Dear angry pregnant woman who called labor and delivery

I didn’t know what to expect when the phone rang at the charting station today. We have a new unit secretary on labor and delivery, and while she is quite nice, she is a bit green and didn’t bother giving me a head’s up before transferring me an unannounced call from the front desk. It was an incredibly busy day for our little L&D. I had just called my program director and missed her, and since it said “private number”, I assumed it was her. I picked it up, and said “Hello?”


“Yes, hello? May I ask who you’re looking for?” It’s the charting area on labor and delivery and only two residents were in it. We’re not normally fielding telephone questions to the public. I assumed the “private number” transferred to us was a personal call for one of us.

“I asked to speak to a midwife or a nurse.”

“I am neither, I am an obstetrics resident. Is there something I can help you with?”

“I have a question. I’m pregnant, and I have a midwife I’m seeing who helped me with my first pregnancy. Well, I’m pregnant again, and she drew my progesterone, and she said it was an eight or something, and she said that was normal but I just don’t think that’s normal. Is that normal?”

“Ma’am, I’m sorry, I really can’t answer that over the phone without examining you, knowing your history and seeing all of your lab results. I’d be happy to see you at our clinic.”

“I don’t understand why you can’t just answer a simple question over the phone.”

“Ma’am, as I said, it wouldn’t be professional for me to make a judgment call without seeing the actual lab results or seeing you in person.”

“Are you telling me you expect me to PAY to see you for an actual VISIT for you to just answer this simple question for me?”

“What do you do for a living, ma’am?”

“I don’t see what that has to do with this! I just want a second opinion to know if this is normal! You just want me to PAY to see you!”

“I would be happy to give you a second opinion with all of the information if I could examine you in my office. I wouldn’t call your work and start yelling at your about how you do your job while asking you to work for free-” that was about when she hung up on me.

Sigh. Ma’am, I work for salary. I actually work for an abysmally low salary. This day that you called and yelled at me for not telling you whether your “I think it was 8” lab results were normal, I came in at 6:30 am and left at 11:00 pm. I missed dinner with my kids. Hell, I missed dinner. I delivered two babies. I rounded on nine postpartum patients and discharged six of them home with new babies. I triaged countless women with complications there for antenatal testing – chronic hypertension, intrauterine growth restriction, gestational diabetes, postdate pregnancies. I helped new moms with breastfeeding, I called a psychiatrist for a mom who showed up in labor with no family, no partner, and scars from self harm all up and down her arms. I had an immigrant tell me how she only went to two prenatal visits because her emergency medicaid only covered her for 45 days. She was a week past her due date and hadn’t been to our clinic since her second trimester. She had no job, no money, and waited to come in.

I personally talked to and examined every single triage patient. I looked over every single one of their charts. I opened up their ultrasounds and labs myself and read the results, I didn’t rely on what was documented in their chart or what was told to me. I checked every LMP, every due date, every AFI.

I felt guilty when I left and that lonely first time mom was laboring alone in her room. Her eyes looked so hopeful when she told me her boyfriend was going to come when he got off work at six. Later, she told me that he wasn’t sure he was going to show up if we couldn’t guarantee she would deliver that night. She was dilated to 7 cm. “You will deliver overnight,” I said to her. When I left at 11 pm, I am pretty sure he wasn’t there. But I have to be in at dawn tomorrow to start it all over again.

For salary, ma’am.

Good luck with your pregnancy. If it is 8, and you’re in your first trimester, especially if you’re bleeding, it’s probably not normal. I hope the practitioner you have chosen to trust with your body and your lab results cares as much as I do, and will discuss it with you.


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Reply turned post, mothers are strong style

Hello hello. I am more than halfway through the first year of my obstetrics and gynecology residency. It has been wonderful and challenging and wonderful so far. I am the chief resident. Our residents did very well on our CREOG exams, so I am quite proud of us. I have been busy and obviously not blogging.

A friend of mine, one of the proprietors of a great local resource center, the Gathering Place, posted a Facebook status yesterday asking for everyone’s favorite quotes regarding birth. I posted two. One was by Kurt Vonnegut:

Hello, babies. Welcome to Earth. It’s hot in the summer and cold in the winter. It’s round and wet and crowded. At the outside, babies, you’ve got about a hundred years here. There’s only one rule that I know of, babies — ‘God damn it, you’ve got to be kind.’

The second was this quote. I don’t know the author, Laura Stavoe Harm, and I don’t know the context, which is frightfully ignorant of me, but I stumbled across it and have always absolutely loved it:

There is a secret in our culture, and it’s not that birth is painful. It’s that women are strong.

My friend, who is a Ph.D. candidate in Family Therapy and specializes in birth related issues including perinatal bereavement and birth related post traumatic stress disorder, shared this blog post, in which a woman who writes about her birth trauma discusses how the quote is painful and triggering to her.

The reason this quote is so damaging for a woman, is that it is not true. The secret is not that women are strong. The truth is, in our culture, strength is simply not always enough to carry a woman through the birthing journey.

I was incredibly strong in my birth…but it was not enough to ward off the lack of good support & the poor care I received from the midwife in attendance. I knew birth was painful – no-one had to tell me that. But what no-one did tell me, was that birth hurts more when we are frightened and out-of-control and feel unsafe. And I certainly felt all of those!

The entire article is nuanced and well written. But, I have trouble seeing how these truths are mutually exclusive. She does come to the conclusion later that “Maybe it is all a matter of ‘where you are’ in your understanding of birth, as to how you interpret this, and other, quotes. If I had read Laura Stavoe Harm’s quote midway through my second pregnancy, my response would likely have been… “Yes!”. But by then I had a wealth of new information about birth, and was beginning to see just was required for a birthing woman to feel safe.”

Yes. Her personal prism is not every woman’s truth, even though her point of view is very important. But that doesn’t make this quote damaging. It’s definitely not as potentially blaming or dismissing as “trust birth” or “your body is not a lemon.”

Here was my Facebook reply:

I respect what she’s saying, and she is certainly an expert on her own experience and trauma. I really disagree with her about the interpretation of that quote, however. I am very sensitive to blaming people for their birth outcomes (and health outcomes in general).

The problem with discussing birth (and breastfeeding and many other topics surrounding motherhood) is the juxtaposition of the universal and the personal. Being an inspirational supporter of unmedicated birth (or vaginal birth or breastfeeding) in general can be a painful reminder to someone who has had an experience like that poster.

I think the conversation about birth in general is often missing a discussion of the agency or autonomy of the woman. I know friends in the birth interest community who laughingly point out headlines when a woman delivers a baby on the subway or on the side of the road in which they mention everyone who was at the birth in the article instead of the mom. Bus driver delivers baby! Onlookers cheered! Father beamed! It was a boy! News at eleven.

What this quote means to me, and I suspect most people who overwhelmingly love it and find it inspirational, is that women are strong. Women will have cesareans are strong. Women who get epidurals are strong. Women who try to breast-feed and don’t or can’t for whatever reason are strong. Women who suffer with infertility are strong. Women who choose abortion are strong. Teen mothers are strong.

The conversation surrounding birth so often focuses on how horrible labor is, and how many things can go wrong. Stephen King wrote an introduction to one of Ina May’s books in which he said he could never tell stories scarier then the stories women tell each other about birth.

I don’t think the secret to being strong is a secret that wasn’t told to this woman, so she failed. I think the secret that women are strong is a secret that isn’t spoken about women in general because our agency is taken away. I think there’s a place for her to discuss her birth trauma, and telling women simply that they are strong isn’t denying her that voice, which I respect. Discussion of birth in general is most likely painful to her, and for that I’m sorry. The secret is, she is strong.


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Jumping in with both…feet

I gave a lecture for the combined didactics of our graduate medical education program and the one at our affiliated hospital. It was a bit of a shock to be asked this early, and it was on a topic for which I didn’t have a prewritten lecture already tucked away. But, it was on breastfeeding, so it was fun to put together. There’s so much good information available out there from the AAFP, WHO, AAP and ACOG.

I was surprised how many of the male residents came up and told me they enjoyed the lecture! Maybe I’m being sexist? One of the male family practice / neuromuscular medicine residents came up and said he’s a midwife at heart and wanted to give me a hug!

Anyway, I’m pooped. Here’s the presentation. (Oh! And I GOT MY OWN DOPPLER!)

WordPress won’t let me embed Prezis anymore, so here’s the link: my breastfeeding presentation.

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I’m at the end of my second week at my new obstetrics residency.

It has been an amazing two weeks. I’ve been at the ambulatory women’s health clinic at the community health center. I’m going to be on L&D soon.

I am going to get my own Doppler! Eep!

Today, I got to do an initial prenatal on my cousin Susan. She had a smile when I opened the door, even though she had already been waiting for hours. As I went through the whole checklist of her health history, I got to hear about her challenging first birth.

She had her records. She had her operative report. She told me she wanted to try for a VBAC. By all criteria, she was a good candidate. I told her that I was happy to say we were just told that the physicians’ group affiliated with the women’s center would now be accepting VBAC candidates because of our residency! The attending physicians and residents would be providing coverage to fulfill the requirements of the hospital. (One of my attendings high fived me when I told her the news!!)

I mentioned that the hospital already had the lowest cesarean rate in the county. She smiled and said she knew. At the end of the appointment, she told me she had researched her options on the ICAN website. I laughed and said that I was a fan.


Plus, did I tell you I’m going to get my own Doppler?


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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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Blogger once thought extinct, spotted!

I had a fun experience recently. We have medical students rotate through our family medicine clinic. We’ve had some great students recently, and I got along great with one in particular. She was waiting to find out if and where she matched in ob/gyn at the time. She since found out she matched in New England, and I think she’s happy, but bracing for the cold! I’m so happy for her.

On the last day she was at our site, she and I were saying our goodbyes. I get to work with a lot of medical students, but she and I had gotten a bit closer than most. I wished her luck in the upcoming match, which was a bit bittersweet for me, considering my crappy match experience. She said, “Now that the rotation is over, I have a confession to make.” I was really curious – I couldn’t imagine what it could be. “I used to read your blog all the time, when I was planning on going to medical school.”

I laughed and blushed, and was really surprised. I have only been “spotted” twice before, and both of those times were years ago, when I was still blogging regularly, once at a Medical Students for Choice conference, and once at a Lamaze Conference. I was planning on writing about her spotting me on here a bit earlier, but I had a little excitement in my life in between. Hope you understand.

I really like to work with medical students. I hope we get to interact with medical students at the new residency. I am pretty sure we will. I hope to incorporate teaching into my practice even after I am done with my residency. It reinforces material, and I end up learning just as much if not more.

Oh, and Happy Doctor’s Day, everybody!

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backyardAlmost seven years ago, I was sitting in a dive bar* with some friends from college. We had moved to different cities after our various undergraduate experiences, and rarely got to see each other. I sat across from them and another mutual friend and coasted on bliss. I relished the comfort and joy of having beer in a bar playing punk music with people who shared so many touchstones with me – concerts, people, places, parties. People with whom I could talk in shorthand. I felt connected in a way I hadn’t in years, years that seemed brimming with pregnancy, parenthood, divorce, work, classes, exams, but not a lot of effortless connection.

But, underlying that social happiness was a buzz of elation because I had just found out that I got accepted into medical school. It was an unexpected, against the odds, fantastic dream fulfilling surprise. I applied late in the application cycle, and had to fight to even get my application considered. I was told to retake the MCAT due to the scores being just too stale to count, even though it was safely within range to be considered. I crammed for the exam in 6 weeks. I hadn’t had a physics class in 5 years. I somehow even improved my score, but was told the application window had just closed. I begged my plight to the young chipper voice at the other side of the phone line who told me just to wait until the next cycle, and I would surely be invited to interview. “Please,” I pleaded. “I’m 34.” I got the interview. I brought the application administrative staff home baked cookies. No joke. And I make awesome cookies.

So, I sat there in the bar with a stupid grin on my face, and I was hyper aware of everything. The delicious beer, the laughter, the music, the horrible overpriced art in the decor, and the strange elation in my chest of a scary dream coming true at that brief, delicious moment in time that the dream is true, but isn’t reality yet. Medical school was just a bunch of fantasy and hopes, not grueling hours of studying and gross anatomy. I was able to spend a night out with my friends on a Saturday still, without the endless string of Monday exams to come for the two years. I promised myself to hold on to that moment, and to never take for granted how wonderful it was to have a dream come true.

Today, I am sitting in my back yard. I recently moved. My house is finally mostly settled. I have a lovely little spot just outside my kitchen on my tiny patio under the awning, with my fragrant potted rosemary bush and subtle wind chimes. The breeze still has a touch of that gorgeous March coolness to it that lingers every year in Miami just a few weeks longer than my cranky cynical mind thinks it should. There are birds and butterflies and bustling neighbors in the background. I have things to do – dishes, laundry, shopping, even more unpacking, but I have time. I don’t have the kids this part of spring break. I am on a light outpatient rotation. I was able to sleep in. I took a deep swig of my coffee and closed my eyes, and felt the breeze. I felt elated. Yes, it’s wonderful to relish these last lovely mornings before Miami gets unbearably hot and muggy. But, I have an underlying elation in my chest.

I got accepted into a brand new obstetrics and gynecology residency. I found out during the shortest and most wonderful interview of my life this Friday afternoon. I am more than halfway through my second year of a family practice residency. I applied to a very geographically limited number of obstetrics programs when I was finishing medical school. I interviewed at several, but didn’t match at any. There’s only one program within 500 miles of where I live and share custody of my boys. The next year, I applied again, and got invited to more interviews. These interviews were at wonderful programs in places where I didn’t know a living soul, like Macon Georgia and West Virginia. In the meantime, I was struggling through 80 hour workweeks that included 6 night shifts in a row. I rarely saw my kids. I rarely saw my friends. I rarely saw daylight. I slowly cancelled all of my out of town interviews, one at a time, as they approached, because I couldn’t see surviving an intern year in an obstetrics and gynecology residency, which would be more grueling than the one I was in, and not have the family support I did here. I also wasn’t willing to move and leave my boys behind. Again, I interviewed at the only local obstetrics and gynecology program. Again, I didn’t match there.

I worked through my second year of family practice residency this year without thinking of reapplying to obstetrics. A new program opened up in Kissimmee, which is about 4 hours north of here, and my oldest son said he wouldn’t move with me if I applied and got in there. This is the first time he said he wouldn’t even go. The interview season came and went, merely a wistful blip on my radar. The osteopathic match drifted by, and the allopathic match started releasing results this week.

Except, I just found out a week ago that a new program got approved. I have heard rumors and rumbles of new at least six new obstetrics programs being opened for over seven years of medical school, fellowship and residency, and none of them had materialized. I never heard a whisper about this program. What’s even more bizarre, I had done a 4th year rotation with the director of obstetrics there, and she must not have known of the possibility yet, and I just finished a four week rotation in their family medicine department with one of their medical directors, who didn’t mention it. Oh, and one more thing. THIS SITE IS LESS THAN A MILE FROM MY HOUSE.

After a flurry of emails, research and phone calls on my part, I procured a phone interview with the new obstetrics residency director and graduate medical education director. It was a five minute interview with two of the nicest people I’ve ever known for five minutes. They had my CV. They had been told about me by the director of obstetrics at the site, by the clinical education director at my medical school, and others. They wanted me, I wanted them, and the match already happened, so they could recruit me directly.

I was ecstatic. My dream came true, again. In fact, my dream from that night 7 years ago included my eventually becoming an obstetrician. That was the promised land at the end of my reverie that night at the bar. It was becoming harder and hard to access that place of joy and thankfulness when I struggled as a family practice resident. Part of the dream had not materialized. I hated to say “Sob, woe is me! I’m going to be a family practice physician!” and realized how stupid and obliviously privileged and ungrateful that sounded.

But today, the dream is realized. It’s still sinking in. And I still have a day well rested and quiet to sit and relish in the fantasy of getting my dream job.

“My goal in life is to unite my avocation with my vocation,
As my two eyes make one in sight.” – Robert Frost

So, one more cup of coffee. One more pause before I get to the dishes in the sink. Because this is the feeling I will be tapping into when I’m exhausted on the labor floor, when I’m struggling with learning a new surgery, when my kids and I are fighting because I’m exhausted and they are resentful because I don’t seem to have quality or quantity time with them. The breeze, the calm, the sounds, and the elation.

*I love that when I googled the name of the bar, a box popped up with information about the hormone prolactin.


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