A Brand New World for Obstetrics

It’s amazing to me when I sit back and look at how the world has changed in the last 20 years and how much it has changed my own profession. I truly do think that the world wide web has probably influenced the current debates, division, and seeds of change that have invaded obstetrics more than anything else.

I remember when I was diagnosed with a condition back in 1987 that I had never heard of before. My 10 minute doctor’s appointment didn’t provide the 17 year old high school senior with much information and absolutely no comfort. I spent the next month going to the library at my high school, pulling medical reference books – piles of text books covering the table in front of me – with strips of papers to mark specific pages in each book. For every paragraph I read, I had to look up 4 different terms, then re-read that paragraph to understand what it was saying. I went to the local community college and pulled up every microfiche and periodical I could find that was listed in their card catalogue that had key words associated with my condition, treatment recommendations, risks and benefits. I was put on a medication that I was actually told to take incorrectly and therefore caused more trouble than it helped. 6 years of taking this medication and I find out that by tweeking how I take the medication it can eliminate most of the side effects I had experienced and would be much more effective.

What if I’d gotten that diagnosis today? First place I would go is home…I would spend an hour looking up those key words. I’d have 5 firefox windows open, one for definition of terms, one for research done on it, one for message boards where I would meet 56 different people all who have been dealing with this for years and sharing their experience with taking the medication I was recommended, one with alternatives to that medication and natural things to add in to my lifestyle even if I take the medication, and one open to Facebook where I’d be telling all of my friends, family, and colleagues that I had this condition and getting emotional support and additional questions to quickly look up in my other 4 windows.

And in 60 minutes I would have learned more than I learned in 6 years after my diagnosis – and I think I was rather proactive in my care!!

I am astonished when my mother goes to the doctor for an issue, comes home with a diagnosis and treatment plan….and never questions it!! I have to remind myself that the world wide web has only been around for less than 15 years and for her entire life that’s just the way it is! You go to the doctor, s/he gives you their diagnosis, and you trust them because they went to school for a decade to learn this stuff and you HAVE to trust them! You simply didn’t have access to the information!!

That is no longer true…and I see the power of the internet every day in my business. I know that I have a LOT of knowledge when it comes to pregnancy and birth, but I also know that I can’t possibly know everything. Nobody can. I know that if someone comes in and says to me, “I had condition X last pregnancy…” even though I have a knowledge of it, I almost guarantee that she knows more than I do! I am the professional when it comes to birth, sure…but I bet SHE is the expert when it comes to condition X! It has become the way of the world that you now have access to all of the information you need to become the expert of condition X if you are personally affected by it.

I do see many physicians struggling with this concept, especially older physicians. They have seen their patients go from, “Pitocin? What’s that? Oh..okay….if you say so doc – I trust you!”…to, “Pitocin? No way! After all, the side effects are…and the preservative is…it can cause fetal distress and required continuous monitoring and I’ve read on 18 message board hundreds of women say that it makes labor more difficult and leads to a c-section!!”

I also see judgments hurled at people who choose NOT to take part in their care and choose NOT to utilize the information that is out there. Trust your doctor or your midwife? But…aren’t they/we the enemy who is only looking after ourselves and worried about lawsuits and our golf game?

Or those who are proactive in their care…
Choosing an epidural? “You must not have read the studies that show that it effects breastfeeding and can lead to a cesarean. “ “No, I read the study that showed that it did NOT increase cesarean rates!”

Homebirth? “ That’s too dangerous…after all, I read on Dr Amy’s blog that more babies die with homebirths!” “But did you read the responses that show how biased she is and all of the studies that show that it’s safer at home?”

We are so new in this world of change that I think that we as a society are like toddlers who have just learned to walk. Our world has opened up…but we haven’t even begun to get used to this new level of the world and truly can’t grasp the enormity of change it brings. As we assume a greater role in our own care, we must also assume a greater responsibility for the outcomes…and I, personally, think that’s a good thing.

I am going to admit something publically and open myself up to ridicule and mud slinging if someone chooses to go down that path…I chose to circumcise my sons. To make it worse, my first son was circumcised without anesthesia even though I REQUESTED it…because the pediatrician (who had been my husband’s pediatrician when he was a baby) said it was too dangerous to do anesthesia, babies don’t feel pain, he’s done thousands of them, I just needed to trust him…as he took my 1 day old baby boy out of my aching arms and I heard the shrill screams coming from across the hall and I broke down in hysterics. Our next child we debated about and debate….and finally chose to circumcise with anesthesia.

And I regret the decision. I don’t feel guilty about it…but I do regret it.

Why don’t I feel guilty? Because, like all mothers, I did the best I could in the moment that I found myself. Back then the only people to ask about things like circumcision was family, friends, and your doctor. Family looked at me like I was insane for even ASKING about it, doctor said “everyone does it” and it was healthier, and friends didn’t have kids yet. Remember, there’s no YouTube videos to see one done, there’s no message boards explaining the lack of medical reasons or the risks, there’s no resources for how to deal with a natural born penises….so I did the best I could. I regret my decision….but I still own that decision.

I think we are so lucky now that we HAVE the ability to learn…and learn quickly!! I look up how to harvest the carrots growing in my garden, I look up how to cook a roast in the crockpot, I look up the name of that guy in the movie that I can’t remember the name of…..and I sure as hell am going to look up medical decisions that have the ability to impact the rest of my (or my children’s) life!

I encourage my clients to research, learn, ask, and make an educated decision for themselves. As far as I am concerned, they are the expert when it comes to their care…my job is to help them stay healthy to the best of my ability and let them know if things are coming up so they can research and make decisions for themselves.

And I think that’s how it should be! Welcome to a brand new world…a world of knowledge, empowerment, and informed decisions! It’s a world where you have become a consumer, not a patient – where you are actively involved and no longer passive in your care.….where you have choices to make and resources available to you. It’s a pretty cool world and if you are reading this on my blog then I know you are a part of this world…glad you joined us.