It's been a long time since I've written here or written anything, actually, beside the occasional email to friends and family, giving them updates. Life last year was full of me living it with little time to reflect on it. Since my last entry, my husband and I had a family-filled wedding reception, we honeymooned, I was offered a faculty position at a residency program, I accepted it, leaving my CHC home, my mother-in-law lived with us for three months...

...and in the middle of that all, we planned a pregnancy and I got pregnant soon afterwards.

I just completed week 4 of my new position, I'm still settling into my new office, while nesting at home--cleaning, preparing the last few necessities I need before the cub makes his appearance. Pregnancy right now, at nearly 34 weeks, is pretty smooth. Recognizing that a full term (well, technically late-preterm) baby could be just 3 weeks away is humbling.

But, I plan to work up until my due date. I'm due on a Sunday, and I plan to work until that Friday. I'll be seeing patients and precepting residents at 39w5d pregnant, barring any late pregnancy complications or labor before then. My last call shift will be at 37 weeks, and I'll be a the hospital rounder at 35 weeks.

I accepted the new position when I was just entering my second trimester. After receiving the offer, I disclosed my pregnancy and the fact that I would want to take 4 months maternity leave. Since that time, I have felt no friction and no discrimination at the fact that I would be taking maternity leave 2.5 months after starting my new position. That has been a blessing and has made the job transition that much easier.

But even in the ideal environment, with an uncomplicated pregnancy, empathetic colleagues, a flexible job and an understanding boss...being a pregnant doctor is harder than I anticipated!

This realization culminated in me spending a couple of hours one evening in OB triage, the very triage I began my education as an intern nearly 6 years before. I had preterm contractions at 26 weeks that were unrelenting. Even after going home with a dose of nifedipine, I continued to contract painfully until 4am, about 12 hours after the every 10 minute contractions started.

I started my clinic day with a constant, dull ache in my pelvic area, which for me felt like what had been my day 3 period cramps in the days when I had dysmenorrhea (painful periods). After my going-away potluck, which made me cry like a faucet, I saw a full schedule of patients to whom I had to explain my leaving the clinic over and over, with varied responses, then scarfed down food and drove to my late-night urgent care shift. It was in the middle of draining a groin abscess and bending over uncomfortably over my patient's pelvis that I realized that the dull cramp had long become contractions that were now every 5-6 minutes. One of my nurses at the clinic, who was an L&D (labor and delivery) nurse that I knew since I was a resident, bade me to go to triage...

...and to triage I went, where my contractions showed on the monitor. Thankfully, my cervix was long and closed. The little guy wasn't going anywhere. My husband and mother-in-law were by my side and my doctor was on call and made it in to evaluate me, sparing me what would have likely been a sterile speculum exam from one of the interns at my new home clinic.

I will not have residents involved in my delivery, not because I don't believe in resident education, but because I'm delivering at my residency program's teaching hospital. They will all be residents that I will work with. I'd rather maintain that professional distance. I may let them ultrasound me to confirm vertex (confirm the baby's head is down), but that's it.

I took the next day off of work. I had to. I barely slept during that night of contractions. It wasn't so much because of the pain--if I knew I were in early labor at term, I know those weren't the type of contractions to change a cervix and I would have breathed through them. However, each contraction was punctuated with a different fear--fear for myself, fear for my 26 week fetus who I couldn't feel kick because my uterus seemed in a tonic state, fear of realizing the statistic...

Fear of being the educated black woman with her baby at higher risk for preterm delivery, fetal and maternal mortality than white women who had not graduated from high school.

Fear makes for painful contractions.

My husband may have driven me back to the hospital if he saw me writhing in pain in bed all night, so I took it outside to our living room. As a physician, I would know if the contractions had taken a turn toward preterm labor, so I suffered in silence. My doctor almost wanted me to take off work the next week, thus missing the last week at my CHC. I at least took the next day off, had a five day weekend due to Christmas, and finished off my duties at work the next week.

I realized, as researchers are starting to realize, the role that stress has in pregnancy outcomes. My stress about leaving the job and my stress at work peaked the day I had those contractions. I entered work expecting emotions to run high at my going away potluck, and then was slammed with a full schedule of patients in my own clinic and a deluge of patients at urgent care with no break for me in site.

I talked to one of my colleagues, who worked that urgent care shift until her 40th week of pregnancy and even came back to work a shift when she was technically on maternity leave and not yet delivered, and she told me she had consistent contractions working that shift. I worked side-by-side with her, both of us pregnant doctors, at one point, and she was probably contracting then. They may not have been as bad as mine, but they were bad enough that she wanted her doctor to check her cervix at prenatal visits.

I wouldn't have known she was uncomfortable then. She was so stoic.

When I made my plans for maternity leave, I did so modeling female physicians who were pregnant before me. I saw them do it, and I figured I would do no less. For the most part, we work until the day the baby is due, or sometimes work until we go into labor if post-dates. We do not reduce call--sometimes, we stack up the call shifts so we do not return, bombarded with call with an infant at home. We do not miss work for prenatal appointments or nausea and vomiting of pregnancy. We try to vomit discreetly between patients in those early stages and make our appointments during our off times.

But I have to salute all pregnant doctors out there, and those who came before me, because 34 weeks in, and this has been hard! I was graced with light pregnancy nausea that lasted until 18 weeks and I have not yet vomited, only one scary episode of preterm contractions and now just have the regular Braxton-Hicks since. I did not have gestational diabetes, my swelling has been minimal so far and my blood pressures have been normal. I've gained twice the number of pounds I'd hoped to, but have a healthy, growing, squirming boy who I predict will be sized like his dad at birth to show for it.

Dad was a big boy.

For the most part, in my mind, I still have my non-pregnant body, so when I see my protuberant reflection in the bathroom down the hall of my clinic, I'm startled and amused each time. Pregnancy brain for me is limited to momentary word-finding difficulties, but it has not affected my medical reasoning at all. I feel like myself until I get up from my chair and feel the effects of baby head having weighed down in my pelvis and waddle and limp to a patient room, or when I try to sit back down and can't put my legs together because it pushes belly up into my lungs.

But to think that this baby may gain an additional 3 pounds, wedge his head into my pelvis and I'll be still commuting 40 minutes to and from work (work is only 15 miles away, but rush hour traffic is horrible!), trying to keep the steering wheel 10 inches away from my belly (doable) for the next 6 weeks makes me realize how amazing women are, most of us still having to work at home and/or at the job, growing tiny humans while being expected to perform at work as if none of it is happening.

I can't even imagine having any of the pregnancy complications my colleagues have had while working.

But power to all pregnant doctors and all mama doctors who have carried one or more pregnancies while doctoring. You made it look so easy that I thought I could do it, and I can, but you are all amazing!

More pregnancy-related topics on the way!

#pregnancy #inequality #obstetrics #worklife #milestone #clinic #preterm #maternity