“I want you to be there when I have my baby…”
The words sting every time I hear them. The guilt flows like a broken dam and pulls at my heartstrings, making me feel so heavy inside…
But, I can’t make that promise. I can’t make that commitment.
Why? I probably shouldn’t explain to my patient the real reason.
Why not? Because it’s not about her … it’s about me. It’s about my family. It’s about my physical health. It’s about my mental health.
Wouldn’t it be nice if we obstetricians could be present for the birth of each and every one of our patients with whom we spent nine months caring for in the clinic?
I’ve done it before. I remember those days. Just out of my residency training. Full of energy. So incredibly passionate, almost possessive about my patients. Connected in such a way that if I missed a birth or a special moment, I felt a sense of loss. My patients needed me, and only me. I made it to almost ninety percent of their births. I only missed the ones when I was out of town or stuck in the operating room while the baby fell out.
My patients loved me. My OB panel was so full, that I had to turn people away. I was so proud to provide that personalized care my patients craved. I was “there” for them. I was in my element and mastering my trade…
And then it happened.
I came home one day from work and my fourteen month-old son screamed when I picked him up and the nanny left. That was it. I had to ask myself. Are there other people in this world capable of doctoring my patients? … Do I really want to mother my children? It was an epiphany of sorts. And I realized something had to change.
So, I started to let go. And it was hard, almost painful from an emotional perspective. I started to make boundaries and say “no”. I educated my patients about the group of providers I worked with and shared on-call duties with. Some of my patients understood, others were angry, a few … just sad.
A friend of mine mentioned to me the other day that she really enjoyed her first birth experience because her doctor that cared for her throughout her pregnancy delivered her baby. Her second delivery was with “some random doctor” that she never met before. She was disappointed. She probably didn’t realize that her doctor was disappointed as well. It is the sacrifice we make. Not being there is a sacrifice. A sacrifice we make for the sake of our families and our children.
I ask myself. What is worse? Missing the delivery of my patient and trusting a colleague to attend … or missing the dance recital at my daughter’s preschool? Who will have the long lasting scars? Who will be most affected? A birth is a moment in time. Motherhood is a lifetime.
So, I talk to my patients, openly. I explain to them, with frank honesty, why I may or may not be there. I express my understanding if they choose to look elsewhere. I can only offer them what I have to give. But, I fully and wholeheartedly trust my team. For this, I sleep at night. We are all in the same boat and we want the same things … balance.
I leave you with a great excerpt from a letter from one of my most adorable patients.
“I gave birth in about 2 hours with no notice and no pain meds of any sort, we didn’t freak out and just went with it because we knew that with you as our doctor, even though you were not there, we were in great hands and we had everything under control … Thank you so much for truly caring and treating us like family.”
Peace. Redemption. Harmony.
burning the short white coat 
I really appreciate and understand this post. I work as a midwife in a busy practice and you get to become close with many patients, not all of whom you deliver. It is a relief when you can trust your co-workers to also take good care of them. Thanks for the reminder that it is okay to take time for yourself and your family. I look forward to reading more of your posts! Susan Myers CNM
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Reading this was like finally seeing someone put in to words what I feel on a daily basis. I have been out of residency for three years and still struggle with the feelings of being torn between wanting to be there 100% for my patients, but also wanting to be there 100% for my two boys. It is so hard to not always carry around some type of guilt. Whether it’s guilt about missing a bedtime with my boys or missing a delivery of one of my patients, there is almost always something weighing on me. I have been trying hard to find the right balance that I fear can never be fully obtained. But as you said, ” A birth is a moment in time. Motherhood is a lifetime.”
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Hi Jaime – thank you! It’s the reason I wrote this post. I realized how many of us struggle with this problem. So many patients just don’t understand that it really is so hard for us. But, you are doing the right thing. Your family needs you. Medicine is a job and is a VERY important part of our lives, but we LIVE for family…
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I really appreciate this honest post. I was cared for by an amazing OB/GYN throughout my pregnancy and for several years prior. But when my water broke three weeks early, both she and her partner were out of town, and I got a truly horrid doctor who my OB admitted later she barely knew. I don’t know if it would have made it better, but I really would have appreciated if my provider had been upfront with me about her partners and the people she uses to back her up, so I could have at least been familiar. At my 37 week appointment I was already 3 cm and the doctor told me the baby might come soon. That was a Tuesday. She and her partner were scheduled to be out of town that weekend. I feel like she could have said something. I went into fast, scary labor that Friday night. The doctor provided such poor care that I complained to the hospital, the state licensing board and the Joint Commission. I ended up being treated for postnatal PTSD and PPD. I tell you this not to make you feel guilty but to underscore the importance of good communication about your back-ups and on call schedule. Had my OB told me the name of the doctor on call during her time off, I would have looked him up, seen a number of bad reviews and asked that the hospitalist or on-staff OB deliver my baby instead. I realize this is not a typical case but it does bring to light the importance of open, honest communication (like your essay) before delivery. I felt abandoned by my provider, and I don’t think that had to happen. Yes, birth is just one moment in time. But it can be extremely defining, especially if you are not treated in the way you’ve come to trust. I still need a nurse to sit with me during routine gyno exams so I do not freak out, and it’s three years later. All because my birth experience caused me not to trust providers and left me scarred, possibly for life. My husband, child and family too. So please keep talking with your patients, tell them about your on-call rotation, offer a chance to meet the other docs or at least become familiar with their work. A lot of trauma and bad feelings can be headed off by open, honest communication with your patients.
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Hi Erin- I truly appreciate your comment. We have worked really hard to build a team of providers that practice similarly and strive to provide a consistent patient experience for our patients. It takes a lot of work and provider to provider communication to make that happen. I realize that is not always the case in On-call groups and it is something we should challenge ourselves to provide for our patients if we expect to trust our partners to care for our patients when we are not working or on vacation.
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I have found that balance by being a solo practitioner who takes on patients who are due in certain months of the year– then I promise them I will be there for three weeks surrounding their EDC but not necessarily in the weeks prior. I do all the prenatal care. We sign a contract to this effect when they join the practice as a new Ob and it works very well. In the months I have no one due I take vacations, go to conferences etc. I am actually in need of someone to join me since I am so busy.
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