Change in Plans
Dr. Scher says he loves working with women, and it really shows: He is utterly devoted to his patients. "There's no area of medicine more emotional than having a baby," says the father of two grown daughters. He's there for the pain and ecstasy of delivery and the trauma of miscarriage. He carries women through the mounting excitement of normal gestation and reassures those experiencing a high-risk pregnancy. "We want a healthy mother and a healthy baby" is the mantra he repeats as he goes about his work.
Karen, 40, is the 14th of Dr. Scher's 19 patients for the day. The two are disagreeing -- not about healthcare but about which salon in Manhattan gives the best bikini wax. On this topic, too, Dr. Scher is an expert. After all, women who get cesareans must have some of their pubic hair removed. Dr. Scher doesn't mind if his patients take care of that part of the preparation at salons, rather than in the operating room, where the mother-to-be would be inelegantly shaved by a nurse.
Then the conversation turns serious. Karen is adorable but tremendous. She's gained 90 pounds at 38 weeks, a time in her pregnancy when she should have put on only 25 to 30 pounds. Though Dr. Scher advises his patients to take prenatal supplements, eat healthfully, and exercise, "I was so hungry!" Karen says.
Dr. Scher measures her beach-bronzed belly to assess the baby's weight and size. "It's humongous!" he says. "Don't flip out, but I'm going to book you for a cesarean section next week."
This is Karen's first child, and though she wants to give birth soon, she's still a bit stunned upon learning that her baby is going to arrive two weeks earlier than she'd expected. And butted up against her desire to get out of her maternity jeans is, quite naturally, a bit of apprehension. She's worried about the maturity of her baby's lungs, but Dr. Scher assures her that most fetuses' lungs are sufficiently developed by 38 weeks' gestation.
Karen is also concerned about her recovery from the cesarean and how bad the scar will be. Dr. Scher assures her that the horizontal incision he'll make along her bikini line -- the most common one performed for C-sections in American medicine today -- will likely heal by ski season and will be low enough not to disrupt her passion for bikini-wearing. Dr. Scher later confides something else: Should Karen carry her baby for a full 40-week term, he fears it will be well over 10 pounds and at high risk for stillbirth. Because he's already settled on the cesarean, Dr. Scher decides not to alarm Karen with this possibility. But he does let her know that such a large baby could sustain injuries during delivery and may stretch her vagina permanently, possibly causing urinary incontinence problems and inhibiting some sexual pleasure. Karen's surgery -- and her bikini-wax appointment -- is scheduled.