e84 Canadian Family Physician • Le Médecin de famille canadien | VOL 60: JANUARY • JANVIER 2014 Refections | Marathon Maternity Oral History Project Web exclusive Rupa Patel: “We straddle those worlds” Narrative 10 of the Marathon Maternity Oral History Project Interview date: November 22, 2008 * Aaron Orkin MD MSc MPH CCFP Sarah Newbery MD CCFP FCFP M y name is Rupa Patel. I have a story as someone who gave birth. I have a story as someone who attended many births. That was in 1996 to 1999. Three years. There was a bunch of us who moved to town and we started looking into what we needed to do. Three couples, and we were all family doctors. We worked a lot those first few years, updating or initiating proto- cols, training the nursing staff. They had an obstetrical program, although it had stopped for a number of years. Many women were traveling out of town. They don’t know who you are. If you see a stranger walk in the door, you are half-naked and in pain, that’s scary. But if you’re seeing someone that you’ve gotten to know and trust, that’s the ultimate relaxation. The physician and the woman, that relationship is central to birth. Maintaining the same provider is actually ideal. It was our gold standard. I don’t think that can happen all the time, but to have that service available is actually com- munity building. At that time, we didn’t know that rural obstetrics actu- ally has good outcomes. Now, it’s pretty clear. The evi- dence is there. There is some risk assessment initially that you can do. Women get transferred, but the stats are good. There was a discussion about risk; we had a consent form. “These are your choices. As someone who lives in Marathon, you can choose to deliver here where there is a slightly higher risk because there’s not the immediate availability of a surgeon, or we can set you up to see someone in Thunder Bay and you can go back and forth and hopefully get there when your labour starts.” I think pretty well everyone decided to have their baby in Marathon. They had some faith in us. In a small com- munity, you get to know people in about 2 days, then it’s all around town. You kind of know if they’re a goof or reasonable people. So we were reasonable people. That was the word on the street. There had been a few births that had gone well and gently. Slowly, one birth at a time, it just sort of happened, and it was great. Trust was earned, plus the births sort of won people over. Giving birth in a place where you work My oldest, Kahvi, was born in Marathon. As a phy- sician in town, delivering in Marathon was a pretty powerful, important message, a very symbolic thing for the community too, that we were having babies there. Nurses or doctors always have the most horrible com- plicated things; something always seems to go wrong with your pregnancy. My baby stopped growing at 28 weeks. My symphysis fundal height just didn’t grow. So there were issues about intrauterine growth retardation, about whether I would deliver in Thunder Bay, if the baby was IUGR, I would have to be somewhere there was a pediatrician. Anyway, we decided that he wasn’t IUGR. When you do an IUGR assessment, you need an ultrasound every 2 weeks and then there’s a parameter of growth that the baby has to meet. So, we’re having the ultrasound in Marathon, to be sent to the obstetrician in Thunder Bay. He’s just a little dot on the machine. You just click and click and it was, like, small. We were like, “Do that again.” So she clicked again and it was borderline. “Do it again.” So she’d click again. We kind of made her decide it was okay. It was bizarre, like within a millimetre or two of the line. You can actually change your measurements quite dramatically. It’s a very fuzzy little creature. So there was a bit of manipulation to avoid the IUGR diag- nosis and just say he’s a small baby. By the strict defini- tion, maybe he was IUGR. So then my water broke. I ended up having to have prostaglandin because I didn’t go into labour. I think I had tetanic contractions, actually. They were 1 minute long and it was, like, a 5-hour labour. I went over to Sarah’s † house because I wanted her to check me there. That’s the thing about giving birth in a place where you work. You know everyone and you’re In 2008, we interviewed women about their experiences of childbirth and maternity care in Marathon, a rural community in north- western Ontario. This narrative is one of a series of stories that resulted from the Marathon Maternity Oral History Project. All of the narratives in this series were edited from the interview transcripts, then reviewed and approved for publication by the women involved. We invite readers to see the accompanying research paper for more on the Marathon Maternity Oral History Project. 1 *Interviewed in Toronto, Ont. † Sarah Newbery, co-author of the study.