This was not on the list of regularly scheduled programming, but I got tagged like 3 times in a post about natural birth and I've had to give this response before, so I figured it would be best just to keep all these thoughts together and accessible. So, as someone who had a natural birth and who is also a certified childbirth educator, here are the things I think are important to know:
1) We will start with anecdotal evidence. My birth. I loved it. It was loooong (78 hours) and my baby was BIG (9lb. 14oz.), but I would not describe my birth as painful. Contractions were uncomfortable (although I have endometriosis and not a single contraction hurt worse than my period cramps), pushing was really hard work (not only was he big, he wasn't ideally positioned), and crowning felt intense, but never once did it feel like I was suffering or needing additional assistance in any way. Now, to hedge, I had a homebirth. I could move freely, eat what I wanted, rest on my own bed or in a birthing tub in my living room. We could come and go from the house as we pleased and be left completely alone when I needed some space. I imagine if I had been in a different environment I would have faced some unique challenges that may have changed how the birth progressed and my perception of it, depending on the limitations of the space.
2) Let's be clear- No medication does not mean no pain relief. It simply means using other tools to cope with discomfort during labor. In my classes, we go over all the different pain relief options and they fill in a tool box with the ones that appeal to them and then have a separate space for ones they want to avoid. Massage, hydrotherapy, positioning, activity, relaxation and mediation, TENS units, aromatherapy- all these things can offer pain relief during labor and help labor to progress optimally. Some people think natural birth just means showing up and gritting through it, and that usually results in the stories you hear about it was so awful or they had to get medication or they were so exhausted after they couldn't function.
3) It's like running a marathon. Ask any long distance runner and they will tell you running can hurt. Your muscles are working hard, your body is taxed, there can be discomfort. But they still run because they know they are working towards a goal. They also know that the pain is PRODUCTIVE and not INJURIOUS, and that is an important distinction. Some people who aren't familiar with extensive physical exertion may not readily understand the difference. You can feel pain when you are injured- like stepping on a nail or breaking a bone. It hurts and it signals your body to have a adrenal response to the situation to cope. However, you can also feel pain during things that are not injurious but actually productive, like running. It may be uncomfortable, but your body is not being harmed or damaged, it's simply working hard. Same thing with birth. Nothing is happening TO you; you are ACCOMPLISHING something. And when the body perceives that kind of discomfort, it does not initiate a stress response, which is good because those stress hormones can actually make pain worse and make you feel panicky. Mentally preparing for this distinction during pregnancy can keep you from panicking when you feel a contraction and stimulating an injurious pain response. Telling yourself or having other people remind you that the discomfort is normal, your body is working hard, your baby is on it's way, etc., can help keep you calm and the discomfort in perspective.
4)One of my pet peeves is when people say "You can't plan labor." Well fucking duh. Everyone knows this. It peeves me because it is usually said in response to a mother trying to prepare herself for her labor or gain more knowledge. It sounds discouraging and frankly really patronizing. The mom knows she can't plan. But she's trying to prepare. And that is GREAT. Our culture does not prepare us for birth at all, but especially not for natural birth and it does take some effort to rectify that. While some people may feel more comfortable with a medically managed pregnancy where they don't have to participate, many others want bodily autonomy and the ability to allow their body to do what it needs to do. What I recommend to my students is this: Make a birth plan- the one you want. The one you envision and hope for. Then make a separate contingency plan. Talk with your birth partner about what you would do in certain circumstances, such as if you medically needed an induction (which is not common) or medically needed a cesarean (also not common). Write those things down so you both are on the same page and know what to do if a situation arises. But then put it away. Don't look at the contingency plan again. You have addressed the "what ifs", now focus all of your energy on your original birth plan. Say affirmations, read birth stories, watch videos, surround yourself with positivity.
5) It doesn't have to be all or nothing. Most people are interested in natural birth for the experience and the health benefits to mom and baby. However, at some point you may decide you want a different kind of experience and that's okay, but you can mitigate the risk to you and baby by knowing about interventions and how to use them. Timing of epidurals, method of induction, etc. can make a big difference in how much risk you are adding on with these interventions. Also, as I tell my students- you can't get an epidural in the parking lot. Chances are even if you plan the most medicated labor in the history of childbirth, you are going to have to deal with a few contractions on your own. So it behooves you to know about how to handle birth in the event that medical interventions aren't readily available.
So there you have it. Per usual, feel free to ask questions, email, facebook, etc.
Showing posts with label the patriarchal medical establishment. Show all posts
Showing posts with label the patriarchal medical establishment. Show all posts
Saturday, December 19, 2015
Sunday, January 18, 2015
Virtue as the Mean
About a week ago I found this article in the Washington Post. It is the experience of one woman, a self-described "physician, teacher, and health policy researcher" while having her baby in a hospital. She details the immense pressure she felt to have a high intervention birth and almost a cesarean section despite her wishes to have a low intervention birth. The big take away from the article, at least from my perspective, was the danger lay women face in the delivery room given the adversity this woman of medicine had to confront in her own labor. At one point she mentions consulting with several other M.D.s of various backgrounds in order to advocate for herself and her child. While I thought the article was an insightful and pointed statement about maternity wards, the larger cultural commentary came from the vary first comment that showed below the article itself. I normally avoid the comment section like the plague but happened to catch this one as it was the only comment at the time. I didn't feel like wading back through that trash to get a direct quote, so I will paraphrase. The commentator basically said "Shame on you" to the mother. She was doctor. Apparently she should have known better and advocated for herself more. If she felt pressured it was her own fault for letting herself get into that situation.
This is not the first time I've heard this argument. It actually comes up quite a bit. Women share their stories of abuse and mistreatment during their births, and they are blamed. It is there fault for not being more prepared, more educated, more anticipatory of the events. It's their fault for relying on doctors. It's their fault for not taking responsibility in their own care. It's their fault, period. I find these arguments confusing for several reasons. One is because there seems to be very few other specialized fields where consumers are expected to have expertise. Most people who go to a mechanic can't build their own engine. Most people who go to a gourmet restaurant can't cook French cuisine. This is also a huge issue of privilege- assuming that someone who is already paying a professional to perform a service also has the time and resources to teach themselves the ins and outs of the field and be independently educated on the topic. Is assuming that someone trained in healthcare and beholden to the hippocratic oath will provide adequate care really that far of a leap?
But another thing about this idea of "it's your fault for not educating and self-advocating" is that it's bullshit. Because women who do all those things above- who prepare and seek out education and information and participate in their care- aren't treated any better a lot of the time. They are labeled as pushy. As non-compliant. Demanding. Relying on Dr. Google. Buying into psuedo-science. Believing everything they read on the internet. They are accused of being selfish and even worse, of not valuing their child's life and health. These women have been dropped as patients by their doctors and had CPS and police called on them. They have been dragged into the OR against their will. Laboring women have been put in handcuffs.
Apparently, there is a delicate balance to be found for a laboring women. She should be educated, but not questioning. Responsible but yielding. She should stick up for herself, but not to the point of stepping on the toes of the almighty gods in white coats. It's not surprising then, that so many women fall short of the virtuous mean. For me personally, I will always recommend erring on the side of education and empowerment. However, I think there is an alternative.
What if, just for shits and giggles, we entertain the idea that maybe, just maybe, the birthing women aren't the problem?
What if maternity care in the U.S. is intrinsically flawed?
What if the entire healthcare system is set up to thrive on profit driven by disease and trauma?
What if the field of obstetrics was never intended to cater to the masses?
What if our view of womanhood and motherhood is deeply ingrained in the patriarchy?
What if profit drives care more than science and research?
What if convenience is more sought after than health?
What if we knew that the U.S. funnels more money into maternity care than any other developed nation but has the absolute worst results?
Maybe that is where all of these people should be pointing the blame. But instead we invent these "mommy wars" and blame some women for being too informed and blame others for being too compliant and once again place that ever-tantalizing image of the perfect (birthing) woman on a pedestal for everyone to collectively emulate. All the while, ignoring the real problem of a deeply entrenched system that as it exists now is set up to undermine evidenced-based care. Education and advocacy gives women a fighting chance. It is the kevlar that they wear when they walk into the war-zone of the current maternity care system. But it is not a guarantee that they will come out unscathed, anymore than blindly following someone across the battle field with your eyes shut and fingers crossed. What we need is a collective cease-fire. A real, open and honest peace talk about how we got to the place where battle was a useful metaphor for childbirth. But as long as women are spending all their time and energy attempting to find the balance between advocating for themselves and being polite, no one is addressing the core issues. No one is trying to fix the problem if we are all too busy arguing about how to adapt to it.
This is not the first time I've heard this argument. It actually comes up quite a bit. Women share their stories of abuse and mistreatment during their births, and they are blamed. It is there fault for not being more prepared, more educated, more anticipatory of the events. It's their fault for relying on doctors. It's their fault for not taking responsibility in their own care. It's their fault, period. I find these arguments confusing for several reasons. One is because there seems to be very few other specialized fields where consumers are expected to have expertise. Most people who go to a mechanic can't build their own engine. Most people who go to a gourmet restaurant can't cook French cuisine. This is also a huge issue of privilege- assuming that someone who is already paying a professional to perform a service also has the time and resources to teach themselves the ins and outs of the field and be independently educated on the topic. Is assuming that someone trained in healthcare and beholden to the hippocratic oath will provide adequate care really that far of a leap?
But another thing about this idea of "it's your fault for not educating and self-advocating" is that it's bullshit. Because women who do all those things above- who prepare and seek out education and information and participate in their care- aren't treated any better a lot of the time. They are labeled as pushy. As non-compliant. Demanding. Relying on Dr. Google. Buying into psuedo-science. Believing everything they read on the internet. They are accused of being selfish and even worse, of not valuing their child's life and health. These women have been dropped as patients by their doctors and had CPS and police called on them. They have been dragged into the OR against their will. Laboring women have been put in handcuffs.
Apparently, there is a delicate balance to be found for a laboring women. She should be educated, but not questioning. Responsible but yielding. She should stick up for herself, but not to the point of stepping on the toes of the almighty gods in white coats. It's not surprising then, that so many women fall short of the virtuous mean. For me personally, I will always recommend erring on the side of education and empowerment. However, I think there is an alternative.
What if, just for shits and giggles, we entertain the idea that maybe, just maybe, the birthing women aren't the problem?
What if maternity care in the U.S. is intrinsically flawed?
What if the entire healthcare system is set up to thrive on profit driven by disease and trauma?
What if the field of obstetrics was never intended to cater to the masses?
What if our view of womanhood and motherhood is deeply ingrained in the patriarchy?
What if profit drives care more than science and research?
What if convenience is more sought after than health?
What if we knew that the U.S. funnels more money into maternity care than any other developed nation but has the absolute worst results?
Maybe that is where all of these people should be pointing the blame. But instead we invent these "mommy wars" and blame some women for being too informed and blame others for being too compliant and once again place that ever-tantalizing image of the perfect (birthing) woman on a pedestal for everyone to collectively emulate. All the while, ignoring the real problem of a deeply entrenched system that as it exists now is set up to undermine evidenced-based care. Education and advocacy gives women a fighting chance. It is the kevlar that they wear when they walk into the war-zone of the current maternity care system. But it is not a guarantee that they will come out unscathed, anymore than blindly following someone across the battle field with your eyes shut and fingers crossed. What we need is a collective cease-fire. A real, open and honest peace talk about how we got to the place where battle was a useful metaphor for childbirth. But as long as women are spending all their time and energy attempting to find the balance between advocating for themselves and being polite, no one is addressing the core issues. No one is trying to fix the problem if we are all too busy arguing about how to adapt to it.
Sunday, June 1, 2014
A Scary New Trend
My apologies if
this seems like one of my ranty posts, but I’m starting to get kind of annoyed
with a new trend that seems to be popping up. This is purely anecdotal, but
from what I can tell natural and or evidence based birth has become some kind
of marketing strategy. Now, part of this is desirable and to be expected. More
women are being informed about their rights and options and are pushing
providers to, well, provide. So in a way it is kind of encouraging to see
hospitals remodeling L&D to be more family friendly and comfortable and to
see places offering tools like birth tubs, stability balls, and wireless fetal
monitors. One would expect that more
doctors and midwives would be looking at the actual research on things like
doulas and VBACs and the hydrotherapy and adjusting their practices
accordingly. These are all wonderful things.
The problem is-
from what I can tell, there also seems to be trend of providers paying
lipservice to these practices and the failing to deliver. I’m talking about OBs
saying they are supportive or pro natural birth and VBACs, but then at 38 weeks
talking big babies, ruptures, inductions, failure to progress, and c-sections. Or OBs and even pediatricians who claim to be
pro breastfeeding or even having lactation credentials suggesting formula and
supplementation without even addressing latch issues or supply. It’s like they
realize that women want these things, but they aren’t invested enough to
actually help them achieve it. There could also be a more insidious reason,
which I hope isn’t the case- providers patronizingly assume that these women
are jumping on some trendy natural birth bandwagon and don’t really know what
they are asking for (and I guess ignoring the fact that these practices are based
on the best medical evidence).
Whatever the
reason, it’s a worrisome trap because we have women who are well informed who
are actively seeking out support for their choices- they know they need to find
a OB who is on board and seek one out- only to find out at the eleventh hour
that they were mislead. So how do you
tell the phonies apart from the real deal?
-
Interview. You are hiring this person to assist
you in the birth of your child. Get recommendations, interview several people,
and pick the one who feels like a good fit.
Red flags: If you don’t have enough time in
your initial visit to go over your questions or the provider seems annoyed with
you, it’s a good indication that they are not going to be very helpful or
supportive. They are used to doing things their way and everyone else is just
along for the ride.
-
Ask them to walk you through a typical birth of
theirs. What procedures are standard? It is true that you can opt out of whatever
you choose, but if your provider is used to doing things the exact opposite of
what you want, there will be stress and friction and that is bad birthing mojo.
Red flags: If they say “everyone” or “all
of my patients,” be suspicious. Unless they have only had one patient, I highly
doubt that every birth, mother, and baby were exactly the same. You want
someone who can recognize each birth as a unique and individual situation and
can do what is best for YOU and YOUR BABY.
-
Ask for stats to back up their claims. They say
they are pro-VBAC? Ask what their VBAC success rate is. Ask for their c-section
rate, their rate of induction.
Red flags: If they don’t know or won’t tell
you, it’s a bad sign. Doctors with good rates are proud of them and they are
happy to tell you.
-
Get the specifics. Under what circumstances
would they recommend induction? C-section? Supplementation?
Red flags: Be wary of dismissive language.
Any “you don’t need to worry about that” or “just leave that to me”s. You are
asking for their professional expertise. Hell, you are paying them for it. It
shouldn’t be guessing game.
-
Don’t be afraid to switch. This is your birth
and your baby. It’s kind of a big deal- like, way more of a big deal than some
doctor’s ego. If you don’t feel 100% comfortable with that person, find someone
else. There are way too many amazing doctors and midwives out there for you to
be giving the shitty ones your business.
Other red flags: Watch out for the
words “try” or “let” or “see how it goes”, i.e. “we can try a VBAC” or “I will
only let you go to 40 weeks before inducing”.
You need someone who is completely supported and invested in your birth.
You need a provider who is going to say “you will have a wonderful natural
birth”, “you are going to VBAC this baby”, “ I recommend X, but the decision is
up to you”.
You have a right to change your
mind. If you decide you want that epidural, or that induction, or that
c-section, or that you don’t want to breastfeed- that is totally okay. It’s one
thing for people to try and help you stick by your original decisions (the “Are
you sure?” and “But you said…”s), but no one should make fun or belittle you or
make you feel guilty about changing your mind.
Don’t put up with providers who
make fun of or talk down doulas, birth plans, etc. It’s not uncommon to hear
statements like “one way ticket to the OR” or “oh, one of THOSE patients”.
These birth practices are based on the soundest medical research and backed by
ACOG. Would you go to a heart surgeon who scoffed at evidence-based medicine?
I know it seems sad and suspicious to be so distrusting of providers, but I have seen too many people get railroaded into a disappointing and even traumatic birth experience by someone they thought had their back. Do your homework and trust your gut.
Monday, December 9, 2013
Just...no.
This has got to stop. I mean, excuse my language, but are you fucking kidding me? This morning this article came up in my newsfeed.
http://www.huffingtonpost.com/2013/12/06/3d-birth-simulator_n_4393960.html
I honestly don't know where to start. I am so tired of seeing the same shit over and over and over again.
"The computer program is limited in that it doesn't include movements of the perineal muscles of the mother's pelvis, nor does it include movements of the fetus."
So basically it tells you diddly squat about whether or not you can birth your baby (here is a hint: you can). It can't tell you what your body or your baby will do during birth. All it can do is kind of guess if two static estimates of two very dynamic entities may or may not be compatible at a very specific moment in time that likely in no way resembles real life conditions. So, for the last time...
So for the love of everything holy, stop. Let's all just STOP trying to medicalize birth. Birth is not medical. It is biological. So is sex. But you wouldn't want a hundred different tests and procedures and screenings to take place every time you have sex, right? And sometimes sex is risky. But you take precautions and if and only if there is a concern to seek medical help for sex related issues. Birth SHOULD be no different. You can birth your baby. By yourself. In the middle of nowhere. If you were stranded on a desert island, you would still give birth to your baby and the odds are highly in your favor that you would both be hunky dory. I get it. I know a lot of women feel more comfortable birthing in a hospital "just in case". And that makes perfect sense. IF something goes wrong, you will want a medical intervention. What does not make sense is turning a normal, biological act into a medical nightmare for no damn reason at all. The testing, the estimating, the guessing...for what? For a cesarean section rate twice the level considered safe and normal? For the worst mortality rate in the developed world? How is that working out for us? If you want a safe birth for you and your baby, the best thing you can do (supported by medical research) is to just stop and trust your body. Your body knows what it is doing. We would not have survived as a species if that were not the case.
All these products and gadgets exist now- breastfeeding screening kits, birth-assisting apparatuses, and now computer simulations- to feed off of the idea that we are not good enough. Just like the beauty industry, the birth industry has made trillions off of the idea that our bodies are somehow less than. That we are lacking and just can't quite live up to what is demanded of us. Listen to me now and repeat this to yourself. Write it down. Tape it to your mirror. Put it in your car. Say it to yourself before every OB appointment.
You are enough.
You can birth your baby.
You can feed your baby.
And if anyone tries to tell you otherwise, get the hell away from that person. Do not let anyone bully or scare you into believing anything else. But what if?
Well, what if? What if you couldn't pass college math and didn't get your degree? What if that interview went really horribly and you'll never get that job? We don't let people control our lives with this kind of negativity in any other area, so why birth? Because in birth they tell us we need to "think about the baby." Let me tell you something- you are that baby's mother. You are thinking about that baby every second of everyday. You care more about that baby than any other person on this planet. You will NEVER make a decision that doesn't take that baby into consideration and for someone to assume otherwise is fucking insulting.
You fucking matter. YOU matter. Just as much as that baby who matters more to you than any other thing you've ever known in your life. And all that negativity- the fear and the self-doubt- is just as poisonous for your baby as it is for you. Get rid of it. Let go of this pervasive idea, this culture of misogyny, that tells you that you are broken.
You are enough.
http://www.huffingtonpost.com/2013/12/06/3d-birth-simulator_n_4393960.html
I honestly don't know where to start. I am so tired of seeing the same shit over and over and over again.
"The computer program is limited in that it doesn't include movements of the perineal muscles of the mother's pelvis, nor does it include movements of the fetus."
So basically it tells you diddly squat about whether or not you can birth your baby (here is a hint: you can). It can't tell you what your body or your baby will do during birth. All it can do is kind of guess if two static estimates of two very dynamic entities may or may not be compatible at a very specific moment in time that likely in no way resembles real life conditions. So, for the last time...
- How much you are dilated/effaced at any given moment tells you NOTHING about whether or not you can birth your baby. (Same goes for the position of your cervix) You could be at 6 cm and anterior for months before birth or you could be at 1 cm and posterior hours before birth. The only time you know for sure that birth is eminent is when you are crowning.
- Ultrasounds tell you NOTHING about how big your baby is or when he/she will arrive. After 20 weeks, estimating size off of ultrasounds is incredibly unreliable.
- Knowing how big your baby is tells you NOTHING about whether or not you will be able to birth your baby. This is coming from a size 2 woman who delivered an almost 10lb. baby. Your body changes during labor. Your hips spread, your tailbone flexes, your ligaments loosen up. The baby is squishy and rotates during birth. None of these things can be determined before you are actually giving birth.
- Your due date tells you VERY LITTLE about when your baby will get here. All a due date will tell you is when you are 38 weeks past ovulation (40th week of the pregnancy cycle). That is assuming you know when you ovulated. If not, it's based off of your last period, which means it's even less accurate. "Normal" gestation is anywhere from 38-42 weeks, which means even if you know exactly when you ovulated you still have a 4 week window of when to expect your baby, and that's on average. It could still be more and less and you and the baby still be perfectly healthy.
So for the love of everything holy, stop. Let's all just STOP trying to medicalize birth. Birth is not medical. It is biological. So is sex. But you wouldn't want a hundred different tests and procedures and screenings to take place every time you have sex, right? And sometimes sex is risky. But you take precautions and if and only if there is a concern to seek medical help for sex related issues. Birth SHOULD be no different. You can birth your baby. By yourself. In the middle of nowhere. If you were stranded on a desert island, you would still give birth to your baby and the odds are highly in your favor that you would both be hunky dory. I get it. I know a lot of women feel more comfortable birthing in a hospital "just in case". And that makes perfect sense. IF something goes wrong, you will want a medical intervention. What does not make sense is turning a normal, biological act into a medical nightmare for no damn reason at all. The testing, the estimating, the guessing...for what? For a cesarean section rate twice the level considered safe and normal? For the worst mortality rate in the developed world? How is that working out for us? If you want a safe birth for you and your baby, the best thing you can do (supported by medical research) is to just stop and trust your body. Your body knows what it is doing. We would not have survived as a species if that were not the case.
All these products and gadgets exist now- breastfeeding screening kits, birth-assisting apparatuses, and now computer simulations- to feed off of the idea that we are not good enough. Just like the beauty industry, the birth industry has made trillions off of the idea that our bodies are somehow less than. That we are lacking and just can't quite live up to what is demanded of us. Listen to me now and repeat this to yourself. Write it down. Tape it to your mirror. Put it in your car. Say it to yourself before every OB appointment.
You are enough.
You can birth your baby.
You can feed your baby.
And if anyone tries to tell you otherwise, get the hell away from that person. Do not let anyone bully or scare you into believing anything else. But what if?
Well, what if? What if you couldn't pass college math and didn't get your degree? What if that interview went really horribly and you'll never get that job? We don't let people control our lives with this kind of negativity in any other area, so why birth? Because in birth they tell us we need to "think about the baby." Let me tell you something- you are that baby's mother. You are thinking about that baby every second of everyday. You care more about that baby than any other person on this planet. You will NEVER make a decision that doesn't take that baby into consideration and for someone to assume otherwise is fucking insulting.
You fucking matter. YOU matter. Just as much as that baby who matters more to you than any other thing you've ever known in your life. And all that negativity- the fear and the self-doubt- is just as poisonous for your baby as it is for you. Get rid of it. Let go of this pervasive idea, this culture of misogyny, that tells you that you are broken.
You are enough.
Tuesday, December 3, 2013
Why I Want to Do Birth Work (And Why I Don't Hate Doctors)
Before I get into the particulars of why I want to pursue birth related work, I want to get some things straight. I know there is a stigma for those that are involved in natural birth or alternative medicine in general that they hate doctors or Western medicine, or whatever. I chose to wear a green shirt today. This doesn't mean I hate the color red. Or people who wear red. It doesn't mean that I won't ever wear red myself...follow? Basically, one person's choices are not a judgement on other people's choices.
Moving on from there. Do I think some doctors and nurses are idiots and totally suck at their jobs? Yup. I also know of a few midwives and doulas who suck. Some people just suck, in all professions. I also know some great nurses and doctors. The reason why I am so adamant about advocacy in this field is because there is a cultural perception that all doctors/nurses/whoever are good and competent just because they are wearing the scrubs. Medical school is hard, yes, but it is not the end-all, be-all litmus test for competency. I have heard or been told of some pretty terrible things medical professionals have told pregnant and birthing women. Things that directly contradict medical evidence and actually have proven to have negative outcomes. Let's see...
I have heard a birthing mother told her body was progressing well so she only needed a "little pitocin" despite the fact that pitocin is contraindicated for non-emergency births.
I have heard of doctors making episiotomies so that women don't "tear" despite evidence that shows episiotomies increase tearing.
I have heard nurses suggest feeding on schedules or supplementing with artificial nipples despite these practices being associated with low milk supply, slow weight gain, and failure to thrive.
I have a friend who had a nurse break her water without telling her or asking during a vaginal check.
I have known countless people who have been induced based on baby size estimated from late pregnancy ultrasounds, despite evidence showing ultrasounds after 24 weeks are unreliable and baby size is NOT a medical indication for induction.
I know of only one person who birthed at a hospital with intermittent rather than continuous fetal monitoring, despite the fact that continuous monitoring is associated with an increased risk of surgical birth.
The list goes on and on. Now, I have also heard a lot of good things, like the doctor here in Tucson who is always on call for breech births because he is the only doctor who was appropriately trained to vaginally deliver breech babies (even twins!). Or some truly wonderful nurses who ended up being doulas as well for many of their patients. So please, don't mistake my passion as stemming from a hatred and mistrust of medical personnel. It's actually quite the opposite. I don't advocate for women because of the "bad" OBs. I advocate for women because there are too many great OBs and nurses for us to continue giving the bad ones our business. We can change the birth culture (and the god-awful maternal and infant mortality rates) of this country by demanding evidence-based care and seeking out those professionals who provide it. But how is a woman supposed to know the difference between providers?
THIS is why I want to do this work. I want to help women make the best choice for them in their birth instead of having to just roll the dice and take what they get. I don't care what you want for your birth- unassisted birth in the woods or scheduled c-section. I just want you to make that decision based on evidence and knowledge, not fear and lack of options. Because no matter how you want to give birth or how you need to give birth, it should still be the most amazing moment of your life. Birth shouldn't be a scary, painful obstacle to having a baby. Birth itself should be an incredible experience. You are doing something wonderful- it should make you feel wonderful. Not scared, or sad, or angry. To achieve this, it is my experience that women need three things- they need to be informed, they need to be empowered, and they need to be supported.
How is someone supposed to know if what her doctor or midwife suggests is best for her if she doesn't know her options or the risks and benefits of each choice? Medicine is just a drop of water in the 5 gallon bucket of knowledge that exists in the world. Obstetrics is an even smaller part. Then take into account where the person went to school, what books they used, which journals they follow and read...you can't expect a person to know everything. Women need the tools and knowledge so that they can be educated about their own care. So that when they hear bad advice or are offered procedures that contradict evidence-based care, they see a red flag.
When women have this knowledge, they are empowered. They can take control of their pregnancies and births and advocate for themselves. They don't have to close their eyes and hope that their providers know what they are doing. They can make decisions, including the decision of which providers to hire. Did you hear that? You are HIRING your providers. You pay them to provide a service. If you don't like their service, don't pay them. Find someone else. So many women stay with their OBGYN for their births just because that was who did their annual pap smear. Swiping your cervix with a q-tip has nothing to do with having a baby. Interview your providers. Find one that works for you. Make a birth plan. Prepare for your birth.
Then surround yourself with support. Find supportive providers, for sure, but make sure whoever else is invited to take part in this experience with you is 100% on board. This may mean they need to be educated about the decisions you made so that they understand. If someone is not supportive, they have no business being in your birth space. This is YOUR body, YOUR baby, and YOUR birth. I have seen women with all the information and capabilities available to them let go of their birth experience because when it came down to it, they weren't supported.
This is what I hope to accomplish. I want to provide women with the tools they need to be informed, empowered, and supported. I want women to be able to own their birth experience. This doesn't mean that everything will always go perfectly. Sometimes, rarely, complications do occur. But if you are an active participant in your birth and you own the experience, you will be the one dealing with problems if they arise and you can still be empowered and supported in those situations. Birth should be something you accomplish, not something that happens to you.
For more information about the movement to improve childbirth, check out Improvingbirth.org
Here is an awesome album from their Facebook page of why women want to improve birth https://www.facebook.com/media/set/?set=a.509315189141974.1073741832.255657527841076&type=3
For more information about evidence-based birth, evolutionaryparenting.com and evidencebasedbirth.com are great resources!
Moving on from there. Do I think some doctors and nurses are idiots and totally suck at their jobs? Yup. I also know of a few midwives and doulas who suck. Some people just suck, in all professions. I also know some great nurses and doctors. The reason why I am so adamant about advocacy in this field is because there is a cultural perception that all doctors/nurses/whoever are good and competent just because they are wearing the scrubs. Medical school is hard, yes, but it is not the end-all, be-all litmus test for competency. I have heard or been told of some pretty terrible things medical professionals have told pregnant and birthing women. Things that directly contradict medical evidence and actually have proven to have negative outcomes. Let's see...
I have heard a birthing mother told her body was progressing well so she only needed a "little pitocin" despite the fact that pitocin is contraindicated for non-emergency births.
I have heard of doctors making episiotomies so that women don't "tear" despite evidence that shows episiotomies increase tearing.
I have heard nurses suggest feeding on schedules or supplementing with artificial nipples despite these practices being associated with low milk supply, slow weight gain, and failure to thrive.
I have a friend who had a nurse break her water without telling her or asking during a vaginal check.
I have known countless people who have been induced based on baby size estimated from late pregnancy ultrasounds, despite evidence showing ultrasounds after 24 weeks are unreliable and baby size is NOT a medical indication for induction.
I know of only one person who birthed at a hospital with intermittent rather than continuous fetal monitoring, despite the fact that continuous monitoring is associated with an increased risk of surgical birth.
The list goes on and on. Now, I have also heard a lot of good things, like the doctor here in Tucson who is always on call for breech births because he is the only doctor who was appropriately trained to vaginally deliver breech babies (even twins!). Or some truly wonderful nurses who ended up being doulas as well for many of their patients. So please, don't mistake my passion as stemming from a hatred and mistrust of medical personnel. It's actually quite the opposite. I don't advocate for women because of the "bad" OBs. I advocate for women because there are too many great OBs and nurses for us to continue giving the bad ones our business. We can change the birth culture (and the god-awful maternal and infant mortality rates) of this country by demanding evidence-based care and seeking out those professionals who provide it. But how is a woman supposed to know the difference between providers?
THIS is why I want to do this work. I want to help women make the best choice for them in their birth instead of having to just roll the dice and take what they get. I don't care what you want for your birth- unassisted birth in the woods or scheduled c-section. I just want you to make that decision based on evidence and knowledge, not fear and lack of options. Because no matter how you want to give birth or how you need to give birth, it should still be the most amazing moment of your life. Birth shouldn't be a scary, painful obstacle to having a baby. Birth itself should be an incredible experience. You are doing something wonderful- it should make you feel wonderful. Not scared, or sad, or angry. To achieve this, it is my experience that women need three things- they need to be informed, they need to be empowered, and they need to be supported.
How is someone supposed to know if what her doctor or midwife suggests is best for her if she doesn't know her options or the risks and benefits of each choice? Medicine is just a drop of water in the 5 gallon bucket of knowledge that exists in the world. Obstetrics is an even smaller part. Then take into account where the person went to school, what books they used, which journals they follow and read...you can't expect a person to know everything. Women need the tools and knowledge so that they can be educated about their own care. So that when they hear bad advice or are offered procedures that contradict evidence-based care, they see a red flag.
When women have this knowledge, they are empowered. They can take control of their pregnancies and births and advocate for themselves. They don't have to close their eyes and hope that their providers know what they are doing. They can make decisions, including the decision of which providers to hire. Did you hear that? You are HIRING your providers. You pay them to provide a service. If you don't like their service, don't pay them. Find someone else. So many women stay with their OBGYN for their births just because that was who did their annual pap smear. Swiping your cervix with a q-tip has nothing to do with having a baby. Interview your providers. Find one that works for you. Make a birth plan. Prepare for your birth.
Then surround yourself with support. Find supportive providers, for sure, but make sure whoever else is invited to take part in this experience with you is 100% on board. This may mean they need to be educated about the decisions you made so that they understand. If someone is not supportive, they have no business being in your birth space. This is YOUR body, YOUR baby, and YOUR birth. I have seen women with all the information and capabilities available to them let go of their birth experience because when it came down to it, they weren't supported.
This is what I hope to accomplish. I want to provide women with the tools they need to be informed, empowered, and supported. I want women to be able to own their birth experience. This doesn't mean that everything will always go perfectly. Sometimes, rarely, complications do occur. But if you are an active participant in your birth and you own the experience, you will be the one dealing with problems if they arise and you can still be empowered and supported in those situations. Birth should be something you accomplish, not something that happens to you.
For more information about the movement to improve childbirth, check out Improvingbirth.org
Here is an awesome album from their Facebook page of why women want to improve birth https://www.facebook.com/media/set/?set=a.509315189141974.1073741832.255657527841076&type=3
For more information about evidence-based birth, evolutionaryparenting.com and evidencebasedbirth.com are great resources!
Monday, May 20, 2013
Babies- Apparently Some Preparation Required
I had big plans for when the semester was over and I would have all this free time to get ready for the baby. Projects I would complete, cleaning, preparing... I made several lists. I had heard about this whole "nesting" bit and I knew once the semester was over I could allow myself to go into full nesting mode. Well, either I'm missing the whole 'nesting' gene, or no one told me that the amount of energy it requires to put on underwear in the morning at almost 9 months pregnant uses up all available desire and will to get anything else done that day. Now this wouldn't be a huge issue if it weren't for the fact that I have accomplished absolutely nothing baby wise all semester, except to accumulate baby stuff that is now filling up my yoga room. Seriously- this picture was taken yesterday.
That is all stuff that needs to be washed, sorted, put away, etc. The only thing I have accomplished is to put some toys in a box on a shelf.
Now, I blame this crazy exhaustion for the most part. It's a lot harder to constantly lug around an extra 30 lbs. than one might think. However, I think I also accidentally psyched myself into complacency regarding this whole having a baby thing in terms of time management. If you know me or possibly even ran into me on the street at any point, I'm sure I explained to you the problem with the U.S.'s obsession with due dates. Assuming for a moment that your estimated due date is accurate (which it's most likely not, unless you were charting your menstrual cycles when you got pregnant and your EDD is based on your ovulation day), that date really isn't so much a "due date" as when you are 40 weeks pregnant. It's essentially meaningless. So why is it so important for the doctor to tell you when your 40 weeks date (what I prefer to call it) is? Well, because most babies are born between 38 and 42 weeks, which means your 40 weeks is right smack in the middle. Now, some babies come a little earlier and are perfectly healthy. Some babies come past 42 and are also perfectly healthy (although it is usually recommended to begin regular non-stress tests after 42 weeks to make sure the baby is just taking extra long to cook and not being delayed because of any problems [also note- a diagnoses of cephalopelvic disproportion, macrosomia (big baby) and low amniotic fluid are incredibly inaccurate at this point. If yours and baby's vitals are fine, induction is usually unnecessary]). But for whatever reason, our society seems to demand an exact date to fixate on. Did you know rather than due dates people used to (and in some places still do) refer instead to birth seasons? What REALLY annoys the hell out of me is when people talk about their baby being "late" after the due date. No. "Late" or post-dates, is not until after 42 weeks. Up until that time, you are still "term" and it is perfectly normal, especially for first time moms who tend to go later anyway [what annoys me even more is that every single piece of medical research and literature stresses that being "late" or past 40 weeks is not a medical reason for induction and drastically increases the risk of complications including c-sections and baby spending time in the NICU and yet for some reason doctors still LOVE to induce at 38, 39, and 40 weeks]. And remember- this is all assuming that your 40 weeks date was correct, which isn't likely. So what is the point of me explaining all of this for the umpteenth time? In order to make sure I didn't fall into the trap of fixating on my "due date" and to discourage people from asking me "why is the baby late?", "are you going to get induced soon?", "are you sure everything is okay?!" I have always envisioned this baby coming at 42 weeks. Which led me to plan as if this baby is coming at 42 weeks, which means I still have a little over 6 weeks to get all this stuff done.
However, you may have spotted the problem with this plan. While it is entirely possible that I do in fact go all the way to 42, it is also entirely possible that this baby decides to make an appearance sooner. Possibly in 2 weeks. Which means I should probably at least have one clean diaper and blanket ready by then. This realization keeps sneaking up on Joey and I as we plan different things. We've gotten into the habit of saying we have "plenty of time!" before the baby gets here to do A,B, or C, but then we realize that in fact we may have very little time and should probably be at least be semi-prepared. So I started with the most urgent thing first- I purchased all of the birth supplies I will need. I'm now at least equipped to get the baby here. My goal this week is to actually get all the stuff that is in that room squared away. And then hopefully I'll still have some time after that to do some things around the house. I do believe that the mother's psychological preparedness has a lot to do with when a baby is born. The hormonal interplay that starts and sustains labor is incredibly sensitive and the presence of any stressors can delay labor significantly. I'm not sure if procrastination is physiologically recognized as being psychologically unprepared, but maybe it will at least buy me some time? So long story short- if you have any extra "nesting" energy in your psychic stores, feel free to send some my way. Because I have a load of baby clothes to hang on the line, but honestly a nap sounds way more appealing.
Friday, February 15, 2013
The Birth Plan
If I have talked to you about birth, I have probably told you to make a birth plan. While some doctors and nurses will scoff at the idea, informing them of your choices is really only half the point. Obviously, that part is very important. But in addition, creating a birth plan will force you to think through your options and make important decisions ahead of time instead of trying to process all of the information during the heat of the moment.
Now, since we are having a home birth we don't necessarily need a birth plan. When you deliver at a hospital, the chances are pretty good that you will not have met any of the nurses or staff. You're actually pretty lucky if your doctor is the one delivering. So it is important to have a record of your requests that you can easily distribute to whoever walks into the room. But with a home birth, we know who is going to be there. It will be the same person we have had every appointment with. We will have gone over all of our wishes, options, and decisions and will all be on the same page.
However, in the highly unlikely event that we need to transfer to a hospital, we want to have a birth plan ready so that we can still welcome our child into the world the way we intended. I include our plan below. If you have any questions or would like the information and research behind our decisions, feel free to comment below or contact me.
Now, since we are having a home birth we don't necessarily need a birth plan. When you deliver at a hospital, the chances are pretty good that you will not have met any of the nurses or staff. You're actually pretty lucky if your doctor is the one delivering. So it is important to have a record of your requests that you can easily distribute to whoever walks into the room. But with a home birth, we know who is going to be there. It will be the same person we have had every appointment with. We will have gone over all of our wishes, options, and decisions and will all be on the same page.
However, in the highly unlikely event that we need to transfer to a hospital, we want to have a birth plan ready so that we can still welcome our child into the world the way we intended. I include our plan below. If you have any questions or would like the information and research behind our decisions, feel free to comment below or contact me.
Roxanne and Joey
Buckman’s Birth Information
Hello! We
have been married for 2 ½ years. We moved to Tucson less than a year ago to
complete our PhDs at the University of Arizona and are so excited to be
welcoming the newest member of our family. Thank you so much for taking care of
us. Here a few things you might want to know:
- We are having a natural birth. Please do not offer or attempt to administer any pain medication, IV fluids, or anesthesia. We will let you know if we need it.
- Our midwife, Lia, will be with us at all times and is crucial to my labor and delivery.
- Please assume any refusal of procedures is for religious reasons. This includes- all medications, vaginal checks, constant electronic fetal monitoring, etc.
In the event
of a cesarean section:
- Do not administer any medication that is not compatible with breastfeeding.
- My husband and our midwife, Lia, will both be present.
- Please describe the surgery and lower the screen so that we can watch our baby’s birth
- Delay cord clamping as long as possible, at least until pulsing ceases.
- Place baby directly on mom’s chest or hand to the father. All routine tests and procedures can wait.
- Baby will stay with mother throughout recovery.
Hi, my name
is Perrin or Leila! Please:
- Check with my parents before performing any routine tests or procedures.
- NO eye ointment, vitamin K (oral or injection), or hepatitis B vaccination.
- I need to be with one of my parents at all times. If I must be taken from my mother, dad will stay with me.
- No baths please!
- I am breastfeeding. I need to be skin to skin with my mom ASAP.
- No bottles, pacifiers, sugar water, or formula.
- DO NOT CIRCUMCISE. Do not attempt to retract or manipulate my foreskin.
Friday, December 7, 2012
The Illusion of Informed Consent
I hadn't thought much about the role informed consent would play in my pregnancy and childbirth. I knew I would eventually make up a birth plan, including my preferences in the case of transfer or c-section, and that these plans would play a crucial role in establish what types of procedures I did and did not consent to. After all, I'm fairly informed on those topics. I had heard stories of women being dropped as patients for refusing to consent to certain procedures, or being bully or guilted into signing on the dotted line. But I figured I wouldn't have to worry about all of that. After all, those were some of the main reasons I was choosing to home birth. So in my limited conceptualization, informed consent was simple. You became informed, and then you either consented or you didn't based on that information. The fact that you informed yourself was all that was required by the establishment at hand.
Apparently I was wrong. Informed consent appears to mean they inform you, you consent. Period. I learned this today after a particularly nasty conversation with a CNM at the campus health clinic. Let me back up a moment. Contrary to what some may believe, my midwife requires me to get the usual pregnancy blood work done so we can make sure everything looks good and there aren't any complications that might affect my ability to safely birth at home (shockingly, she doesn't just bring over her ouija board and call it a day). She suggested I look into getting the lab work done through campus health because it might be cheaper rather than just going through an independent lab she normally uses. So I called campus health and after speaking with 7 different people finally got across what I needed done, and yes they could do it there. Then I got a call back from the one of the nurses saying that if she got the CNM who saw me for my pregnancy test to order the labs, insurance might cover a larger part than if I had the order from my midwife (because my midwife is out of my network). Ok, cool. I like saving money; go for it. So I get a call from the CNM. She gives me a nice little talk about how she will order these labs, but that if the results are funny she would probably handle things differently than my midwife, so I just need to be aware, mentions something about syphilis, do I understand? Well yes, in the event that something is wrong (I'm Rh-, protein in my urine, etc) I'm sure my midwife and I will both want me to seek further attention (you know, right after we do a rain dance and burn a wicker man as an offering). So I go in, pee in two cups and give 5 (5!) vials of blood. Sweet.
Well, this morning the CNM called with my results. She sounds serious. She needs to talk to me. Some of my results that came back need to be discussed. Now I know I don't have syphilis and I know my blood is O+. I have great blood pressure and no edema. So I patiently wait for her to tell what is so terribly wrong. She tells me I have...a urinary tract infection. Oh, ok. I'm not surprised. I have had them before and am usually asymptomatic except for having to pee a lot. And since I'm pregnant, it's not weird for me to pee a lot, so that makes sense. UTI. Sweet. Thanks for your time. But wait! There's more! She also says, in a very worried tone, that my white blood cell count is a little high! Oh the horror! Now, I know what white blood cells are and do. I know what having a lot of them mean. So I asked, isn't that because I have an infection? To which she replied, "Well, yes, it could be. But it could be something else!" Well, ok, on a metaphysical level the possibilities are endless. But since we know I have a UTI, it would seem likely that this is the reason behind the elevated white cells. Or maybe I'm just crazy. And I guess because I was obviously unimpressed with this tidbit, she continued "AND....you platelets are low!" Ok, I don't know that much about platelets. But considering the three ring circus she just pulled with the white cell count and the fact that I have no type of blood disorder symptoms (I do know platelets are in the blood), I take this information with a salt-lick. She tells me I must get rechecked within the next week and keep a close eye and inform my midwife immediately. Ok, I can do that. Sounds reasonable. And then she asks, can my midwife write a prescription? How will I go about getting the required meds for my debilitating asymptomatic UTI? Now, I know darn well she is capable of writing a script, and because she ordered the lab work, it would not be outside her jurisdiction to call in the antibiotics to the campus pharmacy. But she is obviously not offering to do so. Not only that, she is playing coy asking if my midwife will be writing the script. She knows a CPM cannot write prescriptions. She is simultaneously creating a difficult situation and then calling attention to it as if it in some way validates her initial concerns about my choice of care provider. Nice. So she asks, how do I plan on getting the required antibiotics?
This ain't my first rodeo. I have had a few UTIs over the past years and have never taken an antibiotic for them. In fact, I can't remember the last time I took an antibiotic period. Normally I went to the campus health in Memphis, they confirmed I had a UTI, and then gave me a bottle of pills which I promptly dumped in a drawer in my bathroom and never touched. It was the path of least resistance. But here I'm not being given that option. She wants to know where I will get the pills that I will never take. So, I think for a moment then decide to go with honesty. I tell her I'm not worried about a script. I don't take antibiotics for UTIs. She. flips.out. I would have explained I have a drawer full of antibiotics that I can "take" if it means that much to her, but I don't get a chance. I'm going to get a kidney infection, my baby will die, I will die, the whole world will end. Plague. Disease. Destruction. And then, because she apparently detected it was my weakest link, she starts harping about the platelets. I honestly believed I had some very rare, very serious condition. For a split second. Then I remembered that this is the person who is audibly angry, on what appears to be a personal level, about a UTI.
Now this struck me as odd. I had expected the normal, "Well, I have to recommend antibiotics and can't recommend any other type of treatment. If you want to try something else, please check back next week and if your not better, you should seriously consider...blah blah blah." In Memphis, I went to a regular OBGYN for my well-woman stuff. Nothing crunchy or alternative about her or her practice. Because of a type of birth control I was on, I was getting recurrent yeast infections. I had read echinacea was a good treament. I tried it; it seemed to work, so I brought it up at my next check-up. I asked by doctor, was that okay if I just did the echinacea? "Hey, if it works, it works!" was her reply. In fact, she also said she had heard eating yogurt regularly could help balance everything out. Maybe I could try that too. And if they infections became a problem, just call the office nurse and she would call me in a fluconazole script. Everything was fine and dandy and she wasn't personally offended, I never needed the prescription. I was healthy, she was happy.
Not this CNM. She laid the guilt on thick. This was going to affect me and my baby. It was going to be terrible. And then, she told me while I had a right to refuse what I wanted to, she couldn't continue to see me if I wasn't going to get the treatment she recommended. Yep, she dropped me as her patient over a UTI. I was informed, I did not consent, and as a result, I was dropped. Her way or the highway. Which is fine, I'd rather not receive care from a provider like that anyway. And I realize it was completely in her rights to do so. No hard feelings there. I just couldn't believe that something so simple was such a big issue. So I got to thinking about it and I have come to a couple conclusions.
1) The whole incident bothered me, because I don't like to feel as if people are mad at me or upset with me. That's how she made me feel. Like it was personal. Like I was being stupid and irresponsible. There was no respect or desire for understanding. She didn't even ask what kind of treatment I use instead. But as sucky as it was to feel like I "got in trouble", I have more important things to worry about. Namely my baby and my own health.
2)She was making a lot of assumptions. She kept asking about my midwife, as if she was somehow the reason I didn't want antibiotics. Nope. Just me. A choice I have made for myself many times and will continue to make. She also assumed I was simply being pig-headed. If she would have calmed down for two seconds, I could have explained that I would happily consider antibiotics as a last resort. I always do. I've just never needed them. Why destroy my natural flora balance and contribute to resistant strains of bacteria if I don't need to? Seems silly to me. She was also acting like she was the only person who cared about me or my baby. Like those things weren't important to me or my midwife also. She couldn't pause and think that maybe my concern for my baby and I was WHY I am reluctant to use antibiotics unnecessarily.
3)She was a bully. She lied and used scare tactics to try and get her way. I knew it when she tried to pull it with the white blood cell count. So when I got home and looked at my results, I did some research on the whole platelet thing and UTIs in general. UTIs are only dangerous in pregnant women if they develop into rampant kidney infections complete with high fever (which is never good). Obviously I'm not going to let it get anywhere near that point. As far as the platelets, my count was 133 and the normal range was 150-450. That is only 17 units too low on a 300 unit scale. Barely abnormal. So I did some research. Everything I found said as long as you were above 50 units, there wasn't too much need for concern and only 10 and below were truly dangerous. And you know what a common cause of thrombocytopenia is? Pregnancy. Well that explained a lot. So I looked into gestational thrombocytopenia. It's perfectly normal. Happens in quite a few pregnancies. Entirely asymptomatic and clears up right after birth. Nothing dangerous about it. No risks or effects for mother or baby as long as the count doesn't get too low. No treatment required. No. big. deal.
So this CNM was either unaware of this and incompetent, or she deliberately lied and tried to scare me into doing things her way. Lame. So I called my midwife, explained the happenings to her, and ask what she recommended as far as my UTI goes. She asked what I usually do. So I told her, I have a regimen of cranberry supplements, echinacea, and colloidal silver. Great, that is exactly what she would recommend. I can also try laying off sugar for a few days and soaking in a bath with baking soda. Super. I asked was she worried about the white blood cells and platelets? Not at all, perfectly normal. Well that was refreshing!
Here's the thing. It took a lot for me to stick up for myself. If it hadn't been for the fact that I am pregnant and not about to start making health compromises to please other people, I might have just given in. I might have let her scare me. How many other patients has she bullied this way? And why? Probably because of liability. Because everyone in this medical system is freakin' scared of getting sued. Or maybe she is just used to working with irresponsible college students. But come on lady, have a little faith in me. She was impressed the first time I saw her because I had correctly self-diagnosed a corpus luteum cyst. I told her all about my doula stuff and how I was a birth junkie and my PhD program. She knew I was informed and cognizant. She could have given me the benefit of the doubt. But she pulled the patriarchy card. She has the coat, she has the degree, she apparently thinks she has control over my body. Sorry, it doesn't work that way. Not with my body, and not with my baby.
Apparently I was wrong. Informed consent appears to mean they inform you, you consent. Period. I learned this today after a particularly nasty conversation with a CNM at the campus health clinic. Let me back up a moment. Contrary to what some may believe, my midwife requires me to get the usual pregnancy blood work done so we can make sure everything looks good and there aren't any complications that might affect my ability to safely birth at home (shockingly, she doesn't just bring over her ouija board and call it a day). She suggested I look into getting the lab work done through campus health because it might be cheaper rather than just going through an independent lab she normally uses. So I called campus health and after speaking with 7 different people finally got across what I needed done, and yes they could do it there. Then I got a call back from the one of the nurses saying that if she got the CNM who saw me for my pregnancy test to order the labs, insurance might cover a larger part than if I had the order from my midwife (because my midwife is out of my network). Ok, cool. I like saving money; go for it. So I get a call from the CNM. She gives me a nice little talk about how she will order these labs, but that if the results are funny she would probably handle things differently than my midwife, so I just need to be aware, mentions something about syphilis, do I understand? Well yes, in the event that something is wrong (I'm Rh-, protein in my urine, etc) I'm sure my midwife and I will both want me to seek further attention (you know, right after we do a rain dance and burn a wicker man as an offering). So I go in, pee in two cups and give 5 (5!) vials of blood. Sweet.
Well, this morning the CNM called with my results. She sounds serious. She needs to talk to me. Some of my results that came back need to be discussed. Now I know I don't have syphilis and I know my blood is O+. I have great blood pressure and no edema. So I patiently wait for her to tell what is so terribly wrong. She tells me I have...a urinary tract infection. Oh, ok. I'm not surprised. I have had them before and am usually asymptomatic except for having to pee a lot. And since I'm pregnant, it's not weird for me to pee a lot, so that makes sense. UTI. Sweet. Thanks for your time. But wait! There's more! She also says, in a very worried tone, that my white blood cell count is a little high! Oh the horror! Now, I know what white blood cells are and do. I know what having a lot of them mean. So I asked, isn't that because I have an infection? To which she replied, "Well, yes, it could be. But it could be something else!" Well, ok, on a metaphysical level the possibilities are endless. But since we know I have a UTI, it would seem likely that this is the reason behind the elevated white cells. Or maybe I'm just crazy. And I guess because I was obviously unimpressed with this tidbit, she continued "AND....you platelets are low!" Ok, I don't know that much about platelets. But considering the three ring circus she just pulled with the white cell count and the fact that I have no type of blood disorder symptoms (I do know platelets are in the blood), I take this information with a salt-lick. She tells me I must get rechecked within the next week and keep a close eye and inform my midwife immediately. Ok, I can do that. Sounds reasonable. And then she asks, can my midwife write a prescription? How will I go about getting the required meds for my debilitating asymptomatic UTI? Now, I know darn well she is capable of writing a script, and because she ordered the lab work, it would not be outside her jurisdiction to call in the antibiotics to the campus pharmacy. But she is obviously not offering to do so. Not only that, she is playing coy asking if my midwife will be writing the script. She knows a CPM cannot write prescriptions. She is simultaneously creating a difficult situation and then calling attention to it as if it in some way validates her initial concerns about my choice of care provider. Nice. So she asks, how do I plan on getting the required antibiotics?
This ain't my first rodeo. I have had a few UTIs over the past years and have never taken an antibiotic for them. In fact, I can't remember the last time I took an antibiotic period. Normally I went to the campus health in Memphis, they confirmed I had a UTI, and then gave me a bottle of pills which I promptly dumped in a drawer in my bathroom and never touched. It was the path of least resistance. But here I'm not being given that option. She wants to know where I will get the pills that I will never take. So, I think for a moment then decide to go with honesty. I tell her I'm not worried about a script. I don't take antibiotics for UTIs. She. flips.out. I would have explained I have a drawer full of antibiotics that I can "take" if it means that much to her, but I don't get a chance. I'm going to get a kidney infection, my baby will die, I will die, the whole world will end. Plague. Disease. Destruction. And then, because she apparently detected it was my weakest link, she starts harping about the platelets. I honestly believed I had some very rare, very serious condition. For a split second. Then I remembered that this is the person who is audibly angry, on what appears to be a personal level, about a UTI.
Now this struck me as odd. I had expected the normal, "Well, I have to recommend antibiotics and can't recommend any other type of treatment. If you want to try something else, please check back next week and if your not better, you should seriously consider...blah blah blah." In Memphis, I went to a regular OBGYN for my well-woman stuff. Nothing crunchy or alternative about her or her practice. Because of a type of birth control I was on, I was getting recurrent yeast infections. I had read echinacea was a good treament. I tried it; it seemed to work, so I brought it up at my next check-up. I asked by doctor, was that okay if I just did the echinacea? "Hey, if it works, it works!" was her reply. In fact, she also said she had heard eating yogurt regularly could help balance everything out. Maybe I could try that too. And if they infections became a problem, just call the office nurse and she would call me in a fluconazole script. Everything was fine and dandy and she wasn't personally offended, I never needed the prescription. I was healthy, she was happy.
Not this CNM. She laid the guilt on thick. This was going to affect me and my baby. It was going to be terrible. And then, she told me while I had a right to refuse what I wanted to, she couldn't continue to see me if I wasn't going to get the treatment she recommended. Yep, she dropped me as her patient over a UTI. I was informed, I did not consent, and as a result, I was dropped. Her way or the highway. Which is fine, I'd rather not receive care from a provider like that anyway. And I realize it was completely in her rights to do so. No hard feelings there. I just couldn't believe that something so simple was such a big issue. So I got to thinking about it and I have come to a couple conclusions.
1) The whole incident bothered me, because I don't like to feel as if people are mad at me or upset with me. That's how she made me feel. Like it was personal. Like I was being stupid and irresponsible. There was no respect or desire for understanding. She didn't even ask what kind of treatment I use instead. But as sucky as it was to feel like I "got in trouble", I have more important things to worry about. Namely my baby and my own health.
2)She was making a lot of assumptions. She kept asking about my midwife, as if she was somehow the reason I didn't want antibiotics. Nope. Just me. A choice I have made for myself many times and will continue to make. She also assumed I was simply being pig-headed. If she would have calmed down for two seconds, I could have explained that I would happily consider antibiotics as a last resort. I always do. I've just never needed them. Why destroy my natural flora balance and contribute to resistant strains of bacteria if I don't need to? Seems silly to me. She was also acting like she was the only person who cared about me or my baby. Like those things weren't important to me or my midwife also. She couldn't pause and think that maybe my concern for my baby and I was WHY I am reluctant to use antibiotics unnecessarily.
3)She was a bully. She lied and used scare tactics to try and get her way. I knew it when she tried to pull it with the white blood cell count. So when I got home and looked at my results, I did some research on the whole platelet thing and UTIs in general. UTIs are only dangerous in pregnant women if they develop into rampant kidney infections complete with high fever (which is never good). Obviously I'm not going to let it get anywhere near that point. As far as the platelets, my count was 133 and the normal range was 150-450. That is only 17 units too low on a 300 unit scale. Barely abnormal. So I did some research. Everything I found said as long as you were above 50 units, there wasn't too much need for concern and only 10 and below were truly dangerous. And you know what a common cause of thrombocytopenia is? Pregnancy. Well that explained a lot. So I looked into gestational thrombocytopenia. It's perfectly normal. Happens in quite a few pregnancies. Entirely asymptomatic and clears up right after birth. Nothing dangerous about it. No risks or effects for mother or baby as long as the count doesn't get too low. No treatment required. No. big. deal.
So this CNM was either unaware of this and incompetent, or she deliberately lied and tried to scare me into doing things her way. Lame. So I called my midwife, explained the happenings to her, and ask what she recommended as far as my UTI goes. She asked what I usually do. So I told her, I have a regimen of cranberry supplements, echinacea, and colloidal silver. Great, that is exactly what she would recommend. I can also try laying off sugar for a few days and soaking in a bath with baking soda. Super. I asked was she worried about the white blood cells and platelets? Not at all, perfectly normal. Well that was refreshing!
Here's the thing. It took a lot for me to stick up for myself. If it hadn't been for the fact that I am pregnant and not about to start making health compromises to please other people, I might have just given in. I might have let her scare me. How many other patients has she bullied this way? And why? Probably because of liability. Because everyone in this medical system is freakin' scared of getting sued. Or maybe she is just used to working with irresponsible college students. But come on lady, have a little faith in me. She was impressed the first time I saw her because I had correctly self-diagnosed a corpus luteum cyst. I told her all about my doula stuff and how I was a birth junkie and my PhD program. She knew I was informed and cognizant. She could have given me the benefit of the doubt. But she pulled the patriarchy card. She has the coat, she has the degree, she apparently thinks she has control over my body. Sorry, it doesn't work that way. Not with my body, and not with my baby.
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