MARCH 20, 2012 BY 380 COMMENTS
A friend of mine is a physician who wants to speak about transvaginal ultrasounds but whose position makes it precarious to speak publicly about it. So I’m letting this doctor borrow my site for an entry to speak anonymously on the matter. Obviously, I will vouch for the doctor being a doctor and being qualified to speak on the subject.
Update, 9:14pm: This post is being linked to far and wide, so we’re getting lots of new readers and commenters. It’s important that before you comment you read the site disclaimer and comment policy. I delete comments I find particularly stupid. Try not to write one of them.
Where Is The Physician Outrage?
I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.
I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.
I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.
In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.
After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.
Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.
It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.
It’s time for a little old-fashioned civil disobedience.
Here are a few steps we can take as physicians to protect our patients from legislation such as this.
1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.
2) Reinforce patient autonomy. It does not matter what a politician says. A woman is in charge of determining what does and what does not go into her body. If she WANTS a transvaginal ultrasound, fine. If it’s medically indicated, fine… have that discussion with her. We have informed consent for a reason. If she has to be forced to get a transvaginal ultrasound through coercion or overly impassioned argument or implied threats of withdrawal of care, that is NOT FINE.
Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.
3) If you are forced to document a non-indicated transvaginal ultrasound because of this legislation, document that the patient refused the procedure or that it was not medically indicated. (Because both of those are true.) Hell, document that you attempted but the patient kicked you in the nose, if you have to.
4) If you are forced to enter an image of the ultrasound itself into the patient chart, ultrasound the bedsheets and enter that picture with a comment of “poor acoustic window”. If you’re really gutsy, enter a comment of “poor acoustic window…plus, I’m not a rapist.” (I was going to propose repeatedly entering a single identical image in affected patient’s charts nationwide, as a recognizable visual protest…but I don’t have an ultrasound image that I own to the point that I could offer it for that purpose.)
5) Do anything else you can think of to protect your patients and the integrity of the medical profession. IN THAT ORDER. We already know how vulnerable patients can be; we invisibly protect them on a daily basis from all kinds of dangers inside and outside of the hospital. Their safety is our responsibility, and we practically kill ourselves to ensure it at all costs. But it’s also our responsibility to guard the practice of medicine from people who would hijack our tools of healing for their own political or monetary gain.
In recent years, we have been abject failures in this responsibility, and untold numbers of people have gleefully taken advantage of that. Silently allowing a politician to manipulate our medical decision-making for the purposes of an ideological goal erodes any tiny scrap of trust we might have left.
It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.
Because we are their last line of defense.
March 20, 2012 :: 9:35 pm
December 21, 2008 :: 6:33 pm
Doc has posted more amazing photos. He captured the story of what happened in the 30 minutes or so after Jamie was born. (There are no squicky photos, I promise. Cameras were not in the room while I was actually giving birth). It was a little tough for me to look at because the emotion I was feeling is still so sharp in my mind. I was scared to death that there was something wrong with my baby. I’m glad Doc took the pictures, though, because I want to remember.
And here are some awesome active-alert photos of Jamieson with his eyes wide open, just a day or two ago. His expressions amaze me!
December 18, 2008 :: 12:15 am
I’m feeling a heck of a lot better. A bit more each day. My appetite is back, to some degree. I’m eating 3 meals a day, and actually am hungry at breakfast.
I gained 37 pounds during the pregnancy, and have lost about 25 since Jamie was born. That really surprised me. I know the not-eating problem has contributed to it, but I think a lot of it’s just good genes. Speaking of genes, I can’t quite fit into my pre-pregnancy jeans (see what I did there with the homonyms?) – I can zip them up but I have a little pooch hanging over and it’s tight in the butt. The average woman takes 6 to 9 months to lose the baby weight. I think it might go a little faster for me, especially if I start back up with my yoga classes and take regular walks.
Actually, though, I don’t really care if or when the rest of it comes off. I love not caring about my weight!! I think I look damn good for someone who just gave birth a week and a half ago.
December 15, 2008 :: 10:09 pm
In the labor room, the nurse handed me a hospital gown and told me to change in the bathroom. I hopped up onto the bed and the doctor came in to apply the gel that would help get labor started. This was about 1:30. I stayed in bed for about 20 minutes to give it a chance to begin working, and then got up and began walking the halls with Doc. Labor and Delivery at Baylor is not a terribly big place, and so we walked the same circular path dozens of times. At some point Doc went out to the car to get our bags, and Mom walked with me for a while.
My pain level wasn’t too bad initially; it felt a lot like a constant mild cramping sensation. As we walked, the contractions got a bit stronger and I had to breathe deeply through them; they happened about once every time around the path, maybe every 3-4 minutes.
The doctor checked me around 3:00 and I had progressed to 3-1/2 centimeters dilated. He said that we could either wait for up to six more hours and hope I progressed more, at which point we could start me on Pitocin for additional induction goodness, or go ahead now and break my water.
Doc and I decided that it was preferable at this point to just get it over with, so the doctor broke my water, which is about as fun as it sounds. Almost immediately, the contractions increased sharply in intensity. I tried to continue walking around but it quickly became impossible. Once a contraction started, I had to stay in whatever position I was in because moving hurt way too much.
I remember at one point I was on the birthing ball, leaning on the bed, and throwing up into a little basin that Doc was holding for me. That is true love! Plenty of nurses around, and he wanted to do it instead. (And now I can no longer drink orange Vitamin Water.)
Kathryn came in just in time to see this. I didn’t know it was her until later; I just saw a pair of legs in scrubs and assumed it was another nurse since I was preoccupied at the time.
The contractions felt like I had a band across my lower back and around my abdomen, and it was being tightened until it was excruciatingly painful, especially in the back and pelvis. The pain in my uterus was hardly noticeable in comparison.
I worked through contractions for what felt like forever. Doc and I tried the count-up breathing technique, where I took breaths as deep as I could and counted up out loud with each breath to the peak of the contraction, then begin counting down as the intensity lessened. I tried leaning on the birthing ball, on my hands and knees on the floor (I’m sure my butt was hanging out for all the world to see), leaning on the foot of the bed, sitting on the bed with my legs hanging off, and at one point I got into the bathtub. I took off all my clothes in front of everyone before getting in the tub; all sense of modesty had disappeared.
Kathryn worked on my lower back as much as I could tolerate through the contractions, and she also pressed some points in my shoulders that did seem to help with the pain a bit. Doc held my hand the whole time or had his arms around me, helped me count, and tried to keep me focused on my breathing, exactly the way we had practiced in class. He did an amazing job with this, talking me off the “I can’t do this anymore!!” ledge countless times.
The pain during each contraction was so bad that I didn’t even have any reserves left to cry. I don’t think I cried at all, actually. But I know I kept saying “Fuck!” over and over. It was pretty much the only word I could muster. I’m not sure what that says about me.
The problem was, I was only getting about 30 seconds inbetween contractions, and the pain never lessened in the interim to a point that I felt any sense of energy regeneration. Doc and I had previously agreed that I would need to ask for an epidural three separate times before I really meant it; the first two times he would offer me encouragement and try to help me work through the pain. I can’t remember at which points my three requests came, but finally I couldn’t stand it any longer and made my third request. I felt like I was chickening out and caving in to the pain way too soon, but at this point I had been laboring for well over two hours with these unbelievably intense contractions, and I didn’t care anymore about my previous wishes to deliver medication-free. My fancy idealized birth plan had gone out the window when we decided to induce, anyway.
Doc went to find a nurse, and I worked through a few more contractions before the anaesthesiologist arrived. I had to sit upright on the bed for him to put the epidural catheter in, and that just about killed me. The nurse put an IV for fluids into my wrist and the anaesthesiologist worked the needle into my spine. Doc was careful enough, though, to warn him when another contraction was coming so he could stop what he was doing in case I moved. You don’t want to be jerking around when someone is putting needles into your spinal column. Finally the catheter was in and he started the juices flowing. He asked me which leg became warm first (the right one), and I felt a flood of warmth flowing down my right leg and back up again. Then the left one followed soon after. The pain of the contraction that I was in decreased as normal, but then kept on decreasing and decreasing until it was completely gone.
I have never felt relief like that in my life. Epidurals are freaking awesome!
Now I was confined to the bed since my lower half no longer had sensation. I could wiggle my toes a little and bend my legs at the knee just a bit, but could feel nothing. The doctor checked my cervix; I’d only progressed half a centimeter to 4 the entire time I’d been laboring so intensely. He checked the baby, and he was “sunny side up;” in otherwords, facing the wrong way. I had been having back labor, not regular labor, which is why it was so intensely painful and located across my lower back and pelvis. He also said that the reason that I’d only progressed 1/2 centimeter was likely because the intensity of the back labor was causing my uterus to seize up. I was too tense to dilate. The epidural was definitely the right choice, not only because I was able to relax but also because my labor was not progressing properly otherwise.
They had me flip onto my side to try and encourage the baby to start turning into the proper position. I laid like that for a while, talking to Doc and Kathryn and my mom. Kathryn worked on some pressure points on my ankles that are supposed to help regulate labor. She told me later that every time she pressed the pressure points, she could see my contractions on the monitor go flatline. I have to wonder if I hadn’t yet had the epidural and she was doing that, would it have made them stop? Or hurt less? Hard to say, but I find it fascinating that it was having an effect.
When the doctor checked back in a little while later, Mr. Baby had turned about half way around! He decided to reach in and manually turn the baby the rest of the way (Doc said from the chair across the room “Remember: lefty loosey, righty tighty!”), which he did in a matter of minutes.
After that, my job was to lie there on my back until I’d achieved full dilation. By about 8:30 in the evening, I was at 10 centimeters, and it was time to start pushing. Doc and I had talked about the pushing part being with just us in the room (and the medical staff, of course), a fact that I had failed to communicate to my mom and Kathryn before I went into labor. I feel bad about the mix-up, but I felt that this part of the process was really intimate and I wanted it to be something special that Doc and I shared.
A flurry of nurses came in and began to set the room up for delivery. I don’t remember exactly what this involved, but I know there were some tables full of instruments that might become necessary. At almost 9:00, with Doc and a nurse each holding one of my legs up (a lovely position to be in), I began to push. It was an interesting sensation because I couldn’t really feel anything, but the nurse coached me and I was able to get the hang of it pretty quickly. When you push, you take a deep breath and then let it out slowly while bearing down, while the nurse counts to ten. You do this three times per contraction. The baby slowly begins to emerge, but it’s like two steps forward, one step back, so it takes a while. They had set up a mirror so I could watch what was going on, which at first sounds kinda gross but it is completely fascinating. I felt a sense of great pressure, and I watched my baby begin to emerge! It was utterly amazing!!
After 45 minutes of pushing, the baby began to crown. The doctor came in (and blocked the mirror, unfortunately), but at 9:46 p.m., Jamieson Harlan Scott was born. I immediately began to cry with joy.
It was not without complications, though. The doctor had Doc cut the cord, but very very quickly. And then they took Jamie away to the warming bassinet instead of putting him on top of me right away. I knew that something was wrong. They told me that he just needed a little suction to get some stuff out of his lungs, but the way they were furiously working on him told me that it was a lot more serious than that. They had oxygen on him and Doc said that they kept lifting up his little arms, and they would just drop back onto the table like dead weight.
I had some complications myself. My placenta didn’t want to come out on its own. It had gotten itself stuck to the wall of my uterus. The doctor had to manually remove it, and it came out in chunks. Luckily I coudn’t feel any pain from this, but the pressure was intense. They brought Jamie to me about 20 minutes after he was born, and the doctor was still working on me at this point. Jamie’s breathing was still rattly, so they took him again and did some more suction.
I didn’t tear externally, but they had to put in a few internal stitches. Again: thank you, epidural.
When they brought Jamie to me again, I tried to get him to breastfeed, and he latched on like he knew exactly what he was doing. We fed successfully for about 20 minutes, and then they wheeled us up to my postpartum recovery room.
After we got settled in, Doc went down to the waiting room to get Mom and Kathryn. I felt kind of bad because at this point they’d been waiting down there probably almost five hours. I don’t know where the time went, but it was close to 2 in the morning by now. We spent a little time visiting in the room, and they left for home a short while later.
The rest of the time in the hospital is kind of a blur and I’m forgetting so many details already. My mom was there off and on helping us, we slept in short bursts, I fed Jamie when he was hungry, nurses came in and out around the clock to take my or Jamie’s vital signs, we signed a lot of paperwork, learned a lot of things about baby care, Doc gave Jamie his first sponge bath, I tried to eat the crappy hospital food (two words: clear gravy), we practiced swaddling a lot, Doc took a lot of photos, and Jamie had lots of tests and screenings, all of which he passed with flying colors.
We came home on Wednesday afternoon.
I’ll write more about Jamie’s first week of life when I have a little more time.
December 12, 2008 :: 4:50 pm
Well. This has been QUITE a week.
Have I mentioned that the weather turned nice and cold? We even had a dusting of snow one evening. Mom is still here, helping us immensely. The governor of Illinois tried to sell President-elect Obama’s Senate seat. I believe that the earth has continued to spin on its axis.
Oh, also, I had a baby.
Wait, what? You want to hear more about THAT? :)
OK then. I’ve been typing this here and there over a couple of days because, well, I’m finding it is usually more tempting to sleep than to get on my computer most of the time. Right now, for instance, I’m typing with a baby asleep on my chest. If he wakes up I’ll need to put this off once again, but I’m trying to write as fast as I can because I am rapidly forgetting details.
So, on Sunday night (December 7) I didn’t eat any dinner. I just wasn’t feeling all that well. I went to bed early and woke up again about 1:30 in the morning with a contraction painful enough to pull me out of sleep. That was the first one that had ever done that. I wasn’t able to get back to sleep for several hours because the contractions kept coming every 20-30 minutes and I was wondering, is this it? Eventually I made an effort to sleep through the pain because I knew if this WAS the beginning of labor, I would need my strength later on.
We got up in the morning and went in for my 41-week OB appointment with the same doctor that I saw last week. He seemed much less rushed than last week and took more time with me, so I felt a lot better about him this time around. I told him I’d been having contractions since early morning. He checked my cervix — 2-1/2 centimeters dilated this time. I asked if I could possibly be in early labor; he said not likely. I still had a ways to go before getting there.
Because I was at 41 weeks he sent me for an ultrasound to check a few things, and unfortunately there was not enough amniotic fluid left in my uterus. It also showed some particulate matter in the fluid, and he was concerned that it might be meconium, in which case the baby would likely be in some measure of distress.
So he gave us a choice. Either go home, drink fluids all day ‘like a son of a gun,” and come back in the morning for another ultrasound to see if my amniotic fluid had replenished, or head to the hospital today for induction. He said that option A was probably not going to work, and waiting even a day if it didn’t work could be risky for the baby.
This was really a no-brainer decision for me and Doc. We had our birth plan laid out in advance, which directed for no induction unless medically necessary. But if there was ever a medically necessary reason, this was it. That birth plan was for us and our particular ideals, but the minute anything I was hoping to accomplish might negatively affect our baby, then the decision was easy. Baby’s health wins out every time.
We drove across the street to the hospital, got checked in and into a labor room, and called my mom and Kathryn to let them know what was going on.
More to come…
December 9, 2008 :: 5:11 am
Introducing the newest most important person in my life… Jamieson Harlan Scott. It’s kind of a story how he arrived into the world, but it’s too much to type on my iPhone. I will write the full story in a couple days.
He was born on December 8 at 9:46 pm, weighing 8 pounds 12 ounces and 20-1\2″ long.
Stay tuned for photos and more!!!
December 8, 2008 :: 1:25 pm
At hospital. In labor suite. Being induced. Terrible cell phone reception here. More later.
:: 9:06 am
I woke up at 1:30 this morning with a contraction painful enough to rouse me from sleep, plus intestinal discomfort AND heartburn. Had a few more about 20-40 minutes apart. I eventually went back to sleep, and tried to sleep through as many as I could in order to conserve my energy, but was awake periodically throughout the night.
I’m feeling decent this morning. Have had one or two more contractions in the past hour since I woke up for good, but they haven’t been that bad.
I have a doctor appointment at 10:30 this morning; we’ll see what he says about what’s going on.
Send happy thoughts and positive labor-inducing energy my way!!
December 4, 2008 :: 9:27 pm
I’m going a little stir crazy here. Doc and Mom are taking care of absolutely everything: cooking, cleaning, moving stuff around, errands, etc. etc. etc. And that’s really super nice! But it also makes it so that I have nothing to do, and that in turn is making me a little crazy. Over the past week I have: sat on my butt, watched TV, watched movies, played Playstation, eaten three meals a day, gone on walks daily around the neighborhood or around NorthPark Mall, run a few errands, tagged many of my old blog posts, checked e-mail, updated Facebook, sat on my butt, sat on my butt, napped, and did I mention the sitting on my butt part of things?
And said butt isn’t too comfortable to be sitting on these days. One of the joys of pregnancy.
Mom made some freaking awesome brisket today. Sorry, Brett, but as it turns out, my mom’s brisket kicks your brisket’s ass. AND it has CELERY SALT on it! She’s over at a friend’s house tonight, but she left us the brisket, barbecue gravy, coleslaw, buns, and twice-baked potatoes for dinner (all homemade, including the buns). She’s killing us with calories!!
Today I talked to one of the nurses that works with the doctor that I saw on Monday. She was super nice and took the time to talk to me and explain what was going on. I guess part of my uneasiness about this other doctor was that I kind of felt like I might be forgotten since I wasn’t one of his regular patients and he was so hurry-hurry during my visit on Monday. But after talking to Deandra, I feel much much better about things.
My induction is scheduled for 6 a.m. on Thursday, December 11, if Mr. Baby doesn’t decide to make his appearance before then.
December 11 seems like a nice day for a birthday. Of course, I would much prefer if he came of his own free will ahead of that date; induced labors are often longer, more intense, and have more complications such as a higher risk of C-section.
She explained to me what to pack for the hospital: hair care stuff and scrunchies to tie my hair back, toiletries, pajamas, socks, my own pillow.
She also said that beginning next Monday, the 8th, the maternity ward’s remodeling will be complete and all the rooms will be the much nicer newly refurbished rooms. Doc figures maybe that’s why I haven’t gone into labor yet. Mr. Baby is holding out for an upgrade! So really, if he doesn’t come until Monday or later, at least I have snazzy surroundings to look forward to.
December 2, 2008 :: 11:01 am
Ugh. Now it just feels like I was wrong. The baby isn’t going to come at all. Everything I was feeling: wrong. No baby, he’s never going to arrive.
People seem amazed that I am not just lying around in bed all day, that I’m up and walking around and running errands and getting things done. Should I be sitting around doing nothing? Is the fact that I’m mobile and acting “normal” making it so that the baby won’t come? If I act like I’m not pregnant, does that make me actually not pregnant? I felt like crap for about a week and then started feeling a lot better. Did he disappear? Am I faking it now?
Stupid, I know. I’m just tired and feel emotionally numb and weird things go through my head.
December 1, 2008 :: 3:06 pm
Just had another doctor appointment. My doctor, apparently, went on vacation out of the country today and did not alert me to this fact ahead of time. He called last night to check on me and my phone’s ringer was off (d’oh); surely he would have mentioned this had I picked up the phone. I found out this morning when I called his office to say that today is my due date, I haven’t had the baby yet, and should I come in for an appointment today.
So I had to see the third doctor in the practice this afternoon, who I’ve never met before, and he was somewhat brusque, not forthcoming with information, and quite clearly wanted us out of there as quickly as possible.
I understand needing to work quickly since they are short one doctor, but it’s my first baby, my regular doctor left without warning, it’s my due date, labor has not started and shows no real signs of doing so, and I just wish he would have slowed down and showed a little compassion. As it was, I was able to hold back my tears of frustration until after he left the room.
I’m ok now though. So, I am still dilated only 1.5cm, the baby is showing good movement, and they are going to schedule an induction for December 11 in case I still need it by then.
Hopefully I won’t. And all those weird feelings I was having last week meant nothing. That’ll teach me to trust my instincts. Apparently they don’t work very well.
November 29, 2008 :: 9:55 pm
Status of Mr. Baby: Not yet. Sigh.
Doc and I went for a long walk today at NorthPark Mall. We didn’t do any shopping (are you kidding? It’s the day after Black Friday… just the mall walkways were crowded enough) but it was a good place for a nice long walk and some rich-people-watching. Walking and sex are two things that are supposed to help labor begin, so we are doing our part(s) to get this show on the road!
We had a full-size mattress set delivered today so my poor mom has something to sleep on besides a crappy air mattress. Later, when Aquaman (IF HE EVER ARRIVES) is old enough, we’ll convert his crib frame into a full-size bed, and we’ll already have the mattress for it.
I’m bored and getting pretty antsy about labor… when oh when will it begin? I imagine every full term pregnant woman asks herself that question repeatedly. Mom is cooking up a storm and cleaning our house cleaner than it’s ever been, which is freaking AWESOME but also is making me feel guilty. I hope she’s not too bored here.
I haven’t really felt the nesting instinct that pregnant women often feel shortly before labor begins and gone crazy with the cleaning and organizing, although Doc may disagree with me on that. I tell you, though, HE has been the one who has been super busy lately getting shitloads of things done around the house. It’s so sweet how excited he is about the baby, and how much he’s preparing for it. Comparatively speaking, I’ve just been sitting on my ass.