Tuesday, March 13, 2012

Endocrinologists and Obstetricians

When I wrote the distinctively un-creative title for this post, for some reason it made me think I should prepare a poem. Perhaps a haiku, or a limerick.

Doctors have different approaches
To how each subject they broaches
OBs love babies
Endos are 'fraidies
The only word I can think to use now is "roaches"

...Or perhaps

OBs and endos are
different when assessing
risks in pregnancy

...Or perhaps not.

"Poet" is probably out as a potential career path for me, but I do think I've made some worthwhile observations about the differences between OBs and endocrinologists. I talked through some of this the other day with my mother, who is herself an ER physician, and we came up with some possible reasons for the discrepancy.

So far, in my short life as a childbearing woman, I've not had any OBs express disapproval about my choice to have children, despite the fact that I am a "high-risk" patient with diabetes. I do tend to choose my OB carefully, since I like to do pregnancy and childbirth with fewer interventions than might otherwise be standard protocol. There may be some selection bias at work here.

Endocrinologists, on the other hand, seem way stressed out by pregnancy. You can read about my interactions with endocrinologists on this topic here, here, here, here, and here. As you can tell, my experiences with these doctors have been...memorable.

When I talked to my mother about this apparent discrepancy, we came up with two possible explanations. The first is that endocrinologists, especially those who were trained more than 10 years ago, have not been fully able to assimilate how much insulin pumps have transformed blood sugar management and made it possible to have A1Cs regularly under 6.5 or even 6.0, during pregnancy and otherwise. We could call it the Steel Magnolias effect. I'm sure that endocrinologists, particularly those trained several decades ago, have seen individual patients with more bad things happen to them than have happened to Jenn and I combined during 6 pregnancies. We are grateful for so many developments of modern medicine, and know that healthy pregnancies would be much harder without them.

The second possible explanation that I came up with is the emphasis in obstetric medicine on "choice." While the language of choice has permitted the infiltration of some morally illegitimate developments, such as abortion, it has also placed obstetricians less in the role of decision-makers and more in the role of supporters. Of course, the whole natural childbirth movement seeks to grant women even more freedom to make their own decisions about pregnancy and childbirth (within moral reason), so there is still work to be done in this field. However, when it comes to the decision to become pregnant, obstetricians just don't seem to be quick to meddle.

As a final note: I'm not opposed to doctors making recommendations about pregnancy based on a woman's health. But I have heard far too often that being pregnant is not a good idea for me, without adequate evidence to support the recommendation. I have diabetes, but I have repeatedly been told that pregnancy does not pose any long-term risk to my health (and haven't been able to find any evidence to the contrary). I don't currently have any complications of diabetes (circulatory, renal, or opthalmological). In fact, pregnancy doesn't even pose much of a short-term risk to my health, besides the risks that all healthy pregnant women experience. Low blood sugars are a risk, but need to and can be managed in or out of pregnancy.

The one exception to this rule is the endocrinologist I had in St. Louis, Missouri. If you live there, go see Kim Carmichael at the Center for Advanced Medicine. He was awesome. He told me I could have as many children as I wanted. :) While I'm at it, I'll go ahead and recommend my obstetrician, Shanon Forseter. He's a solo practitioner, and trained in maternal-fetal medicine (for those of you who want a doctor with high-risk experience), but very friendly to natural childbirth.

What do you all think? Have you noticed a difference in the way your endocrinologists and your obstetricians treat you as a pregnant woman? I was told by another woman (the same diabetic woman with four children) that she got the same vibe from her endocrinologist. I'm not sure what Jenn's experiences have been like. Anyone's experiences disprove the rule?

1 comment:

  1. I think I've had the exact opposite experience, even though I'm not quite done with my first pregnancy yet. My endo is very "hands off" with my care, but I think that's because I've managed to keep my A1c below 6% this whole pregnancy. So most of my appointments with him are "Keep up the good work, see you in a month." Whereas my OB is extremely proactive and will suggest doing additional tests if something comes up. But I find to be a "let's find the problem before it is a problem" ideal. He also doesn't want me to go into labor on my own, and he's been in the high-risk business for over 20 years. I think he's more of the Steel Magnolias doctor than my endo.

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