#1
Whatever you think of external fetal monitoring, the fetal heart rate strips remind me a little of Adoration. The fetuses have be watched constantly, and the culture of OB/GYN labor and delivery teams is to want someone to watch them. If we're going down to get snacks, we think about who is watching while some of us go. If we get distracted by something, we look up and make sure what we just missed looked okay. If the system breaks down and we can't see the strips the way we usually do, we find a way around this to watch the strips. In Adoration, you can't leave the Blessed Sacrament alone. He is vulnerable. You may not be able to see him as usual sometimes, or you may have to leave, but you're solicitous about Him never being alone. When you get distracted from Him, you check right back in.
#2
I recently heard an argument that it is more merciful to do a KCl termination followed by an induction of a dead fetus, rather than to deliver a live fetus and have it painfully gasping for air. "I couldn't bear watching my baby gasp for air," the argument goes. While I empathize with that emotional response, a KCL termination is different in the objective nature of the act--it directly takes the life of the unborn, and we don't know if it's painful or not. A gentle induction which doesn't take that life directly can be followed by perinatal palliative care. Just like for an actively dying adult patient, morphine can be given for air hunger. Even so, it is not clear if extremely preterm babies feel this, but they can feel pain and much of their skin is not keratinized. (The air hunger question is particularly important because that's the emotional hinge of the argument, but fetuses under OB/GYNs' management are constantly experiencing difficulties with acid-base balance and we don't consider this painful.)
#3
Dear Editor,
NaPro technology is a little bit primitive and behind the evidence-based-medicine times. And it sort of likes that. But it's not really ready for prime time in medicine right now, so let's stop pretending that it is. Instead, why don't we work on getting it there?
Sincerely, a Catholic OB/GYN
#4
I took care of a lesbian patient who was overjoyed to tell me about her coming out. I told her I was glad for every step she took closer to real love. This story happened before the blog issues related to LGBT posts. I'm still angry about this misjudgment of me sometimes. (But forgiveness sometimes doesn't take away all the emotions connected to an experience. So I suppose that's okay.)
Hi mmatins! I am so glad to see that you are back to posting a bit -- a few months ago I spent many hours reading through this blog and I have thoroughly enjoyed and profited from your insights and wisdom; thank you for your witness and service. I found your blog as I was in the midst of an all-to-common fit of worry regarding my (potential) future vocation as a physician (possibly OB/GYN) and the ability to unite this with my faith. I am very curious about note #3 above. Would you be able to elaborate on this at all, at least regarding the aspects of NaPro that are not up to par with evidence-based methods?
ReplyDeleteAnd as an aside, I have been meaning to educate myself a bit about the physiology of fertility, gynecological issues and also regarding mechanisms of birth control. Do you have any resources in mind that are particularly informative, or could you point me in the right direction? I have a background in biology so I would actually appreciate reading peer-reviewed papers and the like. Thank you for any help you could give!
Peace, KT
KT, pleasure to have you back. Spread the word, we're open for business again! Hope your worries were abated when you read. Are you now enjoying that future, or is it still potential? Either way, my deepest encouragement and gratitude for what you're doing. It can be done and it is extremely important and rewarding.
DeleteAhh, #3 has long been on my mind as a complete post because it requires a lot more nuance than five lines of quick take can handle. NaPro swims contrary to a lot of well-performed research with large sample sizes...and that's not always a noble thing. Its gynecology isn't too terrible, but its perinatal management is at best unproven. What established the reference ranges for the progesterone nomogram? Kind of nothing. Some younger NaPro fellows don't follow that progesterone replacement protocol as a result. A few other things, like endometrial cultures and some uses of antibiotics and other fertility instruments have really been disproved as far as I'm aware. But some parts of NaPro, like ovarian wedge resection, are far ahead of their time by being so far in the past and so rooted in treating the causes of problems. There are certainly good things about NaPro, and the good outweighs the un-evidenced-based, which is apparently harmless even if maybe not so useful. It could also be that I'm speaking from a place of ignorance, although I've done the coursework for the medical consultant certificate.
As far as reading about physiology of fertility, the basics will probably not be in recent peer-reviewed literature. I actually recommend taking an NFP course if you haven't already. Marquette offers scholarships for its entirely online training and Billing is typically always offering a course in your localish area. Happy to talk more about these by email (medicalmatins@gmx.com). Another option is to view some of the webinars put out by FACTS. It looks like they're not available until fall 2020, but that's right around the corner and hopefully that deadline isn't extended. Otherwise, you could dive into Speroff's (best REI textbook there is), but it's a bit dense and focuses a lot on IVF/ART.
Thank you so much for these resources! I will definitely check them out and I very well may reach out with some more questions about NFP courses :)
ReplyDeleteI am still in undergrad and still very much discerning the vocation of medicine, but I will soon have to make a decision to at least start studying for the MCAT. Your blog has definitely assured me that the way forward as a Catholic OB/GYN is navigable, so thank you for writing so much about your experiences. My current fears mostly surround the ability of managing a career as an OB/GYN and simultaneously raising a family (but I'm not even sure I am called to the latter, either!). This discernment process is a major exercise in trust for me, but your blog has helped me learn more about what that future could be like, God willing.
Thanks again!
KT
Don't forget to think about careers that have shorter, more manageable training periods that would be more open to children, and more open scheduling later in the career. I have a post here about that. Not to overcomplicate things or to discourage you, but only to free you to do whatever you and God want.
DeleteSorry, the link I provided was to multiple posts. Here is a specific one: How to Discern whether You should Become a Doctor.
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