Tuesday, July 2, 2013

10,000 Babies: My life in the delivery room by Silvio Aladjem M.D.

Silvio Aladjem M.D, board certified in Obstetrics, with a sub- specialty of Maternal Fetal Medicine MFM,  has written a memoir of his vast and eclectic experiences in the newly published book 10,000 Babies: My life in the delivery room.  This book is not only a collection of anecdotes and experiences, but it also provides historical information about childbirth in general.  The reader can learn the intriguing history of the hospital birth as well as the neonatal intensive care unit (NICU) , the use of ultrasound and prenatal genetic testing.  The author's career spanned a great number of years during a monumental time of change in the area of obstetrics as well as the use of birth control.  Filled with facts, real life stories, and historical information- this is everything you wanted to know from your OB-GYN but would not otherwise have.  This is a unique glimpse into the mind and experiences of a doctor.

There is only so much medical information one can find on the internet, and very little available about personal experiences from real life doctors.  Doctor Google offers incomplete and unreliable medical information based on  anecdotes that unqualified hypochondriacs post.  Regrettably, many rely on internet research for medical information, and advise- especially when it comes to pregnancy.  Simply consider the abundance of online forums, websites and apps dedicated to the subject of pregnancy.  Pregnancies widely vary, yet moms continue to compare symptoms and experiences nonetheless resulting in unnecessary panic and worry.  This book is a wonderful and timely resource not only for those who thirst for more medical knowledge, but also moms who wish to learn more about pregnancy from the point of view of the doctor.  The author writes simply so that the layman can understand.  He does not extensively use medical terminology, and when he does, he explains medical concepts simply.  A times I found these stories to serve as a springboard in my quest for further research.  His writing style is certainly that of a doctor.  He retells his stories objectively without the insertion of his opinion.  The dialog that he includes between patient and doctor as well as the commentary, is professional and to the point.  He does not let bias or emotion taint his communication, written in reporter-like fashion.  Just as with any professional doctor, the reader will find that in his professional relationships he can not make future promises or predictions to his patients - something that many patients erroneously feel entitled to receive.  The author recognizes that unexplained stillbirths still do occur in even an apparently well monitored diabetic pregnancy without warning.  Such deaths are "a tragic reminder that  research ...still needs to be undertaken" (page 98), and that there are elements in childbirth, such as the uniquely complex organ, the placenta, that still remain a mystery.  The author does well to cite statistics in the areas of maternal mortality and its vast improvement.  The story "Just Give Me a Hug" would have provided a good opportunity to discuss the high rate of stillbirth up to 1 out of 160 births, that still exists today in this modern age. 

Silvio Aladjem M.D. has had a broad range of experiences as a doctor in the field of obstetrics. Not only has he assumed the medical care of his patients, he has had to take over the role of psychiatrist and social worker when accessing the mental state of his patients as well.  Just about every pregnancy scenario is covered ranging from the standard textbook pregnancy to a high risk pregnancy ending in an unexpected stillbirth.  He has seen the spectrum of mental illness in his patients and their families as well. Some stories are humorous, and even difficult to believe  such as the naïve, and ignorant couple married for over twenty years that erroneously believed that by taking turns taking a birth control, that a woman would be adequately protected from pregnancy. 

Several patients were victims of dysfunctional and abusive relationships. The reader will certainly cringe at the capacity of one partner to emotionally and physically abuse his enabling victim.  Dr. Aladjem has found that on such occasions he had to act as a mediator or even contact social services on behalf of his patient.  It is incredible the stubbornness parents will have when it comes to such innocuous topics such as knowing the sex of the unborn baby.  It is amazing to believe in this day and age, that a psychosis can convince a woman she is nine months pregnant and in labor, when she isn't or vice versa- that she adamantly denies a pregnancy even in the midst of labor pains.  The ignorance of such patients amazes me to the point of disbelief.  I can only imagine that the doctor encountered these delusional patients earlier in his career when pregnancy in general was considered taboo in society and shrouded in shame and mystery. 

Other stories are heartbreaking such as the unexpected stillbirth of a young diabetic woman, or the couple that chose to carry a pregnancy in which their unborn child was diagnosed with anencephaly, a terminal condition incompatible with life.  Clearly this author  triumphantly shares with the reader the autonomy that birth control allows.  For example, a young woman had  experienced her 8th miscarriage, and had not sought medical answers.  She was in an abusive relationship in which her partner forbade her from spending any money for specialist care.  Dr. Aladjem had to become her advocate and help her to fulfill her desire for autonomy from an abusive relationship and for birth control to end the cycle of miscarriage.  Another woman had hyperemesis which she wrongly attributed to pregnancy.  The Dr. later learned in an interview with the patient it was due to emotional problems resulting from a stressful relationship with the husband and mother in law.  The Dr. had to mediate and act as his patient's protector to facilitate her emotional healing. 

The author's passion about his medical field is clear in the pride he has when he discusses medical achievements.  His triumphant tone of writing when he talks about a positive outcome with a patient or a new medical advancement is obvious.  Even though he doesn't include the dates of his practice, based on the stories and the social norms, one can surmise that he practiced during the cusp of great medical advancement in the areas of  Obstetrics, specifically the NICU, MFM and birth control somewhere between the 50s- 80s.  To the author's credit, he does not explicitly address controversial issues such as choice and birth control.  His writing indicate he is an advocate of birth control.  Yet, with humanity he recognizes the miracle of the birth of a terminally ill baby that the parents chose to carry to term.  The experience is described with endearment as he shares with the reader his amazement that they "both deeply loved their child" (page 202) and he did not want to deny their request to monitor the heart rate of their baby during labor- which at the time was not standard practice.

The ominous statement on the back cover, "Sometime in the future, they [those who have not become parents or already parents] may even relive any of these stories" is not comforting,  yet statistically  true nonetheless.  This harbinger of reality brings to light the possibility that the reader too may find herself faced with a high risk birth that ends in a loss. Some of these stories might be too distressing for an emotional  pregnant woman to read.   On the other hand, in this modern era of health education in modern public schools, where every teen is fully educated in birth control, I doubt any reader in this day and age will experience a pseudo- pregnancy or that any male, will find himself ingesting a birth control pill in the belief that it will prevent a pregnancy in his female partner.  Silvio Aladjem MD also provides insight into his own career and his motivations for choosing this specific area in medicine for his practice.  This would be the perfect book for any layperson interested in obstetrics or the medical field in general.  As a blogger I received this book published by author House for the purpose of writing this review. 

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