As any physician who has published a book, it gives me great pleasure to announce the upcoming release of Pregnancy Your Way: Choose a Safe and Happy Birth. I am grateful for the opportunity to tell readers what I have observed about safe pregnancy over the last five decades. From nurses, doctors, and most of all, from my patients who have allowed me to participate in their lives and their care, I have learned much. Like most doctors, I have felt personally responsible for the good outcomes of my patients. In more than 6000 births, I had no mothers with eclamptic seizures, no mothers who became permanently injured, and no mothers who died. There are many good stories here.
In some ways this book is a memoir, but with lessons, if you will. The stories illustrate real-life themes, struggles, and problem-solving in pregnancies.
It is my goal to provide readers, especially women who are pregnant, with valuable information which can increase their safety, comfort, and good birthing experience. A safe and happy birth experience reaches far into the future of every family.
Nothing in this book is meant to take the place of a face-to-face relationship with your doctor. The current medical environment makes it very difficult for both patients and doctors to develop any kind of good working partnership about pregnancy choice. My goal is to provide women and their families the information they need to actively participate with their doctors in their pregnancy choices.
Share
I met Alicia for the first time when she had come into labor and delivery (the area of the hospital designated for deliveries) at term. She had been followed by one of the approximately thirty family practice doctors I worked with. Her doctor had called me and asked me to see Alicia. Her blood pressure was 130/90. From her records I could see that her initial pressure was 90/50. Her labs indicated worsening kidney and liver functions with low platelets. When I went to see her, I asked, “How do you feel?”
“I don’t feel bad,” she said. “I don’t have any pain anywhere.”
“I want to listen to your lungs and to check your reflexes. Is that okay?” I asked. “The nurse said your cervix is closed, so I don’t need to recheck that. Your baby appears to be in good shape according to your monitor.”
Alicia’s lungs were clear. No evidence of pulmonary edema or congestive heart failure. Her reflexes were very active with some clonus, which means after tapping her knee, instead of one kick, there were several. I reported to Alicia,
“You have a significant elevation of blood pressure and very active reflexes, meaning that you have preeclampsia. I want to deliver you soon. Your baby is ready. I don’t want you to have a seizure or a stroke.”
I knew I needed to explain to her why I was recommending a cesarean section. “Because your cervix is closed, induction could take a long time,” I said. “You could have a seizure or a stroke in a long labor, so I want to go ahead and do a C-section. Do you understand?”
Alicia answered, “I think so, but I don’t feel bad. I didn’t know I was so sick.”
I didn’t tell Alicia at that time how worried I was about her physical condition. In residency most of us learn not to frighten our patients. Anxiety can seriously interfere with labor. Patients need to feel they are the only person who matters at the time.
“We’ll be doing general anesthesia, which means you’ll be going to sleep for your C-section,” I said. “With your blood pressure higher than it should be and your lab values indicating you have severe preeclampsia, we need to deliver your baby without a long induction.”
I wasn’t worried about the general anesthesia because I had a good anesthetist, and I knew I could get the baby out in two minutes or less.
In approximately half an hour Alicia, was on the operating table ready for surgery. Vitals including the fetal heart rate, were stable. Within another thirty seconds the breathing tube was in place and I could start the surgery. The baby was born approximately two minutes later with Apgars of 8+ 9+ and weighed 7 lbs. 10 oz. Alicia’s vitals remained stable during the surgery and her blood loss was minimal. The surgical closure repair took approximately fifteen minutes.
Alicia awakened easily. Blood loss remained minimal. Her pressure remained constant. To treat her hypertension and preeclampsia post-operatively, I began IV apresoline, propranolol, and magnesium sulfate. Alicia did well post-operatively. Each day her pressure came down a bit, as expected.
On the fifth day, I sent her home on oral apresoline and propranolol. Three days later, Alicia came to my office for a scheduled postpartum visit. Her blood pressure was 110/75, her incision was doing well, and her baby was eating and gaining weight. Kidney and liver function had returned to normal. She returned for another scheduled post-operative visit a week later. She was still doing well and scheduled a follow-up visit with her family practice doctor after that.
