Tuesday, February 26, 2008

ME VS. THE OB

Those of you who have been reading since the beginning know that I have strong feelings when it comes to medical treatment and intervention. Those who are new might have found that sentence amusing seeing as much medical intervention was used to get me where I am today.

Allow me to sum up my feelings in a nutshell: For many years I have been treated holistically (mostly by a homeopath) when I have been "sick". This has worked wonders for me as a person who has had persistent upper respiratory infections, allergies, and her fair share of neuroses to treat. This by no means means that I am anti-doctor, or anti-medical intervention when necessary. What it does mean is that I often question my doctors (when I see them) and do plenty of research on modern medical "technology".

There was no question about seeking the help of my RE in order to conceive. (Perhaps if I had started trying at 21 instead of 31 I may have taken a different route, but I am well aware of the time factors involved with holistic healing, especially to such a deep level as dealing with infertility.) At 10 weeks my RE released me to my OB. To him it seemed best that she follow me because of some early bleeding episodes. I was worried too, and so I (in what I feel now is a bit of a moment of weakness), chose this path of least resistance. To be completely truthful, though I may have wanted to see a midwife instead of an OB, here in Quebec they are in very high demand. One usually has to book her midwife when she starts trying to conceive, and so this was not really an option for me.

So to my OB I went. I was comfortable with the medical intervention I had had up until 12 weeks (my weekly ultrasounds). Even though I know it is not the best thing for the baby, I felt I had to compromise for my own peace of mind. I was ok with doing my integrated screen at 13 weeks, knowing that there would only be one more ultrasound to go (which would be much later at 19 weeks).

There was a blip at 20 weeks when I had my episode with my ovary twisting. I knew that the medical staff could only see what was going on by doing another ultrasound. This did not bother me as much as the shot of morphine I was offered at the height of screaming in pain. Of course I took the drugs- talk about a real sweet deal in a moment of utter weakness. I still question whether that shot was completely necessary. I know in the long run it did not harm the baby (though who will really know...). I also know that it was offered to me way too readily by the nurse, probably to make her feel better about me screaming in pain. The pain never came back... This leads me to believe that if I had just ridden out that last bout of pain I would not have had to introduce drugs into my system.

Perhaps many of you are rolling your eyes at this point thinking: what's the big deal. Well to ME it WAS big. It`s pretty much informed the rest of my pregnancy.

So here we are at the end of the journey. I am finding I have to make more decisions now that I have had to in the last 37 weeks combined. The reason: birthing a new human being into this world.

I have no choice but to give birth in the hospital because I have been followed by an OB. Thank goodness I have a wonderful doula lined up, because I can't imagine walking into the hospital with my teeny tiny bit of labour knowledge. Unfortunately, I am finding that choices that I want for my birthing and the first days of my baby's life are being met with resistance from my OB because they are not conventional.

Let us examine for a moment....

Exhibit A: My OB wants me to have another ultrasound to see the size of the baby. She expressed some concern because some overweight women have large babies.

Me vs. the OB: I have already committed to not having further scans. My OB thought I was immediately wacked because who would give up a chance to see her baby?? Also, the point of this scan would be to determine whether or not a c-section would be recommended. There have been studies AT THIS VERY HOSPITAL that show that 100% of the women who were recommended to have a c-section, but who chose to try vaginally first actually succeeded in their vaginal deliver (more pointedly: NONE required a c-section.) Furthermore, while my doctor may be concerned that I am large, and therefore my baby may be large, if she looked at my weight gain (only 10 pounds) and my fundal height (measuring slightly low), she could pretty much ascertain that there is no 10 pound baby Buddha growing inside me.

Exhibit B: My OB told me that I may test positive for Strep-B, as one of my urine test results earlier in the pregnancy showed traces of it.

Me vs. the OB: I do not want myself or my baby treated for this unless it is absolutely necessary. There are 2 reasons for this: primarily, I do not want to introduce unnecessary antibiotics into my own body (that will then be transferred to the baby), and second, I do not want to be attached to an IV if at all possible. I am not going to delve into the stats on this one, but let me say a few things. The only way Strep-B can be passed to the baby is if he aspirates on some fluid during birth. First of all, aspiration on fluid is very rare; second, contracting Strep-B from this fluid is even rarer; third, having a complication as a result of this is even further removed. When faced with the question from my OB "why would you want to take a chance and put your baby in DANGER?" I am left to reply ì truly don`t feel that my son is in danger.

In case you guys think I'm a nutbar with this one, allow me to calm you with these few things... First, I pretty much instantly started a homeopathic and vitamin regime to eliminate the Strep-B. Second, as I have previously stated, I ok with intervention if necessary. So if the baby aspirated on birth, I would probably not decline an antibiotic injection for him (which would be the same thing he would get if I was hooked up to an IV throughout the entire delivery... but we would know at this point that it was indeed needed.) And finally, let me share this with you: my swab test came back negative. I don't have Step-B after all.

Exhibit C: I asked the OB whether she needed to mark in my chart that I did not want the baby to receive any eye drops when he has his post-birth checkup in the nursery.

Me vs. the OB: Basically she said that no, this was not something that would go in my chart, as it has to do with the baby post-birth, and not with me. And then she stated that she believed that this was an issue that was non-negotiable. I corrected her and told her that indeed it is negotiable, I just had to sign the appropriate document. In any case: since when did treatment in a hospital become non-optional? And since when did the parents of a child not have the right to make the decision about what they thought was best for their child? Further more, just to make it clear: the purpose of these antibiotic drops is to treat the baby in case the mother has gonorrhea or chlamydia- 2 STDs that can cause eye issues and blindness at birth. Again, allow me to assure you: I do not, nor have ever has either of these.

Exhibit C: All my questioning obviously ruffled a few feathers... At one point my OB stated: "I didn't know you had a medical degree, and with a specialization in obstetrics!"

Me vs. the OB: It is my right to be informed about what is going on with me and my child. I refuse to apologize for asking questions regarding things that I am concerned about, even if they are the very things that modern medicine is built upon.

Exhibit D: Finally my OB says: "Let me guess, you're not going to vaccinate the baby?" (shaking her head slightly)

Me vs. the OB and pretty much the rest of the medical world: That's what I'm leaning towards. And man, it's going to be a long 18 years.

It's about time I made some conclusion to this post/rant. If I sound a bit defensive, I suppose I am. These instances, along with some situations that my doula has warned me may arise while birthing my baby, have really left me with a sour taste.

Yes, you guessed it: I am going to try my best at a natural vaginal birth. I don't have a birth plan that has more detail than that because I know things can change in an instant. The one thing I am completely committed to is having an open mind. What I don't like is people telling me that they know what is best for me and my baby, and telling me that I should ignore all my natural impulses.

I'm sure I'll write more about my feelings, fears, and hopes for birth in another post. I can hardly believe that it's so close!

18 comments:

friend #2 said...

let me be the first to comment and wish you all the best in this process. It is not going to be easy. But I know you and that you will stick to your guns for what is necessary but also not take any risks for what is not. Stoopid doctors, just becuase they went to school 16 years longer than I did, they think they no everything...
However meet me over at MSN to discuss the vaccination topic more in depth : )

Aurelia said...

Mrs.C--I'm just going to say that you can do some of this, without doing all of this. So for now, I hope you won't feel too committed to only doing it this way vs. another way.

I had a lot of concerns like you, but in the end did do some of this, even though I thought I wouldn't.

To clarify some of the OB's remarks--if you have ever had strep B then you carry it, period, even if the latest swab was negative. And it can appear again in your body and start up again. The IV to be honest, is no big whoop. I thought it was huge too, and it turned out to be super easy, and if you do have an emergency during labour, it means you can get an epidural and stay awake for a c-section.

I know you don't want a c-section, heck neither do I. But with your early bleeding episodes and the IF...you just might have a problem delivery, due to a problem placenta and need to get medication or a transfusion during it.

And about the eyedrops? That's because if you refuse, they take your husband aside and ask if he consents as well and if thinks there might be a reason to worry. (ie. has he had an STD and you don't know? Is he concerned about having an STD?) Yes, kind of horrifying to think about, but unfortunately a possibility in a world where 50% of spouses cheat. They always always ask spouses alone about this when it comes to the health of babies because everyone lies to protect themselves.

And their job is to protect the baby, not the parents feelings.

I really hope I haven't hurt yours with this comment. I could go on but I won't. Just keep an open mind, okay?

sky girl said...

You're so informed! Good on you. I didn't even know they gave eyedrops after birth. Shows how informed I was.

I don't know if it's standard but I had an IV started even though I didn't have Strep B. I guess they do it in case of emergency.

I think that doctors are so used to not being questioned that they forget we have every right to.

Good luck Ms. C. It seems like you're willing to keep an open mind even though you know what you want. Can't see anything wrong with that.

xo

Angie said...

You will have to stand your ground. I hope you are able to have the experience you desire.

orodemniades said...

Having issues with my OB now, too, and boy is it scary. I don't know why, I've been pretty proactive (and they're pretty low-key, preferring a non-interventionist approach - until now) and haven't really had trouble until now.

I don't understand why they think you can't deliver vaginally because you might have strep B or a big baby? And why do they need to give you an IV when they can just treat you now for Strep B? To me the IV is a definite warning sign, once they have that attached it'll be much, much easier for them to a) add Pitocin or some other induction medication without your knowledge (sorry, any medical people reading) and b)gives them a headstart on c-section proceedings. Color me paranoid, but that is absolutely the number 1 reason why I will be refusing an IV, I'm not going there if I can possibly help it.

Now, I must somehow incorporate your strengt into my Friday meeting with the OB...

My Reality said...

I know bottom line, you will do whatever you need to for a safe delivery. I think it is good that you are not just taking the doctors word as gospel, you are researching your stuff.

Give them hell and stand your ground! I can't believe you are almost there!

sarah said...

So nice to hear from you again.I'm so glad you have the doula--otherwise you'd really have to do all the fighting.
Keep us updated.

Erin said...

I know it's really, really late, but could you consider switching to a midwife? I've had Bradley students switch this late, and they've all had great birth experiences. Having had a natural birth, I can completely understand why this is so important to you--but I really think a birth plan is a great idea. A birth plan isn't a "set in stone, this is the way it will be" document. It's simply a "if things are going well and the baby and I are healthy, these are the things we'd prefer" document. I actually have my students write both their normal birth plan and also another one in the event of complications (such as a c-section), so that if they are faced with a medically-necessary intervention, they've thought through those possibilities ahead of time and know what they can do to make it a good experience even though it's not what they wanted. It wouldn't be a bad idea to try that--labor is not the time to have to make such decisions!

OK, enough assvice--I can't believe you're 37 weeks! I am so excited for Baby C to be here and to hear all about your birth!

Thalia said...

I'm with aurelia. It's great that you are informed so well, but keep an open mind. re the current scan, I don't really understand why you are worried, an ultrasound is very low risk for you and the baby. Tell me you at least know whether the baby is head down or not? Because if it's breach then you are really getting into a difficult situation.

On labour as well, it's important to keep an open mind so that you don't beat yourself up afterwards if things don't go perfectly. They might not. Natural births are great, but remember that the majority cause of women's death before the start of this century was childbirth. Medical intervention has saved a lot of lives - babies and mothers - so it's not all bad.

I do hope everything goes well.

Natalie said...

Mrs. C - I'm sorry you're having to fight with your OB about all of this. That makes me so very sad... and frustrated for you! I am lucky to have Midwives who support my ideas, even in a hospital setting. You know how I stand... I'm doing most of the same things as you.... avoiding interventions. I'm sorry your OB just can't see why.

In response to aurelia: "if you have ever had strep B then you carry it, period, even if the latest swab was negative. And it can appear again in your body and start up again."

Just want to clarify that strep B is usually present in everyone, it's only an issue if it colonizes in the vaginal or anal area. That's why they do the test when they do, hopefully pretty close to birth. It is ALWAYS a possibility that it could colonize after the swab test, with anyone - yet they generally do not put everyone on the IV unless they test negative as there is an extremely small risk. So to me it makes no sense that the OB is worried about GBS given that she tested negative! Why do the test then?

Gil said...

Oh, don't you just LOVE the snarky comments about you knowing more than they do? Sometimes I could just... *makes throttling gestures* You hang in there though. But remember to be flexible. As in all things, sometimes you have to pick your battles. Make em good ones! And it's great to see you post again. I hope we'll get updates when THE time comes!! Hugs from down the road.

robin said...

I have to de-lurk to congratulate you on standing your ground. I'm due at the same time as you, and have found myself making similar choices -- Rhogam? Flu Shot? Aiie! -- and it feels like so much heresy to disagree with the docs. Kudos to you! Keep listening to your gut. I'll be rooting for you, and hoping you have a safe and empowering birth.

Portraits in Sepia said...

Wow, I loved reading your post. I think I trust my doctors a little too much and don't ask enough questions. I hate being at their mercy.

sariel & shlomit said...

Ms. C...you make me proud to be your friend as always!!!!
Wish you didn't have this tsuris at this point but I guess there's no avoiding it....
i can't believe you're so close now....WOW!!!!!
keep us posted
sending loads of love to you and the C and ???
peace
shlomit

Lut C. said...

Doctor's don't like their authority challenged, but that doesn't give them the right to be rude when asked questions.

I hope everything goes smoothly with the delivery.

On vaccines, you may be interested in this book review over at Leery Polyp.
Where I live, vaccines are not really controversial.
I know it's different in North-America. There is a lot of bad information circulating on the net, based on shabby research. Someone wrote an excellent post about it a few months back, but I can't remember who.

MrsSpock said...

I've had classmates in my hypnobirthing class switch providers in the last month of pregnancy because of similar issues. For me, I narrowed my options (really few in my area) quite early on. IF treatment in itself does not put you at high-risk for delivery automatically. Unless you have a diagnosed placental issue, a uterine anomaly, gestational diabetes, or preeclamptic symptoms, you are low-risk.

Ultrasounds are very low-risk, but not every provider does them at the end of a pregnancy. Mine doesn't. An experienced provider can palpate the position of the baby easily. In fact, in subsequent pregnancies, a baby may not drop into position until hours before delivery.

I am having a natural birth but plan on antibiotics for Strep B if necessary. Even though transmission rates can be small, when it is transmitted it is very very bad. When I worked L & D, our protocol was to start antibiotics as soon as the water broke and then give every 4 hours after. Does your provider delay breaking water?

Remember, too, that only a certain percentage of women will test positive. If you did opt for the antibiotics, it is fine to request that they "saline lock" the IV instead of keeping you connected to a bag of fluid. Most antibiotics infuse within 30 minutes, leaving you free to move around for most of the time. You can request that the IV be placed in the forearm, rather than your wrist or the crook of your elbow, leaving you free to assume whatever comfortable position you desire.

I myself am signing a waiver to refuse erythromycin eye ointment. It is your right to do so. Most of us are routinely tested for gonorrhea and chlamydia during pregnancy, since it can be silent in women.

I do plan on vaccinating, but understand your fears. A good book about vaccinations is Dr Sears "The Vaccine Book". He sites research for all his recommendation. There was an article about vaccines he recently wrote in Mothering Magazine that is very informative.

JMB said...

I'm not going to jump in on most of the issues-I was positive for strep-b both times around (twice with #1, at 14 wks and again at 38), and both kids did aspirate a small amount. It happens. As for the IV and all of the other stuff, do what you are comfortable with. If you feel you are making an informed decision, it's your decision and obligation to honor your wishes.

My one main comment, however, is that you can't assume that you have a small baby just because you didn't gain a lot of weight, and that your fundal height is on the low side. This again, is my anecdotal assvice, but here it is. I gained 8 pounds with my first, and measured either right on or a little behind. He was 9lbs, 2 oz and 23 inches. I have very generous hips, and needed help to deliver. I avoided a c-section, but not by much. He was in the beginning stages of distress, and he had to get out. We also found out that there was a copious amount of mecunioum present that hadn't been present when my water was initially broken. Second baby, I gained two whole pounds, induced four days early, 8 lbs, 12 oz, 21 inches. I didn't need help this time, but I'm afraid of how big she would have been had I been allowed to go on my own. You have had a very limited amount of ultrasounds at this point, and one more, if anything just to prepare you for what may lie ahead, may be good for BOTH of you. As Erin said, plan for the unexpected, and you will be more in control of the experience as a whole. Having a duola will be a great help, but I have to say, that even with a ton of support, labor is something that ultimately, only you are going through, and it will astound you as to what you feel and experience. I'm not gushy about the whole "experience" that people go on about, but I can tell you that each labor threw a curve or two at me that I never expected.

Good luck and good health.

Anonymous said...

I just wanted to say it is so nice to hear that holistic treatments and medical treatments don't need to be exclusive. You can use both to be your best.