A Day in the Life of an Ob-Gyn
At 11:45 on a sunny September morning, Linda Missry, 36, is lying in a bright room at Mount Sinai Hospital in Manhattan, completely and utterly focused on her task. She's about to give birth to her fourth child.
"I'm not so comfortable anymore," she says plaintively. Linda's doctor, Jonathan Scher, M.D., an esteemed New York ob-gyn, infertility specialist, and author of Preventing Miscarriage: The Good News, offers her the only help he can: encouragement. "Push, push!" he says, with genuine excitement. On his orders, Linda bears down. Her legs shake.
Any minute now, I think, flashing back to the final moments of my own delivery six years ago, when my second daughter's birth was attended by an obstetrician so blasé I swear he stifled a yawn during my 17 minutes of pushing. I wish I'd had a cheerleader like Dr. Scher by my side.
After three decades of practicing and teaching medicine on three continents (Dr. Scher is a board-certified ob-gyn in the U.S., holds medical degrees from the University of Cape Town in South Africa, and is an honorary fellow of the Royal College of Obstetrics and Gynecology in London), he still clearly adores his work. That passion bubbles over to his patients, some of whom travel from as far away as France and Italy to see him. Over the years, he's come to view women as his partners in the prenatal process. "Obstetrics is not a disease," he says. "It's a natural function just like eating, sleeping, or drinking -- you shouldn't even call pregnant women patients!"
Though it's not yet 9 a.m., I can barely keep up with the very fit Dr. Scher as he dashes up three flights of stairs (hospital elevators are notoriously slow, he explains) to visit with patients recovering in the maternity ward. To keep up this pace, he works out five days a week and watches what he eats -- that is, when he has time to eat, which during a typical day at the hospital may be never. "I order a salad for lunch and at 4 o'clock it's still sitting there," he says, pointing to a table in the residents' lounge as we hustle by.
In quick succession, Dr. Scher visits four new moms. With his South African accent, he's not only a medical authority, he's a class-A charmer. (Think a shorter Cary Grant with a wall full of medical degrees.) After gushing over the women's newborns, he asks how they're feeling. One second-time mom, in a room stuffed with "It's a boy!" bouquets, has severe pain under her right breast. "I'm worried it's my gall bladder," she says.
"Sometimes when you're pushing the baby out, you strain your intercostal muscles," Dr. Scher explains, pointing out the line of muscles located at the base of her rib cage. These muscles can become tender during a woman's last trimester, when they're squeezed by her expanding uterus, and again when she crunches up her body during delivery. Examining her, he asks, "Is the pain getting better? You're not coughing up blood or anything like that?" She says the pain has been lessening and there's no blood. "Then forget about it; just take the painkiller," Dr. Scher says, assuring her that the pain will abate as her body heals. Her baby cries, loudly. "What a beautiful boy!" Dr. Scher exclaims. "Whenever you get the pain, think of him!" He hugs her and we head off to the next room.
His rounds completed, Dr. Scher heads downstairs to check on his three -- excuse the term -- patients who are in labor. In addition to Linda, there are two first-time moms: Janet*, a 30-year-old who went into labor naturally, and Marcia, 42, who had been induced that morning.
He leaves each woman comforted by his sure knowledge, genuine warmth, and a piece of advice: to spend at least 20 minutes each day lying on her stomach or side. The idea behind this is simple: When a woman sits up in bed cradling her newborn, gravity pulls the extra fluid she's retained from the pregnancy and intravenous line, if she had one, to the lowest point in her body -- the vaginal and rectal area. When she turns over, the fluid that's accumulated will "drip, drip, drip" away, says Dr. Scher, to be absorbed back into the circulatory system and eventually excreted, helping the swelling go down.
Dr. Scher is also scheduled to perform an amniocentesis in the hospital's clinic at 10:30. At 9:36, however, Janet is already 10 centimeters dilated and pushing with the help of a nurse. Next door, Dr. Scher breaks Linda's amniotic sac. With her last delivery, labor had proceeded so quickly there was no time for pain relief. Because the same thing might happen again, she received an epidural early, just in case. "Okay, you're going to go fast," Dr. Scher says to her. "I'm not leaving the floor!"
As we walk out, I start to worry that both women are going to deliver at the same time. Dr. Scher assures me that has never happened. "Never," he repeats, dashing down the hall to the nurses' station to fill out some charts in the little window of time he has before the real action begins.
When Dr. Scher first started practicing medicine in London in the 1970s, he kept track of each baby he delivered by slipping a birth announcement or photo under the piece of glass that topped his desk. Two years later, the desktop became so crowded he could add no more. He's now lost track of how many babies he has delivered and no longer saves each and every announcement, but he enjoys receiving them nevertheless. After all, who wouldn't want to be thanked for a job well done? Today, some of his babies have become patients as they grow up and start families of their own -- perhaps the biggest thanks of all.
In the doctor's unassuming office on Park Avenue, a bottle of champagne -- a gift from a patient -- sits on the desk he shares with one of his partners. Next to it are stacks of files of patients he'll call to report test results or give advice on hormone replacement therapy. A people-oriented doctor, he's perfected the art of dispatching each call quickly without seeming to hurry a patient off the line.
About half his patients come in for gynecological exams; the rest are pregnant or hoping to be soon. Women call all day, too, with a grab-bag of questions: what to do about excessively heavy periods, whether to be concerned about spotting during pregnancy, and which psychologist he would recommend for marital problems (his truly empathetic personality makes him a natural confidant). Today, a woman in her 33rd week calls to say she's no longer feeling her baby move. Though Dr. Scher is pretty sure that everything is fine -- by 32 weeks, babies usually start running out of room to squirm around -- he schedules a sonogram just in case, but mostly to allay the woman's fears.
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!"
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.
At the hospital, Linda is nine centimeters dilated by 10:04 a.m. "Another half hour or so," Dr. Scher predicts. He heads to the door and notices Linda's worried look. "I'm not going away!" he assures her.
He checks on Marcia in the next room. She's been suffering from elevated bile salts, a rare gall-bladder condition brought on by pregnancy that makes her feel itchy all the time. Though uncomfortable, it's not life-threatening. But Marcia has researched the condition online and found studies suggesting that it can cause stillbirth.
"Having a high-risk pregnancy does not mean that the delivery will be high-risk too," Dr. Scher says, trying to calm her. Though he appreciates when patients show interest in their own care, he's wary of medical information they cull from the Web -- while some is helpful, much of it is not. "People can get the wrong perspective on a condition, which causes them unnecessary worry," he says. Marcia is bearing the pain stoically, but Dr. Scher encourages her to get an epidural now. He explains that if the anesthesiologists are needed for cesareans and other emergencies, they may not be able to attend to her precisely when she needs them, and she could end up laboring in pain until one becomes available. Dr. Scher believes that suffering is not a necessary part of the birthing experience and counsels his patients that wanting pain relief is nothing to be ashamed of.
Dr. Scher says more than 80% of his first-time moms choose to have a "walking" epidural, in which a cocktail of pain medication is injected into the lower spine. Unlike paralyzing anesthesia, this medication masks pain but not feeling, so a woman can experience the sensations of childbirth without the agony. Though laboring mothers-to-be are technically able to walk around while on this medication, Mount Sinai does not permit them to do so, a practice that's followed by many hospitals for liability reasons.
"Linda says she can't wait!"
He rushes into Linda's room and determines that though she may want to, she's not ready to push just yet. He dashes back to Janet. I feel as if I'm in a hospital version of a Marx Brothers movie. For a few minutes, I'm convinced that today is going to be the day that two women deliver at exactly the same moment.
No dice. At 10:44, Dr. Scher delivers Janet's baby boy with great joy. As he's finishing, Linda's nurse interrupts him again: "She's bursting at the seams!" He ensures that Janet is all right and is back with Linda by 11. She starts pushing, and this time Dr. Scher is staying put.
"You're just about there," he says.
"I want it to come out already," Linda moans. But then her contractions slow, and she begins to lose steam.
At 11:30, Dr. Scher checks in on Janet again. He then heads over to the nurses' station, where he fills out a birth certificate for Janet's baby, makes a call to the office to pick up his messages, and phones his wife, Brenda, letting her know that he has delivered one baby and is waiting for two more to arrive.
Finally, at 11:51, Linda takes a breath, pulls in her chin, and bears down. As I watch, the baby's head emerges. It's covered with a mass of dark hair! One more push and the shoulders are free. Then the legs appear -- they're long and skinny. "Mazel tov! It's a boy!" crows Dr. Scher. The baby wails, getting his first gulp of air. I wipe away my tears.
A baby has just been born. It's the most natural thing in the world as well as one of the most extraordinary. And even though the doctor has witnessed this too many times to count, he agrees. "I still get a kick out of it," he says.
Leaving Linda to enjoy her baby, he's now 90 minutes late for the amnio. After performing it, he spends the rest of the afternoon monitoring Marcia's progress.
*Some names have been changed.
Copyright © 2003. Reprinted with permission from the March 2003 issue of Child magazine.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.