Swimming with pregnant women.

Making pickled eggplant. To everything there is a season.

This is a purely personal essay. It is quite long. There is also some sexual language and discussion that may make some readers highly uncomfortable and might even be triggering.
 

My first day of Residency the Chief of Obstetrics and Gynecology stepped up to the podium and gave us all her best death stare. “Do any of you know what a Gynecologist does all day?”

The young woman sitting beside me said, “torture women.” Mercifully our boss started to giggle and couldn’t stop. Soon everyone was laughing and giggling. It broke the ice.

It has taken me until now, in retirement, to come up with a good, if not funny answer. A Gynecologist listens to and talks with women all day about the most intimate details of their lives.

I enjoy doing things I find difficult (trust me, this is not a non sequitur). For example, I am very proud that after three years of dedicated practice I can now compete against adults in fiddling competitions. I competed in the Novice Class until this month and was usually trounced by 12 and 13 year olds. The first week of August I competed in Seniors (65 and older) for the first time. I finished 10th out of 16 competitors. In my defense I am much better on a 5 string and competitions are usually 4 string.

Another example of doing things I find difficult is swimming. I go swimming every morning at either 5 am or 5:30 depending on the pool hours. This morning I swam 5 kilometers in about an hour and a half. My biomechanics suck and have since I was six and took my first lessons. I just don’t have a swimmer’s body. However, as long as I go very, very slowly I can swim for a long ways.

I used to have the pool to myself. It was just me and the life guard. Starting a couple of months ago I was joined by 4 young women. Terra and Lana are the two Obstetricians that bought out my long time colleague Shells. I worked as a locum for over thirty years for Shells, a nickname she earned because she is seriously addicted to Sunflower seeds and there are always bags of seeds and jars full of shells everywhere she goes.

Terra and Lana’s presence in the pool is a direct consequence of Dobbs. So for that matter is the presence of Tracy and Ronnie. They are nurse practitioners and midwives that Terra and Lana hired.

Terra and Lana are locals. They were born and grew up here. I was their mothers’ Ob/Gyn. They went to American medical schools and were planning to stay there and practice. Dobbs convinced them America was slipping back into the 1800s. As young women with daughters and options they decided maybe right wing Alberta was a better bet long term.
 

Tracy and Ronnie are from the area. Not close enough to know the people but close enough to know the culture. The four women have a lot in common. They all grew up farming and or ranching. They are all under 30.

And they are all pregnant. For each of them it is either baby 2 or 3. They are all between 3 and 4 months along.

Can you see the problem? Four women running a busy Ob/Gyn clinic with them all pregnant at the same time is a sort of risky business model. They need another Doctor, an experienced one.

The four of them want to open a desperately needed Obstetric and Gynecology Centre. Not only is there a critical shortage of Ob/Gyns in this catchment there is a shortage of beds, delivery rooms, and operating suites. There are 80,000 people within an hour drive of here who are closer to us than any other Women’s Health Centre. And the 80,000 people I just mentioned have one of the highest birth rates in the first world.

Alberta is the youngest Province in Canada. This is the youngest part of Alberta. As a side note it is also one of the most highly educate populations in Canada. Over 70% of adults in that group of 80,000 have either a university degree or a trade ticket are both. Over 30% have at least a Masters degree. The most common occupation here is self-employed.

That is probably not what you think of when you think of Rednecks. This is however the most Redneck place in Canada. You might be surprised to know we are proud and happy being Rednecks.

The average woman in this area will have 3.8 children over her lifetime. This despite the fact that the women who live here are more educated than the Canadian average. The average income here is $69,000 a year which is among the highest in Canada.

Exactly why the birth rate is so high isn’t clear. Young populations have higher birth rates than older populations. But it is also partly the presence of high birth rate groups, such as younger female immigrants, Mennonites and Hutterites who still live in colonies, and several First Nations. Beyond that I think there is just something about this part of Alberta that encourages expansion.

This area, we call it the Big Empty, has a much lower population density than Montana. And it is bigger than Connecticut. The wind blows non stop. The winter is long and features some of the coldest temperatures ever measured in Canada. It is a desert. Summer can be the frying pan of hell and in a normal year we get more than 70 tornadoes. We proudly claim the largest hail on Earth.

For all that young people are flocking here. Why? World class schools, world class health care, stunningly low crime rates, clean air, clean water, flourishing small towns and then comes the clincher, the most affordable housing in Canada.

If you were a young couple looking to have children and raise them in a safe place you could do worse. This is one of the centers of Canada’s oil patch. Also of the remnants of the coal industry. But it is also the center of the alternative energy industry in Western Canada and there is affordable land here if you want to farm and ranch and a large community of organic and regenerative farmers and ranchers. There are also tremendous recreational opportunities most made by Mother Earth but also man made, pools, arenas, ball diamonds, soccer pitches, downhill and cross country ski resorts.

Now ask yourself if you were two young single mother’s trained as Obstetricians with young families and someone said hey come home, we’ll give you a house and pay off all your student loans wouldn’t you say yes. That is the deal we pitched Terra and Lana. And they would have turned it down except for SCOTUS.

I am under no delusions. My new found swimming buddies are partner shopping. I am a decent bet. Gabby just announced she wants to work another ten years (she is only 57). I am already restless in retirement. It might be nice to contribute to making Canadian healthcare, especially women’s healthcare better. I love to innovate.

I have always recommended that if possible pregnant women swim regularly throughout their pregnancy. It helps maintain cardiovascular fitness, is easy on the joints, and helps maintain some degree of strength and flexibility. It also improves mental health and provides a sense of well being.

For many women pregnancy inflicts a real physical cost. Health Canada has made postpartum care a high priority. The very first goal of postpartum care is to enable the mother to recover from the physical demands of pregnancy and giving birth.

The postpartum period is a significant time for the mother, baby, partner, and family. It is a time of transition and adaptation and is formative for everyone. There are physiological adjustments for both mother and baby, and significant social and emotional adjustments for the entire family.

Complex and finely tuned adjustments have physical and psychological benefits for the mother and her baby. It is important that everyone involved in the care of mothers and babies knows and acknowledges these benefits so that systems are planned and organized around the mother/baby unit and not around health care providers (HCPs).

The goals of care during the postpartum period are to:

  • Support and promote the physical well-being of mother and baby and enable the mother to restand recover from the physical demands of pregnancy and birth;
  • Support the developing relationship between the baby and their mother as well as the mother’s partner and family;
  • Support the mother’s and her partner’s emotional and mental health needs;
  • Support infant feeding;
  • Support the mother’s confidence in herself and in her baby’s health and well-being, enabling her to fulfill her mothering role within her particular family and culture; and
  • Support partners and other family members to enable them to develop confidence in their new role.

According to the principles of family-centred care, it is incumbent on HCPs to:

  • Treat families with respect, dignity, and kindness, and learn about and respect their values and beliefs, using them to guide their care;
  • Maintain open and ongoing communication with the woman and her partner/family;
  • Plan the timing and purpose of each postpartum contact in partnership with the woman and her partner/family based on their individual needs;
  • Provide culturally competent and safe care with cultural humility;
  • Provide information and support in a timely fashion, according to the needs of the woman, her partner, and family. Ensure that information is evidence-based and accessible according to their culture, language, and abilities so that they can promote their own and their baby’s health and make informed decisions about their care and any necessary treatment.

What my four young friends would like is for me to join them as a partner and focus on prenatal care, postpartum care and general Gynecology. We are going swimming together every morning as part of the prenatal and postpartum care regime I think should be offered to every woman.

It isn’t just swimming I would like to offer. It is also Watsu and Water Dancing. These therapies were both developed in the 1980s starting in 1980 when Harold Dull developed Water Shiatsu (Watsu). In 1987 WATA was created by Aman Peter Schröter and Arjana C. Brunschwiler. Water Dance is WasserTanzen in German and WATA is the abbreviation of WasserTanzen. I find Water Dance easier to say and explain to patients. Both were developed at Harbin Hot Springs in California but have spread all over the world.

One major difference between them is that in Water Dance the therapist guides the patient under the water. But both are extremely intimate and create deep relaxation in both the giver and the receiver. This has profound benefits for both mental and physical health. They are just one set of therapies I’d like to offer to all expecting and new mothers. Every day we go swimming I do one of the techniques with one or two of my prospective colleagues. I think I am successfully showing them the benefits of these aqua therapies.

If all they wanted me to do was cover for them during their maternity leave I would have no problem saying yes. Even being responsible for prenatal and postpartum care for a large practice appeals to me. I just am not sure I want to return to being a Gynecologist. I find it extremely difficult.

My first problem is that you have to be able to listen five times and speak once. I am a chatterbox. I am also a typical man, I want to jump in and solve the problem.

Even more difficult is to never be judgmental. You can’t imagine how hard it is to not say, “are you fucking insane” at least twice a day. The hardest I bite my tongue is when I am treating young girls. Here mothers begin bringing there daughter to see their gynecologist at 11-12. In Canada the recommended age is 13 to 14.

Mothers start their daughters earlier here. Partly that is because menstruation begins earlier here and often leads to questions that might be better answered by a gynecologist. Adding to that is the reality that twice in the last five years their have been epidemics of STIs among local 11 and 12 year olds.

A few months before I retired I had a 12 year old girl ask me if there was a way to reduce the pain of anal penetration while still having what she called an “ecstatic orgasm”. She was having this experience with a 13 year old boy.

I sucked it up and explained to her how to have pain free anal sex that produces ecstatic orgasms. Then I discovered the boy wasn’t wearing a condom when they had anal sex because she couldn’t get pregnant. She also wanted to know how to get the other boys she was “fucking” to also have anal sex with her. I wanted to scream but that is no way to build trust.

I started having sex with my girlfriend Sou-Sou when we were about two months older than my patient. Yet as a father of daughters I could well imagine how this girl’s father would feel if he ever learned about his daughter’s sexual precociousness. The thing is the daughter is my patient and it is her sexual and reproductive health I am responsible for and her privacy I must protect.
 

I also had numerous heartbreaking conversations about infidelity. Everywhere from a few times to dozens of times a year I would have a girl or woman who was faithful to their partner that I had to tell they had an STI. Believe it or not I hate making people cry.

Then there are all the issues that arise when a patient with an STI tells me she has had multiple partners recently. I need the names of all those partners so Public Health can contact them and arrange testing and treatment. Needless to say many patients are not initially cooperative with my request for partner names.

I hate giving people bad news and you have to deliver a fair amount of bad news as a Gynecologist. In my last year of practice I had 2 ectopic pregnancies, 3 cases of cervical cancer, 4 ovarian cancers, a single case of uterine cancer and numerous cases of fibroids. These aren’t situations where you just tell the patient the bad news and move on, you are the Doctor they expect to guide them back to health.

I am just scratching the surface. I haven’t even got into the peri menopausal and menopausal women who think they are losing their minds. Or the women who have lost their libidos and need to know how to get their sex drive back.

The cases that gut me the most though involve rapes, incest and child abuse. In 33 years of practice I have done over 1,000 rape kits. I have reported over 600 cases of incest and child abuse. Seeing how few of these cases lead to conviction has left me with a deep, deep sadness and a seething rage.

I was thinking about all this while I was cycling home from the pool. I found my former colleague Shell, my wife Gabby, and my daughter Nippy waiting for me. Shell it turns out wants to come out of retirement and join the new Women’s Health Centre. She wants me to join her and Terra, Lana, Ronnie and Tracy. Much more importantly Gabby and Nippy want me to seize the opportunity.

Long story short, I guess I am no longer retired. I am going to see if I still enjoy getting up every day and doing difficult things.

​​​​​​{ I am off to bed. I will respond to comments tomorrow}