Soothsaying and Specializing
His first patient of the day, Sharon, is six weeks pregnant with her third child. She's been spotting and has a cramp in her left side. Sharon fears she's having an ectopic pregnancy, in which the fertilized egg implants outside the uterus. Though they're real and dangerous, ectopic pregnancies are rare. But Dr. Scher is used to worried patients self-diagnosing, so he uses an ultrasound to check her womb.
"Just look at that great picture!" he exclaims. "Here's the yolk sac feeding the baby. It's excellent!" The bleeding and cramping are fairly common, he explains, and nothing to be concerned about. The worry lines on Sharon's face smooth out. Patients arrive happy too. Elizabeth Neidell, 30, who's in her 38th week, wants to know when she'll give birth. The baby's head isn't in her pelvis, where it needs to be for delivery, Dr. Scher says. "Judging from experience, you're going to go a few days past due," he predicts.
Soothsaying is another requirement of an ob-gyn's job. Many women want to know when -- exactly -- their baby will arrive. By noting the baby's position and checking the mother's cervix for dilation and effacement, obstetricians can make an educated guess about when that moment is likely to be. But even after all these years practicing medicine, Dr. Scher admits that predicting nature is an imprecise science at best.
Because he specializes in high-risk pregnancies, Dr. Scher must deliver the news of a miscarriage more often than he'd like. Today is no exception. A patient early in her first trimester has just miscarried for the second time. Dr. Scher orders a D&C -- a dilation and curettage -- for the next day. With the patient under mild sedation, a sterile plastic tube with a sharp end will be inserted into the uterus. The doctor will use this tube, attached to a suction machine, to lightly scrape and empty the uterus. A chromosomal analysis will be conducted on the fetal tissue samples to discover what went wrong. "That way we can try to fix the problem," he says, noting that miscarriages occur for many reasons, including chromosomal abnormalities, a weak cervix, and insufficient amounts of progesterone.
Conducted in the doctor's office, a D&C takes only a few minutes, but it can be emotionally wrenching. The woman whispers the sad news to her husband in the waiting room and asks him to accompany her during the procedure the next day. He holds her hand and nods.
As men have become more involved in their wives' prenatal care, Dr. Scher has developed empathy for husbands as well. In fact, he likes having dads around. "It makes them appreciate their wives for the rest of their lives," he says. "It's good for them to see what women go through!"