walk me through interviewing care providers. & fear of medical authorities (drs and midwives)

[cyclamen]

We're not thinking of TTC for another 6 months or so, but I'm thinking ahead.  Anyhow hope you can bear with me, this is long.

I'm hoping someone can walk me through this like I'm an idiot, because I am. This is a post about fear.

Relevant:

I am TERRIFIED of doctors.  In a nutshell, both my parents had chronic mental and physical illnesses.  I was also sexually abused by my dad for many years but it took me a long time to admit that maybe it had done something to me, affected me in some way.  I still don't like saying it.  Like I might be broken.  I'm a pretty stable and mentally healthy person otherwise but I have anxiety about authorities, and authorities includes doctors and midwives, HB and otherwise. 

[cut some other stuff about bad dr experiences trying to resolve pain during sex]

I did have DD in a small local hospital, and I was please with the outcome (healthy both of us!).  Everyone was kind and it was very hands off.  I was left alone for most of my labor which I was very happy about.  But it was not planned.  I just walked in when I was in labor.  I had seen a dr once during my pregnancy and heard everything was good, then never went back because I didn't feel like I could say "no" to more vag exams without a fight.  I don't want a fight.  To forestall that conflict, I did all the research for an unassisted birth.  But during labor I felt it was right to go to the hospital, so I did.  I think it was the right decision not because anything bad or dramatic happened (it was very uneventful, and probably could have done it alone at home in less time) but it just seemed... right.  In the future I want to find a dr I can trust to make good decisions with me.

DP and I agreed, I can't skip some kind of formalized prenatal care next time.  I took care of myself, but now I have DD and I have to do everything in my power to be healthy and sure that I will be there until she grows up and has her own babies and those babies have babies.  I can't let fear stand in my way.

The hospital midwives I saw for my PP care were also very kind and respectful and didn't treat me like a fool.  I think I'd like to go with them in the future.  So how can I talk to the hospital midwives at the midwife practice about, for instance, not having vaginal exams until late in labor?  I think that's my big thing.  I've done a lot of reading and I don't believe that they are necessary/beneficial, but I'm not a doctor so it just comes out like I'm selfish and afraid.  Has anyone made this request with success before?

I want to be a normal person and not afraid, and I want what's best for me and my future babies.  I am not against the idea of a homebirth - I'm not really for it, for myself, either, but I don't want to turn this into a novel... so at this time I am really looking for more info about interviewing care providers for a hospital birth.  Especially appreciated would be thoughts from others who found a good doctor and planned their hospital birth instead of just walking into it with some sandwiches.  If we go this route again, of course I plan on staying home as long as possible....

Edited by cyclamen - 12/23/10 at 9:01pm

[mckittre]

I'm sorry your past experiences have made this so hard for you.  I don't have a lot of experience interviewing care providers (not a lot of options here), but I will say that the hospital-based nurse-midwives that I'm seeing don't believe in lots of vaginal exams themselves, and fully admit that they don't do much good.  I'm 41 weeks pregnant and at every appointment they ask "do you want to be checked?" and when I say "nope", they just nod and say that the exams don't predict anything.  So you might be pleasantly surprised if you do bring up the question, and a good provider probably wont think you "sound selfish and afraid".  They might just think you've done your homework!

[AutumnAir]

Okay, just playing devil's advocate here, but why can't you skip the 'formalised prenatal care' this time? What would be wrong with doing your own care?  You can get a blood pressure monitor and urine dip sticks for yourself and measure your own fundus.  Dopplers/fetoscopes are easy to come by too.  If anything sent up a red flag then you should definitely refer yourself to a professional, but as long as you and the baby are healthy I wonder whether it might not be more beneficial to you both for you to avoid the extreme stress that you're likely to face with formal prenatal care.

On the other side of things - I had some very bad experiences with doctors too and had a *lot* of anxiety about it this time around too.  But the culture I was in was far less 'demanding' of things like routine VEs - I was never checked at all.  Did have some pressure to have a 'stretch and sweep' when I was a couple of weeks 'overdue' but was fairly easily able to say no and be respected.  I also found that it was worthwhile to mention that I needed special treatment because of 'sexual abuse issues' - I didn't get any more detailed than that, and didn't mention that most of the sexual abuse was actually at the hands of doctors - but I was clear that I expected to be treated with a lot of gentleness and respect (which obviously everybody should be, but sometimes they just need extra reminders!)  

You could interview the hospital MWs and just float the issue and see how they would react to you not having any VEs during pregnancy - it might be completely normal for their practice anyway.  

Good luck (((hug)))

[cyclamen]

Originally Posted by AutumnAir 

Okay, just playing devil's advocate here, but why can't you skip the 'formalised prenatal care' this time? What would be wrong with doing your own care?

....

You could interview the hospital MWs and just float the issue and see how they would react to you not having any VEs during pregnancy - it might be completely normal for their practice anyway.  

I think that of all my options: 1) invasive formalized prenatal care, 2) unassisted prenatal care and 3) respectful formalized prenatal care, option three is my lowest-stress option.  I was largely comfortable doing unassisted prenatal care during my previous pregnancy, but I think if I thought I could have found a care provider who wouldn't push, I probably would have been even more comfortable with that. 

However, it's very encouraging to hear that not every care provider does routine VEs, etc!  This makes me much less nervous about bringing up the idea.

Originally Posted by mckittre 

So you might be pleasantly surprised if you do bring up the question, and a good provider probably wont think you "sound selfish and afraid".  They might just think you've done your homework!

Thank you for saying this.  It makes me feel much less anxious about the idea of talking to the midwives!

[~Amy~]

My experience with avoiding vaginal exams (which I did until I went in in labor) was that it was pretty easy to do if you keep your pants on  I just declined to change into the gowns.  I refused the PAP that was offered at my first visit & at my 6 week postpartum visit.  I didn't change into the gown when I got to the hospital, either, although, I did allow a check because I wanted to know where I was (water had broken but I was considering going home if I wasn't really dilated at all since contractions hadn't started).  My pretty mainstream OB practice didn't blink an eye at my refusal so I suspect midwives would be even more receptive to your request.  There's nothing whatsoever selfish about having a say in your own prenatal care.

[MegBoz]

Yeah, I wouldn't worry about negative reactions to not wanting VEs - especially late-pregnancy VEs (i.e. not in labor). My MWs (hospital-based CNMs) never even offered to check me! They didn't offer, I didn't ask, always had my pants on at my prenatal apts with them - no problem. The only time I had any internal exam was when I had my GBS swab *I* requested an internal to confirm baby's position. I'd heard horror stories about missed-breeches so I was paranoid. I know now that decent MWs are able to confirm position through external palpation, but I didn't realize that at the time & was paranoid & preferred the confirmation of a VE. I don't think she would have even offered without my request.

I also requested "minimal" VEs in labor. I said I'd consent to one on admission to confirm I'm in labor & one when I feel the urge to push to confirm I'm 10 cm, but otherwise I'd rather not know how far dilated I am. I think that's exactly how it was phrased in my birth plan & all 3 of the CNMs -including the more medically minded one- were fine with it! No problem at all! This time around, I'm planning an HB but if I went back there, I might even tell them, "Hey, I really feel the urge to push so I'm gonna start pushing." Based on what I've since learned, I don't think an exam to confirm 10 CM & get "permission" to push is always necessary so I'd be comfortable declining that one too.

As for specific interviewing techniques, I've always advocated open-ended questions. Don't ask, "Is it OK for me to refuse VEs in late PG?" You don't want to know if the HCP will "let you" do what you want - instead you want to know how they normally practice - what is their "default setting" so to speak. Finding an HCP whose practices & philosophies are consistent with your desires is what you need in order to reduce any need for any 'fighting' or disagreements.

So I'd ask, "What are your thoughts on VEs in late PG?"

"How often do you feel it's necessary to perform VEs throughout labor for non-medicated mamas?"

(I'd clarify "non-medicated" since mamas with an epidural can't feel things & therefore I would imagine it's harder to confirm labor is progressing as opposed to stalled, so I'd imagine monitoring would have to be different.)

I'd also want to know how much your HCP will be there while you labor. There really isn't much point to confirming with your HCP that s/he doesn't require hourly or every-2-hours VEs in labor if that HCP won't even be there & the nurses - total strangers to you - will be monitoring you! Granted, if you have a birth plan signed off on by the HCP, the nurses may be cool with following it, but still that's an important issue, IMO.

I'd also ask how many HCPs are in the practice. Are you fine with getting to know 5 or even more? I would imagine it would be hard to truly feel a degree of trust and comfort with that many different HCPs. I felt fortunate to have only 3 CNMs in my hospital-practice, but now they're up to 5. I guess it's good for the women in our area to have more MWs, but it also has a downside.

I started out with a practice of OBs at Johns Hopkins - teaching hospital - and then was told there was a 50% chance that in labor, I'd get a resident I'd never even MET before. Um, yeah, I don't think so! So again, more Qs to ask about how the rotations work & who you could end up getting.