Stuff I’ve Seen (Part I)

7 02 2012

OB has been an interesting experience so far, and one thing I haven’t really talked about yet are the patients.  They are, after all, supposed to be the primary object of my attention.

In my previous rotations, I saw sick people.  Most of the patients I see now are young, healthy women.  Sure, some have gestational diabetes or hypertension, but after delivering their babies they will go back to being young and healthy.  The site where I’m doing the rotation is very high-traffic and because it is inner-city, the patient population reflects that.  About a quarter of the women I’ve seen are teenagers (ages 15-19), more than half are early 20’s; the oldest I’ve seen was 40.  About 5% were married, and I don’t know for sure how many fathers of the babies will have an active role in the child’s life.  Most are on Medicaid, a small percentage of them have private insurance, and the rest are uninsured.  Half bottle-feed and half breastfeed (I’ve yet to see someone choose formula who wasn’t on Medicaid and getting state assistance).  Every woman has taken prenatal vitamins.  So that’s the first-week demographic based on what I’ve seen so far.

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Today in the blog will be the first in a series of posts entitled “Stuff I’ve Seen.”  Super creative name title, I know, but it’s been another one of those 14 hour days and maybe a better name will spark my neurons when I’m thinking about something else (or, as so often happens in clinic, not thinking at all).  Because every case here is interesting, but I don’t want to bore you with a massive case-centered reflection on each one.  So here we go:

1.   There was recently baby girl here named Princess. Now before y’all are up in arms about a potential HIPPA violation here, remember that 1. This is only a first name, and 2. If this name was unique I would not have written it.  Which is why this is amusing.  Princess is like the 700th most common girl’s name, so it’s not unique. The name Unique (all 20-something spellings included) is around 800th.  And in case you’re interested, the name Prince is about 520th in popularity among boy’s names.  That’s really all that needs to be written about this subject, but rest assured I will keep an eye out for the unusual names 😉

2.   The lengths that doctors go to in order to make sure their patients’ treatments are covered by insurance never ceases to amaze me.  Picture this—a woman has 5 kids and wants to get her tubes tied, but her insurance is through a Catholic provider and they won’t pay for a “tubal ligation.”  So what does the doc do?  A slightly more complex procedure by which two slits are made in the uterus, the tubes are cut, and the bits still connected to the uterus are folded into the uterus with the edges tucked and sewn into the slits there that the surgeon made before.  The result?  Sterility.  The irony here is that when you just tie the tubes with string, it’s less effective birth control than the Catholic-insurance-approved method.

3.  I got to sit in on a C-section to deliver quadruplets!  The babies were about 3 lbs apiece, and one of them was growth-restricted (only weighed a pound and a half).  It was the coolest thing I’ve seen in a while.  It was super-coordinated, and they had a massive team of nurses, neonatologists, respiratory therapists, and even the life flight crew there to help in case they were needed.  They were not, of course, natural quads, but a product of fertility treatments.  After the craziness that was Octomom and the McKinney (I think) septuplets, fertility docs stopped implanting more than 4 embryos at a time because you just can’t carry 6 or 7 or 8 healthy babies to term without (95% of the time) serious morbidity and mortality.  Quality over quantity, friends.  Now the lead authorities are thinking of cutting that number down to 2 because fewer of the implanted embryos are lost.  Looking at that tiny, growth-restricted baby, I’m okay with that.  Especially because all four of those quadruplets, delivered really prematurely, are in the NICU, and they aren’t doing well.  Mom will leave the hospital without her babies.

4.  Patients at the clinic fill out forms whenever they come for appointments, and we see those before we go into the rooms to see them.  The questionnaire asks about birth control.  One response today said “Had my tubes tyed.”  Another said “want toobes tied.”  This is one of those times where my ‘if you can’t spell it, you can’t do it’ rule goes out the window 🙂

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2 responses

7 02 2012
MJ

“2. The lengths that doctors go to in order to make sure their patients’ treatments are covered by insurance never ceases to amaze me. . . ”

Do you you know what this procedure is called? I was under the impression that NO sterilization procedure was acceptable, however a ‘uterine isolation’ (i.e. tubal ligation) was acceptable if it was done to prevent serious complications NOT related to fertility. This is the principle of double effect that justified the unintended sterilization in Catholic moral teaching.

11 02 2012
Glia414

MJ, thank you for your comment. Yes, this is called uterine isolation (the Irving method, a procedure very different from simple bilateral tubal ligation). I’m not sure what you mean by ‘prevent serious complications;’ my guess is possible life-threatening conditions of future pregnancies, and I do know that in these situations the Catechism actually does allow abortion. What slips my understanding is why it is only this method of permanent sterilization the Church allows. Traditional tubal ligation, coil embolization (putting metal coils in the tubes and letting them scar over), and uterine isolation are the same idea, and have about the same effectiveness in preventing viable pregnancies. All three methods can still allow conception to occur (implantation either never happens or is in the wrong place, resulting in ectopic pregnancy and potential fatality for the mother), which is why I’m puzzled that 1. The Catholic church is okay with this method, and 2. They are okay with only this method (versus the IUDs, especially Mirena, which prevents conception altogether).

On a personal note, I’m a Christian (raised Catholic), but I find the whole teaching on birth control both hypocritical and ridiculously prideful. The Bible teaches that God is all-powerful, how can you truly believe that any form of man-made birth control can stop Him from giving someone a kid? Especially because, according to the teachings, Mary was on the ultimate birth control and still became preggo. Food for thought.

So, what do you think?

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