C-section or vaginal delivery - the need to control

There is a big debate, in our gynecology department, about the "trendy" rise in c-sections vs vaginal delivery**. It seems that when given a choice between c-section and vaginal delivery a lot of woman prefer the surgical procedure upon the natural birth. I am not regarding the cases where c-section is indicated to save the life of the baby or the mother, but rather in the absence of medical indications the mother chooses  the "quick and painless" approach.

As a doctor I can understand the comfort of a c-section, the procedure is scheduled to a convenient time (most commonly in the morning after a nice coffee and breakfast) and I have the control over what is going on. As a patient I think everyone acknowledges that there is no pain like labor pain (not that I know it for a fact but I believe my wife) and the comfort of painless labor is very appealing. While picturing the birth of a baby in the eyes of a mother I'm sure that there is always the fear of pain that comes with it. When given the choice, by the physician, c-section or vaginal - painless vs painful the decision is not really a fair one.

On the other hand I see the underlying need here is what pushes most people today in this world regarding their decision making and actions. The need for CONTROL. " I want to have control over this terrifying and overwhelming event" "This is nothing I can fully prepare for and I rather be in control then face the consequences".

The act of giving birth is one that requires the most trust, in the body, and the will to just LET GO. I think this is the one place that if a woman does not let go of her control the labor cannot continue or even slows down. It's an important lesson to realize that our body is just a vessel through which LIFE is taking place. Creation is stronger then our will to control it.

Try and ask yourself: "Are you willing to let go and trust yourself or do you need to be in control?" "Do you rather have a c-section or vaginal delivery?

The facts are that c-sections carry a higher risk then spontaneous labor, for the baby and the mother. The risks are not only immediate risks due to the surgery but also future risks concerning the well being of the baby and further pregnancies (click here to see a list of these risks), all these risk are of minor importance, of course, if the need for medical intervention is essential. 


There are also risks in spontaneous vaginal labor, I'm not denying that, but remember, this is what your body is intended to do, this is what women have done thousands of years before you - YOU CAN DO IT! Believe in yourself and in your body's ability. You have the ability to give life, it is a gift that not everyone gets a chance to fulfill, take advantage of it, LIFE.

**There is a rising trend favoring cesarean section. In the UK during 1953, 2% of births were c-section while in 2001 that number got to 21%. The nation average in the USA stands on 24% and the differences between private sectors and public are large. (numbers taken from: Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML. Caesarean section for non-medical reasons at term. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004660. DOI: 10.1002/14651858.CD004660.pub2.)

Hospital discrimination and fair treatment

I always had a feeling that there is some kind of hospital discrimination but I never saw it happening as obvious as today. I believe unfair treatment happens all over the world but to be able to look at things from the eyes of an outsider helps give perspective and objectivity about a fairly common situation.

A 32 year old patient arrived to the delivery room today after giving birth in the ambulance bringing her to the hospital. I first saw the baby, he seemed healthy enough and was going through the Apgar scoring and initial check ups / screening. The mother arrived shortly after with the umbilical cord dangling between her legs, waiting for the last stage of labor - the delivery of the placenta. As expected in a few minutes and a little push on the belly from a midwife the placenta came out completely.

The woman was suffering from some lacerations due to the delivery and needed stitches, I was shocked when the doctor started stitching without any local anesthesia. At first I thought its probably going to be one or two stitches and that they decided to spare the needle poke. I was wrong. Lets just say that it was a lot more then one or two.

I could tell that the lady was simple minded and belonged to a minority group. She was very poorly dressed and her hygiene was the dictionary definition for the word "dirty", non the less she was in pain and yelled out in agony but the "professionals" just told her to relax and that it should be over soon. There was not much I could do as a student, but I knew this was hospital discrimination. If she were a bit cleaner and a bit "whiter" the attitude would be different I'm sure. I asked the doctor afterwards why she didn't use any anesthesia, and she told me that in her opinion the patient didn't need any anesthesia.

I regret not asking the doctor there and then why she didn't use any anesthesia. Maybe I should have insisted.

This story is really shocking but discrimination doesn't have to be so obvious, it can be a attitude towards a patient or even just a face not in place. I just want to use this blog to address any doctors / future doctors that may be reading, we are in a profession that people trust us, trust our opinions and believe in our words and actions, even when life is on the line. We cannot take advantage of this trust, we must be true to our profession even when the patients is not aware of his simple rights, like getting anesthesia when being sutured.

I pray for the ability to always see each patient as the human he is and the miracle that he is. I hope I will not be institutionalized by the day to day practice and forget my humanity.

Opinion on abortion

There are many opinions on abortions, but I think most will agree that it is a difficult procedure for both mother and physician. I don't think it matters what's the indication. Today I saw an 18th week pregnancy being terminated. It was the first time I witnessed an abortion.

The indication was clear: multiple genetic abnormalities were confirmed by amniocentesis and USG. According to the doctors opinion the fetus was not compatible for life and an abortion had to take place.

The procedure was technically simple: The patient was placed under general anesthesia. The cervix was dilated and evacuation took place. It only took 10-15 minutes to preform yet I believe no one in the room was left untouched, even the most experienced doctor in the room admitted that this was the worst part of being a gynecologist "I never get used to it" she said.

The debate over legalizing abortions is one with no definite answer, I believe that both opinions "pro life" or "pro choice"can be understood and have a righteous background. I can just say that observing the abortion left me with many questions.

Drowning in thought and emotion

• Questions regarding our medical opinion and the weight it carries. 
• Ethical grey areas that no one really knows what is right or wrong and how to act. 
• Moments in life where our actions as medical doctors can come into conflict with our beliefs.
• A practice that combines life and death so clearly but can be regarded as nothing more then a "medical procedure".

I have not yet established my opinion on abortion and I have a feeling that I will never have a definite one. I can only hope that as a doctor I will do what I think to be the best thing at that moment for my patient. Hopefully those would be the thoughts that guides my actions.

If anyone is interested here is a link about facts collected on abortions and their outcomes that were published in well known journals.

Gynecology Rounds!!!

I started my gynecology rounds today. Last rounds before I get my M.D. I hope I will get the best out of it. I've always found an interest in gynecology, this could be the chance to check it out to see if I may have a future as a gynecologist.

Wish me Luck!!!

What does a medical doctor do

I often come across the question "what does a medical doctor do"? This is most often presented to me by myself to myself or by other people towards the medical profession. I find this question interesting because I think the answer differs from doctor to doctor. I'm not talking about the professional differences between the different fields of medicine I'm talking about the philosophical angle that SHOULD be equal to all doctors.

We all know the phrase "do no harm" and Im sure that this part of the keeping our patients safe is practiced by all, no one with a healthy mind would want to inflict harm to a patient. The problem with defining what exactly does a doctor do starts right after med school and changes as time goes by. I see the burning enthusiasm in fresh "green" doctors that are willing to see the patients as a whole and treat the person rather then the charts. And then I get to know a different kind of doctor, one that is "institutionalized", a doctor that is so overwhelmed with the scope of work and the amount of patients that he forgets his REAL mission. A doctor that sees a chart and numbers rather then a person. I also recognize a third kind of doctor, one that finds a way out of the institution and back into seeing a patient as he really is.

When the time comes and I REALLY need medical attention, I would want to find a person next to me that sees me and not a robot that works on autopilot. I am sure he does not want to work this way but because of society and the hospital protocols push him to it. These protocols save lives everyday, no doubt, but isn't there any other way?

I don't want to seem too criticizing but I do want to shed a bit of light onto the "sacred profession". I write these opinions at the beginning of my journey in the world of medicine to try to help me remember the true path that should be taken by my colleagues and I. I also write this to help me understand and except the doctors that, in my point of view, had caved into the needs of society. I know that I WILL be one of them I can just hope that I can find my way out.

I hope that after getting the skills I greatly need in order to understand medicine to the fullest I can successfully navigate to find a way to look beyond the charts and numbers in order to see the human standing in front of me. 

Stiff neck

I woke up this morning with a stiff neck. I started getting signs that something is giving way after swinging my daughter up in the air yesterday. I didn't regard it as much at the beginning but during the night after waking up every time I needed to turn around - I got the point.

The most common cause of a stiff neck is stressful muscle activity or unhealthy sleeping habits but of course there are all the other frightening causes like spinal trauma, meningitis, disc herniation or arthritis, the scope of this post is too short to cover all those topics. Lets just say if you have any history of falling down a ladder or if you have been in a motor vehicle accident and you are suffering from neck pain - GO TO THE DOCTOR. If you have a stiff neck combined with fever or chest pain - GO TO THE DOCTOR.

In my case the stiff neck was obviously because I moved my neck in a wrong way and I sleep with a really bad pillow - this combination cooked up a great pain in the neck. So what should I do? Well because it started off really bad in the middle of the night I just took a pain killer (Ibuprofen or paracetamol) to take the edge off so that I could get some sleep.

Normally the best thing, I think, for a stiff neck is a long warm shower followed by a short massage with any muscle aching ointment you favor (voltaren gel, tiger balm, po sum on oil, bengay) They all work great. Just make sure you rub them in good and wait for that burning feeling, this means its working. I just keep the place wrapped  in a scarf or anything warm just to keep the blood flowing to the area to allow all the nutrients and inflammatory cells to do their natural healing job. [If you suffer from a more chronic, non muscular problem these methods may not help you]

It usually takes a few days until the neck is fully functional but you should feel slightly better after about 24-48 hours. If it doesn't get any better after a week, I would get it checked by a professional just to be on the safe side.

Just a few more sentences for the holistic point of view. A body that is in pain is trying to tell you something. Try not to "shut him up" completely with NSAIDs (non steroidal anti inflammatory drugs) and pain killers. Try to listen to what the pain is telling you.

• Maybe you are working too hard, pushing your body too hard or resting too little?
• Maybe your sleep is not good enough or deep enough to accommodate your bodies needs.
• What measures can you take to ease up, take it a notch slower?
• Should I start exercising more? Should I change the type of exercise?

Remember to be thankful for the days without pain. I heard an old saying once: "A healthy body doesn't feel its different parts". When we are healthy it seems like everything is working great and we don't feel any discomfort, sometimes we forget how fortunate we really are that everything is working exactly as its supposed to.

While writing these lines I do feel much better then before buts it's not over yet. I think I'll take another shower and rub down before the day ends.

Med school with a baby

Attending med school while raising a baby isn't easy. I'll try and bring a bit of pros and cons here to help anyone that is contemplating with the subject. It's funny how crazy things occur while life is happening. I started school six years ago and today I am married and a father to Emmanuelle - my beautiful daughter. If you had asked me then, if I would build a family during med school I would just laugh and regard you as naive, but guess what happened?

LIFE.

I met my wife during med school and we decided to take the leap and make our connection sacred, so we got married and since my wife took some time off school we both decided on having a baby. I was a little reluctant at the beginning because I was worried about the consequences; med school with a baby? will I have enough time to study? am I ready to be a father? and many other what ifs.

During the first few years in med school the curriculum is very demanding and when you get further down the line it seems as if more and more things are falling into place and you have more time on your hands, I don't really know if you really have more time or that you just get used to managing your time better and that makes all the difference. 

Emmanuelle was born in May and my life has never been the same.

At first the feeling was overwhelming, we had to get used to a whole different reality of long days and even longer nights together with the fact that we were in charge of a magnificent creature that is fully dependent on the two of us. I couldn't even think about school, we were both totally indulged in this new commitment.

During the next 11 months we learned how to divide our time, at first it was hard but with the help with my wife I could take a few hours off each day to study. 2-3 weeks before the exams, when I really needed time to cram, I would head out of the house (library or friends house) just to be able to concentrate on the topics I needed to go through before the test.

Positive points about going through med school with a baby:

• The joy and fulfillment that your baby gives you. 
• All is secondary to this great miracle (yes even the exams). 
• It helped me take into perspective the important points of life and really not go over my head for one more exam. 
• The feeling of coming home to a warm and welcoming house is much more fulfilling then returning to dorms. (not that I have anything against dorms everything has its own time in life I guess).
• I was surprised how there was a smaller financial burden then I first thought - at least for the first year, we got a lot of hand-me-downs and breast feeding is really cheep :)

Some negative points you should consider:    

• You need to be able to grab the hours you can and make the best out of them.
• Be ready to sleep less hours.
• If you are a planning to breast feed…well thats a different story all together. You can have a look here.
• It could be financially debilitating. Especially if you need to buy all new things and can't get by with second hand products.

In conclusion I think having a baby could be the best thing that ever happened to a med student but thats just me personal opinion. This post is longer then I planned but I think you get the point, if you have any questions about my personal experiences on going through med school with a baby just ask and I'll be glad to answer.

Emmanuelle 10 months

Relax time

It's time to relax!!! I have successfully passed the exam. I now have only ONE more exam left and I can add the prefix Dr. to my name. I don't like the saying "time passed by so quickly" or "it seems like just yesterday that I started". I have to say one thing - It took a LONG time, and it wasn't easy.

I'm not celebrating yet. I still have one more exam planned in about two months but until then I have a few weeks that can be used for relaxation and getting my head straight before plunging into another study marathon. I think I'll give myself 6 weeks of studying for the next exam as its fairly easier then the past ones.

Relax for me means long walks with the dog, playing video games, eating out and enjoying a book that has nothing to do with medicine. If I plan this time right I will be able to approach this next marathon with new strength and a thirst for knowledge. If I don't clean my mind then I can reach the next exam exhausted and without the willpower to sit and read. This is not a cliché this is real advise. When I look back at times that I had no intervals between exams or that I didn't use the time given to me correctly and I remember me being just like a rag doll, with hardly any life in me.

Stress relief before exams

This entry will be about my way to cope with the stress that is common before exams. Tomorrow I have a HUGE exam - if there are any medical students out there - I'm sure you can relate. The day before the exam is stressful, of course, everyone knows that but it is also a time to organize your thoughts. I have studied for the upcoming test for about 2-3 months, that is a lot of time. I know all the topics for the exam inside out. There is no need to study the day before the exam nothing really sticks.

I use the day before the exam for stress relief. In order to relax and get my self ready I choose to work on my self confidence. I do a kind of meditation to set my mind for success. After taking a few deep breaths and making sure that I am completely relaxed and comfortable I start imagining myself walking in the room where the exam should take place, when I reach my desk I imagine the questions that I will be asked (if its a written test I imagine the page with the questions on it), then I start answering the questions in my mind (try not to doze off - it could happen if your totally relaxed) always answering with confidence and getting them all right!!! The point of this exercise is to use as many DETAILS as you can to make the picture as REAL as you can (imagine the clothes you wear and the colleagues that are taking the exam with you). Finally when the exam is over I imagine the score I get.

This exercise has never failed me, I do it once or twice before each exam and when the day comes not only do I successfully pass but the degree of my stress is lower and my confidence is higher. I'm not promising you get the grade that you imagined...that would be awesome...but just believe in yourself and you'll do great.