Dr Alan Lindemann: 5 Things I Wish Someone Told Me When I First Became A Doctor

An Interview With Luke Kervin

Trust is very important when a woman starts into labor. Many patients have told me in the midst of labor they couldn’t do it. I would tell them I thought they could, and it helped them get through labor because they knew me, I had seen them on every one of their prenatal visits, and they trusted me.

As part of my series about healthcare leaders, I had the pleasure of interviewing Dr. Alan Lindemann.

An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D. teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. A former Clinical Assistant Professor at the University of North Dakota, he served as a clinical faculty member and preceptor with medical students in rural rotations. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at LindemannMD.com.

Thank you so much for joining us in this interview series! What is your “backstory”?

I was raised on a small farm in rural North Dakota. My high school wasn’t as good as those in metropolitan areas. I didn’t have to study to pass my courses, so I never learned how to study. I had a hard time with algebra, but I didn’t have anyone to help me with it.

We had many kinds of animals and I enjoyed taking care of them. People would bring me their cats and dogs when their pets had troubled labors. This was long before veterinarians were widespread in rural areas. I knew I wanted to be a doctor, but also knew I needed to pass algebra to get into medical school.

When I went to college, I majored in languages. I grew up in a community where many people still spoke German. I found I could assimilate languages easily, so taking French, Russian, and German in college seemed the right thing to do.

While I was studying languages, I learned how to study and got help mastering algebra. I then applied to medical school and was accepted.

Can you share the most interesting story that happened to you since you started your career?

I have had the privilege of delivering quadruplets. The parents came to see me because the mother had conceived with in vitro fertilization and was pregnant with four babies. Fertility specialists consider pregnancies with quadruplets undesirable, and pressed the parents to have two of the babies removed. This was not acceptable to the parents. I was the third obstetrician they visited, and the first to agree to work with them in delivering four healthy babies. The parents have kept in touch with me over the years. Two years ago, when the quads were 21 years old, the family welcomed the opportunity to meet with me and talk about their experiences. The video is available for free on YouTube.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

On my LindemannMD.com blog, for a short time we had a pop-up menu encouraging my former patients to contact me for old times’ sake. One of the emails I received was from a man who reported that his mother told him I had laughed at the size of his feet when he was born. He contacted me after all these years — he was born during my OB/GYN residency in 1978. I am always amazed at the people who contact me about the care they received from me even years ago!

Are you working on any new or exciting projects now?

I would like to make my video on reducing maternal mortality available to medical students. I will be beta testing working with medical students on a subset of this video, “How to Do a C-Section.” When I was in medical school, a c-section rate greater than 15% was considered excessive. Today the c-section rate is 32% . I believe part of the reason for this is medical students no longer are taught how to manage vaginal births with breech babies, twin births, and women who labor slowly. Those who teach these things in medical school are evidently not teaching students how to turn a high-risk pregnancy into a low-risk pregnancy.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

When I was in medical school, technological intervention in labor and delivery was minimal. Women could get up and walk around; in fact, they were told to walk around to hasten labor. Many times I sent my patients home if labor seemed to have stopped because I did not want repeated vaginal checks of cervix dilation, which I believed significantly increased the risk of infection.

In my first practice, I joined a physician who had been delivering babies for many years. He told me to avoid maternal mortalities for two years if I wanted to stay in the business of delivering babies, and “the best thing to do with your hands is sit on them.” I have delivered 6,000 babies with no maternal mortalities by helping my laboring mothers avoid excessive checks for cervical dilation and avoid being confined to a bed with all kinds of technological monitoring equipment strapped to them.

Is there a particular book that made an impact on you? Can you share a story?

I have long felt that vaginal birth with as little technological intervention as possible is the best approach in delivery for both mothers and their babies. Michael Odent, a French obstetrician, has written many books about what can best be described as birth without violence. I was fortunate enough to be able to acquire a copy of his 1994 book, “Birth Reborn.” Some of his early books are collector’s items and expensive. However, he has since written a number of books about natural childbirth methods and the basic needs of women in labor. Because I believe in allowing women to labor and deliver their babies without excessive intervention, the writing of Michael Odent resonates with me.

How have you used your success to bring goodness to the world?

The maternal mortality rate in the United States is higher than some third-world countries. In many developed countries, the maternal mortality rate is two to three per 100,000 births. In the United States, it is 19 per 100,000 births. The American Institute of Medicine has researched maternal mortality in the United States and come to the conclusion that as many as 60% of these maternal deaths are unnecessary.

Even more alarming, the maternal death rate for non-caucasian women is as high as 40 per 100,000 births.

My web page, RuralDocAlan.com, provides links to many articles I have written or contributed to on how to reduce the maternal mortality rate in the U.S. I want to get information out to pregnant women on how to avoid some of the problems which lead to this inordinately high maternal mortality rate in the U.S.

Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant to you in your own life?

Pregnant women so often feel they shouldn’t question the expert, the obstetrician. My goal is to provide pregnant women with the information they need to ask questions about their choices in their pregnancy and delivery. In today’s medical environment, it is very difficult to raise questions about care choices. I want to encourage women to have the confidence to trust in themselves.

Can you share your top three “lifestyle tweaks” that will help people feel great?

First: Trust is very important when a woman starts into labor. Many patients have told me in the midst of labor they couldn’t do it. I would tell them I thought they could, and it helped them get through labor because they knew me, I had seen them on every one of their prenatal visits, and they trusted me.

Second: How did I establish trust? I saw my prenatal patients often and I always encouraged them to bring their husbands and children to the visit. I wanted to listen to them and hear what they were worried about. I saw my patients as often as I thought necessary regardless of whether insurance would pay for the visits.

Third: Trust yourself. Part of a woman’s trust depends upon finding a provider she trusts. I recommend women interview their provider on their very first visit. There’s time to seek out a different provider if needed. Trust is especially important once labor starts. Often women become anxious when they enter the hospital for their delivery, and when this happens, labor sometimes stops. We know labor stops for deer, for example, if danger approaches. Many doctors think when women show up at the hospital and aren’t in labor, their patients don’t recognize labor. From my perspective, knowing the need for trust during labor, if you become afraid when you get to the hospital, your labor will likely either become dysfunctional or stop.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

One:

I grew up in a German community. In the German language, verb prefixes can be separated from the verb and put at the end of the sentence. When the language police began trying to make English fit Latin rules, they decided it wasn’t proper to end a sentence with a preposition. When I started my medical school rotations at the University of Minnesota, I made the mistake of asking “Where are you going to?” This provided quite a bit of amusement to the other residents who responded “Now we know you are from the Midwest.” The last time I checked, Minnesota was in the Midwest, but they had been taught English according to Latin rules.

Two:

As a college senior, I worked as an orderly in a rehabilitation hospital. I was paid 95 cents an hour, although the pay eventually went up to $1.10 an hour. I could have made more money working as an orderly in a hospital. I wish someone had told me. In any case, I learned a lot about patient feelings and normal behavior taking care of the patients in the rehabilitation hospital.

Three:

In one of the little towns I worked in, I had a great clinic nurse. She called patients when I asked her to and she did so with great precision and tact, something sometimes hard to accomplish over the phone. She told me something I had suspected, but not actually heard from a nurse about nurse’s training. She told me her training was more about shifting blame than about learning nursing content. On her final test for her certification, she said she had done well and finished 20 minutes early because she had answered enough of the questions correctly to pass. I’ve had the privilege of working with many great nurses, but she was one of the best I have ever worked with.

Four:

Until you have been sleep-deprived from working 36 hours straight, it’s hard to imagine what it is like. During my residency, I was on 36 hours, off 8 hours, on 14 hours, off 8 hours, on 14 hours, off 8 hours, and then on again 36 hours. If someone had a vacation, it was 36 hours, 14 hours, and 36 hours. Most residents had this same schedule. We all just accepted sleep deprivation as a fact. If we were lucky, we’d get a morning shower and at least clean up for the day. We’d look better than we felt. If we were super lucky, we’d even get breakfast, but the line was long. On my drive home, I would fall asleep for most red lights. Luckily, I never had an accident. We now know that driving while so sleep-deprived is much like driving while drunk.

Our generation fought against these hours to make it better for students and residents today. Nobody should be taken care of by an M.D. who has been without sleep, food, or a shower for 36 hours, and today they are not.

Five:

I often found myself driving fast hurrying to get to a delivery. I often got stopped by the police. One time, for some reason, I got out of my car and ran back to the police car with flashing lights right behind me. I told them to give me a ticket if they wanted, but I had to get to a delivery. They said they’d not give me a ticket and would escort me to the hospital, but by the way, you were going 65 in a 25-mph zone.

In all of my 6000 births, I never got a ticket going to a delivery, but I did get one going back home.

If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?

If I could start a movement that would bring the most amount of wellness to the most amount of people, I would bring down the fetal and maternal morbidity and mortality rates.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them :-)

Dr. Neel Shah (drneel.com) is one of the most outspoken physicians looking for ways to reduce maternal mortality, especially the c-section rate in the U.S. If I couldn’t meet with him I would at least love for him to write the foreword to my forthcoming book, “Pregnancy Your Way.”

What is the best way our readers can follow you online?

My web site landing page is RuralDocAlan.com, which contains contact information, newsletter sign-up, and links to my blog and my social media.

Thank you so much for these wonderful insights!