Well we’ve done it. Yesterday, unbeknownst to Dr Kim Jong Un’s Obstetric Dictatorship, we dodged the snipers and crossed the border to South Korea. A land of relaxed receptionists with big hair that don’t look like they work in a modelling agency, a land of a small simple office without as many machines that go ping, a land where, to some extent, you can choose your own adventure.
Instead of waiting, silently, in the office to see the obstetric god arrive, and sit across from us at a huge desk, the doctor met us in reception, introduced himself, and shook both our hands. He smiled.
I didn’t know whether to laugh or cry. The office was really small, and simple. It was like comparing the Wizard of oz with the booming voice and the big green screen to the simple little man behind the curtain. My knees stopped knocking.
“firstly, let me say Dr North Korea is a very good doctor. However people have many reasons for wanting to change or get another opinion,”.
Ok. So a) in South Korea they are still professional enough to be loyal to their countrymen . That’s good. I have used these lines many many times in the face of complaints about fellow lecturers. It’s appropriate. And b) our South Korean doc has rung the hospital and spoken to the head nurse who recommended him to me, because I never said who my doctor is. Interesting. He’s a fact finding do-er.
“Absolutely” I replied, noting the absence of nuclear weapons and people marching like Hitler’s Ss on cans of redbull, “we’ve never had any reservations about him as a doctor. Never. For us, it’s the communication & feeling of involvement that is the issue”.
Involvement in your own birth experience? Crazy talk.
“Firstly, I’m going to ask a lot of questions this visit. We’ll start at the beginning. Because I want a complete picture before we start. Is that ok?”
Nodding, smiling. Hub in boots, did you see him look me in the eye just then? Wasn’t that cool ? My mind wandered back to the first visit to North Korea. The massive kerfuffle because I asked the receptionist to photocopy all my originals of test reports. what, all of them? Big sigh. Really. There were so many clean surfaces in reception that she was concerned about opening a cupboard to reveal equipment and use paper that might mess up the feng shui. That should have been a SIGN.
So the Dr South Korea with the nice bedside manner went through our little journey , and stopped to sniff the flowers on the way.
“You’ve done really well to make it this far. Your case has clearly been well managed , but YOU have done very very well to be here. What can happen with a haematoma is….insert details of certain death & placental abruption here with my brain going la la la la laaaaaaa…. The prognosis for a 60ml haematoma is VERY BAD. Very bad. So to be here still going at 25 weeks is excellent. It looks like the worst of it may be behind you”
I snap out of my la la laaaa land. Did you hear that, hub-in-boots? Part of the success is US! We’ve done something right! And it might get better! I’m like a kid that went to the principal’s office expecting a detention, and instead got a most improved award.
“Now at your age, there is a higher risk of preterm birth. And this also goes for an ivf pregnancy, and diabetes. But this is a higher risk than the general population. It’s not a fait accomplis. It means your risk may be 1 in 10 instead of 1 in 20. And I’m assuming here that the clot is no longer an active issue when I say this.”
One in ten? One in freakin’ ten?? The government of North Korea had me believing it was a 50/50 proposition we’d make 32 weeks. I felt the bricks I’d been carrying in the gulag instantly lift off my head. But I’m mixing up my contemporary dictatorships with my Stalinist states here.
We went on to discuss caesareans.
“So the thing with the Caesaerean is, at 40, you only have a 50 percent chance of a natural birth, at best. And that is before any complications. At 40, your body is not as good at reacting to what is required of it in labour. It doesn’t respond as well as, say, you at 20 or even 30.”
Oh! Hub in boots and I exchange glances. This is INFORMATION. This is what it looks like. We never had this before.
“so many women who start to labour will end up, after a long and difficult time, having a caesarean anyway. Which is sort of the worst outcome for mother and baby in terms of breastfeeding and bonding. So we’d already be thinking about a caesarean for you. Add to that the large baby issue, which may or may not be an issue with the diabetes, issues with blood sugar and the haematoma, and it seems silly to take the risk on what is likely to end up being a caesarean anyway. We tend to treat IVF pregnancies with kid gloves also. They are very precious. This is a very precious baby we have here. The planned c-section gives us more control. We could induce you early, but inducted labours tend to not proceed as smoothly, and we run into the problems again.”
I still don’t want one, my inner 3 year old stamps her foot. I could do it!!!!
But my outer 40 year old says it kind of sounds sensible.
“Now with the diabetes, we normally look at a 38+3 delivery. You may be able to go to 39 weeks, depending on this next scan. If the scans showed isuses, we may be talking 38, 37. But I’d be looking at the 5 days around August 11. I think Dr North Korea is talking and planning around the clot being an issue in labour, but I really don’t think this is going to be an issue. And there are difficulties using steroids for lung maturation if you have sugar problems. It stuffs you up.”
Oh. My. God.
Hub-in-boots looks like he’s about to cry.
This is the FIRST time anyone has mentioned to us numbers that look even vaguely like full term numbers. You can hear us both start to breathe more deeply. It is palpable.
The visit goes on. And on. We are not rushed. We are asked “any questions”, but not in the usual stacatto standing -at- the- door- with- his- hand- on- our- back- reading- from -a- script- waiting- to- shove- us- out way. This is a genuine invitation. With answers that follow.
He thinks a spinal block in a casesarean will be the best for mum and bub. We weren’t allowed to talk about these options with Dr North Korea. Apparently the spinal is less invasive. Dr South Korea thinks I’ve been managed very very conservatively, but it’s worked, so keep doing it.
I ask about the need for further formal scans, not scans in the ob’s office.
“Yes. Definitely. I’d like you to get one straight away, and check your cervical length, the whereabouts of the clot, and the bright bowel on the baby. That bowel needs follow up. I’ll see you in two weeks, and we’ll review it. Your cervical length was good last time, but it should be checked. We’re looking for shortening, or funnelling, and anything under 2.2 might signal a problem for us. (He draws what he means on a piece of paper). Then I’d like a scan at 28-30, 32 and 36 weeks. Minimum”
“Right. Because we asked Dr M this, and he said no.”
“Yes, but obstetricians are not trained ultrasound specialists. You want the specialist on the job for this. It’s important.”
Yes. This is what I thought. This is what the ultrasound doc said to us would happen, as soon as the baby was viable. And Dr North Korea dismissed this question, just last week, out of hand. Yes, it’s another airfare to Venice on scans, no, I don’t care about the money.
I asked about emergency labour situations prior to 32 weeks. We are in agreement which hospital has the best neo natal intensive care unit.
One downside is the new doctor is not currently on staff in that public hospital. The old doctor is. Dr South Korea openly states this is a possible advantage in sticking with Dr North Korea But he also says he wouldn’t send us to the inferior NICU where he is. He’d ring colleagues, and get us in to the good one, and get us delivered there.
We talk about vacancies, we talk about money. We talk about the pros and cons of switching, and when it is possible to switch. He even suggests I ring back the head nurse of maternity and ask for her input on the decision. He waits for a fax on my 12 week scan, to check the PAPP-A levels that may indicate more risk of stillbirth or preterm delivery. They are fine. He is so open. I want to hug him.
“I’d LOVE to know what he charges” says Dr South Korea. We laugh. And tell him. I realise I’ve missed something in the North Korean fee schedule, Dr South Korea can’t possibly be dearer. I look into it later and I have missed the delivery fee. With that, there’s not much difference. In fact Dr South Korea may be cheaper after Medicare refunds.
Dr South Korea is happy, impressed even, with my blood glucose management. He thinks the treatment path is fine. He trusts my endocrinologist.
Dr North Korea basically said it was out of control and I was damaging the baby through my choice of endocrinologist and not going on insulin. He’s like the big bully in the playground that doesn’t want to share his patients with doctors that won’t do what he says.
Back in South Korea, he’s happy with the use of oral tablets not insulin. He’s happy with my endocrinologist. He thinks the endo is the best person to talk about breastfeeding, but he can’t understand why it would be a problem. Difficult? Maybe. Impossible? No.
He talked about skin to skin contact ALL THROUGH the operation after initial checking of Gumby by a midwife. He said the post natal support in our hospital is SECOND TO NONE. He swept away the thick cobwebs of worry with a simple flick of his informative wrist.
It’s possible Dr North Korea is also Captain High Risk pregnancy. It’s possible we only made it this far because he was ultra conservative in his management of my pregnancy. I respect him for that. I thank him for it.
But I also have to be in the ultimate out of control situation, major surgery numb from the waist down, and put this person in charge of the birth of our child. I have to be in the same room as him. I have to be comfortable he is giving us the best advice, and I have to feel intellectually and emotionally satisfied that there are good reasons behind that advice, as we get to the pointy end of proceedings. I have to feel I could be in the room with him, and let him have that level of control over me, and over my baby.
So it’s a sitting with it decision. We are both unsure. We are not rushing it. Tomorrow, I have the scan that was ordered in South Korea, land of choice and information. Next Thursday, cross the border back into North Korea, waiting to see the reaction of the dictatorship to news of a second opinion.
Then Tuesday week, we brave the snipers and head to South Korea again. Possibly to stay.
For a bit of a laugh, I’ve added a poll so the silent majority out there can air their views on our little saga. I can’t promise we’ll listen as we decide whether or not to change doctors, but I’m interested in your thoughts.
After meeting Dr North Korea last week, I have a feeling my sister will vote 10,000 times for option b. This may skew the results slightly.