You Will Die if You Conceive

Behold, children are a heritage from the LORD, the fruit of the womb a reward. Like arrow in the hand of a warrior are the children of one’s youth. Blessed is the man who fills his quiver with them. Psalm 127:3-5a (ESV)

It was 2:30am as I placed some large, wet sponges over the open wound to keep it and the bowel moist. “Now, we wait to see if her bleeding slows,” I said to the OR tech across the table from me. I had just tied off the blood vessels feeding the uterus in an attempt to stop the hemorrhage. If that failed, hysterectomy was the next step.

My patient, 27 years old, had given birth just hours earlier. Nothing I had done helped slow the ensuing hemorrhage. Hemorrhage after or associated with childbirth can be so heavy, so much and so fast that it frightens the most seasoned OB doctor, and I was no exception. Women still die in childbirth and hemorrhage is a major cause. God was merciful to her that night. The bleeding slowed to a trickle. After several units of blood and a night in the ICU, she recovered completely.

“Can I have another baby?” she asked me on her day of discharge. I thought back to the horror of four nights earlier–my fear that she would die in my care, that I wouldn’t get the bleeding slowed in time to save her life. I got sweaty again just thinking about it. But, the bleeding did slow. The uterus still had plenty of blood flow to it in spite of the blood vessels I had ligated. I explained she could have more children, but that her risk of hemorrhage would be somewhat higher. And she did. Several more children, all without complications.

Several years ago, I was busy in the OR when my partner needed help with a patient hemorrhaging after childbirth. Since I couldn’t leave, they called someone else to help my partner. When I finished my surgery, my partner was already done and told me about the case. “I went right to hysterectomy. It was easier. Besides, she had three healthy kids already.” My partner had tried no conservative surgeries. Why? Possibly because of the severity of the hemorrhage (but I knew that not to be the case), or because of lack of skill to perform the more conservative operations (possible), or because my partner didn’t want the hassle of missing office with a long drawn-out affair in the OR when a hysterectomy could take care of the problem quickly and, besides, she had three healthy kids already.

Besides, she had three healthy kids already. My partner’s implication was clear. Time to stop. Three’s plenty.

Two times this week I’ve had consults with women who were told by their doctors to have no more children because of risk to their lives. After I reviewed the past records, I saw nothing with either that would preclude more children. The first patient hemorrhaged with her sixth and then told me the clincher. “My OB doctor told me six children was more than enough for anyone, anyway.” The other patient’s husband underwent vasectomy because the doctor told him his wife would die if she had another baby. How tragic.

I’ve done OB now for over 30 years now and I’ve cared for women experiencing about every complication that can occur related to childbirth. Hemorrhage, eclampsia (seizures), heart failure, kidney transplants, long-standing diabetes, uterine ruptures, fetal distress and severe infections to name a few. Many pregnancy complications are more likely to occur with subsequent pregnancies and can entail significant risk. When I counsel women on future childbearing, I never sugar-coat the risks. But, I’ve yet to tell a woman to never conceive again. I’ve yet to recommend a tubal ligation or hysterectomy because of pregnancy risk. (One of my patients underwent cesarean section seven times–so much for the “you can only have two or three cesareans” theory.)

Unfortunately, I see women again and again in my practice who have undergone a tubal ligation on the advise of their OB doctor, or been advised to stop childbearing because of excessive risk, or, as above, had a hysterectomy when a lesser surgery would have likely helped. Women who have received such advise should take it with a healthy grain of salt.

* Details of above stories altered to protect privacy.

Easter Thoughts

I am reading a biography called, A Short Life of Jonathan Edwards by George M. Marsden. I downloaded it from Amazon to read on Kindle for iPhone. (I’m dropping names to show I’m a 21st century guy.)

Jonathan Edwards, a Puritan, preached the famed “Sinners in the Hands of an Angry God” sermon. That’s about all they teach about Jonathan Edwards in secular texts, making him appear to be a mean, nasty, uncaring man. Of course, no one asks students how they would respond to words in Revelation on which he preached that sermon.

Was he mean and nasty and uncaring? Of course not. Father of 11 children, author of a multitude of books and theological treatises read the world over which are still selling today, he is still regarded as one of the greatest thinkers of the 18th century and possibly the greatest theologian the United States has ever produced. He was a graduate of Yale, pastored only one church that being in North Hampton, MA, started the fire of Christian fervor that engulfed the colonies which was called the Great Awakening, was a missionary to the Indians in western Massachusetts and one of the first presidents of Princeton.

His love for God defined his life. He recognized the sovereignty of God and sought to bring glory to God. Every thought, every action, every moment of study, every book, every writing was to glorify the God whom he loved.

He wrote a biography of David Brainard, a young man who was missionary to the Indians in Delaware and other areas in the Northeast. David Brainard developed “consumption” (tuberculosis) and died at age 29, the last 6 months of his life in Jonathon Edward’s house. Mr. Brainard was too ill to continue his missionary work. Jonathon Edward’s daughter, Jerusha, provided care for him until his death, she herself developing tuberculosis and dying one month later. The biography of David Brainard remains Jonathon Edward’s most popular work and few missionaries, even today, enter missionary life without reading and benefiting from this inspiring story.

Mr. Marsden’s biography of Pastor Edwards disappoints, however. In Mr. Marsden’s study and documentation of Pastor Edward’s life, Mr. Marsden misses the whole point. He looks up and down–behind every tree, under every rock, around every corner–to find what made Jonathan Edwards tick. In the end, Mr. Marsden seems to throw up his hands in confusion. He just can’t understand how Pastor Edward’s passion and love for God and God’s redemption determined all the decisions he made throughout his life. He spends one chapter comparing Mr. Edwards to Benjamin Franklin who was Pastor Edward’s contemporary contrasting the “enlightened” (promiscuous, secular) Mr. Franklin with the stuck-in-the-past, stuck-in-one-place, father of 11, married to one woman Pastor Edwards.

Obviously, Mr. Marsden is/was an academic sort who out to impress someone with his scholarship (or to make a buck on a book deal). How he got the treatise published mystifies me because he can’t see the forest for the trees, ignores the 800lb gorilla in the middle of the room, demonstrates obliviousness to the obvious and just doesn’t get it. He can’t accept that Pastor Edward’s whole life center on bringing glory to God, on treasuring Christ above all, on marveling in the work of Christ on the cross and on worshipping the One who hung the stars in the heavens.

Paul provides the answer to this confused presentation and says it best in 1 Cor 1:20-27 which I’ve copied below.

“Where is the one who is wise? Where is the scribe? Where is the debater of this age? Has not God made foolish the wisdom of the world? For since, in the wisdom of God, the world did not know God through wisdom, it pleased God through the folly of what we preach to save those who believe. For Jews demand signs and Greeks seek wisdom, but we preach Christ crucified, a stumbling block to Jews and folly to Gentiles, but to those who are called, both Jews and Greeks, Christ the power of God and the wisdom of God. For the foolishness of God is wiser than men, and the weakness of God is stronger than men.  For consider your calling, brothers: not many of you were wise according to worldly standards, not many were powerful, not many were of noble birth. But God chose what is foolish in the world to shame the wise; God chose what is weak in the world to shame the strong;   (1 Corinthians 1:20-27 ESV)

God, in His sovereignty, chose the simple to confound the wise, chose what the world considered to be foolish to shame the wise and chose the folly of what we preach to save those who believe. And what was the complicated, difficult message that Paul preached? The message that we preach? “…but we preach Christ crucified, a stumbling block to Jews and folly to Gentiles, but to those who are called, both Jews and Greeks, Christ the power of God and the wisdom of God. For the foolishness of God is wiser than men, and the weakness of God is stronger than men.”

So I was disappointed in the biography. Not in Jonathon Edwards, mind you–he remains an inspiration to me–but saddened that Mr. Marsden didn’t get it. I fear Mr. Marsden may not be/have been a believer. I do, however, find myself inspired again by reviewing the life of this great saint. And I’ve found myself humbled all over again by my unworthiness and shame while exulted by the magnitude of Christ’s sacrifice for me. For me. On the cross of Calvary, where He gave His own life to bring me into His fellowship, into the body of Christ, into eternal joy. For me.

So Easter now is just around the corner. I pray again He will forgive my sin and rebellion, my ongoing string of failures, disappointments, sins and unbelief and present me faultless to the Father, guilty no more, covered by His wonderful blood, held in His nail-scarred hands, to gaze into His face and worship Him. Forever.