Richard Rubin, MD, an obstetrician-gynecologist at Concord OB/GYN, says he’s seen pretty much everything in more than 20 years of practice. On the other hand, he says he still gets surprised when individual cases proceed in an unpredictable way. Dr. Rubin is highly aware that, in being present at the birth of someone’s baby, he becomes a part of their life story.
What convinced you to go into obstetrics and gynecology?
My father was an ob-gyn, so that certainly influenced me. In medical school, I thought I would be some kind of surgical specialist, but during my medical residency, I connected with the idea of having patients who I would see long term. Rather than take care of someone and let them go, I wanted continuity. That’s been true at Emerson, where I’ve been on staff for ten years. I’ve seen people before they get married, during their pregnancies and then followed them for years thereafter.
Do you see many high-risk patients?
We see quite a few, many because of age. Anyone age 35 or older is considered to be at high risk. Other high-risk groups include women who are obese, have diabetes, prior history of preterm birth and those who have had a prior cesarean section. Many women who had a c-section want to have a vaginal birth, and we offer that at Emerson.
We are fortunate to have three maternal-fetal medicine (MFM) specialists from Brigham and Women’s Hospital on-site. I send them patients who have something in their history that is concerning to the couple or myself. Our MFMs might look at an earlier workup on the patient and bring that into the chart. Also, we may pick up something during prenatal care or on an ultrasound that is suspicious. We can often get a patient in to see one of our MFM colleagues quickly to evaluate and form a plan.
What are your clinical interests in addition to obstetrics?
I perform minimally-invasive surgery, including total laparoscopic hysterectomies and hysteroscopic surgeries. The goal is to provide the patient with successful treatment while having the lowest impact on them. If someone walks in asking for a hysterectomy, they may not have explored all of their options. Patients may not be aware that we often can provide different treatment, such as a medical approach, for their bleeding or peri-menopausal symptoms. I’ll spend the time needed to discuss those options and explain the impact of having a hysterectomy. I’m also interested in low-risk pregnancy, which means being as low-impact with a patient as you can be.
What does low-impact care look like?
If someone has no risks factors, it means getting out of her way and allowing her to have a natural birth experience. In such cases, you need to have the patience to let labor run its course. My experience is that patients really appreciate it when you give them a little more time to have the baby on their own. I always ask the patient at the beginning of labor what her plan is, and I explain that we offer a number of non-medical techniques for pain relief — the labor tub, balls and different positions. I often ask patients during labor “Is there anything we can do for you?” without specifically offering pain relief. We let the patients ask for pain medication if needed so that we don’t make them feel pressured into abandoning their birth plans.
Is Emerson a good place to practice obstetrics?
It’s a great place. Our labor and delivery unit is a place where, if there is a problem, we have people who are willing to work together in order to solve it. I’m aware that many women travel a distance because of Emerson’s reputation; they want to deliver their babies here, or they want to have their surgery here. People appreciate that we have all private rooms on our postpartum unit.
Overall, I think everyone at Emerson understands that having a baby is a moment in time that people always remember, and we are part of that special life moment. I’m also pleased that, if someone is diagnosed with cancer, they can often have their surgery here, possibly performed by Colleen Feltmate, MD, a gynecologic oncology surgeon from the Brigham and Dana-Farber with whom we collaborate.
What do you enjoy during your time off?
I love traveling with my family. My wife is German, so we visit Germany and travel from there — to Denmark, France and Italy. I also love to run; that’s my regular activity. I’ve been running for the last 20 years, including in marathons. These days, I’m pretty happy running around Sudbury.