Tuesday, September 30, 2008

Call me old

My age may be showing here but I cannot resist writing about this interesting encounter. A twenty something was in my office today for a routine check up. She has two children ages 5 years and 18 months. I delivered the eighteen month old and it was a miserable pregnancy as Christine (fictious name) was and still is single albeit with a good job that provides her with an excellent income. Let's face it, parenting a toddler is a full time job, so if economics necessitate that you work, qualified help is essential. Even marshalling all of her resources, Christine could never get enough rest and was pushed to the point of exhaustion trying to meet her commitments at work.

I was happy to learn that Christine is now engaged to the child's father. This will be her first marriage and a large, lavish wedding is planned in a few months. After catching up on this social history and congratulating her we moved on to current medications. Yes, she had seen a psychiatrist post pregnancy and her anxiety and depression are now marvelously controlled on three medications. I agreed that she is now much more animated than in the last months of her pregnancy or postpartum.

Her method of contraception is an IUD (intrauterine device) that I place at her postpartum appointment and yes, she has been very happy with this as it has required little thought and resulted in no side effects. Oh, by the way, she queries, could I just get that IUD out of there while I am in the process of doing her Pap smear?

I am sure I visibly swayed as I almost fell out of my chair. Why, I asked, would she want to get rid of a perfectly functioning IUD? Well, she replies, she had actually been lying to her boyfriend, now fiance of three years, that she was on the birth control pill when she got pregnant with their now 18 month old. Her cause for concern is that she did not get pregnant right away and now he wants another child once they are married. Did I mention that he is twenty years older than she?

I had to take a few moments to get this straight. She now has two children under the age of six, she wants a third with a man she is not quite married to yet whom she lied to about how their first child was conceived. She is so stressed with her job, these two children and this marriage to a man with whom she has been less than truthful that three medications are required to deal with her anxiety.

Reviewing the medications I informed her of the possible effects on a fetus. This convinced her to leave the IUD in place until she had a chance to review all of this with her psychiatrist. It also gives me a chance to gather my strenght for what will almost surely be another eventful pregnancy.
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