Two ways to make an Ob patient cry

1. Tell her the sex of her baby. Today was the first time I had seen that moment, and I teared up, too. Labia are remarkably distinct in a 20-week fetus! The couple was there with their daughter and had expressed wanting a boy, for variety, but when they heard they were going to have another daughter, they still got so happy. She went from an amorphous "it" to their little girl. I have always liked the wait-and-see, surprise route, but this was clearly very special, too, a moment when she became more real to them.

2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?