Dec 19, 2009

sex in the clinic

I think my title should be clearer. It should read ‘identifying sex in the clinic’.

If you fella open this entry for the wrong reasons, may god bless you.

The awesome thing about O&G is like you’re playing a bit of everything.

We can operate like a surgeon, dispense like a physician, give advice on women’s health like a public health officer and lastly do scan like a radiologist. I know you’re wondering what’s with my obsession with role-playing.

Probably one may put it that we’re ‘Jack of All Trades’ and I think you know what follows.

But I believe (wholeheartedly, if not, more), that we’re not master of none, but rather we’re master of jack of all trades, and some of the senior consultant or professors that I knew have truly escalated themselves to being master of all trades, like Prof Abrahams.

Going through the 4 months posting in O&G, a house officer not necessary able to equip himself with the adequate scan skills especially if that person has no vision. No vision that one day, without an interest and a reasonable basis to be retained in the hospital, or due to unforeseen administrative decision, he or she will be sent to a district clinic to run the mother and child clinic. It is there when he will be conducting scan for a big crowd of pregnant (and sometimes grumpy) mothers. At that point, they will probably proceed without sufficient scan skills and simply main hentam, till they were being given the privilege and proper training in the obstetric scan course, or they have a really nice, caring, dedicated, honorable family medicine specialist to teach them without any remuneration.

But one thing that basic obstetric scan course may not cover is how to scan for sex. I mean, the politically-correct word to be used is ‘gender’. Most of us learn how to scan for singleton or twin, location of placenta, presentation, fetal heart, amniotic fluid index and the growth parameters such as CRL, BPD, AC, FL, HC and etc, because those are the essentials that will ultimately interfere in the management of this pregnant lady to safeguard the best delivery scenario for the mother and the baby.

Now after saying that, I think most of the mothers couldn’t care less about those parameters that we’re saying. Their main concerns can be summarized into two.

One, “Is my baby healthy/normal?”

Often the misleading “Yes” can be interpreted as baby’s totally healthy without any disease by the general public. A screening of parameters and amniotic fluid index, may only tell us that baby is generally well, but only detailed anomaly of some organs or minor physical anomaly ie the existence of extra digits can only be excluded by a ‘detail scan’ which must be done by an experienced person or the fetomaternal consultants. Even if the detail scan is a clean sheet, it can confidently promise a physically-normal baby but, the baby may also still be abnormal, ie having endocrine disease, psychologically-twisted or perhaps just born evil. The usual term would be ‘prognosis is guarded’. Guarded by who? No, I don’t have the answer for this one.

Second, “Boy or Girl?”

Now the importance being put on this question differs from one person to another.

Once I had this interesting interaction with this elderly mother.
She: I know you can see whether boy or girl?

Me: How?

She: you see something with the legs.

Me: Oh… ok…

She: So what is that something with the legs?

Me: Oh it is that something between the legs.

She: What?

Me: Err. The genitals, between the legs, of course.

She: Oh.

Technically, being a boy or a girl doesn’t really matters in the aspect of the health.

Is boy stronger than girl? Or otherwise?

Therefore inadequacy or when luck is not on your side, inability to inform the anxious couple from the ultrasound seems to cause disappointment in the couple and frustration in the doctors. This frustration may sometimes lead to destructive statement like, “Oh, jika perempuan, tak mau ke? (Oh, if a girl, you don’t want her?”. Maybe in China, with a one child policy, the ultrasound ability to know the sex early may have a remarkable impact, in which a female fetus may not even make it to see the sunlight.

In actual fact, knowing ‘sex’ may have several benefits as well, in our setting.

1. Social reasons. Somehow one way or another, telling the mother the sex of the baby does open up lots of conversation and trivial talk. Usually I would only give them a ‘maybe’ as in “maybe a girl or maybe a boy, you know this scan is black and white, can’t really tell for sure”. And once, I had a lady just after delivery smiled and told me “Scan u betul lar. Memang lelaki (Your scan is correct, really a boy)”
I overheard what my specialist Dr R once said to a pregnant mother.
She: So, Dr. R, is it a boy or girl?
R: Scan shows probably a boy
She: really?
R: Well, it looks like boy, it sounds like a boy, but still may not be a boy. (Lingamgate)

2. Economy reasons. The expectant parents can start buying clothings and stuff like blue for the boy, or red/pink for the girl. Some parents want to buy definite stuff and don’t really go for neutral colours like green, yellow or purple.

3. Family planning reason. Simple actually, no matter how modern our world is, there are still parents who would continue the waiting game, or rather the producing game until they have both – a boy and a girl. There after 4 girls, and getting to know for sure (or 99%) that their 5th child is a boy, they can probably contemplate on permanent contraception like tubal ligation, which can be done simultaneously in case the mother end up with emergency C-Section.

What are the signs we really see to determine sex?

For the boys, we’ll see the ‘sausage with eggs’,

The image “” cannot be displayed, because it contains errors.

while for the girls, we’ll see ‘burger’,

It's a girl!  Twin B - 18 Week Ultrasound

which is the ultrasound signs of the genitalia.

No wonder, the young generations (even some old ones) are fonder in taking them in, savoring and enjoying like food.

OK. Bad joke. Apology.

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