OBGYNDoc
Minneapolis, MN
Female, 36
I am a practicing Obstetrician and Gynecologist, providing care for women in all stages of life. Approximately half of my practice consists of pregnancy-related care, including routine prenatal care, high risk obstetrics, and delivering babies at all hours of the day. The other half consists of gynecologic care, which ranges from routine annual check-ups to contraception and menopause. I perform many surgeries, including laparoscopies and hysterectomies.
After having one miscarriage, the risk of having subsequent miscarriage is only slightly higher (approximately 30% rather than 25%).
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Most couples do relax a bit with their second and subsequent pregnancies because most of the anxiety is related to the fear of the unknown. Just having had the experience of knowing what a labor room looks like, what it feels like to have an IV, what to expect when it is time to push, and how to cope with the sleepless nights of caring for a newborn can alleviate the stress that a first-time parent experiences.
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In my practice, we do not perform water births. For one, when a patient is in a tub full of water, it is extremely difficult to intervene should an unforeseen emergency arise. I have seen enough difficult and harrowing deliveries to know that I always need to be prepared for an emergency- vacuum and forceps deliveries, as well as maneuvers for shoulder dystocia (when the baby's shoulders get stuck under the mother's pubic bone and won't deliver) can be life-saving, and the decision to use these maneuvers is made in a split-second. Every minute of delay could result in permanent injury to the baby. Secondly, as a provider, it is also important that I protect myself from exposure to any bodily fluids. When a patient is delivering in a tub, I think it is nearly impossible to avoid direct contact with the water, which is contaminated with the patient's bodily fluids. We all should practice with universal precautions- protect ourselves from direct contact with blood, amniotic fluid, etc, regardless of who the patient is and what diseases they have been tested for. I don't have a problem with laboring in a tub, however. As long as the baby can be monitored safely and appropriately, and as long as the baby's heart rate is appropriate, then I think a tub labor can be a nice alternative for someone who is hoping to avoid an epidural or IV pain medications.
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The majority of miscarriages occur in the first trimester. By the time you reach 12 weeks, if a normal heartbeat is detected, the risk of miscarriage is only 3%.
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If a patient has evidence of an infection, I would certainly bring it up.
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When it comes to circumcision, I can only present the facts, and then the parents have to make their informed decision. The benefits of circumcision include decreased transmission of STDs such as HIV and HPV, and therefore decreased penile cancer; there are also decreased rates of urinary tract infections. However, the American Academy of Pediatrics states that there is no medical indication for circumcision. There are many reasons people choose to have their child circumcised- religious, cultural, and social. It is now standard to use local anesthesia during the procedure, but of course, there will be discomfort associated with the procedure.
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Without becoming too political with this question, I'll simply say no. My responsibility to my patients is to provide them with counseling and the resources available to them when faced with a difficult decision about continuing or terminating a pregnancy. I always support my patients in their decisions. For every pregnant patient, I present the options for genetic screening available. Some people choose to be tested because they are looking for peace of mind, others choose to be tested because they would prefer to be prepared in the event that they are having a child with special needs. Others choose to be tested because they would terminate the pregnancy if there was an abnormality. All are valid options, and I want my patients to feel empowered to make their own decisions based on the education I provide and based on their own personal beliefs.
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