Ambivalence with Miriam Sheinbein, MD
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What context does the episode give about its 2019 recording and pandemic interruption?
Hello, Nocturnist listeners. It's Emily. In case you missed last week's episode, we are back. We're picking up where we left off with season three of our podcast last spring. Just so you know, these stories and conversations were recorded back in 2019, before the events of 2020 upended our lives. So listen with that context in mind. Here's the show.
At The Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
Life as a doctor is busy, so fitting children into the equation is really hard, especially for women whose physical bodies are affected by pregnancy and childbirth. This is The Nocturnist, stories from the world of medicine. I'm Emily Silverman. In this episode, we talk to family medicine doctor Miriam Scheinbein, who had her entire reproductive future mapped out until life started throwing her curveballs.
And for reasonings I cannot recall, I asked a colleague to pull my IUD. Here's Miriam. I was finishing up my medical school family planning elective when my eldest son Kruve was born. Without skipping a beat, I graduated medical school on time and flew across the country to start residency in family medicine at San Francisco General, breastfeeding a six-month-old. About a year and a half later, I was pregnant a second time. On our sixth wedding anniversary, my husband, your Ron and I scheduled our second trimester anatomy scan for a post-call afternoon. We were excited to find out the sex of the baby and then to celebrate the news over dinner. As a family medicine resident, I could easily see it was a boy.
What I did not foresee was that our 20 week pregnancy would be diagnosed with a severe heart defect in compatible with life. we were shocked. And the choice for us was unambiguous. We had a healthy two-year-old boy at home. Our daily reassurance that we could have another healthy child. So that night, I called a trusted medical attending who called abortion provider colleagues who figured out where I could be seen the soonest. And the next afternoon, a teacher of mine placed laminaria to dilate my cervix, and the following afternoon, another teacher performed my abortion. And without skipping a beat, I flew to Phoenix to take step three of my U.S. medical licensing exams. Over two days, I held my diarrhea for the test breaks, and I pressed my arms tightly against my engorged breasts, not expecting that after a 20-week termination, my milk would come in.
Then, life as a resident and a young mother went on as usual. We did not take long to try to get pregnant a third time, and my daughter, Ramon, was born my last year of residency. When Ramon was nine months old, on the eve of Yom Kippur, the Jewish fast day of atonement, Yaron and I climbed into bed. Reflecting on our year, Yaron asked me how I was feeling. I broke down crying, realizing just how unhappy I was, trying to balance career with two little ones at home, underslept and overworked, not knowing how to find time for whom or for what, feeling insufficient in all parts of my life. I always thought that I wanted two boys and two girls, but for me, Going from one to two felt significantly more than double.
So when it came time to try for another, I was no longer so sure. Finally, out of training and in my dream job practicing family medicine at Planned Parenthood, I felt whole again with a five-year-old and a two-year-old at home. and my youngest one just started sleeping through the night. Did I want to risk giving up that wholeness for another child? And separate from that child, did I want to risk another pregnancy or birth? I was still traumatized by my first birth experience, a highly medicalized labor and a difficult C-section, followed by a failed trial of labor for my second birth. I felt like I was headed straight for a placenta accreta or some other dreaded medical complication. Nonetheless, and for reasonings I cannot recall, I asked a colleague to pull my IUD.
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Chapters
5 chapters
1
What context does the episode give about its 2019 recording and pandemic interruption?
0:00–8:48
2
How did Miriam’s first pregnancy and unexpected fetal heart defect shape her medical decisions?
8:48–18:16
3
What was Miriam’s experience with the abortion procedure and its emotional impact?
18:16–24:17
4
How did Miriam cope with ambivalence after her second pregnancy and what therapy helped?
24:17–29:26
5
Why does having a second child feel like more than double for working mothers?
29:26–32:58