With all of the news recently about the measles outbreak in California, I have seen many news articles and blog posts referring to the parents of unvaccinated children and their contribution to the epidemic. As an obstetrician, when a pregnant patient informs me that she is not planning on vaccinating her unborn child, I can refer this discussion to her family practice or pediatrician. Maternal vaccinations during pregnancy is a topic I need to discuss with each of my patients. This can be one of the most frustrating conversations that I have each day, as there is good evidence to support the benefits but an enormous amount of unsupported evidence on the internet. This topic and others repeatedly arise in my daily work, so I have decided to address the most common in a letter.
Dear Pregnant Patient,
As part of my training to become an obstetric MD, I have spent 4 years in college, 4 years in medical school and 4 years in specialty training. I am required to perform ongoing medical education each year and also read journals to keep as up to date as possible. What I don’t read are articles on the internet that are not supported by medical fact. Just because you have found an article via Dr Google to support your position, doesn’t mean that I need to agree with it. Please read below as it will save you an inordinate amount of time searching the internet.
1. The fact that you are seeing me for an ob visit is a reminder that you are pregnant. I would not prescribe a medication that would cause harm to your baby. So if I inform you that you need a medication, don’t ask “Will that medicine hurt my baby?”
2. Pitocin is a medication that has reduced maternal deaths from hemorrhage in the developed world by 70%. It is much more effective when given prior to a hemorrhage (prophylactic) than once a hemorrhage has occurred. Similar to wearing a seatbelt, everyone needs to wear one because you can’t always predict who will be in a car crash or have a hemorrhage.
3. If I discuss your weight and recommended weight gain during pregnancy, I am not trying to be judgmental. I am attempting to improve the health outcome of both you and your unborn child. Obesity and excessive weight gain are associated with preterm delivery, diabetes, hypertension and increased risk of operative delivery.
4. I try to stay on time as much as possible with my office schedule, but sometimes need to attend to a patient in labor. If your appointment is delayed because of this, please remember that you will be a labor patient soon.
5. Vaccines during pregnancy are meant to protect you from getting ill as well as protecting the health of your unborn child. During the first year of life and before infants are vaccinated, they are susceptible to illnesses from the caretakers in their life. Your hurry to get out of the office today or the pain you may experience from a shot are not reasons to decline vaccination.
6. An ultrasound assessment of you baby is usually done at 5 months of pregnancy to rule out major problems with the pregnancy. At this time we can usually determine the sex of the baby. We will not order the ultrasound earlier so you can fit the “Reveal Party” into your social calendar. We will not repeat the ultrasound just to be sure the baby is a boy or girl. If you can’t bond with your child because you’re not sure if it is a boy or girl, there are bigger problems.
7. All obstetricians have the same birth plan for their patients – Healthy Mom, Healthy Baby. We will honor any of your birth plans as long as it doesn’t conflict with our birth plan. And remember how much experience we have had and how many births that you have attended.
8. Childbirth is painful – I think it started with that passage in the bible about Eve eating an apple. If you don’t want pain meds, we won’t force them on you. If you do get pain meds, realize that it may not work 100% of the time. You don’t get a medal if you decline pain meds and it is not any one persons’ fault if your pain medication doesn’t work as well as you expected.
9. We are always available after office hours for emergency calls. Calling at 2 am to ask if you can take a Tylenol or at 5 am to report on a mild pain that has been present for 3 days is not an emergency.
10. The Family Birth Center has a limit on the amount of people who can be present during the delivery of your child. Family does not refer to your sister’s boyfriend’s cousin – especially when they can’t remember your last name when looking for your room.
11. If you are unable to be “skin to skin” with your infant immediately after birth, you and your child will still have a chance at being well bonded. I think most of us are bonded with our mothers and we were whisked off for a bath and to be bundled up before being able to see our mother’s face a few hours later. My youngest daughter was 25 months old when she first saw my face and heard my voice and she knows just as well as her sibs whom to ask for money or a car ride.
I love being part of a woman’s pregnancy and birth. Hopefully my Birth Plan coincides with yours.