The Evil Obstetrician

Published on August 20, 2015
Here is a story about the evil doctor who delivered our baby.

Long story short: Our obstetrician hide from us about his traveling schedule, and repeatedly advised us to have induced labour.

On Week 37

Firstly, Kate was born on week 40. But our visit to our obstetrician/gynae (OB) on week 37 was a big surprise.

The OB told us 2 problems:
  1. AFI (amniotic fluid index) is at a low level of 5 cm
  2. Fetus growth is stagnant at 3.1 kg
Everything else is okay - fetus heart rate 140, regular movement, wife feeling good

Without asking for our opinions, he asked us to go to hospital on that night to have induced labour!

We were shocked, and said we want to think about it.

And he impatiently rescheduled us 2 days later for another checkup.

Research on AFI

And so I researched on AFI, and what it means to have 5 cm of amniotic fluid.

I learnt more from Contemporary OB/GYN:
  • There are 2 techniques to measure the amount of amniotic fluid
    • AFI - Sum of 4 pockets
    • SDP - Single deepest pocket
  • Oligohydramnios
    • The condition when amniotic fluid is low
    • AFI < 5cm
    • SDP < 2cm
    • Polyhydramnios - is the condition when amniotic fluid is too much (I will not discussed this condition here)
  • Using ultrasound to measure AFI and SDP is not that accurate (e.g.. 60% positive predictive value when tested AFI < 5 cm)
Reading up on MidwifeThinking reassured me:
  • "AFI increases the detection of oligohydramnios resulting in increased rates of induction without improving outcomes for babies."
  • "There is a lack of evidence supporting induction for oligohydramnios in ‘low risk’ pregnancies ie. when there is nothing else ‘abnormal’ going on with mother or baby"
  • AFV reduces significantly after 37 weeks – this is normal.
  • The intervention used to manage polyhydramnios or oligohydramnios ie. induction also carries risks which need to be taken into consideration.
  • The other alternatives are planned c-section or awaiting spontaneous labour.
I was pretty confident that Kate is fine.

I decided to decline induce labour unless the foetus is in critical condition.

The Next Checkup

We went for the scheduled checkup (48 hours after that surprise diagnosis).

The AFI is 4.95 cm, and the weight is 3.2 kg.

There is still growth in the foetus weight - that's fine. The AFI remains roughly the same, which is too low.

The OB still recommends induced labour, and even suggested c-section --- but we declined.

And so he referred us to do a 1-hr doppler test at a hospital to check on the blood flow, etc.

We went to the hospital immediately, and the result: AFI is 8.5 cm!

The AFI measure is much higher than his measurement (only 5 cm).

We took the result to our OB, and he congratulated us on the good result.

The Dishonest Obstetrician

The most interesting part of our story is this.

The OB then informed us that our next checkup will be next week, with his partner, because he will be overseas at a conference!

How could he!?

I mean, shouldn't he inform us about his unavailability much earlier?

He didn't tell us the number of days he will be in his conference. We had to separately check with the nurse, and she told us the doctor will be on leave for 10 days. What a long conference, over SG50 long weekend..

We are not the only case

At the clinic, we suspected he must be using the same technique on other patients.

And so we chatted to another mother, and she told us she will be induced that night, because her AFI is 5 cm!

What a coincidence!


Saying NO to Induction

I shared the story at midwifethinking.com, and she replied:
Unfortunately this seems quite common ie. and OB suggesting induction to fit with their own schedule – but not being honest about it. I am please you had the courage to say ‘no’ and stand your ground. 
We have to learn to say "no" to induction.

PS: I shall not mention the doctor name. I do believe he is capable and he handled the caesarean well. But we will never find him again, if we have our second.
"I earned extra 2 weeks to have bigger head!"