Taking care of baby business

Dr Joanne Said is an obstetrician at the pointy end of maternal-fetal medicine, and it is, she says a challenge and a privilege …

DR Joanne Said sometimes feels like a real-life Nina Proudman.

“Her life is chaotic, and sometimes my life is chaotic too,” Dr Said tells the MJA. But apart from her choice of career, that’s as far as comparisons with the lead character in Offspring can go, thankfully.

Dr Said is an obstetrician, and is Head of Maternal Fetal Medicine at Sunshine Hospital in Melbourne’s north-western suburbs.

A graduate of the University of Melbourne, Dr Said came to Sunshine via her internship at Austin Clinical School, an HMO year at the Royal Children’s Hospital, obstetric and gynaecological training at the Royal Women’s Hospital, a year at Warrnambool and another at Mercy Hospital for Women in Heidelberg.

Somewhere in there she finished a PhD on inherited thrombophilia, while completing her training in maternal-fetal medicine, and had a daughter, who is now 9 years old.

“By the time I finished all that training in 2008, I swore I would never sit another exam again,” Dr Said says.

Obstetrics and gynaecology (O and G) weren’t the obvious choice when Dr Said began medical school, however.

“I had no intention of doing O and G at all,” she says, “I was aiming for psychiatry originally, but by the end of my first year I realised it wasn’t for me. In fact, O and G was the last thing I wanted to do — it was very unpopular.

“I spent most of medical school thinking paediatrics was what I wanted to do. In my fifth year, O and G was my last rotation and I decided that I just had to endure and get through it.”

Instead, Dr Said discovered her vocation.

“I became so immersed in it, and enjoyed it so much that by the end I realised that I had to seriously think about changing my career path. I tried to tell myself I didn’t enjoy it, but I did. I loved it.”

It’s the multi-faceted nature of O and G that appealed, and still appeals, to Dr Said.

“I liked that there was so much you could do to care for mothers and their babies. Some of that was medical and some surgical, and I loved being able to combine those kinds of things.”

While obstetricians generally deal with healthy women delivering healthy babies, Dr Said became engrossed by maternal-fetal medicine (MFM).

“MFM is about the high-risk pregnancies,” she says. “We call them the one-percenters — the rare, weird and wonderful.”

For the fetus, that can include chromosomal problems like Down syndrome, as well as spina bifida and other physical problems that can develop through pregnancy. For the mother, it can mean getting women with pre-existing conditions like cardiac issues, kidney disease, diabetes or lung problems safely through pregnancy.

“We give people the right information, counselling and advice, and treatments if appropriate,” Dr Said says. “We detect problems, intervene where appropriate and offer advice and management.”

There are not always happy results, of course. Just before talking with the MJA, Dr Said had hosted a regular pregnancy loss clinic.

“It can be very sad, of course,” she says. “We try to provide support and to treat each loss with the respect it deserves. There’s been a stigma associated with pregnancy loss and we’re trying to take that stigma away.”

Terminations are part of the job, and a challenging one.

“In Victoria, terminations are legal at any time in the right circumstances for all concerned,” Dr Said says. “Just because it’s legal doesn’t make it the right decision in all cases, however.

“You absolutely have to put aside your own feelings and beliefs, and that can be very challenging. That’s why we use a multi-disciplinary approach, so people can voice their concerns and a collective decision can be made within the legal framework.

“After all, there’s no going back, so we need to be very certain that the diagnosis is correct, and that is reviewed very carefully.”

As a student aiming for a career in O and G, the issue of terminations wasn’t part of Dr Said’s thinking.

“Not at all, I didn’t think about it for a second,” she said. “Medical students are very much protected from it.”

As head of MFM at Sunshine Hospital, however, Dr Said is responsible for a group of University of Melbourne medical students doing their O and G rotations with her.

“It’s hard to bring them into the consultative process and we tend not to involve them directly in that way. When I have case-based discussions with them we do talk about the ethical issues from the point of view of the patient, and the doctors, the ones doing the procedures. We challenge their ethics.

“The fact is MFM is at the pointy end of this issue. It’s not going to suit everyone.”

As part of its Transition to Practice program, the University of Melbourne offers 4-week “vocational selective” rotations.

“The students who come to us in that way really want to do MFM and those students we do expose, and we support them appropriately.”

The gender balance in O and G is about 80–90% female, according to Dr Said.

“And that’s good, but it can be challenging. By the time they come to us as senior trainees or junior doctors, their biological clocks are ticking anyway, so it’s also the time when many decide to get pregnant.

“We’re in the business to understand that, but yes, maternity leave does make for a management challenge sometimes.”

Dr Said is unashamedly devoted to her job.

“Mostly I enjoy coming to work,” she says. “It’s busy but really rewarding. I can’t get over the privilege of taking care of people during their pregnancy. Even when their pregnancy has been difficult and you’ve been watching over them the whole way — it’s so beautiful seeing them be mothers.

“It’s lovely to pop in and see them afterwards and cuddle the baby for a bit. So very rewarding.”