by Alan Lindemann, M.D.
I considered a couple of specialties when I was in medical school, possibly ENT or peds. But I soon realized in my obstetrical rotation that one thing obstetrics had to offer that other specialties didn’t was that with pregnancy, the doctor and parents could aim for a particular outcome, a healthy baby. It wasn’t a matter of identifying and curing a disease. To me, the choice to work with a mother to have a healthy baby is much like steering the pregnancy. Certainly all doctors want to have success wth their treatments and their surgeries, but the practice of obstetrics has more impact on future life.
Knowing that we can choose our goals makes it possible to change what we don’t like. For example, nausea and anoxeria are manageable. Management means eating the right things at the right time for the right weight gain. Knowing that blood pressure is manageable can add safety and duration. In other words, the pregnancy can get closer to term, adding safety for the baby. Then there is depression, which can be managed prophylactically. Let’s not have post partum psychosis. And under no circumstances should babies be sent home when there is nothing for them to eat. Hospitals pressure physicians to send new mothers home before their milk comes in. Saves the hospital lots of money on the books, but many of these babies will wind up readmitted to the hospital for “failure to thrive.”
Steering pregnancy helps moms, dads, and babies do better. We can avoid strokes, seizures, eclampsia, liver and kidney damage, death, and prematurity. Of the 700 maternal deaths a year in the United States, 30 to 45% are considered preventable. Obstetricians who understand what it is to steer pregnancy are needed to avoid some of these preventable maternal deaths. I have produced a video course, “How to Avoid Losing Your Life in Childbirth” to help pregnant women and their families gain some notion of what can be accomplished when they enter into skilled steering of their pregnancies in conjunction with their obstetrician. It’s time to remove insurance companies and hospital CEOs from interfering in medical decisions only patients and their physicians should be making.