Change of Pediatrician

It’s amazing the difference that a single change can make. Valerie had spent a considerable amount of time researching the kind of attendant that she wanted during delivery and had settled on a midwife team whose offices were about a half hour away, and who would only deliver at the hospital in downtown Charlotte, about an hour’s drive away. But it was relatively late in the process when it came to our attention that, after David had been born, the attendant who would dismiss him from the hospital would not be the same attendant who dismissed my wife. Midwives and obstetricians don’t check babies – only mommies. So, whereas we had spent some months finding just the right midwife, we had to settle on a pediatrician in a matter of weeks. And here’s the rub: the primary thing we needed a pediatrician to do is to okay the removal of our baby from the hospital. Well baby visits and immunizations aside, the pediatrician’s immediate job was to be on site at the appropriate time. We had several strong recommendations for pediatricians within minutes of our apartment, one of whom was even covered by our insurance. But since they were all located directly adjacent to the hospital that was also 2 minutes from our apartment, not a single one of them would be available to dismiss our baby from the hospital in downtown Charlotte.

So we got a recommendation from our midwife for a pediatrician whose main offices were in the same building as hers and signed up for an interview. Now, I had not been present when Valerie was interviewing the other pediatricians, but I managed to make this one, and I had all kinds of alarm signals going off during the meeting. The woman was jovial and grandmotherly and seemed very very competent, but also struck me several times as having that trait you hear about so frequently in doctors: the God complex, that overwhelming sense that they are the doctor and you are not; they know what’s best in all things medical, and you do not. It’s all very well for you to go and do your own research and have your own opinions, but they’ve been doing this sort of thing for years with literally thousands of patients, so they really know what’s best in your situation. And perhaps they do. But it’s not a very comforting notion when faced with our own particular needs in our own particular situation. My child is a patient of course, but I am also a customer. However, the doctor we interviewed was competent and grandmotherly, and most appealing of all was that this office had a lactation consultant on site. The lactation consultant was very important to Valerie, and no other doctor’s office had had one. And ultimately, we had little initial choice – we needed a doctor who could check out our baby from the hospital. But we decided to stick with the half hour drive, at least until Valerie and David had settled down with nursing.

Looking back, something was wrong from the get-go. Our primary concern for our baby in the hospital was the getting out of it. My grandfather died in a hospital from a disease that he contracted in a hospital after surgery. The hospital recovery room is small and uninviting; the beds are designed to fit only one person and are generally uncomfortable. And yes, there are reasons for possibly staying a few days; reasons that are largely negligible for a family that lives right next to the hospital/medical complex of a different city. We had wanted a post-partum hospital stay of something like 6-12 hours, which was completely beyond the pale for our doctor, so we had negotiated 24 hours, rather than the standard 48. (48 hours in a hospital !) But when we finally saw the pediatrician making her rounds – because it was the weekend, it was a different one than the one we had met – she had heard nothing of our interview. She was shocked that first time parents would want to leave the hospital before two days were over, and immediately started trying to negotiate (that is, scare) us back up to a reasonable check out time. You need to be at the hospital in case the baby gets jaundice. That would have stumped me, but Valerie was brilliant: will staying in a hospital prevent jaundice? No. But if he gets it, he would already be in the hospital, rather than needing to be re-admitted. (Remember please that we live less than a mile from a different hospital.) We stood our ground. The doctor agreed to sign us out at 28 hours, provided that we promised to visit the lactation consultant the next day. Since that was our plan anyway, we concurred.

This is the point at which it gets a little surreal for me. You already know that David came quickly to some pretty high levels of jaundice. He had no signs at all in the hospital, but by the next morning it was noticeable. If we had stayed 48 hours in the hospital, I suppose we would be there still. What gets me though is the response of the pediatrician’s office. As we first came in, I had just been noticing that they put the names of all their doctors on the front door, followed by whatever special letters they had earned to go with their names. Our lactation consultant was listed as well, with the letters L.N.P., Licensed Nurse Practitioner, which is to say a nurse who is almost a doctor. And in the visit, which was certainly long enough, her manner was much more that of a doctor than anything I had imagined for a lactation consultation. She poked and prodded the baby, and asked us questions, and yes, she watched David nursing. But it was nothing like the sort of training experience that I had been expecting. She did say that he looked a little jaundiced and asked us to come in again the next day for another check.

The next day he was worse. Our little white baby looked like he had spent a few days surfing in off Cocoa Beach. Immediately upon looking at him, seeing that he wasn’t moving in the right direction, and without spending more time coaching our nursing technique, she began to suggest supplementing with formula. It was as though our lactation consultant was being paid off by Similac.

She sent us to the hospital for a heel-prick blood test, and had us sign up for another visit the next day with a doctor, since she wouldn’t be in the office that day. Of course, when we got the report from the test that his biliruben was at 18, it became a spiral of panic. The doctor ordered the glow-worm suit for us and fitted us with the ultimatum that if he didn’t have some kind of bowel movement by 10 o’clock, we were going to have to supplement. That night of course, was the night of the baby who makes no messes. He had a little bit of product number 2 at 1 am – too late to avoid the similac monster – and not again for another 31 hours. Oh, we supplemented all right. We also pumped, and fretted, and soul-searched, and wondered what went wrong for our beautiful baby who was so healthy and so strong in the hospital.

The next day, biliruben was up to 18.9 – to be expected for a baby who had made no deposits for so long. So we signed up for another visit and redoubled our efforts to feed him properly. Some time that evening though, our soul-searching became inverted. What if it weren’t merely we who were doing things all wrong? What were these awful doctors doing in the mean time? Nobody yet had encouraged us in what to do to get off the formula slope. I had gone and done research on nursing and come up with a dozen solutions, while our doctors had merely made threatening pronouncements. On top of that, every doctor’s visit was costing us $20, which sounds reasonable until you make it an everyday experience. Lastly was the drive: 30 minutes each way, plus time spent at the office. Wasn’t there some other office we could call on, something closer? Yes, there was. So the next morning, right at 8:00, I called the pediatrician in our own town. We had a baby currently under treatment for jaundice, but could we still switch doctors? Yes, we could. Could we switch that very day? Yes, we could.

It was blessed. Probably the biggest difference was that David had started making waste again, so that we had already turned a corner in the night. But the drive to the doctor was so much easier, and frankly, his manner with our baby was so much more personal, his manner with us so much more reassuring. His weight was up; we would do another blood test; provided his biliruben was down, we could even skip a day for the doctor visit. When the test came in, it was 17.8, to sounds of general rejoicing.

That, of course, could have been nothing more than coincidence and convenience. But what happened the next day gets so much better: We had another fine night and a baby who was clearly on the upswing, but in the morning, it appeared that he had been bottle-fed so frequently that he was getting lazy. Why bother with the breast when the bottle puts out milk with so much less effort? And I thought to myself, just because our pediatrician doesn’t have a lactation consultant on site doesn’t mean there isn’t any in town. Let’s get a recommendation.

It was an amusing conversation:
“Hello, can you recommend to us a lactation consultant?”
“Well, what exactly is it that you’re dealing with?”
“Well our 6 day old baby has jaundice, and we’ve been having to supplement his feeding with formula. Now we’re starting to get concerned that he’s going to start rejecting his mother’s milk because the bottle is so much easier.”
“Ohhhh, I don’t know anything about that. It sounds, though, that the first thing I would recommend you do is to visit a lactation specialist…”

Right. Apparently, the reason the pediatrician didn’t have a lactation specialist on site was that there was already a lactation specialist on staff at the hospital right next door. So we called and set an appointment and had an amazing visit with a woman who was trained and truly enthusiastic about the art of breastfeeding. The lady had jumped in and was training and giving advice before we had hardly sat down. She weighed the baby before and after a feeding, thereby determining exactly how much he was eating in a feeding (information that our other doctor had assured us was impossible to come by without first measuring it in a bottle). We determined that the supply of milk was up to where it needed to be; the only problem was that, since jaundice makes you sleepy, he was falling asleep to easily to eat all he needed. Of course, when he doesn’t eat all you have for him, the body gets the message and makes less, which was probably the cause of our supply problems to begin with.

She praised our efforts to figure things out at home and set us up with a plan for keeping his intake where it needed to be while making sure he didn’t somehow revert to being a formula baby in the process. At the very beginning of the visit, when we had mentioned that we had visited a lactation consultant at the other office, our new specialist started by asking us what sort of plan she had given us. Plan? Feed the baby. That was the only plan we had. Later, when I was expressing relief at how different this encounter was from the previous one, I think I mentioned in passing that the other consultant was listed as a nurse practitioner. I received a sharp look. A nurse practitioner? Well that was the problem. Nurse practitioners are trained to function like doctors, who schedule themselves to handle a visit in an average of seven minutes. Whoever nursed a newborn baby in seven minutes? Our visit had been longer than that, but Valerie thinks it was because she forced it.

Since yesterday, things have been much better. David turned a week old this morning, as we were in the Doctor’s office awaiting yet another heel prick. He’s starting to look a little more Irish and a little less Indian, though we still have to tie him to the glow-worm suit until his biliruben comes back less than 13. All in all, I think we’ve turned a corner. It’s amazing the difference that a single change can make.

2 thoughts on “Change of Pediatrician”

  1. Oh man. That’s frightening that the one doctor couldn’t figure out the weighing business. When Adam was having to transition from gavage feedings to nursing in the NICU, I had to do the weighing every single time. He also had to work on waking up long enough to nurse enough.

    Like

  2. The waking up thing is getting better but not there yet. I was relieved that I was actually making enough milk; I was getting worried because David would eat so much more afterwards from the bottle. The LC told me to pump after every feeding to keep on tap for extra eating and to keep my supply from going back down again.

    I’ve been told that if we can get the jaundice down, he’ll start being more alert during feedings and eat more heartily. I’ve seen a bit of this happening but I don’t think we’re there yet.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s