Wow, I have so many concerns about the birth

[Kewpie80]

...that I'm hoping you seasoned mommies can help with.

I would LOVE to have a homebirth or at least deliver at a homey birthcenter, but I am considered high risk because of my diabetes and hypothyroidism. Have you ever heard of a woman being watched through her pregnancy by an OB, but then being allowed to deliver with a midwife? Do you think this would be a possibility for me?

The OB I will be seeing specializes in high risk pregnancies and is an expert in fetal medicine and diseases. I did a bunch of research on him yesterday and he is known for a lot of intervention. He has a high interest in amniocentesis. I've heard that this test is both painful and potentially dangerous. Am I allowed to refuse these tests?  He is also not very good with the bedside manner according to a bunch of reviews on him.  He is abrupt, curt, and unfeeling.  This is not the type of dr I want, but I have been referred to this doctor by 2 of my endocrinologists.

I also want little to no intervention during labor and delivery. I don't want pitocin or anything. I'm terrified that I either won't have a choice or they will give it to me without my knowing. Can I refuse this somehow?

Of course if the baby or I am in danger, I will agree to a C-section, but I've heard of dr.s getting tired of waiting and pushing one on a woman when it's not medically necessary. This scares me too. 

My last concern is that I do NOT want the baby taken from my room unless it is medically necesary and he/she has to be treated in the NICU or something. Otherwise, I want him with me or my husband.  I dont want him taken to the nursery AT ALL and I want him laid on my chest right after being born instead of whisked away. Are there ways I can have this? I'm afraid of making a scene in the middle of the maternity ward...

Am I worrying way too much?  

[KempsMama]

I can address a couple of your concerns.  Go over your birth plan in detail with your husband, regardless of where you plan to birth, addressing all possible scenarios.  Make sure your DH asks what medications they are giving you and why.  You have the right to decline any treatment, and while some practioners use bullying tactics, you have the right to stand firm. 

As far as being seperated from your baby, I had a c-section after an attempted V-BAC, three days of labor, and my babe and I were never in different rooms.  My DH went to the corner with him when he was weighed, they handed him to me as soon as I was stiched up and he stayed with me through recovery.  It's very easy to avoid seperation.  With my first I had an emergency section under general anesthesia, and my DH stayed with babe the whole time I was out. 

[Smokering]

You absolutely have the right to decline amniocentesis, and indeed everything else if you so desire. But surely there's another OB around who's both competent and not a jerk? That guy sounds like trouble waiting to happen, if you want low-intervention and respect. 

[MsBlack]

The biggest issues are whether or not you can maintain safe levels of blood glucose, and thyroid hormones.  Both diabetes and hypothyroidism do have risks--but it's all about control of these conditions during pregnancy.  It's a good idea to have an endo on your team, to help you keep an eye on things and make needed changes in dosages of meds and so forth.

I've worked with homebirth moms who had hypothyroidism--well controlled with meds, endo on hand for consult/adjustments.  No issues.

Are you a type 1 diabetic, type 2, or are you talking about gestational diabetes?  Knowing that would help me make further comments.

Meantime, I agree--it is your right to choose against amnio, which does increase your risk of miscarriage.  Knowing what is offered, having true and thorough informed consent makes all the difference. 

I also agree with pps who suggest finding another OB!  If you or baby's condition truly merits care by the best of the best--if there are already problems, not just risks, then it may be worth his attitude to receive his knowledge.  Only you can decide that.  But if we are talking mainly about 'potential risks' and all is so far going well, then I don't see why you can't shop for a different OB.

[Climbergirl]

I have hypothyroidism and just gave birth at home. I had blood tests every 6 weeks to monitor my levels and that is fine. I am not sure you are truly "high risk" though? Sounds like your endo sent you to this particular OB? I would definitely shop around. With my first, I ended up with a csection, and since DS1 was not breathing well, they took him to another room and DH followed. I absolutely think the csection was not necessary and things were just not handled properly. Trust your instincts. If they guy worries you, then you probably should be. I picked a doula that was a midwife assistant in case my midwife could not make the birth (we had horrible blizzards here last year). Good thing, because the doula caught DS2! We were all amazed at several instances of how I choose things based on my instincts and they turned out correct.

[gemasita]

I see that you TTC for a long time (as I did but you REALLY had a long journey, didn't you?  ).  I know for me, I really want my birth experience to be very positive since this will be the only baby we have.  If you have ANY reservations about this doctor, I urge you to keep looking.  I'm sure the endo's suggested him because he's really good at the high-tech stuff but did they know what type of birth experience you were looking for?  You might try contacting some doulas in your area and see if they can guide you to a low-intervention perinatologist or one that works along with midwives?  And they can probably tell you which hospitals are better for low-intervention birth and not trying to take the baby to the nursery.  I have Hashimoto's and am having a homebirth.  I do see my endo every few months and get my thyroid levels checked monthly and haven't needed any other special attention.  And of course, you can decline anything you want.  I had one u/s and the doctor was really pushing an amnio for no good reason so I declined that.  It's hard to say no, esp when they are using scare tactics, but this is the time to really stick to your guns and do what is right for you.

Oh, and like the pp's said, definitely look into hiring a doula.  I have had so many clients tell me that if I wasn't working with them, they would have never known or had the strength to say no to things like them trying to whisk the baby away.  Sometimes just having a doula in the room can make it easier to say, "no thanks, I'll keep him/her on my chest for a while longer."  The doula can always help by saying, "Are you ok with that or did you want to...."  I feel bad for people who are on their own and afterwards, wish they had known they could just decline things they didn't want.

Oh, I also just realized you are in Raleigh.  I'm in Apex.  PM me if you want some location-specific info.  I definitely have some for you.

[savithny]

Your last list of stuff isn't stuff that the doctor generally initiates -- that's all stuff controlled by hospital policy.  

While there are still really old-fashioned hospitals out there that haul babies off to the nursery for obligatory hours of observation, IN MY EXPERIENCE they are not the norm.  

Now, my experience is in the Northeast US, friends in Northeast/Northern Midwest, smaller towns, non-research hospittals...  but in my personal experience and from what I hear from friends and relatives, many hospitals have changed their ways.  

My hospital requested a birth plan and had checkboxes for all the things people freak out abuot here at MDC: "I will nurse.  Do not give my baby artificial nipples. Do not give my baby formula.   DO not circumcise my baby ..."  etc etc.    The hospital did all newborn procedures in the room at mother's side, on mother's belly or in arms if possible, and didn't move baby even for weighing for up to an hour after birth.  The nurses all were ready and able to help initiate immediate breastfeeding.   There was a "nursery," but it was for emergencies and sick babies (very sick babies had to be life-flighted to a bigger hospital) and I never saw a baby in the nursery while I was there.   And all that was *standard*.  If you *wanted* them to take your baby away you had to *ask* them to do it.

So -- you need to check out any hospital you might be birthing at.   You really might be surprised to find that they're not *all* like the ones in the horror stories.  Of course, some still are (there has to be a source for the horror stories somewhere), but you won't know until you check them out for yourself and ask around.

[msmiranda]

As others have said, you absolutely can refuse any medical care you don't want.  The question is whether you will be able to withstand pressure from authority figures (most of us have been trained to view doctors as authority figures).  I think it is important to know whether your diabetes is type 2 or type 1 (I doubt you mean gestational since you seem to be very early in your pregnancy).  Type 2, if well controlled, I think puts you in a strong position to see a regular OB and just see an endo on the side for your hypothyroidism.  If type 1, my understanding is that that is a much more high risk situation, and I haven't researched it so I don't know when interventions are called for or not.  But, if you are in an area that has more than a handful of doctors, I would shop around and not take your endos' recommendations to see the doctor you have described here.  It sounds like you and he would not be a good fit because you desire as little intervention as possible.  I would never have an amnio, particularly if I had had a difficult time conceiving, so I totally understand.  It sounds like this guy might try to pressure you to have one -- which you can still decline but I know that for me even though I am very strong in my beliefs about less intervention in pregnancy and birth being the safer route for most mothers and babies, sometimes it is hard to say no to someone who will always have at least a little bit more knowledge than you do, and hard not to let them get you rattled.

[Italiamom]

Originally Posted by msmiranda 

As others have said, you absolutely can refuse any medical care you don't want.

Start looking for a good doula.  They are worth their weight in gold for hospital births.

Start prepping your partner, now, for standing up for you, and to stand up to scare tactics.

Start looking around for another care practitioner... Yikes!  Try posting in your tribal area for recs, and also maybe try getting ahold of some midwives in your area.  They would be able to tell you whether you would fall within their scope of practice, and most provide an initial consultation free of charge.

Remember that you have a legal right to refuse any procedure or intervention.

[mama de dos]

Congratulations on your pregnancy!  I wanted to type a quick response, though I wish I had more time.  I strongly  encourage you to talk to an experienced doula in the area (like gemasita!) who can guide you toward less interventive practitioners and hospitals.  You ABSOLUTELY may refuse anything you want!  YOU call the shots here, not your OB, perinatologist, endocrinologist, or anyone else!  YOU are in charge of your body and your baby and if any of your providers sees it differently, you should strongly consider switching providers.  

I have had 2 homebirths in your area, and I know my m/w recently cared for a mom w/diabetes.  I'm not sure if it was Type I or II, but I do know this mom worked really hard to keep her sugar in good control and was able to have my homebirth m/w as her provider.  Again, if you aren't comfortable with the treatment you're getting, keep talking to more people.  Do your own research and stick to your guns.

As far as hospitals and taking the babies away, protocols are very, very different from place to place.  UNC is working toward becoming Baby Friendly and is the only hospital in the area to follow those guidelines.  They make a big difference, and many of the things you want are the norm at UNC, but are NOT the norm in other places, and you will have to fight/advocate for them- usually not where you want your energy to go during pregnancy and labor.

As far as a peri/maternal fetal med specialist, I've heard great things about Dr Ivester at UNC and Dr Steube is an amazing breastfeeding advocate.  She specializes in diabetes, but I don't know anything about what she's like as a care provider.  It might be worth an interview to see what you think.

http://www.med.unc.edu/obgyn/patient-care-services/maternal-fetal-medicine    (then you can click on meet our providers and see those 2)

Best of luck and congratulations again!!