A Day in the Life with Dr. Cindy Maxwell
Dr. Maxwell is making pregnancy seamless, safe and stigma-free for women with obesity.
Dr. Cindy Maxwell can’t stop smiling. As the Head of Mount Sinai Hospital’s Maternal Fetal Medicine Program, which includes the Medical Disorders in Pregnancy Program, Dr. Maxwell’s Mondays are dedicated to patients with medical conditions ranging from inflammatory bowel disease to cancer. But her greatest passion, and the majority of her practice, is caring for women with obesity who are trying to become pregnant, are already pregnant or have recently delivered. On the chilly spring day that I was invited to shadow Dr. Maxwell, she had a patient induced and consulted with numerous others, trekked back and forth between two Sinai Health locations, skipped lunch, huddled with trainees and nurses and patiently posed for a portrait photo. Even amid the chaos and the busyness, she greeted every interaction with a smile on her face.
8:00 AM—Family Breakfast
Dr. Maxwell’s day starts at her east-end home, where she lives with her two daughters, ages six and 10, and her husband, who is also a maternal fetal medicine specialist at Mount Sinai. As the eldest of five daughters from a Bathurst, New Brunswick family, all of whom went to Harvard University, Dr. Maxwell prizes family time.
Her own family’s morning routine involves a vegan breakfast of oatmeal or Dr. Maxwell’s new favourite, quinoa flakes. She combs the girls’ hair and walks them to school.
“The time that we spend together reassures me that I’m doing the best that I can for them,” she says, referring to her kids, “and then I can go on to help other people, too.”
9:30 AM—Clinic Begins
The first appointments at the Monday clinic, held on the third floor of the Ontario Power Generation building, the iconic curved and mirrored building at the corner of University Avenue and College Street, are usually scheduled for 9:30. That gives Dr. Maxwell time to check in with fellows, residents and nurses before seeing her first patient of the day.
Anastasia and her husband, Jamie, eagerly await the arrival of baby Penelope.
10:00 AM—Induction
Wearing black, knee-high boots, with her white doctor’s coat covering a fashionable fuchsia dress, Dr. Maxwell hustles down busy University Avenue to the 15th floor of Mount Sinai. She’s here to meet with Anastasia Danos, a 34-year-old Toronto chef who is looking forward to meeting her first baby — a girl — after being induced today.
Like Dr. Maxwell’s other Monday patients, Anastasia has an elevated body mass index (BMI) and was referred to Mount Sinai because her previous obstetrician predicted a high-risk pregnancy. The care she receives from Dr. Maxwell and her team is just like what any other expectant mother deserves: compassionate, thorough and with the safety of mother and baby always at the forefront. That means not only taking into consideration the unique medical situation of pregnant women with obesity, such as an elevated risk of diabetes, hypertension and other conditions, but their unique physical needs as well.
For instance, the hospital bed that Anastasia reclines on comfortably accommodates patients of any size, and the door of the room she’s in is wide enough to let the bed pass through easily, in case Anastasia has to be wheeled to an operating room for a Caesarean section (C-section) birth. The cuff that is used to measure her blood pressure is burgundy, not blue, meaning that it fits a larger arm without squeezing, which can artificially raise blood pressure measurements. And her hospital gown, printed with little flowers, keeps her fully covered and comfortable. All of these adaptations are made behind the scenes, typically without discussion, and in each interaction, the nurses and doctors here are mindful about using language that makes patients feel at ease.
“They’re little things and we don’t make a fuss about them on a day-to-day basis,” Dr. Maxwell says, over the Doppler-amplified sound of the heartbeat of Penelope, soon to be born to Anastasia and her husband, Jamie Whitehead. “But they make a huge difference to the patient’s overall experience.”
It’s an experience that Anastasia calls “world class.” She was transferred to Dr. Maxwell’s care after having several miscarriages in the past few years. Now, she’s finally about to realize her dream of becoming a parent.
“The care, the detail, the communication between doctors and with my family doctor — everything is streamlined and I didn’t have to do any of the legwork,” Anastasia says. “Right now, I’m just looking forward to holding my baby and being her mom.”
Dr. Maxwell with the McNama family (L to R): Brandon, baby Mabel, one-year-old Grayson and Caitlin.
11:30 AM—Post-partum Visit
All smiles, Dr. Maxwell strides through the door of a small consultation room back at her clinic. It’s a full house: New mom Caitlin McNama, an event planner, sits in a chair beside a desk, holding three-day-old baby Mabel in her arms. Husband Brandon hovers by the examining table, doing his best to occupy their one-year-old son, Grayson. Doctor and patient discuss breastfeeding and future options for birth control.
“Dr. Maxwell has really listened to what I’ve had to say and she always ended appointments by asking if I had any questions or if there was anything else I needed to know,” says Caitlin, who was referred to the clinic during her first pregnancy, and returned for her second, because she has celiac disease coupled with an elevated BMI. “She worked really well with our life, too.I was working through one pregnancy and then I had a baby with me during the next one, and they were really accommodating with any requests that I had.”
Just like Anastasia’s labour and delivery room, the clinic is designed to be comfortable for all of Dr. Maxwell’s patients, without explicitly showing how it’s been adapted for women with obesity. Although these design tweaks — for example, the roomier chairs — are much appreciated: “Being plus-sized and having a toddler at some of my appointments, these chairs are extra comfortable,” Caitlin says.
12:15 PM—Lunch on the Run
On clinic days, Dr. Maxwell and her team see 45 to 50 patients. They are a mix of pregnant women visiting for routine check-ups; new moms, like Caitlin, following up post-partum to ensure they are healing well after C-section births; and emergency visits prompted by new health challenges or complications.
It’s no surprise Dr. Maxwell usually doesn’t break for lunch. Instead, she snacks on a few dried apricots between appointments, or during the frequent huddles she has with her team throughout the day. Today, the team discusses special care plans for particular patients and brainstorms about how to better identify and manage sleep apnea in pregnant moms with increased BMI.
Dr. Maxwell consults with her team (L to R): clinical clerk Fartoon Siad; nurse Catherine Chan, RN, LC; fellow Gharid Nourallah; University of Toronto fourth-year medical student Alison McFadden.
1:30 PM—Reviewing Patient Records
A lot of Dr. Maxwell’s work can be done over her smartphone on the go: communicating with colleagues, reading reports, checking her calendar. But a few times a day she retreats to her office to read files away from the busy clinic floor. Gifts from patients, including ceramic angels and a little music box with butterflies on it, line her windowsill.
“The gifts are lovely mementos because they always remind me of those patients and those families.”
The walls are filled with framed degrees from various institutions, including Harvard University, where Dr. Maxwell spent about 13 years doing her undergraduate degree, medical school and residency training.
“I had the good fortune of being able to study at Harvard, and it was a very challenging, very gratifying period of my life,” she says. “But I always knew I’d come back to Canada. When I had the opportunity to do my maternal fetal medicine training at University of Toronto, which already had a reputation as a premier international program, I thought, ‘Ah ha, this is it. This is my opportunity.’”
She’s used that opportunity to improve pregnancy care for women at Mount Sinai and, specifically, to create a stigma-free environment for patients with obesity who might be at risk of medical or surgical complications.
“We try to strike a balance between helping each woman understand her pregnancy risks, and not making her feel singled out,” she says. “We always think about providing care in a positive way.”
3:30 PM—Celebrating a Sister
This particular Monday, Dr. Maxwell leaves the clinic earlier than usual. One of her sisters, Linda, the second born, a doctor and entrepreneur, is being honoured by Ryerson University for her work as the founder and executive director of the university’s Biomedical Zone.
“We have a long-standing tradition of supporting one another for these sorts of things,” she says, adding that her other three sisters all trained as lawyers: One is now a judge, one is a health policy lawyer and one is an information technology and privacy law specialist.
8:00 PM— Family Time
Dr. Maxwell’s day ends as it begins, with family. After cooking and eating dinner (her husband is the family cook, while she’s more of the sous chef), supervising her daughters’ homework, reading and projects, she sees the girls off to bed. That’s when she has time to work on personal projects, like her scientific writing, presentations and grant proposals. And it’s also when she and her husband get to connect and chat with each other about work, kids, vacations and other things that make their busy lives so fulfilling.
“I am, at the core, a very optimistic person,” she says.“I think it’s a reflection of the satisfaction that my work gives me and the impact of being able to spend time with my family. It keeps me grounded and happy.”
Story by Nancy Carr | Photos by Jacklyn Atlas