Self-Fulfilling Prophecies

Doctors are a strange bunch. We champion science and evidence based medicine, quoting the latest research journal or study. But we are also a little superstitious, though we don't like to admit it. We talk about our "clouds" - whether we attract business or not when we are on call. I once had a resident who, taunting our superstitious natures, would declare on call, "Not even God can sink this ship." Without fail, those nights exhausted us with endless admissions.

I was telling this story to another physician, and when I started it, she said, "I bet the patient had a C-section." The story starts like this. A woman walks into labor and delivery closely followed by her doula, birthing ball, and yoga mat. She has a typed five page document with her birth plan, a smooth satisfying natural child birth.

Although some physicians roll their eyes, I support mothers like this. In my first year of medical school, I took an elective to see the childbirth process from a patient's point of view, and I trained in one of the most hippie-friendly open-minded areas of the country. I champion patient decision making. Complementary and alternatives approaches to medicine intrigue me.

But alas, the superstitious of us might believe that she sealed her fate with a self-fulfilling prophecy. Over the next few days, she needed induction with escalating doses of oxytocin and became more and more exhausted when the process of labor dragged out. Finally, after several days without sleep, she decided to get an epidural. By now, the idealistic and lofty goals of the perfect delivery were out the door. She struggled with her pre-formulated plan, asking the obstetrician whether she should get a Cesarean (which, on a totally separate note, would be a great spelling bee word; I never get it right).

Of course, she ended up going to C-section for arrest of descent, and of course it was at three in the morning. Because of her prolonged labor, her uterus would not contract after delivery and she had massive bleeding. We activated the massive transfusion protocol. Of course, her IV access was poor and I was under the drapes putting in extra IVs so she could get fluids and blood. She required everything we could think of: oxytocin, methylergonovine, prostaglandins, misoprostol, a Bakri balloon. We almost called interventional radiology.

Fortunately, she had a healthy baby and her anesthesia was well maintained with her epidural. She never needed to go to the intensive care unit and got through the whole ordeal just requiring a few units of blood. We go through our lives trying to plan as much as we can, certain we know what would make us happiest. But the superstitious among us know that sometimes when that patient with a doula and birth document comes in, it might be prudent to plan for the worst.