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Lifting a Taboo

My first real experience with labour and delivery came when I was about eight years old.

Our neighbours had a hobby farm, and one of their goats was delivering a breech kid. To me, it was a horror scene. Momma goat was crying out, there was slime, feces, urine, and SO MUCH BLOOD. I thought for sure the momma wasn't going to make it. Her kid was coming out hooves first, all gangly and needing to be pulled out of a hole that did not look at all accommodating.

I was seriously scared about the possibility of that happening if I ended up having a baby.

For most people who don't go into health care, they do not see more than a handful of births in their life, if any. Those of us in health care though can see any number of deliveries, some witnessing thousands in their lifetime.

Some of these births are romantic and lovely. Mom sneezes and suddenly a beautiful happy baby is on her chest. June Cleaver would be so proud. These are the things that dreams are made of.

But, because of the way our brains are wired, we remember the unhappy deliveries in a vain attempt to prevent them from every happening again.

The deliveries burned into our memories are the ones that we are monitoring closely for hours at a time, crash sections that do or don't save a baby, where everything that could possibly go wrong, no matter how wonderful the parents are or how clever and diligent we are, everything goes wrong.

Our bad days can be really, really bad. It's no wonder that so many health care workers are superstitious and get angry if certain words are spoken on the unit. We hold onto the lessons we've learned, memorizing all the things that went wrong as though we can prevent a poor outcome in the future. *

It's not surprising that health care workers are more likely to experience post partum depression and perinatal anxiety. Every twinge, cramp, sneeze holds more meaning than it reasonably should. Realizing that our babies are healthy can take weeks of nothing going wrong before we believe that somehow fate has left us alone.

But what really breaks my heart is the way that we deal with our own losses.

The folks that I talk to, and myself, will hide our losses. We don't want to bother anyone else. We know how hard loss is on our colleagues so we do all we can to hide our emotions and contribute to our friends' suffering. We are already suffering enough for everybody else.

This is only made worse by the culture of ignoring loss, where we are encouraged to pretend it didn't happen, that it's not a big deal. The paternalistic way that medicine has been taught, encourages downplaying the impact of a pregnancy loss for our patients. We wouldn't want to encourage their hysteria! Even though we KNOW this is not patient centred care, the initial thought is minimizing our patients' pain. And then we act with kindness because we also know that's awful and, well, dumb.

But health care workers keep working. When we're sick, tired, sad, or actively miscarrying, we keep working. Presenteeism is something that gets drilled into our heads during training. When we have a loss, and heaven forbid need to go to the emergency department for help, we minimize our own pain. "Don't worry about me! I'll be fine. Did you get your break yet?" We are very good at deferring our own suffering and deflecting any concerns or questions back to the one who is checking in on us.

Female physicians feel a need to prove that we are as strong as a male physician and continue to work until the last minute, ignoring our pregnancies.

Researchers are finally looking at the link between being a physician and issues of fertility, miscarriage, and pregnancy complications. My favourite quote of the linked articles comes from Dr. Ayesha Khan; "there is very much this idea of, ‘If you can’t cut it, too bad.’” It seems so unfair since so many of my colleagues defer having children until their career and their practice is settled, leaving much less time to be successful when IVF is required or they have recurrent miscarriages.

I am very grateful that we are discussing the impact of our careers on the rest of our lives. The taboo associated with miscarriage, pregnancy complications, loss, and infertility has to be lifted. If we are going to be our best for our patients, we can't do it under a shroud of our own shame.

*poor outcome is doctor speak, usually means death

This post is written in time for the Bridget's Run in Barrie, October 21, 2023 in support of those who have suffered loss. Bridget's Bunnies is working to make sure no one has to suffer alone.

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