just want to remember my birthday. If she did forget the area code, I’d have trouble respecting her mind. Or, I would at least try to figure out why she wasn’t oriented.

I saw “Most Hated”, which I kind of didn’t like. Well, it made me wonder about the history and self esteem of the patient. It also reminded me of the brother of a tattoo artist in a city I lived in years ago, a brother who was notorious for being a conceited, inebriated, loud, omnipresent nuisance. He had the nickname of “the Hated Joe Schmo”. Even though he was covered with tattoos, courtesy of his super cool brother, I don’t think he had “Most Hated”. It would have been appropriate.

I saw “Live Fast Die Pretty” on someone’s arm. That made me giggle.

Story #5

Not really a funny story, but something I wanted to share. I was wrapping up my ob/gyn rotation, and one of the nursing students who was also at the site told me that she would want to go to me as an obstetrician if she was ever pregnant. I am always grateful and pretty much floored when someone from inside the system tells me that. We were working with several wonderful obstetricians at the time. I don’t think it was a commentary against them. I don’t mean to get all sappy, but I think I love it so much, it really shows when I am talking to a patient. I also think it is uncommon for someone to be a mother, a patient, and frankly an adult with real world problems before becoming a physician. I am not knocking my younger peers. They say they don’t know how I do it as a mom. I don’t know how they do it as a young adult coming of age. I think my empathy comes from a different place than some physicians. Even physicians who are parents often became parents second, and were navigating the medical side of pregnancy and birth with a much greater ease and insider perspective when they went through it.

Should I throw in another story of hot jizz to wrap this up? I am fresh out, at this time. Let’s see if this newly renewed excitement carries through to me finishing the post about epidurals and informed consent, too.

Until then, live fast and die pretty.

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Autism and obesity, a confounder

The journal Pediatrics released a study recently claiming an association between autism and maternal obesity during pregnancy. As soon as I heard this study being splashed all over the media, I winced. As much as the journalists point out “correlation, not causation”, they also throw out vague warnings about obesity. On NPR this morning, the story was covered as being another casualty of the “rather striking epidemic of obesity”, and, in this article in the Washington Post, despite the lack of causation, the author warns “[s]ince more than one-third of U.S. women of child-bearing age are obese, the results are potentially worrisome and add yet another incentive for maintaining a normal weight, said researcher Paula Krakowiak, a study co-author and scientist at the University of California, Davis.”

Because, it’s all just our fault because of our behavior, right moms?

I don’t think so.

I was already pondering autism and causation recently. It has been an interest of mine for quite some time. Before I knew that I was going to go to medical school, when I got my first job at the first health food store, I was intrigued by the parents of children on the autism spectrum who would come into the store, desperately seeking anything to help. Many were trying gluten-free, casein-free diets, long before the recent gluten-free craze. Many were buying supplements. I was surprised at how many children on the autism spectrum there were. This was in the mid 90’s, and my first glimpse at the burgeoning numbers of children living with this diagnosis. I decided I wanted to work in the field, and help unravel this mystery for these parents.

Since then, my focus has obviously shifted. However, I have two cousin Susans with two sons each on the autism spectrum or with related developmental delays, which were also included along with autism in the study. One is closely related to my younger son’s father, and one is closely related to me. They are not related to each other at all. I know it is just anecdote, but I was already trying to look for a pattern – something they had in common. Why were their children affected, and mine not? I was overweight, possibly obese according to BMI, during both pregnancies. One of my cousins was, and one wasn’t.

Well, this study made things click in my head. There is a confounder strongly associated with obesity that was not looked at in the study. It is also associated with high circulating androgen levels, which have a known association with autism spectrum disorders. And, interestingly enough, both of my cousin Susans have this condition, and I don’t. It’s polycystic ovarian syndrome (PCOS). It is a lot less common than obesity, and would probably make more sense as a causation, both prevalence-wise, and physiology wise. I did a quick literature search, and couldn’t find anything on it.

I am not sure how difficult it would be to do a case-control study on this. It would be easy if I was at Kaiser. It was probably easier to look at weight and height at delivery than delve into gynecologic histories to find if there was any diagnosis of PCOS in the subjects of the study.

Well, trying to do some research on this is a definite possibility. Hopefully in the near future.

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Reply turned post, same old song about breastfeeding shame

On my Facebook page, I linked to this article asking the president of Facebook to change its policies on breastfeeding. In case you don’t know, Facebook considers photographs of breastfeeding to be obscene, and deletes them as pornography. Yet, they put underwear advertisements from American Apparel on my homepage.

The letter uses statistics from this recently publicized article from Pediatrics that enumerates the risks of our low breastfeeding rates in the United States in numbers of money spent and lives lost. This is a common way to discuss large scale public health issues. But, as usual, someone wants to hold breastfeeding to a different standard than other health issues.

A former friend of mine, who I thought I had blocked on Facebook, but I guess I hadn’t, replied with this comment:

i’m all for facebook changing its policies, but i don’t think that we need to demonize women who choose not to (or cannot) breastfeed.

*facepalm*

OK, I know the post took the mortality numbers and ran with them. I have to admit, they are startling numbers, and there is something about putting a mortality number on something to really drive home how policies can really affect public health. It’s all theory on the internet when we’re bloviating about whether breastfeeding in public is obscene, or whether being “pro-life” really can be reconciled with being against legal and safe abortion, but numbers of actual deaths per year are a powerful, powerful argument. There is nothing inherently different about breastfeeding that makes it somehow sacrosant, however, and therefore we cannot use our most powerful tools to promote it. There was not ONE word in this article that I thought demonized women who choose not to breastfeed. It acknowledged how breastfeeding successfully, even getting out of the hospital breastfeeding, needs a lot of support and education. It needs all the help it can get, and treating photos of breastfeeding like pornography on the most popular, incredibly pervasive social media outlet in the world may be a factor in the public perception of breastfeeding. Period. It wasn’t this post that linked breastfeeding to preventing almost 1000 deaths a year. It was the researchers who were published in Pediatrics, and then the article was publicized by outlets like CNN.

Here was my reply:

I don’t think that this post does that. It is a letter to the president of Facebook about its policy on breastfeeding photos being obscene, and draws attention to the fact that breastfeeding is important by using real epidemiological statistics on the public health effects of the low breastfeeding rates in the country.

I know that discussing breastfeeding’s very real health benefits may make women who don’t or can’t breastfeed feel bad, and that’s a shame. It’s hardly the most important point, however, as the statistics in the article clearly explain, and isn’t a reason to suppress real public health statistics on its benefits. It’s hard to discuss breastfeeding without talking about the true risks of low breastfeeding rates, and how these low rates may be related to how it is treated by various media sources, including social media.

One journal article on why women choose not to even initiate breastfeeding showed that the most prevalent reason was fear of what others, especially their partners, will think of them. The public shaming of breastfeeding is an important topic, even when discussing why some women choose not to breastfeed.

I didn’t see one line in this piece that said women who don’t or can’t breastfeed are wrong in any way. It’s an important health decision with important health consequences, and when I talk about it as a public health issue, I am not commenting on individual women’s health choices, which, when regarding many aspects of pregnancy, birth and parenting, are complicated and multi factorial. I don’t think this piece was, either.

In fact, in the comment section, I think the author answers this point rather well. Mothers, especially first time mothers, cannot make an informed health decision about breastfeeding when the behavior is shamed socially by prominent, pervasive outlets like Facebook. When mothers who don’t breastfeed have their bottle feeding pictures banned from Facebook for being pornographic, then we are talking about a similar issue. Otherwise, I don’t this article has anything to do with demonizing women who don’t breastfeed, but is rather about shaming women who do.

********************

I want to add, since this is my blog and not Facebook, that this is a major pet peeve of mine, and this person knows it. I hate that almost any internet discussion of breastfeeding is derailed by “Don’t hurt mothers’ FEELINGS!!!” and accuses me of being unsupportive.

I have a very good friend who had an awful struggle with breastfeeding who eventually had to give up and use formula, another who had to stop due to allergies that led to constant GI bleeding and anemia in her child, and a few cousin Susans who didn’t breastfeed after the first feeding or two in the hospital. I was a doula to a mother with MS that couldn’t breastfeed because she wanted to go back on her medications. I find it really insulting to be told that I am not supportive of mothers, since it is something I take very seriously. I have wiped tears off of a mother’s breast while helping her tape tubing of an supplemental lactation system to her breast, and I doubt any of these people who have accused me of that have ever been that supportive of mothers trying to breastfeed without judging them. And, I think crying “FOUL!” any time the subject comes up allows people to have an excuse to not consider the true risks to not breastfeeding, and casts it as a lifestyle decision rather than a health decision. And, I think this recasting of breastfeeding is a major reason why women choose not to do it.

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Second stage, take center stage

When Amy announced the Fifth Healthy Birth Blog Carnival Get Up, Stand Up, which is based on the Lamaze Healthy Birth Practice “Avoid giving birth on your back and follow your body’s urges to push,” I knew exactly what I was going to write about. I have been planning a post on the second stage of labor, which is the pushing stage, for a while.

To me, this is the neglected part of birth, which is surprising, because it is, well, the actual birth part of the birth. Many women, even if they are the birth advocate types, focus more on the pregnancy, then some thought to the first stage of labor – the dilation and effacement process. OK, let’s not talk about what I think most women do. Let’s talk about my first birth.

I chose my provider and my place of delivery. I chose a midwife who delivered at the hospital near my house. I thought choosing a midwife meant I would have a “natural” birth, and having the baby in the hospital meant I would have a “safe” birth, and didn’t give it much more thought than that. Not that I didn’t give pregnancy, birth and parenting much thought. I was a pre-medical student and a voracious reader who worked in the health food industry. Trust me, there was thought. I read Mothering Magazine, Parenting Magazine, Healthy Pregnancy. I read What to Expect When You’re Expecting. This was 1999. The internet was decade younger, and so were my friends. I didn’t consider myself to be a particularly young mother at 25, but I was the first out of my group of friends to have a baby.

Since a recent newspaper article I had read (in the real paper, they didn’t have archives on the internet at the time, much less cesarean rates by hospital by state, thanks to the wonderful birth advocacy bloggers we have today!) said that my hospital of choice had a 50% primary cesarean rate the year before, I thought using a midwife and not electing to have an epidural would lessen my chances of a surgical delivery, since I was low risk in every other conceivable way. I was also terrified of the epidural, since my brother had just had a spinal tap, and said it was the worst experience of his life. Unlike many pregnant moms, I was told horror stories about spinal punctures, not labor pain. Ha! Imagine if it was the other way around. Anyhoo, back on track…second stage, right.

I ended up flat on my back (with pitocin and external fetal monitoring) pushing against a cervical lip for three hours, while being barked at and blamed by my CNM. I don’t look back on my first stage of labor as painful, even with pitocin, no epidural, and being placed on continuous monitoring. I remember that midwife trying to rub out my inflamed cervical lip with horror, however. I remember begging her to stop, and feeling defeated while I was forced to push, and push, and push, as my mother, husband, and even the labor nurse looked on with dread. I was unprepared for pushing the first time around, and terrified of it the second.

I was not allowed to labor down. I never felt the urge to push. I wasn’t encouraged to stand up. The bed wasn’t raised, I wasn’t told to get in the Captain Morgan position (*wink wink nudge nudge* Amy). I wasn’t allowed to be in any position but flat on my back. I was told by my midwife that my fetus showed signs of distress on the strip and this was the only safe say to be. Know that I know a heck of a lot more about pregnancy, birth, and cardiovascular physiology, I find this laughable and despicable on her part.

Finally, I peed (hey, it’s a medical and birthy blog – get used to the TMI!) all over the midwife (ha! karma!) and then the baby came out soon after. Maybe if I was allowed to walk around freely (like, to the bathroom to empty my bladder after my IV infusion…) I would have been able to deliver my son a little more easily.

It’s not just the attitude of the midwife that I found troubling. Looking back armed with a lot more knowledge, it was her bluster with an absolute LACK of evidence to back her up that I find truly appalling. I was at another birth recently, of my cousin Susan, and it was an affront to evidence based medicine from beginning til end. At one point in the fiasco of a second stage, the NICU doctor rushed in. The obstetrician was so horrified at the possibility of a shoulder dystocia that she called in every available practitioner on the labor floor. (The fetus was not predicted to be macrosomic, the mother was not a gestational diabetic, and there were no other predictors of dystocia, but the obstetrician mentioned it so many times during the pushing stage that the mother to be actually told her to “shut up about it already, I get it” and then the doctor said she had to mention it repeatedly for legal reasons….huh?) I was at the mother to be’s head, supporting her, talking to her softly, and supporting the back of her neck and head when she was pushing.

The NICU doctor placed herself right next to me, and when the pushing started up again, the NICU physician turned to me and started chastising me loudly, saying I was “doing it wrong”. She ordered me to painfully shove the mother’s head into her chest so that her chin was hurting her. She kept saying “harder!” to me, not the mom, and finally said “No, like THIS” and shoved her head so her chin hit her sternum.

I was furious. What was worse, the husband started watching me with every push, and would tell me if he thought I wasn’t pushing her head into her chest hard enough.

If my cousin wasn’t about to push out her son, and I wouldn’t have been completely out of line with a physician at an institution where I would most likely be doing clinical rotations, I would have LOVED to step out of the room with the NICU doctor and ask where the literature was on chin and neck positioning during the pushing stage, and what measurements had been done of the force of shoving the mother’s head into her sternum to determine the proper crushing force. Like the existing evidence on upright positioning, which the mother to be had to insist on after some time on her back. The NICU doctor didn’t tell anyone to stop directing her to do Valsalva (holding your breath and pushing against a closed throat instead of unrestricted breathing) pushing, and didn’t ask if anyone allowed her to labor down and wait for an urge to push before ordering her to push. That didn’t seem to bother the NICU doctor.

But I didn’t. I stayed with my friend, who asked to be repositioned even more favorably in an even more upright position. The obstetrician acquiesced (yay!) and the baby was born soon after.

This is the first post in a two part series. Being at a primip delivery can be hard,

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Amnesty International takes on maternal mortality in the U.S.

Amnesty International just released a report on maternal mortality (and near misses) in the United States, treating it like a human rights issue. It’s often asserted, including in this report, that infant and maternity mortality are key indicators in the health and social justice of a country.

I need to finish reading the 154 page report (ulp!) so I can get my thoughts together to be a coordinator for local lobbying. I like their proposal to ask Representatives and Senators to call on President Obama and Health and Human Services Secretary Kathleen Sebelius to create an Office of Maternal Health at DHHS, and to improve collection of data on perinatal mortality and morbidity on a state by state level.

Then, I’ll report back, and hopefully get to my cousin Susan’s birth story and the NIH VBAC conference.

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Exciting things a-brewin’

I am going to be in a production of Eve Ensler’s The Vagina Monologues tomorrow night. This is my third year being involved with our medical school V Day production. I was the narrator for the past two years. This year I am performing the poem at the end, a poem about birth called “I Was There in the Room”. It ends with:

The heart is capable of sacrifice
So is the vagina
The heart can forgive and repair
It can change its shape to let us in
It can expand to let us out
So can the vagina
It can ache for us and stretch for us, die for us
And bleed and bleed us into this difficult, wondrous world
I was there in the room
I remember

I also was selected to be a delegation coordinator for Amnesty International’s lobbying effort to bring attention to maternal mortality, including lack of prenatal care and racial disparities.

So, I know I am supposed to write up my cousin Susan’s birth story (which will probably be my first non guest post at Mothers in Medicine), and talk about the whole NIH VBAC conference thing, and recruit more doctors for my survey, but I’m a little busy right now. I’ll get to them soon, I swear.

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Birthin and babiez!

I am on my way to one cousin Susan’s labor tonight. (Wheeeeeeeee!). She’s a first timer and things are looking wonderful so far.

Another cousin Susan of mine has had totally horrid luck when it comes to secondary infertility. Well, the urban legend happened. She experienced a bunch of barriers and complications, it seemed impossible, they just gave up, and it happened naturally. They heard a heartbeat in the right place today. Big deal!

So, good things are brewing. I have a big smile on my face. I am headed to a birth. Not sure if I will be checking in any time soon, but I hope this is indeed as much of an upswing as it seems.

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Advice for a mom-to-be

When I was pregnant with my first son, I was the first of my friends to become pregnant. The internet wasn’t what it is today, and since I was pregnant in 1999, the only information I could get seemed to be on millenium babies. I read Mothering magazine along with the more mainstream pregnancy magazines, read “What to Expect When You’re Expecting”, hired a CNM, signed up for a childbirth class (that was woefully inadequate), and figured I had my bases covered. I was sooooo unprepared.

So, I have a friend who my cousin Susan (I have to start doing this) is newly pregnant. I referred her to the Childbirth Connection, the Lamaze Health birth practices, and the Coalition for Improving Maternity Services. I wanted her to have sites with comprehensive, general information about all the major aspects of physiological pregnancy and birth.

I also directed her towards my blog roll, but I warned her that blogs tend to be more focused, current, and geared toward activists, not moms to be.

Any other suggestions? What do you recommend to a newly pregnant first time mom?

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In which I come out, and my cousin Susan

I have been blogging for a while. I used to have no audience, other than a few friends. Blogs used to have about the significance of a myspace page, and now have become much more wonderful and important. But, I have had to reevaluate what and who I write about, in a few ways. I don’t write about my family that much, other than the odd funny anecdote. I have pulled one or two posts in which I spoke critically about physicians or professors. It’s OK to complain to my friends about that. It’s not OK to have that up on a blog that is searchable, even if I haven’t ever mentioned my name or institution on this blog.

So, two things are changing on the blog. I am going to come out, first of all.

*Ahem* My name is Hilary Gerber, and I go to Nova Southeastern University in lovely Ft. Lauderdale, Florida.

My name and this blog can be linked in various ways on the interwebs, and I was a little annoyed at only the persistent boundary line crossers making that link. I may as well own the connection.

I was also nervous, for a while, that my loving but very socially conservative family would be googling me for some reason.

Well, my brother is the president of a local chapter of the Young Republicans, and blogs under his own name about tea bagging, so I decided I have just as much right to put what I think out there. It’s not like I’m springing it on them that I’m a liberal. And, with all the posts I have been putting up on Facebook recently about the Tebow ad, they must know I am pro-choice. So, hi mom! (I don’t think she reads my blog. But, one day she might stumble on it.)

Secondly, I am still struggling with the best way to write ethically and responsibly. I have decided that whenever I talk about someone’s health experience, especially reproductive experience, I am going to call this person “my cousin Susan”. I don’t have a cousin Susan. She is going to be a stand in for all of the wonderful people whose stories have taught me something. I am going to be trying to go back through older posts and edit in My Cousin Susan. I try to shift around some identifying features, or be vague, already. But, this way I can just assign it to this mythical person, and hopefully make it seem less privacy invading for the original person.

I know I don’t own other people’s lives and stories. I am not a physician yet and don’t have that HIPAA thing going on in most situations I have been in yet, but I am a doula, I have been a midwifery student, and even as a friend, I feel somewhat guilty when I talk about some aspect of someone else’s health or life experience. But, I learn so much from these realities, more than I could ever learn from a textbook or a journal article. They are a big part of why I am so dedicated to women’s health, especially surrounding birth.

So, in order to balance the ambivalence I feel about sharing these stories, which I do, I am going to start calling the main character “my cousin Susan”. I’ll tag this post and all the others with “My Cousin Susan”, and link to an explanation in the side bar.

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Overheard in the hallway

Let me paint a scene for you all.

[In a medical school hallway, two academics greet my visibly pregnant cousin Susan, who has a history of anorexia prior to pregnancy that should have been clearly apparent to these people who work on the same floor as her]

Not Clueless Academic: (to my cousin Susan) How’s the mama? Lookin’ more like a mama these days!

Clueless Academic: (to Not Clueless Academic, in front of my cousin Susan) I can’t wait until that skinny minnie gets HUGE!!

[Close scene]

*headdesk*

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