Labor and Delivery

(For some reason, Labor Day this year makes me think of my first experiences on the Labor and Delivery unit – 40 years ago this month!)

“Please call 2350 STAT” were the most dramatic pages I got during my residency. It was Labor and Delivery at Central Maine Medical Center in Lewiston. I can still feel the mixed worry and excitement that call gave me. I never felt anything positive being called to a code or other medical urgency. I don’t revel in the drama of disease, even though I, obviously, handle it. Delivering babies, with or without the drama, had its own magic.

I had a reasonable education in office gynecology in medical school. But obstetrics is more of a carve-out in Sweden, something family doctors, or allmänläkare (general physicians) don’t really come in contact with. Prenatal care and Infant care are (or were, at least back then) centralized at clinics that sometimes, but not always, were housed in a primary care office building. They are still viewed as their own specialties and mostly nurse-run under protocols with physician supervision.

Because my medical school was 5 1/2 years compared with the US 4 year curriculum, I felt better prepared, medically, than my fellow residents. I started my American residency having already had hands-on experience in the “smaller” specialties people think of as surgical sub-specialties: otolaryngology, orthopedics, ophthalmology and so on. But I had a fair amount of cultural catching up to do, learning where the Americans did things differently than the Swedes. I knew the diseases, but drug choices and general approaches were sometimes very different.

Obstetrics was an entirely new field for me. The Lewiston program was known for its strong OB experience, which is not why I picked it. I was looking for a program in Maine and liked what I saw in Bangor and Lewiston more than Augusta or the urban Portland. But Bangor seemed so far north – and here I am, practicing almost 200 miles further north of Bangor today! I also resonated with the faculty in Lewiston.

So there, wouldn’t you know it, OB was one of my first rotations. It was a trial by fire. I learned so much, so fast. And, wouldn’t you know it, the fist delivery I did on my own, with the summoned obstetrician guiding me from the delivery room doorway, still in his street clothes, was a double footling breech. Everything turned out just fine, but I decided right then and there that I would not be doing obstetrics in my own practice.

But, even though I never practiced obstetrics after I left Lewiston, some of my OB experiences have etched themselves in my mind and helped form me as a physician.

I still think about the woman in tears about her unwanted pregnancy that turned out to be a beautiful baby boy that strengthened her whole family. And I still remember the woman who thought she was too old to become pregnant and the magical moment when we listened to her fetal heart tones, both of us holding the Doppler in silence.

Knowing how to deliver a baby made me a better doctor, even though I chose not to continue doing it. It made me comfortable during snowstorms with closed roads in northern Maine. It made me comfortable doing my routine well woman care. The number is only my best estimate, but I can honestly say to a female patient, “I’ve delivered close to a hundred babies”.

Off The Record

Good, Strong Heart Beat – 140 and Regular

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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