We tend to get a fair number of patients transferring their obstetrical care around the first of the year due to new insurance plans. If I can make one plea to my pregnant friends; unless there is a legitimate reason (moving, insurance or your old OB was really bad) please do not transfer care in the middle of your pregnancy. Especially if you are a high risk pregnancy. It can be really difficult to transition to a new practice while maintaing continuity of care. Anyway, I am digressing... My latest transfer was 38 years old and she was coming to us as her husband's job switched them from their Kaiser Permanante insurance. I was already groaning. I have nothing against Kaiser as a healthcare system, but it's so annoying to get their transfers. Their printed records are often out of order, contain a lot of duplicated reports and are ultimately incomplete. In this instance, my patient's husband bound her records in a clear plastic binder. Remember when you were in the third grade and figured that if you put your book report in a clear plastic binder it would guarantee you an 'A'? That type of clear plastic binder*. Oh, and there was one more detail. This was her 13th baby.
I always take an interest in looking at the new patients forms, as I feel they tell me volumes with a single double sided page. Penmanship, spelling and grammar is a starting point. Answers that are too detailed or too sparse are informative as well. It's also intriguing when patients (who do have prior pregnancies) presume that they can just skip the section on obstetrical history. Although this patient let us know that we didn't include enough spaces (6) to accommodate her, and thus felt she was allowed to omit this information. "So, how many pregnancies in total?" I asked her. "Fifteen" she replied "I had two miscarriages." Wow, I thought to myself. She's had the same number of miscarriages as I've had and she's having her thirteenth child and I'm waiting for my first. Anyway... this baby will be her fourth girl; she's had nine boys. Out of curiosity, I asked her if she noticed any different symptoms between a girl or boy pregnancy, as I've had a few other grand multiparous patients report that they could distinguish. "Nope." she replied "In fact, I don't ever have any pregnancy symptoms. My cycles are irregular, and I often don't know I'm pregnant until I'm done with my first trimester. I know there are some women who have issues with nausea, so they stop after their second or third, but not me! I kept going..."
After more than ten years in clinical practice, I like to think that it's pretty hard to offend me. Upon hearing that comment, I nearly threw up in my mouth a little bit, and it wasn't due to the residual HCG still in my blood stream. Earlier that week, I saw a patient who had been hospitalised with her 'nausea issues' as she was severely dehydrated and had lost 8 pounds in less than a week. More so, I was irritated that not only did she expect everyone to have easy pregnancies like her (she probably has no concept of the word 'infertile') but apparently we're also supposed to produce enough offspring to field an entire starting line up for a soccer team (with two available subs). We've made a lot of advances in modern medicine and we no longer live in an agricultural society. My grandmother was born in 1901 as her mother's 12th child, as only five of her siblings lived past the age of five and her parents needed the kids to work on their farm.
Flipping through her plastic binder bound records, I saw that her Kaiser providers had asked her about birth control on a few occasions. The notes read: patient refuses any method of contraception. She states she will have as many children as she is granted. "So, is she trying to catch up with Michelle Duggar?" my medical assistant asked. I just never have been able to fathom how some couples accept having a large brood of kids, just because they can. Biology may have granted them seemingly unlimited fertility, but that doesn't mean they're not entitled to some self determination. More so, isn't a house full of screaming kids sufficient as birth control? Seriously, how to they find time for a quick shag, let alone capturing their fertile window? (sorry, I'm going to sound a little judgmental here) I also think it's a bit irresponsible in regard to the environmental effects of overpopulation. I've joked that the Duggar offspring alone are going to bring the world population to 8 billion. Last year, I attended a lecture that projected if each couple produces an average of three children, the would population will be at 16 billion by 2100 (it's is also perceived that 12 billion could be incompatible with life). That forecast is a little scary, as it means our children may not live to see their grandchildren. The speaker concluded, "it's not just a matter of if an individual family can afford a third child, but can our society afford your third (or more) child?"
Speaking of financial matters, how does one afford a family of 15 on a single salary? I once read that the Duggars (even before their reality show) are debt free, as they have several income properties. However, the cost of living is significantly cheaper in Arkansas than in the Bay Area. I often wonder how we'll managing financing one child, let alone a baker's dozen. How do they handle doctor's visits, back to school shopping, field trips, before approaching orthodontics, college tuitions, weddings... Perhaps it is my perspective as an only child, that I just can't comprehend growing up with so many siblings. I wonder how many children are sharing a room. How do they manage family dinners, vacations or other childhood experiences? At what point does it feel redundant? Do the milestones seem less special? Does it occur to them that they seem to be having kids for the mere fact that they can? I may be jealous of her fertility and easy pregnancies, but I wouldn't want what she has. May the force be with them.
*While I appreciated their efforts to present her records in a nice and neat manner, it created a lot of extra work. I had to take a scalpel to scrape off the dried glue, just to be able to separate the pages, and our HIMS clerk had to make photo copies of her records as the original papers still had glued edged and wouldn't fit through the scanner.