Monday, February 22, 2010


Obstetrics and Gynaecology has always been high on my list of possibilities, but this morning it doesn’t really grab me as a future career. Not that it is boring or anything, although the pace seems nice and relaxed – 15minute appointments for returning patients, 30minutes for new patients, and plenty of coffee breaks. And there is a nice variety, from the very first patient who is in her early 20s and trying to conceive, to a lady in her 70s who is recovering from endometrial cancer. There are prenatal checks and postnatal checks. I am kicked by overexcited babies in the womb and garbled at by toddlers. The O&G specialist is very welcoming, we go through patient histories and he explains his practice. I want to see more, so I make the mistake of staying to observe an amniocentesis.

The couple comes in – they are in their early 30s and have a toddler at home. They are looking forward to a sibling for their other child, but the screening for Down syndrome has come back as high risk, so they want it investigated. There has been some trouble earlier in the pregnancy with a clot, and last week the woman noticed she was losing large amounts of clear fluid. She thinks maybe it was something to do with the clot, and is not too troubled because everything feels normal now. The specialist looks more concerned. So we go next door for the ultrasound. We all look up at the screen; see the little head, the little spine, the little heart. But the specialist sees more. He realises there is not enough amniotic fluid to take a sample. The lady starts to cry; she knows something is wrong, and deep down has known for some time.

The specialist explains that essentially, her waters have broken, and contractions will probably start within the next few days. Her 15-week-old fetus is going to be born early and die, and it cannot be saved. They discuss outcomes if the baby, by some miracle, makes it to term. It is more susceptible to infection during pregnancy, its musculoskeletal system won’t develop properly, and most importantly, neither will its lungs. It will not be a viable birth. So they discuss termination options. She cries, but she does not break down – she is saving that for later. Her husband holds her hand and asks all the questions that she cannot. I admire them both – their hearts are breaking, but they hold it together and learn about all their options before they leave. I hope they’ll be ok.

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