Monthly Archives: September 2011

On Childbirth Education: I don’t know why I expected differently.

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We’re attending a childbirthing class- Extended Prepared Childbirth, to be precise. The idea behind the class is to provide parents with a full range of their options so they can make informed decisions during and before labor and delivery.

I don’t know why I expected a class that is put on by a hospital to offer all the facts and figures about interventions.

So really, my fury last night was my own fault.

It began within ten minutes, when the PowerPoint presentation said that “EFM (external fetal monitoring) is only used when medically necessary” and the teacher followed it up with how it’s ‘routine’ in every hospital. So, naturally, I raised my hand and inquired why the presentation says it’s only when needed, but hospitals do it as routine care? The teacher informed me that usually, Mama is monitored for ten or twenty minutes out of the hour. Since that didn’t answer my question, I clarified. “Why does the presentation say it’s only used when medically necessary, but our local hospitals use it as a routine procedure instead of when indicated by medical need?” The teacher’s reply?

“EFM is medically necessary in every single birth.”

…. it took a few deep breaths to calm down after that one, but since EFM doesn’t actually do anything to the body (most of it’s ‘side effects’ are psychological or caused by the restricted movement, not by any actual interference in the body’s processes) I didn’t want to raise a fuss.

My next near explosion came from her comment about Cesarean birth- namely, the comment that it was ‘relatively safe’ (compared to what? She never did say), and her comment about how VBAC (vaginal birth after Cesarean) was much, much more dangerous than having a repeat Cesarean. 

There was no mention anywhere about alternatives to C-births. No mention that when your baby is having fetal heart tone changes, a position change could ease it, no mention that when s/he gets stuck at the shoulders (a rare condition called shoulder dystocia) instead of a C-birth, you could just roll onto all fours to widen the pelvic area…

There was also some discussion about how going past your due date is dangerous and worth scheduling a planned C-birth for, some talk about CPD (cephalopelvic disproportion, where the baby’s head is too big to fit through the mother’s pelvis bones) with no mention that the only women who really have issues with CPD are ones with rickets or a similar bone warping disease or injury.

We were given all the wonderful reasons why an epidural is completely safe, with no mention of how it lowers the infant Apgar scores, and increases your chance of surgery by 50% (if given too early in labor) or the side effects of having a catheter inserted into your spine.

We heard a lot of “There may be rare other side effects, talk to your doctor” but no mention of the common ones- headaches, drops in blood pressure (mentioned but then poo-pooh’d away- with a literal wave of her hand!) and the increased need for forceps or vacuum assisted delivery.

I should have known better than to attend a class on ‘interventions’ at a hospital sponsored birthing class.

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Update: Success!

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Update!

Burrowing into bed with frustration, I finally gave up and just went to Dr. A’s clinic. I found out why I couldn’t get a hold of any of my familiar, well-liked receptionists- they’ve all been replaced with chain-clinic receptionists. After several dodges and hems and haws, (including being told that she couldn’t find my chart) the receptionist mysteriously happened to find it in a stack of charts sitting next to her desk- after my CMA (beautiful, glorious familiar face!) pointed out that it was… you know, right there.

She said it would take an hour to copy, and she would personally fax it over.

An hour later, I called Dr. B’s clinic, and lo and behold, my charts were in! Not an hour later, Dr. B had reviewed my paperwork, approved me for an initial review and consultation, and tomorrow at 2pm I go in for a finalization of my transfer of care.

About time!

Catching Up: My journey so far

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Ordinarily I make an attempt to post things that seem profound to me, or things that I feel would benefit another mother who’s in a similar situation.

At this point, I think I just want to document and sort out what’s happened so far.

I have been seeing a lovely OB, whom I shall call Dr. A at this point because he really, really is a fantastic, fantastic man. That may sound strange, but I don’t want to associate him with the terrible practices that the company who purchased his clinic holds. I won’t name them either, because… I’m paranoid. I don’t want to cause my previous doctor any issues.

I’ve been seeing Dr. A for years for my women’s health care, including the infertility treatments that blessed me with my daughters. He’s always been kind and caring and open-minded. During this pregnancy, I have always, from the beginning, said that I want as few interventions as are medically necessary. Unfortunately, partway through (at about 23 weeks, maybe a little earlier) he started talking about how I would need to deliver in the OR, I would need to have an IV, I could only have one person in the OR during my delivery- two, if I fought hard for it. These were not his policies, but the hospitals- and he only delivers in one hospital. He did mention he was uncomfortable with my laboring and delivering in the L&D room, in case something went wrong.

I was very much against the need to deliver in the OR. To quote my dearest friend, “That’s like cooking with the fire department standing over your shoulder, hoses loaded.” That is, it felt like too much overkill and too much anticipation of tragedy- and I firmly believe that you find what you’re looking for and that if you are expecting something, it will come to you- good or bad. I have no complications in my pregnancy aside from slightly low blood pressure, and to me it felt very wrong to be anticipating issues that would probably never come up.

Then the second half of this equation struck- my beloved doctor and his clinic became a part of the local conglomerate of clinics. Their office and their practice was eaten up by another chain of clinics, who truly work more like a chain of stores or restaurants than a place for a woman to receive loving care.

Because I was upset by the enforced restrictions placed on me solely because I was having twins, I tried to schedule an appointment simply to speak to my doctor. This is a man whom I trust, whom I am expected to continue trusting while he guides my children and myself through their passage into this world.

I couldn’t get a hold of him. I was thrown into an automated system, which then transferred me to a chain-clinic nurse. Not the nurse I know and trust at the clinic- not the triage nurse there in the office. A nurse who wasn’t even associated with my doctor except to be owned by the same chain- and she told me that I couldn’t talk to him, not even for ten minutes, I couldn’t have an appointment because he was booked full until the 23rd of September and unless I was having an emergency I would just have to wait.

I called back several times to see if there had been any change, because it was very important that I speak to him.

I never did reach him. Or his nurses. Or even his scheduling desk.

This was the point where I decided to try to transfer providers. Unfortunately, I found only one midwife with an opening to see me and none of the OB’s I called would accept me as a transfer, as I was already ‘with established care’ and I was past 20 weeks.

Since the Birth Options class I took (highly recommend, by the way) pointed out that, as a consumer, I do have the right to choose to transfer care at any time, including in labor, I refused to accept that I had no other choice.

I found one midwife, covered by my insurance; I found one OB, who would review my records and decide if I was a candidate for his care.

(I also found a doula who was and is incredibly supportive of me during this time.)

Tuesday (what was that, the.. 6th?) I spoke to the midwife, who informed me that while I was a lovely candidate for home birth and she would be honored, it was an unfortunate reality that she would be out of the country during the entire month I was due. (Being twins, I could delivery any time between mid-November and mid-December).

Midwife ruled out.

So that very same day, I went to a different OB clinic (We’ll go with Dr. B! Because I am creative. Not.) and filled out the paperwork that releases my medical records to Dr. B’s clinic and arranged everything. Now we were waiting on Dr. A’s clinic.

And waiting. And waiting. And waiting.

Today, I called Dr. A’s clinic. I was transferred three times to three different departments (none of which was actually Dr. A’s clinic), and then was sent to Medical Records. Medical Records transferred me again to Medical Release, which is apparently a different department. I was answered by a lady who was incredibly rude, cutting me off partway through my sentences and scoffing at my requests. I asked her if my records had been transferred yet, and she informed me (in a far less polite way) that the clinic had never received that release.

I watched Dr. B’s clinic fax that paper.

The lady informed me (once again, in the rudest way she could) that perhaps the paper had been faxed to Dr. A’s clinic, in which case it would have to be sent to Medical Records, who would send it to Medical Releases, and then they could verify the forms and send the verified form to Medical Records who would send the records to Dr. A’s clinic, who would then send them to Dr. B’s clinic. Eventually.

I requested Medical Releases direct fax line, and she, with great reluctance, rattled off a number so fast it makes me grateful I worked in call center customer service or I would never have recorded it fast enough. Then she hung up on me. The old fashioned way, without even a curt ‘goodbye’ or ‘is that all’.

I took several deep breaths and then called my mother, who happens to work for nameless chain-clinic. She informed me that I was, once again, getting a run-around. She recommended that I go directly to Dr. A’s office and fill out the release (again) and then stand there in the office lobby while they collect my records. They would then fax the records directly to Dr. B’s clinic, and I could also request hard copy to carry with my own two little hands over to Dr. B’s clinic.

Dr. B’s nurses’ response to all this? “…. if you can get us the records, it’s likely he’ll be able to look at them today, or maybe tomorrow and we can have you set up pretty quickly!”

I love you, Dr. A. You’re a fantastic man, with years of experience and knowledge, and I know that if I could have gotten to see you for a few minutes, we could have come to an arrangement that was mutually acceptable.

I hate your new bosses and I hate nameless chain-clinic. They have made it impossible to see you, speak to you, or hear from you, and I just cannot deal with it. I’m sorry, but I need to make this transfer.

Even if Dr. B reads my records and turns me down, I’m not going to deliver at the downtown hospital that is Dr. A’s first choice. I have never had pleasant experiences there. I can’t even get a hold of them to get a tour of the birthing center!

If push comes to shove (literally! … baby joke, there.) I will just labor at home until it’s time for hospital, and then I will just toddle over to the local hospital and check myself into the ER.

I’ve been told I have no options. There are -always- options, if you’re brave and stubborn enough to fight for them.

Thoughtful Conversations You Never Have

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I’ve been reading a lot, recently.

I’m full of ideas on what I want for my birth- not specifics, this time, but the overall theme and sensation I want during my delivery and the time leading up to and away from it.

However, I also find myself reluctant to speak of it to anyone. I’m even faintly nervous to talk to my doula about it- after all, birth is only interesting to those who are birthing.

I wonder, why is it that we feel so reluctant to speak of something that we find truly important to us?

My mate commented that he tried to speak minimally of work, because he understood that nobody else really cares, since it only affects him. I think, in my personal experience, it’s a similar reason why I choose not to speak about my important things.

After all, they’re only important to me!

But… if I never speak of this important thing, then another girl who is looking for something may not find it. She may be looking for information on her own birth, or for validation or justification or just reassurance. She might be looking for something, anything- just like I am, right now.

If I don’t share my personal revelations, then what becomes of that theoretical girl?

Of course, if I do share them, it’s possible nobody will care. Is that a legitimate reason to avoid talking about it? Or is it my own fear of ridicule, or worse, being ignored or dismissed, that makes me so hesitant to shout out my choices?

I’m afraid of being rude. I’m afraid of talking so much about this passionate thing that I am experiencing that those who aren’t interested will become bored or irritated by my over-eager and hungry chatter. I’m afraid enough of these things that I avoid talking about this passion of mine, even with pregnant women. They might enjoy it, but what if… what if they don’t? What if they feel I’m judging them, even though I’m not? What if they don’t want to talk to me anymore because I can’t shut up?

What if?

Nicked from Birthing from Within

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“Oh honey,

it’s alright you cryin’

and don’t know why.

Sometimes when a pregnant woman

is cryin’ over nothing’,

she cryin’ for her baby ’cause it can’t cry yet,

and when she laugh over nothing’

she laugh for her baby all happy in there.”

–Advice from an old African American Woman

Nicked from the Birthing from Within book, by Pam England and Rob Horowitz