Sunday, March 20, 2011

An Open Letter to Pre and Postnatal Medical Providers

You guys really rock.  The vast majority of my interactions with you have been pleasant, professional, and compassionate.  The midwife who cared for me during the first 33 weeks of my pregnancy with T was so fantastic and knowledgeable that I don’t understand why any woman would request an MD instead.  The lactation consultant who took time out of her busy day to mail me helpful tips to get me through nursing with stitches along my areola blew me away.  The nurse in the delivery room who knew something was wrong with the amount I was bleeding after T’s birth before we did and tried to get us help, boy did we love her.  The doctor who found evidence of the left behind placenta 5 days after T was born was so gentle and kind as he was removing clots that were blocking his ability to use the ultrasound.  He knew what he was doing was excruciating to me and as I broke down and cried from the pain he told me he was sorry over and over.  He was so extraordinary that he is now my doctor.  And the kind doctor who told us I had miscarried this past summer, well she could not have treated us with more compassion during one of the most difficult moments of our lives. 

Again, the majority of my dealings with you guys have been great.  Please accept my constructive criticism in the spirit it is given.  I know you can’t be perfect, heck that’s a big part of one of my points, but everyone (including me) can strive to be better.   So four things:

1.        1. Please be sure to listen and always remember to be compassionate.
This is really the most important part of any medical professional/patient relationship.  It is the reason that the woman who delivered T is no longer my doctor.  It sucked that she didn’t come back to delivery after she was called and told I was bleeding heavily.  It sucked that she forgot to see me in the hospital the morning after T was born, she did send someone that afternoon after the hospital contacted her.  But several days later when I was dropping huge blood clots and knew in my gut that things were not right she and her nurse dismissed my concerns on the phone and only agreed to let me come in the next day and see another doc when I pressed the issue.  I did not have a history of being a frequent caller or extra appointment maker.  I was scared and I felt like my doctor wasn’t listening and I had nowhere to turn.  I honestly didn’t give a shit that part of my placenta was left in my uterus.  Accidents happen.  My former doctor is human.  The problem was fixed with a very quick outpatient surgery.  If she had been sympathetic and kind she’d still be my doc.  She made me feel like I was bothering her and she was always in a rush.  How can doctors effectively treat patients without carefully listening?  This fall I had a second D&C after my miscarriage and all of the “products of conception” were not removed creating an incredibly unfortunate 6+ week period of uncertainty until I finally passed the material and the pregnancy hormone was out of my body.  The great news was I avoided yet another D&C, the even greater news was my doctor was fantastic to me and I didn’t think about leaving him for a second.
2.       2. It is not useful to tell women that nursing does not hurt if you are doing it right.
I was told this by a lactation consultant in the hospital.  I was told it again in by a lactation consultant the doctor’s office.  I wanted to nurse so badly, but it hurt like crazy.  After talking to my mom friends I learned not only does it hurt, it often hurts with each kid.  And after a while it doesn’t hurt anymore.  It would be much less disheartening to a hormonal new mom if the lactation consultant explained that until your nipples toughen up it totally hurts.  But it is really worth it, it does get better, it provides fantastic benefits for both your baby and you.  I still don’t know why I forced myself to stick with it, but I don’t begrudge women who didn’t.  Who wouldn’t feel like they were doing it wrong?  Who wouldn’t want to give up?  I believe more women would continue if they were given better information.  It certainly was demoralizing to hear it shouldn’t hurt.  We can take the truth!  We’ve just given birth for God’s sake, we can deal with pain.  Especially if we know it won’t last forever and it really is best for our child.

3.       3. Change the practice of referring to a miscarriage as a “Spontaneous Abortion”
     I am 100% pro choice.  I am grateful for my right to choose what happens to my body.  I know the term “Spontaneous Abortion” is a medical one, but we hear you say it to each other and occasionally to us.  We see it written down.  And the pain it causes in unnecessary and frankly cruel.  How hard would it be to change the terminology?  In our society the word Abortion is so loaded.  To someone like me it means choice.  And I’ll tell you what; there is NOTHING about a miscarriage that involves choice.  In fact, it is the complete absence of choice.  It is heartbreak, it is helplessness, it is the fear that you have failed, that your body isn’t good enough, the worry that you somehow caused it to happen.  No matter what the modifier is before it, the word Abortion is the most unhelpful one I can think of when describing a miscarriage.  It’s an easy change and it would save a lot of hurt.

4.       4. If it isn’t an emergency please do not leave an unclear message on the voicemail of a pregnant lady after the office has closed on Friday afternoon requesting a phone call first thing Monday morning because a blood test needs to be retaken with no information about what was wrong with the first test and with no reassurances that everything is fine with your pregnancy.
     Tomorrow morning I’ll be explaining to the nurse practitioner at my doc’s office that she created an enormous amount of anxiety for me this weekend.  I will be kind and constructive; I don’t want to alienate her because I might need to see her in the future.  But really, what the hell was she thinking?  I had seen her earlier on Friday morning and we had discussed my miscarriage and anxiety about this pregnancy.  To make matters worse, the on call doctor for the weekend wasn’t part of the practice.  My doctor was on vacation and there was no way to find out what the nurse was calling about.  The on call doctor told me there was definitely no imminent danger to my baby, if there was I would be instructed to go to the ER.  He also mentioned he tells his nurses not to make calls like this on Friday afternoon so patients don’t get upset.  Smart guy.

Yes, these examples come from my personal experience.  But they boil down to some pretty universal things.  Treat us with compassion and listen to what we are saying.  Tell us the truth.  Avoid being hurtful at all costs.  Don’t create worry where there doesn’t have to be any.

Thank you to all the medical professionals out there for helping so many people.  And I will promise to continue to try to treat you all with kindness and consideration.  Emotions run high when it comes to growing babies.  As patients it is our responsibility to treat you the way we want to be treated even if we are scared or receiving terrible news or have just had a really shitty day.   Thank you again for doing your part.  

Karen Cordano

And thanks for helping me bring this little guy into the world.  Please ignore the job I did butchering his hair.  


  1. Regarding #2 - I agree with you. It HURT a ton with my first, the first six weeks were torture. However, I am not lying when I say that it NEVER hurt with my #2. It hurt for just a little while with #3. Honestly, you aren't doing anything wrong when it hurts, most of the time. There are so many factors, and most of them are outside our control! Cut new moms some slack and say, it will probably hurt, and here are some factors that you can change, and here are some factors that you can't.

  2. This is such a good post. It's great to read about (and to reflect on my own) positive medical interactions, and it's outrageous to hear about some of the things you were told (and yes, I have my own outrageous stories, too. Ugh.). I can't believe they told you it wouldn't hurt to nurse; I'm not planning on ever having kids, but that's something I knew about and it's absolutely ridiculous that someone would tell you that! I read that part out loud to Dulcea and then yelled at it. She said you should just be allowed to tell everyone to fuck off if it feels necessary.

    The compassion part is huge. There are so many professions where you're the person people turn to for help, and I think it's really important for the expert/authority/professional to know how to say, "I know where you're coming from, whatever you're going through is normal (even if it's not common!), and we'll get you through it." NO MATTER WHAT. Just saying those words is so important and can get you started on the right path, whether you're a doctor, a dog trainer, a receptionist...

    Anyway, thanks for a great post. I hope everything goes well when you reach them on Monday! We'll be thinking of you.

  3. Yeah, it fucking hurt. And it sucked royally to hear that I was doing it wrong if it hurt. It hurts! It hurts it hurts! I howled in the middle of the night. I pushed through and stuck with it, but not without feeling like I was doing it wrong and failing to get it right. And as a new mom, I didn't need that shit. It just hurts less if you aren't doing it completely wrong.

  4. Thank you for this blog entry, Karen. The phrase I use is "nipple stretching pain", and then I let moms know that it is exactly what it is. Nipples. Stretching. I abhor the "it only hurts of you're doing it wrong" line. As moms, we blame ourselves for everything. I can't tell you how many times I've heard a new mom say "I just KNOW I'm doing it wrong!" only to discover a significant tongue-tie or some other reason for the excruciating pain...
    Thank you again, for this blog post. It had an effect on me today.

  5. Thanks for the comments, friends.
    The breastfeeding thing is really something I know a lot of moms can relate to. Although I have a dear (and lucky)friend who nursed 2 kids pretty much pain free. But it is really frustrating for so many. Suzie-I'm not surprised you would never say that. The consultant who really helped me at my doc's didn't say it either.

    The larger thing for me was I feel like these general points encompass the majority of crappy doctor stories we all have. The person I know who had a scheduled c-section because of a number of compelling reasons? At her first prenatal visit for her next pregnancy a new doctor (who was working WITH her doctor in that same practice) told her the c-section was completely unnecessary. Needless to say, she left the appointment in tears. Thankfully a nurse who remembered her from her first pregnancy was there to comfort her and let her doctor know what happened. But, Jesus! That doctor needed to be told, "Avoid being hurtful at all costs." and "Don't create worry where there doesn't have to be any." She'd never met my friend before, she didn't have firsthand experience with her pregnancy, she just read a fucking chart! So many crappy things could be avoided if people behaved with a bit more respect.