I am experiencing everything that is wrong with our health care system

[AbbieB]

I am 18 weeks this week. This is my third pregnancy. My first 2 children were born at home, with the same midwife.

For the first time I am experiencing typical, mainstream health care for pregnant women. I am seeing hospital based midwives for my prenatal care, and I plan to birth at home with my original midwife (long story as to why.)

I have been seeing this practice since 14 weeks. I have had 4 appointments already! The first was the typical first appointment with all of the collecting of history, labs, etc... you would expect. The second was a dating ultrasound, I did not feel it was necessary (my dates were solid, no chance of being wrong) but I had been measuring ahead and we wanted to rule out twins (nope, just 1). Then I had a very hostile 3rd appointment which was suppose to be a get your lab results in person appointment but turned into a need to get more labs. And then yesterdays 4th appointment to go over those labs, which turned into a need for more labs.

It all of the testing and labs that I want to talk about.

First, every single lab and test I have been through has come back normal. Completely normal.

I am STD free (these were run 2 times for some reason, the second time by the awful midwife who did seem surprised to see that the first set had come back negative.)

My blood and all of the antibodies and Rh factors and whatever else are all normal. My blood pressure has been steady and normal.

My weight has been fine. I actually lost a few pounds and have yet to catch back up.The midwives are all very happy about this and have told me I do not need to gain anything, that weight loss is good (this will be significant in a minute.)

My urine has been steady. I have had protein and keytones present, dark urine color, but all 3 labs came back totally normal. Each of these appointments have been first thing in the morning after some early morning morning sickness and some night time dehydration as a result. I let them know that I have always had protein present in my urine, for both of my previous pregnancies and even when not pregnant. My GP and original midwife have let me know this is to be expected because of my health history (I've had mono and scarlet fever.)

All 3 of the different tests that have been done already for diabetes have come back normal, not even in the pre-diabetes range.

The baby looks and sounds good. Completely normal and growing well as far as they can see. I have only had my belly palpated once, at that first visit to get a fundal height, which was never measured with a tape, just estimated. The only actual baby check done has been with a doppler and a sonogram.

I have had my thyroid and progesterone tested twice (and 2 times before that this pregnancy with my GP.) These are of great concern to me. I have hypothyroidism so i know to stay on top of that. And I had scary low progesterone levels, causing all kinds of issues and I have been supplementing to keep my levels up.

So here is the problem:

Despite ever single lab coming back normal, one midwife is hell bent on diagnosing me with gestational diabetes because my first baby, 8 years ago,  was 10 pounds. She said I must be diabetic because I had a big baby. It does not matter that she was 3 weeks over due, it does not matter that my 2nd baby was average sized, it does not matter that my maternal history is full of big babies, it does not matter that all of my blood work says I'm not diabetic. She is convinced I am going to develop it and I must have had it before (not according to the labs either time!)

Another midwife is concerned about all of the keytones and protein in my urine and thinks I'm headed for PIH, despite steady, normal range blood pressure) and PreE. This is the same midwife that thinks it's good that I have lost weight and not regained. Ummmm, keytones are present in the urine when the body is burning fat and when a pregnant woman is not eating enough calories!

All three midwives are not concerned about my thyroid levels creeping up and my progesterone being at the absolute minimum normal level according to the lab ranges. I have been told to stop supplementing by all 3 and that my progesterone looks good, is not on the low side, I should not worry.

Not one person has asked my what I eat and how much. Not one person has asked me what I drink and how much.

It is clear to me that I am being treated by a system that looks at me through a statistical filter. The only thing that matters are labs. I am seen as broken waiting to be fixed. If the standard labs don't find anything that the person assumes is there, then it's time to order another test to look harder for it. There is no expectation of health and well being. There is no assumption that pregnancy is normal until proved otherwise. There is no effort being made to look into the reasons for why a thing is the way it is, just tests and quick fixes.

I am so thankful to have my homebirth midwife on board. We go over all of the labs, talk about the results, look for explanations as to why something seems off and work together to treat the underlying cause. I need to drink more water. I need to eat more frequently, and more calories. I will be a little more diligent it taking supplements and eating foods rich in natural sources of those elements that may be missing from my diet. I will keep taking the progesterone. I will go back to my GP if my thyroid keeps creeping up to get my medication adjusted. I will keep measuring my belly myself and feeling those reassuring kicks to know my baby is alive and thriving.

[BroodyWoodsgal]

Um, you have had more "medical care" in the last four weeks than I have had in all my pregnancies combined. It's no wonder so many people look at me sideways when I speak of low key prenatal care or UP!! You just connected so many dots for me...I didn't realize this was the nature of so many womens prenatal care!

If you really must stay with this practice....well, then I guess that's just what you have to do...you've got to just start nodding and smiling when you are with them and do a complete memory wipe when you walk out the door. Just forget about the whole thing and skip back to your MW who knows what the hell is going on.

I can't believe how they are trying to peg you as diabetic!! Look at you, losing all kinds of weight and having normal labs....you crazy diabetic, you!!

Do you think they are trying to risk you out of homebirth? Anything is plausible in a situation like this I guess. I know it must be bizarre to  actually be going through this....but I say you can hate it, or deal with it. Hating it and being angry...fills you with hate and anger. Dealing with it with the knowledge that they are just doing what they think they should be...fills you with indifference and understanding. When I have a human inside my body, I like to be filled with positive things. I know you do, too!!

Sorry again for this aggravation....you're just about half way there, mama....you can make it!! Do not internalize any of the bullcrap they are trying to get stuck in your head. Dont second guess yourself or let them tell you you are sick....if your body, baby and labs are not telling you that you are ill...you are not ill. The insane effort to peg you as high risk is an itch that will have to go unscratched for these crazy OBs in MWs clothing....it's going to be okay.

[AbbieB]

I'm right there with what you are saying. This is more "care" than I have had with my past 2 pregnancies as well. I did not even mention all the stuff i have already declined to do, like internal exams and the GD test that involves drinking the gross liquid, prenatal screening galore, etc... Shoot, my second pregnancy was mostly self care!

They do not know I'm planning a home birth. They don't know they are my back up. I'm just playing the game so I can have easy access to medical care should I need it. I had some early pregnancy instincts that told me I should seek some traditional back up, and I'm following it.

Two of the midwives, the ones that have not been awful, have been asking me why I'm not planning another home birth and have said some things that I have interpreted as gentle read-between-the-lines warnings that I'm on track for an intervention full experience should I choose a hospital birth. Both have apologized for some of the testing because they do not agree with it in my situation, but their hands are tied by rules and regulations as far as what they can do and not do without having me be bounced to the doctors at the practice. Florida law is very strict when it comes to midwives. Both have offered me names of home birth practices and birth centers, all of which I had already interviewed and decided against for various reasons. They had more names from further away, but I'm already working with one long distance midwife.

As a 40 year old mom with 2 kids, one with down syndrome and cancer, I am understanding of some of the standard of care practices that are just automatic. Most traditional practices I interviewed would not see me or labeled me high risk right off the bat. This practice has not. Two of the midwives have been great at offering me alternatives to help me avoid the totally arbitrary label of high risk but still allowing them to fill in all the blanks on my chart. I'm OK with urine collection and blood draws. Once you are grabbing some blood for something I agree with, it's not that big a deal if they are yet again checking for diabetes, STDs or whatever else. I'm not cool with pelvic exams, to much doppler and sonogram looking and listening, taking drugs to manage things that can be managed with diet and exercise (or at least given a shot to me managed with.)

I believe that to some, my status as a mom that does not wear a wedding ring (but happily married to the same man for 9 years plus 6 years of cohabitation) and on medicaid will bring up nasty assumptions. Like, yes, all my kids have the same father. I am aware that my refusal to do any screening for birth defects will bother some medical professionals. the awful midwife telegraphed her disgust at me being OK having yet another baby with down syndrome quite plainly. I'm sure the lack of wedding band and insurance status and declining a battery of tests she suggested had a lot to do with her 2nd round of STD testing in 2 weeks. Frankly, I would not have been surprised had I seen a drug screen in my chart.

I'm a strong confident pregnant women. I had much greater obstacles to overcome to birth my first 2 children. It will take a lot more to shake my confidence in my ability to gestate and birth than a ridiculous number of over kill labs and one cranky midwife that I will not be seeing anymore.

[BaileyB]

Originally Posted by AbbieB 

I am 18 weeks this week. This is my third pregnancy. My first 2 children were born at home, with the same midwife.

For the first time I am experiencing typical, mainstream health care for pregnant women. I am seeing hospital based midwives for my prenatal care, and I plan to birth at home with my original midwife (long story as to why.)

I have been seeing this practice since 14 weeks. I have had 4 appointments already! The first was the typical first appointment with all of the collecting of history, labs, etc... you would expect. The second was a dating ultrasound, I did not feel it was necessary (my dates were solid, no chance of being wrong) but I had been measuring ahead and we wanted to rule out twins (nope, just 1). Then I had a very hostile 3rd appointment which was suppose to be a get your lab results in person appointment but turned into a need to get more labs. And then yesterdays 4th appointment to go over those labs, which turned into a need for more labs.

It all of the testing and labs that I want to talk about.

First, every single lab and test I have been through has come back normal. Completely normal.

I am STD free (these were run 2 times for some reason, the second time by the awful midwife who did seem surprised to see that the first set had come back negative.)

My blood and all of the antibodies and Rh factors and whatever else are all normal. My blood pressure has been steady and normal.

My weight has been fine. I actually lost a few pounds and have yet to catch back up.The midwives are all very happy about this and have told me I do not need to gain anything, that weight loss is good (this will be significant in a minute.)

My urine has been steady. I have had protein and keytones present, dark urine color, but all 3 labs came back totally normal. Each of these appointments have been first thing in the morning after some early morning morning sickness and some night time dehydration as a result. I let them know that I have always had protein present in my urine, for both of my previous pregnancies and even when not pregnant. My GP and original midwife have let me know this is to be expected because of my health history (I've had mono and scarlet fever.)

All 3 of the different tests that have been done already for diabetes have come back normal, not even in the pre-diabetes range.

The baby looks and sounds good. Completely normal and growing well as far as they can see. I have only had my belly palpated once, at that first visit to get a fundal height, which was never measured with a tape, just estimated. The only actual baby check done has been with a doppler and a sonogram.

I have had my thyroid and progesterone tested twice (and 2 times before that this pregnancy with my GP.) These are of great concern to me. I have hypothyroidism so i know to stay on top of that. And I had scary low progesterone levels, causing all kinds of issues and I have been supplementing to keep my levels up.

So here is the problem:

Despite ever single lab coming back normal, one midwife is hell bent on diagnosing me with gestational diabetes because my first baby, 8 years ago,  was 10 pounds. She said I must be diabetic because I had a big baby. It does not matter that she was 3 weeks over due, it does not matter that my 2nd baby was average sized, it does not matter that my maternal history is full of big babies, it does not matter that all of my blood work says I'm not diabetic. She is convinced I am going to develop it and I must have had it before (not according to the labs either time!)

Another midwife is concerned about all of the keytones and protein in my urine and thinks I'm headed for PIH, despite steady, normal range blood pressure) and PreE. This is the same midwife that thinks it's good that I have lost weight and not regained. Ummmm, keytones are present in the urine when the body is burning fat and when a pregnant woman is not eating enough calories!

All three midwives are not concerned about my thyroid levels creeping up and my progesterone being at the absolute minimum normal level according to the lab ranges. I have been told to stop supplementing by all 3 and that my progesterone looks good, is not on the low side, I should not worry.

Not one person has asked my what I eat and how much. Not one person has asked me what I drink and how much.

It is clear to me that I am being treated by a system that looks at me through a statistical filter. The only thing that matters are labs. I am seen as broken waiting to be fixed. If the standard labs don't find anything that the person assumes is there, then it's time to order another test to look harder for it. There is no expectation of health and well being. There is no assumption that pregnancy is normal until proved otherwise. There is no effort being made to look into the reasons for why a thing is the way it is, just tests and quick fixes.

I am so thankful to have my homebirth midwife on board. We go over all of the labs, talk about the results, look for explanations as to why something seems off and work together to treat the underlying cause. I need to drink more water. I need to eat more frequently, and more calories. I will be a little more diligent it taking supplements and eating foods rich in natural sources of those elements that may be missing from my diet. I will keep taking the progesterone. I will go back to my GP if my thyroid keeps creeping up to get my medication adjusted. I will keep measuring my belly myself and feeling those reassuring kicks to know my baby is alive and thriving.

OMG I totally feel you! I am not pregnant but am TTC-ing and having been seeing 7 doctors for my knee. 7!! Every time I see an orthopedist they tell me I need to see a rhuematologist and every time I see a rhuematologist they tell me I need to see a orthopedist! I JUST WENT THROUGH THIS WITH MY RIGHT KNEE 2 YEARS AGO!!!  It is so frustrating. I used to think that pregnant women on MDC who wanted home births and non-hospital/clinic care were crazy. Well I guess now I am crazy because I am all for non-trad medicine for my hopefully upcoming pregnancy.

[jenrose]

I feel your pain.

Yes, I have risk factors. They are mostly under control. I've had ridiculously simple births in the past (with most of the same factors) but very much wanted to do genetic screening this time around because my last child was born wiht a rare chromosome disorder (smaller gene area affected than DS, but much more profound effects on learning, speech, etc.) I'm hypothyroid, that's the one thing that isn't totally in range. The first half of the pregnancy I was mostly seen by a perinatologist. The big thing about getting pregnant this time was that neither my husband or I was willing to even try again if we didn't do genetic testing this time around. We love our daughter, but I know my limits, and another severely special needs child due to chromosome issues is not something I can handle at this point. Shiny's issues nearly killed me. Not in pregnancy... stress afterwards. Adrenal collapse, thyroid collapse, pulmonary embolism... there's a reason I have huge gaps between my kids. There are no guarantees, but we wanted to avoid the avoidable this time around. Which came with a price.

I have had SIX ultrasounds this pregnancy. It makes me crazy. First was because I needed to switch from a natural anticoagulant protocol to lovenox due to weight gain issues. (12 pounds in 2 weeks at 6 weeks pregnant starting at almost 300 pounds was not going to work.) Since I'd been having some non-uterine pain, we needed to confirm pregnancy in the uterus before putting me on massive blood thinners. Then I had a fair amount of spotting, and they did a scan to make sure baby was still doing okay because I've had miscarriages in the past. Then we went in to do a CVS, and they did an ultrasound and THEN told me they'd need to wait until I wasn't spotting anymore to do the CVS, so we did another one the next week to do the CVS... which the lab screwed up. So I had another one for an amnio, and then the anatomy scan. I don't regret getting the genetics tests, it just makes me crazy that they were all, "And you'll have another scan at 28 weeks, and one at 32... because you are at risk for IUGR or a big baby." (Baby's been spot on 50% for everything so far...)

And I said, "No I won't. We'll do a scan if we have an indication. Me being fat is not an indication when baby's growth has been on track and I delivered a baby with a 14.5 inch head with craniosynostosis vaginally."

But the message from the perinatologist is "I don't care what your obstetrics history is, you're fat and old and sick and therefore a ticking time bomb of destruction." Or something to that effect. Thank god my homebirth midwife is sane. 

So things have been mostly mellow with the midwife since the 20 week scan. Until I got sick a week and a half ago. At first it was nothing much, but then turned into bronchitis/pneumonia/something that won't quit, so I've ironically been to L&D twice in the past week, ER once, urgent care... 

At L&D, me lying there being a "good" patient on the monitors... I had pulled something in my belly and was having constant burning pain, knew I had an anterior placenta  but not exactly where it was lying at 34 weeks... I asked them to do a quick scan to confirm whether or not the placenta was in the area of pain. My mother nearly died of an abruption while losing her last baby while on blood thinners. This is NOT an unreasonable fear for someone with burning constant pain in the abdomen at 34 weeks pregnant!

The doctor on call was all, "Baby looks great, I'm sure it's fine."

I said, "No, we need to do the scan, because otherwise I'm going to be stressing out about abruption until I know where the placenta is."

She sighed and humored me, and what do you know, the placenta is on the other side, well away from the pain, thus it is a pulled muscle and I do not have to worry about it anymore.

THEN... after she spent all this time talking me OUT of a simple test that provided damn near instant reassurance... she told me, "You know, you really should have a hospital birth."

*headddesk*

This went back and forth for a while, keep in mind my midwife was there with me the whole time, totally had my back (both for the ultrasound and for homebirth). 

The doc didn't give a rat about these critical facts:

1. I have a very simple obstetric history, birth-wise

2. I live 7 minutes from the hospital in heavy traffic, a hospital with great homebirth transport policies and speed and a level 3 NICU, where the high risk doctors are very familiar with me.

3. My risk factors are under control and being closely monitored and treated and have jack-all to do with actual birthing.

4. I WAS THERE IN L&D. RIGHT THEN. So clearly, I understand that things can go wrong and sometimes we need medical help... and I'm willing to ask for it early if I feel it appropriate. 

5. I'm trained as a doula and childbirth educator and have been reading about birth, etc. ESPECIALLY  my risk factors for 18 years. Some of it, I've been reading about for 27 years. And not just "consumer books" but medical textbooks, research, midwifery periodicals, OB periodicals... It's not like I'm clueless about what can go wrong. I've LOST pregnancies. I've HAD a baby with a problem. And I'm under zero illusions that birth is "perfectly safe"... including at the hospital.

6. I have PTSD symptoms associated with past hospital care. I'll go in if I need help, but if I plan a hospital birth, there is zero chance of me having a birth that will not retraumatize me. I'll deal if we have to go in, I won't put it off if it's necessary, but if I can give birth safely to a  special needs kiddo in a horse trough in my kitchen and have our outcome be MUCH better than most of the kids with her syndrome born in hospitals, I think the odds of me doing okay with this one are pretty damn good.

At least planning a homebirth, if I transport in I get the natural-birth-friendly docs and staff, whereas if I plan a hospital birth the ONLY option they give me is the high risk docs and their protocols. My highest risk period STARTS about the time the hospital would want to send me home. I had my first in the hospital because I was "high risk", and not one damn thing they did made us safer. NOT ONE THING. And they damaged us unnecessarily. If my risk factors justify mandatory hospital birth, by the logic they use I shoudl be hospitalized for the whole pregnancy and 6 weeks postpartum. Only, oh, hey, wait... one of the things that would make me higher risk... IS HOSPITALIZATION. It's on the list. High on the list. 

My 18 year old daughter said, on the way out to the car, "She wasn't listening to you and kept talking over you."

I said, "And that, my dear, is the #1 reason I wont' plan a birth there."

In an emergency, fine. We'll deal if it comes to it. But plan it that way? She was all, "We can do a beautiful natural birth for you!"

I'm sorry. My midwife? She LISTENS to me. She ADVOCATES for me. I can trust her judgment for a lot of reasons, but one of the biggest? SHE TRUSTS ME BACK. And the caregivers I keep? Are all like that. My kids' pediatrician. My primary care doc. Even the perinatologist we see as backup, because he's a consultant and not primarily responsible for my care, will agree to disagree and doesn't push if I disagree with his recommendations. He knows I've done my homework. And he doesn't just pat my hand and tell me everything's fine if I'm worried, and he doesn't tell me dead baby stories if something concerns him that doesn't concern me.

(For example, my blood pressure is generally fine in pregnancy when I'm not sick, and my blood glucose levels have Never Ever Ever been high. He sees me as a potential statistic due to weight and age, so I keep track of my BP at home, and even really sick right now, it takes a nasty bout of coughing to get me up to 130/80... and my 1 hour post-massive-birthday-meal blood sugar reading was a whopping...112.) 

It just makes me crazy when they can't see past the statistics. 

And very thankful that my homebirth midwife is sensible and able to work within the system enough that I can feel safe staying at home and still get things monitored as I see they need to be.