Patients often ask me what it is like to be an obstetrician
I answer: “It is a fantastic career. I love being an obstetrician. It is wonderful to be able to support a patient on her pregnancy-and-delivery journey and to celebrate with her and her husband/partner the birth of their new baby.”
So often, a very special and personal relationship and friendship develops with a patient because childbirth is such a special time on life’s journey. It is wonderful to see her and her husband/partner again for management of subsequent pregnancies. It is wonderful to see an old patient again when she comes with her friend who is pregnant, and whom she has recommended to see me for pregnancy care. The continuity of care can also be through the husband. A while ago, a husband asked his second wife to see me for pregnancy care. He and his first wife (whom I had managed in pregnancy) were divorced and he had remarried.
The postnatal visit after the last pregnancy can be a very emotional time. Last week a patient with floods of tears gave me a big hug while her husband watched and smiled. She told me how grateful she was that I was her doctor and how much she was going to miss me.
Because childbirth is such an important time in a woman’s life, this special bond can continue over the years. It is so pleasing to see a patient again not only for the management of her next pregnancy or for gynaecology problems, but also when she is out and about with her family. She introduces her children to me and explains to them the important role I had in their birth. It is exciting and a great honour when these children, having grown up, come to me for management of their pregnancies. Those patients are called ‘second generation’ patients.
Some time ago my wife and I were having coffee in a large local restaurant. On the other side of the restaurant was a relatively large group of mothers with children. We casually looked over without paying close attention and said to each other how lovely it was to see a group of mothers and their children enjoying themselves together. Soon after, one of the mothers came over to us. My wife and I went over with her to their table. It turned out all the mothers were all related, all had been patients and I had delivered all their children. How special!
I am constantly amazed about the miracle of life. With the use of ultrasound scanning, I can visually track and monitor a pregnancy from the first visit until the birth of the baby. At six-weeks pregnancy the baby is actually four weeks old. It is <0.5 cm long. The baby’s heart can be clearly seen beating regularly. Incredible! This can be such a wonderful emotional experience for the parents-to-be.
While there is so much joy, my lifestyle as an obstetrician is not in my control. Although I can plan my day, I never know what I am going to be doing next. This is because of the unpredictable nature of obstetrics. A patient can go into labour at any time and on any day. She may have a straightforward vaginal delivery or a complicated childbirth. There can be a life-threatening obstetric crisis at any time.
Deliveries at any time means I have to immediately stop what I am doing at any time and rush to the hospital. As an obstetrician, I need to be available (‘on call’) for my patients 24 hours a day, seven days a week. The only time I am off call is when I arrange for an obstetrician colleague to be on call for me. This only happens when I am away at a medical conference, on holidays or attending a special event.
As a busy obstetrician, I have interrupted sleep on a regular basis. The sleep pattern is a bit like you experience with a newborn baby. But my interrupted sleep pattern continues. It is like that newborn baby never grows up. I can go two nights in a row with minimal or no sleep. But if it is three or more nights in a row it can be a challenge. I drink a lot of strong coffee on a regular basis. I smile when I hear how salaried emergency staff after they are called in out of hours are not allowed to go back to work without an eight-hour break. I can be up all night, go home for quick shower and then go to my office, bright and alert, for a full and busy day of consulting, patient interaction and decision making.
Adverse developments in labour can happen very quickly. The right decision needs to be made to safeguard the mother and her baby’s wellbeing. It is just the couple, her unborn child, the midwife and me in the delivery room. As an obstetrician, I need to act quickly and appropriately in a crisis. There are no peers, no support team. I don’t have time or opportunity to deliberate about what to do. I just have to act as I see appropriate. In these times I am grateful that I have had many years of clinical experience as an obstetrician. I have delivered thousands of babies. I also call on my excellent training, on my wisdom and my discernment to help me make sure ‘I get it right’.
Shortly after I started in private practice, I asked another obstetrician who had been in practice for many years what was the worst part of the job. He answered, without hesitation: “the loneliness”. On reflection, I consider that was an excellent answer, with which I agree. It is especially stressful when a crisis happens in the early hours of the morning when everyone else is at home asleep.
Patients often tell me and tell others how calm I am, even when there is a crisis. I put that down to being very experienced. But it can be stressful. I am very careful and I try to anticipate problems and so endeavour to avoid them happening. I often tell a patient I how much I value her wellbeing and the wellbeing of her baby and that I endeavour to treat her the same as I would if she was my own daughter.
As well as the joys, there are the sad times. As an obstetrician I need to be able to support and provide empathy to a couple when the pregnancy does not work out and there is not the planned and so-wanted happy outcome.
It is not unusual for patients to discuss and seek advice on non-pregnancy issues, such as relationship issues. This can be in all sorts of areas. Although I am not a trained counsellor, I am pleased to help as I can. Often they just want someone to confidentially share a burden with. There was one time a husband gave me a tie as a thank you gift for helping to save their marriage. The advice I had given when they shared information about their marital crisis was obviously very appropriate for them.
The impact of this hectic, unpredictable lifestyle on my family and on me in other areas of my life are huge. An example of this occurred recently on Sunday afternoon. There was no one in labour and so my wife and I decided to go to the cinema to see a movie. I can only book seats for the cinema at the last minute and not say the day before because I don’t know if I will get there as someone may go into labour. I always have an aisle seat at the cinema and church as I don’t know if I will be able to stay. Two-thirds of the way through the movie we went to see that Sunday afternoon, my phone vibrated. I keep my phone on silent mode in the cinema. I left the cinema to answer the call and was told by the midwife a patient had arrived in labour and was 4 cm dilated. On that occasion, I could return and see the rest of the movie. After the movie, I drove my wife home and then went to the hospital and delivered the baby. Once we had Gold Class seats and I had to leave to go to the hospital just as the movie started. I am grateful to Events Cinema for being understanding and issuing me with new replacement tickets.
There has been many a school function or school sporting event my wife and I have attended to support our children that I have had to leave. We usually went in two cars as I am so unreliable. I remember an occasion a short time after I started in private practice (and when I was not game to take any time off) when our older daughter was performing in a primary school production at the Opera House. The children were travelling in by bus, as were some parents, but not me. As the bus was about to leave the school the hospital contacted me to say a patient had arrived and was about to deliver. I said to my wife: “You go on the bus. I will go to the hospital and then meet you there”. The delivery took longer than anticipated and so the performance had started when I arrived. I arrived at the Opera House but was not allowed in until intermission. Amanda (my daughter) said to me: “You weren’t there!” She was very upset. In the sea of many parents in a packed Opera House auditorium, she found while she was performing on stage my wife Robyn and my empty chair beside her. More recently, my granddaughter was performing in a function at NIDA. A patient arrived at the hospital fully dilated just as the performance was about to start. I left, made a dash to the hospital for the delivery (got there in time) and returned to NIDA. Again I had to wait outside until intermission. I missed Ame performing as she was on stage in the pre-intermission session.
I have to be careful about working in the garden. I realised soon after I started in private practice I could not mow the lawn myself. To turn up to the hospital for a delivery ‘all hot and dirty’ from mowing the lawn didn’t look good. Recently on a Sunday afternoon, I wanted to pave a small area next to the letterbox. No one was in labour. I changed, had pavers ready, mixed up the cement and was about to start when the phone went. A patient arrived at the hospital fully dilated. I attended. The paving eventually got done.
I need to plan a significant holiday over nine months before the date so patients can be advised. My wife and I have organised a holiday in September. As soon as the date was set, I posted the time I will be away on this website, on my Facebook sites, on my Twitter site and on my Google+ site. So many patients have told me how much they appreciated the postings as it meant they could plan their next pregnancy so they will not be due when I will be away.
There have been interesting interactions with the police when driving to the hospital. Once I was called in the early hours of the morning to attend urgently for severe foetal distress. I was driving carefully but was exceeding the speed limit considerably as I was more concerned about the baby’s life and wellbeing. A police speed trap was set up on the other side of the road. When the police saw me coming from the other way to their camera and realising I was travelling at a good speed, a police officer ran across the road waving his arms for me to stop. I braked and stopped in front of him. I jumped out of my car and explained I was an obstetrician on the way to the hospital for a potential life and death emergency and I did not have time to stop. I said they could escort me, they could take me in their police car or let me go, but I did not have time to stop. This confused the officer and it was obvious to me he did not know what to do. He said to me: “leave your licence with me and go”. I said: “it is illegal to drive without a licence”. He said: “don’t worry. There were no other highway patrol cars at this time of night in this area of Sydney, so no other police would stop me”. I asked him for his pen, wrote his name on the back of my arm, got back in my car and took off to the hospital. I was able to deliver the asphyxiated baby who recovered fully and has done well. When I got home, I phoned around police stations and located the police officer’s sergeant. I explained to the sergeant what had happened. He apologised for the officer’s behaviour saying he should never have taken my licence. He made the police officer return my licence to me that day in the daytime when he was off duty. Another time on the way to the hospital in the early hours of the morning my car broke down. A police car pulled in behind me to see what the problem was. One of the police officers was the husband of a patient. So, I got into the back seat of the police car and they took me to the hospital for the delivery.
I always have to be very careful with alcohol when out and when relaxing at home as I never know when the phone will go. I never drink excessively anyway, but if I know someone is in labour and we have friends over, I will avoid alcohol. If no one is in labour and I am soon to go to bed, I will often have a nip of a good quality scotch.
One part of my job I enjoy very much is the interaction with people of so many different backgrounds – different occupations, different ethnicities, different religions, different ages, different socio-economic backgrounds, different values and different views, different lifestyles, and even different sexual orientations. I enjoy chatting with my patients and their husbands/partners very much about topics relevant to them and learning from them. I become abreast of what is relevant to people and how they think and see life. People vary so much. There is an expression ‘all you know is all you know’ and for most people, they only have the opportunity to interact to any significant extent with people of the same background as themselves. As an obstetrician, I can cross lots of life’s bridges and my life has been enriched because of this.
I can think of a number of considerations that help me stay healthy – physically, mentally and emotionally – with such a hectic lifestyle. I am careful with what I eat and drink and I watch my weight. I go to the gym when possible. I have a personal trainer for two one-hour early-morning sessions per week. Mind you, sometimes I don’t get to a session or have to leave a session early because of a patient in labour. I have a strong Christian faith, which gives me great strength. I have a fabulous marriage to a marvellous and very patient wife. I have a wonderful and close family. It gives me great joy that my daughter Emily is now working for me as a medical secretary.
A lot of my colleagues at my stage wind back their obstetric practices and focusing on gynaecology, which has less stress and more predictable hours. Some subspecialise from the beginning of their career as they don’t want the crazy, stressful, unpredictable lifestyle with the long and unpredictable hours of an obstetrician. Some from the beginning of their career decide to join a group obstetric practice where they can share their obstetric workload and especially their out of hours availability with other obstetricians. While this business model enables an obstetrician to have a better lifestyle it does not facilitate an obstetrician having meaningful relationships with individual patients. As well in the rostered ‘on call’ set up of a group practice a patient does not know which of the group’s doctors will attend on their delivery day. As for me, none of the above scenarios are appealing. I love my work and the relationships I have with my patients too much.
Yes, it is a very unpredictable life that has lots of highs and some lows. It is never boring and has lots of stressful moments. If I had my time again, I would do the same and become an obstetrician. I can’t think of another job that can give the same joy, rewards and satisfaction as being an obstetrician.