The
resident
was
apologetic
over
the
phone,
embarrassed
for
reasons
outside
his
control.
He
was
transferring,
from
his
hospital
to
ours,
a
pregnant
patient
who
required
consultation
for
a
non-obstetric
illness.
This
alone
was
hardly
unusual;
we
routinely
accept
transfers
from
smaller
facilities
lacking
specialists.
But
he
was
not
calling
from
a
small
hospital.
He
was
standing
in
a
respectable
tertiary
center
with
appropriate
specialists.
But
their
specialists
refused
to
consult
because
the
patient
was
pregnant.
She
had
arrived
the
day
before,
her
condition
quickly
identified
and
a
consultation
ordered.
The
specialists
then
categorically
stated
that
they
didn’t
see
pregnant
patients.
The
obstetricians
cajoled
and
appealed,
hoping
to
avoid
transfer
for
services
available
where
she
was.
The
patient
sat
overnight
in
medical
purgatory,
hoping
for
doctors
who
remained
hidebound
against
entering
her
room.
Ultimately,
she
came
to
our
facility,
where
consultants
happily
saw
her
and
treatment
proceeded.
Pregnancy
Is
Not
Siloed
Outside
of
obvious
exceptions
(gerontology,
male
urology),
obstetrics
overlaps
the
broad
topography
of
medicine.
Pregnant
people
have
cancers,
heart
disease,
epilepsy,
and
suffer
vehicular
traumas.
Most
physicians
are
thus
requested
periodically
to
see
them.
Patients
in
rural
areas
particularly
benefit
from
local
co-management;
a
new
physician
refusing
to
see
them
yields
geographic
barriers
to
care.
Or
perhaps
the
patient
already
has
a
doctor,
but
that
doctor
drops
them
at
the
first
sight
of
human
chorionic
gonadotropin.
Declining
physicians
often
assert
an
insufficient
knowledge
of
pregnancy.
However,
obstetricians
are
never
requesting
that
cardiologists,
neurologists,
or
psychiatrists
perform
ultrasounds
or
deliver
babies.
We
consult
for
care
that
is
cardiac,
neurologic,
or
psychiatric.
The
question
really
is,
does
a
specialist
understand
their
specialty
in
relation
to
pregnancy?
How
does
pregnancy
interact
with
the
kidney,
and
the
kidney
with
the
pregnancy?
When
a
specialist
pleads
insufficient
knowledge,
the
gap
is
not
really
in
obstetrics
but
rather
their
own
field.
They
understand
their
organ
system
in
males
and
older
women,
and
how
it
intersects
with
countless
other
diseases
and
physiologies,
but
not
pregnancy.
Often,
someone
will
claim
expertise
in
disease
“X.”
They
advertise,
publish
reviews,
have
waiting
rooms
full
of
X;
but
when
X
and
pregnancy
collide,
they
suddenly
abduct
their
palms
in
feigned
befuddlement.
And
even
for
patients
not
currently
pregnant,
that
doctor’s
long-term
relationship
risks
becoming
unequal
on
the
basis
of
biological
sex.
Say
the
physician
has,
in
their
office,
two
patients,
of
whom
one
is
capable
of
pregnancy
and
the
other
not.
Regardless
of
what
may
happen
to
the
pregnancy-incapable
person
—
they
age,
they
develop
new
diseases,
they
worsen
—
the
doctor
will
still
be
their
doctor.
But
for
the
other
patient,
their
relationship
may
one
day
plausibly
end.
Abortion
Is
Also
Not
Siloed
As
obstetrics
is
sown
broadly
into
medicine,
so
is
abortion,
a
fact
increasingly
clear
since
the
Dobbs
decision.
In
2022,
in
the
weeks
and
months
after
criminal
abortion
bans
first
fell
upon
us,
I
fielded
nervous
questions
about
high-risk
pregnant
patients
from
physicians
in
anesthesiology,
emergency
medicine,
radiology,
and
other
fields
—
doctors
who
perhaps
once
believed
that
abortion
bans
did
not
impact
them,
that
perhaps
they
were
separated
from
obstetrics
by
magical
shields.
Then
one
day
after
the
bans,
a
radiologist
worries
about
fetal
x-ray
exposure,
and
an
oncologist
their
chemotherapeutics;
a
cardiologist
agonizes
over
a
pregnant
patient
with
heart
disease
descending
into
failure,
their
lungs
flooding
with
fluid.
Knowledge
Is
a
Choice
Pregnancy’s
physiologic
changes
are,
admittedly,
myriad
and
entangled.
In
many
states,
abortion
bans
are
also
ambiguous
and
confusing.
Additionally,
training
programs
outside
obstetrics
often
insufficiently
cover
obstetric
physiology,
let
alone
how
their
field
interacts
with
abortion.
How
many
future
cardiologists
in
fellowship,
for
example,
learn
about
which
cardiac
conditions
may
or
may
not
warrant
consideration
of
abortion
for
maternal
risk?
Despite
educational
gaps,
we
could
still
learn
if
we
so
choose.
Obstetric
physiology
is
complicated,
but
we
are
all
appropriately
intelligent
to
have
completed
medical
training.
A
residency
may
have
neglected
to
cover
pregnancy,
but
we
can
later
acquire
new
skills.
Acquiring
skills
is,
in
fact,
a
perpetual
and
inescapable
aspect
of
our
long
careers.
Ultimately,
as
physicians,
we
choose
our
knowledge,
our
comfort
levels,
the
conditions
we
do
or
do
not
treat.
We
are
not
Trinity
in
the
Matrix
needing
someone
to
download
the
file
on
helicopter
flight.
Rather,
when
we
look
upon
the
array
of
our
skills,
each
represents
a
past
choice.
None
of
us
can
obtain
mastery
in
everything,
so
we
select
what
we
do
and
what
we
do
not
learn.
These
decisions
have
many
drivers,
including
personal
interests
and
backgrounds,
but
they
can
also
reflect
our
values.
America
has
the
highest
rate
of
maternal
mortality
in
the
industrialized
world,
driven
in
part
by
the
intersection
of
pregnancy
and
chronic
illness.
These
are
the
patients
we
see
in
maternal-fetal
medicine,
but
we
also
must
often
work
in
close
collaboration
with
other
fields.
The
imperative
to
improve
the
maternal
mortality
rate,
both
clinically
and
morally,
should
never
be
shouldered
entirely
by
obstetrics.
In
this
regard,
I
would
urge
a
broader
cohort
of
physicians
to
acclimate
to
abortion
and
pregnancy
within
their
fields.
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