27 January 2012

The Good, The Bad and The Indifferent of My Annual...

I had my annual last Friday. You know, that annual. The legs-in-the-stirrups-scoot-down-a-little-poking-and-prodding annual. It wasn't bad, but it really never is. 

I feel like post-baby, my relationship with my doctor has changed. I liked her a lot before I was pregnant - she was originally at the practice I went to for that sort of stuff, and when my doctor retired (he was actually the one who delivered me... Fancy that!), I began seeing her. When she moved to a location much closer to where I lived, it was a sealed deal - she was my doctor. I loved her while I was pregnant. I had a so-so pregnancy, filled with ups and downs (I touch on some of it here in my birth adventure story). She was emotionally supportive, especially when I needed it most; she was very knowledgeable and compassionate; she took really great care of me. In the first months post-partem, she was a God-send and really restored my slightly wavering faith in the medical community (I realize not all doctors are like her, but she was/is great).
OMG... Remember when he was that little?!

But now... I feel like that bond is lacking. I haven't seen her in almost a year. Obviously she knows me - she's been my doctor for over six years now. I went in for my appointment last week optimistic about seeing her but ended up leaving feeling slighted... Unhappy, even, of all things!
It started out uneventful. Height. Weight. Blood Pressure. Medications. Allergies. Here comes my first point I'll put under "The Good" - In addition to the routine "I have these memorized" questions, the nurse assistant asked me some health-gauging questions. "Do you exercise?" "Sort of..." "How often?" "Whenever it snows?" Not amused, but it counted. "Are you depressed?" This question always gets me. There's a caveat I always feel necessary to throw in; "Yeah... A little... But it's been that way awhile now." No further questions asked. I'll ding them a smidge on the lack of probing further. Overall, I think this new line of questioning is much nicer - it helps jog the patient's memory for questions to ask and helps the doctor identify areas to focus on with the patient. Win-Win!

Now it's time. "Change into the gown; Open in the back; Don't tie it." I know the routine. I wait for the nurse assistant to leave and hurriedly change out of my clothes, making sure to stack them neatly on the chair (with my socks and underpants tucked away prudently). I'm always so nervous that my doctor will walk in mid-change and see me naked. Strange thing to worry about? Possibly... I always end up with plenty of time to wait. Thanks to the advent of Words with Friends, I have something to occupy my five minutes. Truthfully, it felt like much much more than five mere minutes, but a crinkly gown and 65F room can do that to you.

After what feels like a frigid eternity, she knocks on the door and walks in, smiling as usual, wearing her cool opalescent shoes, "Good morning, Ana!" (You may or may not know that I just go by Ana - it's not my "legal" name nor the name that shows up on my medical charts). She remembers me! Un Punto Positivo! We chat for a few minutes - "How's the baby?" "How's the house?" "How's work?" "Good." "Okay." "Fantastic."

She has me lean back. Breast Exam Time. I get scolded for not checking them myself monthly. I apologize for not having pumped that morning, and if they felt lumpy, that might explain some of it. (Thankfully not lumpy). We talked about breastfeeding. This plus one is negated by a big old negative one right here - "That's great that you're still nursing. I let my girls until they decided no more. The two oldest were weaned by 10 and 11 months when they lost interest, but my youngest went until 15 months then I went to a conference. When I came home, I was dry, and she didn't want anything to do with it anymore. I let them go as long as they wanted, but they were all done by eighteen months... like normal."

WHOA! Hold the press! Like normal? Okay, okay, maybe she just wasn't listening to what she said and how... I agree and say that I'll nurse Niko until he's ready to be done with it - we still nurse in the morning, afternoon, and evening before bed. More when I'm home more, but, you know, whenever he wants within reason. Moving on, feeling a little off-kilter.

Normally, my wonderful doctor would warm the speculum for me by running it under hot water for a few seconds. Those things are arctic! I swear they must store them in a refrigerated compartment in the table... No such luck! Negative point! Thankfully she works swiftly, while I try to maintain conversation while she's swabbing and prodding.

Me: "Can I tell you something?" (as she's knuckle-deep, feeling my uterus from the anterior)
Dr.: "Yes..."
Me: "Do you know how big my friend's baby was that she just delivered?"
Dr.: "How big?"
Dr.: "Whoa! That's a big baby! Where'd she deliver?"
Me: "At home."
Dr.: "Oh."
Me: "Do you know how big the placenta was?"
Dr.: "I can only imagine... That big of a baby must have needed a big one..."
Dr.: "Yikes! Did she have a midwife?"
Me: "Yeah.. Two midwives in attendance and a doula and an EMT and some of her family."
Dr.: "That's so risky having a baby at home. I don't like to be one to over-medicalize birth, but some things are just dangerous."
Me: "She lives 15 minutes from a hospital. They would have been ready to go in an instant if it was necessary. The midwife gave her another week before she needed to go see a doctor."
Dr.: "I know, but it's just... I just delivered a colleague's patient - normal pregnancy, no problems, healthy mother, normal progression, quick labor, no pitocin just an epidural, and she hemorrhaged fifteen minutes after giving birth. Perfectly healthy and needing blood transfusions. Sometimes things like that happen which makes me most nervous about having babies at home. There are no transfusions at home."
Me: "They were fifteen minutes away. It was her second baby."
Dr.: "Well, if it was her second, I guess that's a little better... Did she have any pain management?"
Me: (not sure if it's a trick question...) "No... "
Dr.: "I bet you were happy with your epidural."
It took me a moment to answer... "No... I don't think I was... I think if we had waited a week, I would have had the baby without being induced, getting an epidural, or needing a C-Section. Plus, it was super-itchy. I hated it."
Dr.: "The pain people say comes from induction is no worse than birth pains. It's the same. Induction doesn't make it any more painful - that's labor."
Me: "I don't know... Those were pretty bad... but they hurt because they were forced. You know, the best part of the whole thing was the 10cc of morphine I got before you made the incision. Other than that, I really wish I'd have waited. I don't think it would have been so difficult if we'd have waited..."
Dr.: "Maybe... You know, women get very upset about being induced or having C-Sections, but don't we all have the same goal? A healthy mom? A healthy baby? I try to explain to patients their options and help them make the best decisions for themselves. Sometimes I have to make the decision, and as difficult as it gets, it's what I feel is safest. I want every woman to have the birth she wants. I try to make that happen."
Me: "I'm not mad I had a C-Section. It just would have been nice to do the way it's supposed to happen. We should have waited. We'll never know..."

Sorry that took so long. I didn't know how to paraphrase it correctly. That's just about verbatim what the haps were in the office that fateful Friday morning. Negativos puntos... There were a lot of mixed messages sent during the conversation. While I have no intention of having any more children until I'm married (please come soon!), I don't know that I could do another pregnancy with her. I think I'd be more apt to take the HBAC route with the next one and consult a midwife for my care, with a Plan B doctor in the wings at one of the three hospitals within fifteen minutes of me. I may be in the market for a new OB/GYN (if you have recommendations in the Cleveland area!). I have about a year to decide before I need to make another appointment. We'll just have to see if my unrequited love for my doctor remains steadfast or if I may wander...

I'll close this with a clarification: I'm not upset about my birth experience. I think it went just peachy. I'm not mad. I'm not sad. I'm not disappointed. I don't think I failed. I don't think my son wasn't meant for my birth canal. I think we went in too early, but I was ready for it all. I wouldn't trade it for any other experience. It is ours and that is, apparently, just the way it was meant to be.

Do you love you doctor? Do you dread your annual? Why or why not? Tell me about it! Share in the comments or on the FaceBook.
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