Tuesday, July 10, 2012

Choosing a Provider: My Story

I started out this journey with my OB/GYN that I have had for several years. She was amazing as a gynecologist and I really liked everyone in the practice. I assumed I would feel the same about them as OBs. I was wrong, but I didn't know that at first. I had a conversation with my OB at the first appointment. I asked about their C-Section rate and philosophy as a proxy to get through to whether or not they had a focus on natural birth. She told me that they weren't sure of their C-Section rate (a big red flag, which I didn't know at the time), but they only did C-Sections when they were medically indicated. They recognized that this is major surgery and took it seriously. I felt good about this response and conveyed my wish for a natural birth, which was met with warmth and support from my OB.

After months of research, I wrote our first draft of my birth preferences with my doula's support. I took a list of questions to the OB, when I was 7 1/2 months pregnant, to ensure that I would be supported. I could tell my doula was attempting to prepare me for the possibility that the this OB may not perfectly support my wishes, but I was CONVINCED that given our previous relationship and how woman-focused this practice was as GYNs that there would be no problem. I couldn't have been more wrong.

My first question to her was regarding their policies on inductions (which you may remember from my last post put you at risk for all sorts of things, including a c-section). Her response was that "We always induce at 41 weeks and our threshold for you would probably be earlier because you are overweight."

Being of Cherokee philosophy, I have two modes that coexist when I am communicating to someone who I am beginning to not like: the first is what I would love to say to them, but I only do so in my head and the second is my filtered, respectful response. As I have told my students about Native culture, your responses to others' treatment of you says more about you and what you are capable of, rather than what the original person deserves from you. So here is what happened.

In my head: "Wow, thanks. So, I'm chunky which clearly means my body is defective. Nice."
Out loud: "Hmmm. Ok, so I understand that being overweight puts me in a higher risk category for certain things in pregnancy, but since I have had a completely uncomplicated pregnancy with no health problems, what would be the medical rationale for inducing me, at what I am assuming you are recommending is more like 40 weeks."

OB/GYN: "Well, you have to understand that the goal, nationally, is no longer to have a vaginal birth. It is to have a healthy mom and healthy baby and we will always err on the side of caution with inductions and c-sections."

In my head: "What did you just say to me?!?"
Out loud: ....stunned silence.

OB/GYN: "Well you need to remember that it's not like it was in our grandparents' generation where they would have 9 children and only 4 of them would survive. If you have 2 pregnancies, we want you to have 2 children."

In my head: "Oh, do you? That's comforting. Wow, are you trying to sell me a 50% mortality rate right now? You so don't know who you are talking to..."
Out loud: "Well, ok, that is one way to look at it."

Next question: "Since we are looking for a hypnobirthing - gentle, relaxed birth, how do you feel about me taking different positions during labor?"

OB/GYN: "We will support you no matter what. But I do want you to be prepared for anything. I know when you first get pregnant, you go online and read websites and it just gets overwhelming. But we, as OB/GYNs, know best and you just need to keep an open mind."

In my head: "I hate you so much right now. Not only are you being condascending 'go online and read websites', you are totally prepping me for medical intervention even though you can't have an open mind about natural birth. You clearly forgot that I have a doctorate, am intelligent, am a researcher/professor and have a choice to drop your ass like a hot potato."
Out loud: "Ok, well that answers my questions - thank you!"

I drove home crying. Not just because I was 7 1/2 months pregnant and needed to find a new provider. Not just because I was soooo wrong about how supportive my provider would be to me and my baby. And not just because she was really condescending and clearly didn't know me at all. It was mostly because I realized that I, along with women everywhere, were being treated like idiots and that our bodies were clearly flawed with the one thing we were born to do. This was more heart-wrenching to me than anything else.

So I contacted my doula IMMEDIATELY, wrote a shocked email to Yoga Linda to get emotional support and prepared for a new road on my journey. With my doula's support and referrals, here is what I learned in researching a new provider:

OB/GYN: Many have entered this field to be surgeons. At minimum, they see things through a clearly medical intervention lens. Your chances of a medical intervention are very high if you start out with an OB. There are many really great OBs, so don't take this as a "all OBs suck" statement. Just know that you are dealing with a medical professional who is going to see everything as a potential problem with a medical intervention to treat it. By the way, I also found out that it is absolutely normal for an OB/GYN to go through their entire medical training and NEVER see a natural birth. This blew my mind.

Med-wives: There are midwives that function very similarly to OBs, but have lower intervention rates. Med-wives are nicknamed this because their approach is also very similar to OBs.

True Mid-wives: These are individuals who are committed to giving the best care possible, while keeping medical intervention at a minimum. They listen to you, keep you informed of choices, are very well-trained in giving physical, emotional and medical support through the whole process. They typically stay with you throughout your labor at your setting (which can include birthing centers or hospitals) and only bring in OBs if it is indicated.

At-home Midwives: If you are at a low-risk, these midwives will give you prenatal care, get you set up at home for labor and delivery, help you deliver at home and prepare and help with a hospital transfer if necessary. Midwives carry a significant amount of medical knowledge and medical interventions, so it is not nearly as risky as the culture leads us to believe. In fact, this is how many other countries (with lower infant and mother mortality rates) have their babies AND statistics show that home births are actually safer than hospital births.

Given that this was my first birth, I chose to go with a midwife practice that had a great reputation, Women's Health Associates, had a 6% unplanned c-section rate (RIDICULOUS - since the national average is well over 30% now and I found out later my old OB/GYN's rate was over 40%) and had the same philosophy that I had. They also used the hospital so that if anything did go wrong, the OBs at Yale can step in and help.

Here is how my birth preferences review went with the midwives:

I handed her my birth preferences.

She read each one carefully and out loud.
Midwife: "Great! About 90% of this we do actually naturally! We will never induce you prior to 42 weeks unless you had a major medical condition and we have exhausted all other natural attempts, we want you to labor at home with our support over the phone, we do all paperwork prior to the hospital as a policy, you can wear whatever you want and we'll keep the lights low and your music on, we will most likely get you the tub room because you are a great candidate for it, you can be in any position you want, we do not routinely do continual monitoring - you will go where you want and we will follow you, we never do early cord clamping, we are very committed to attachment and breastfeeding, and we will always consult with you prior to doing ANY kind of medical intervention and give you all the options."

Me: "In terms of the IV, am I allowed to drink fluids?"

Midwife: "Let's change that language. You are the person in charge - there is no "allowing" - You do not have to consent to anything that you don't want. Even if we had to give an injection of something, we are more likely going to do a Hep Lock with your permission so that you can still move around and be comfortable."

"The only other thing I see on here is that we routinely do a pitocin shot as the baby is coming out...[explained why and their medical rationale]. But you can decline this if you would like - you are not alone - many mothers do choose to waive it and that is fine, so do some research on it and let us know and we will respect those wishes."

In my head: I love you.
Out loud: I love you.

My lesson learned: Choose a provider you trust, who has the same philosophy as you (no matter what it is) and who makes you feel safe. The day after meeting my midwives for the first time, I slept 12 hours. I finally felt comfortable and safe and knew if there was a chance that I could have a natural birth experience, these ladies would do whatever they could to make it happen safely and comfortably.

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