Nurses pushing on stomach after birth - help. - Page 8

[holly6737]

If she desires something other than what her hcp offers, she either should change her stance or she should go elsewhere. If there's no where else to go, then she should either conform to the hcp's recommendations or she has the right to choose to go without care. I completely support firing patients for going against important recommendations. For example, I know of patients who have been fired from their hcp's for refusing the rhogam shot. Absolutely. I absolutely support that. And that's not the hcp's fault if the woman ends up without care. That's the woman's fault because she didn't accept the shot. I know of kids who have been fired from pediatric practices for not getting shots. I completely support that as well. What I provide is a service. It's my license. I control what I provide. If you want something that I don't provide, you do not have the right to force me to provide it (unless you are covered by EMTALA). I also have agency.

Quote:

Originally Posted by womenswisdom 

Taking a chance and jumping in here. I have read the whole thread and been following along. Something you said, Holly, stuck out at me. I agree that you have the right to make decisions about how you practice, but what happens if a woman desires something other than what you have to offer? What if she goes into the community and finds that there are no options for hcps who will "allow" her to do what she believes to be best for her and her baby? There are areas in which, even though something is "evidence-based", or even more dubious, the "standard of care", the alternative choice is still a reasonable one. If a woman cannot find a hcp who will provide care, then she either has to consent to something she doesn't really want (not exactly "informed consent" if the alternative is to be dropped from care, right?) or take a chance with a type of hcp that might not be optimal for her situation but will respect her ability to make her own choices.
For example, in many parts of this country, there are vbac bans in all hospitals within a reasonable driving distance (I'm talking within, say, an hour). So what is a woman to do in that circumstance? Either she consents to surgery that she may not feel is the best and safest choice for her and her baby or she hires someone that you might consider to be inadequate to provide care for her. Another example would be antibiotics for GBS, frank breech presentation, induction at x weeks, the list goes on. The issue becomes that when most or all of the available providers in an area make a decision about what they will do, it directly impacts what choices are available to the women in that area.
There are benefits and risks and the only person who should get to say what course of action is appropriate is the patient, with full information. What you as a health care provider would consider the optimal choice for you, in your evaluation of the risks and benefits, may not be what your patient believes is the right choice for her. All testing and interventions come with both benefits and risks and a health care provider should be able allowed to dictate the course of care for the patient, even if the hcp truly believes that what the mother is choosing is detrimental to herself or her child. That's not their job. If you, as a midwife, do not offer space for women to make their own decisions, then they will find someone who will support them, and the person who will do so may not be the best choice for their situation. And the responsibility for that will be partly on you.

[holly6737]

Originally Posted by SimonMom 

I'm still interested in your evidence for your evidence based practices. :p I'm a scientist, I am capable of reading the literature. Show it to me. :) You totally glossed over any of the studies I pointed you in the direction of. You want to be believable? :p Then show us the evidence. That should be easy. 

Any true scientist would work at an institution that has access to UpToDate. Log in. Look up anything you want. Otherwise, I would refer you to all of the position statements of the ACNM, the complete Varney's midwifery, the complete Williams Obstetrics, the complete William's Gynecology and the complete Gabe's Normal and Problem Pregnancies. The Green and the Gray journal are also good reads, and you should also have access to these journals through your institution.

[Just1More]

Oooookay.  I've been reading along, and I'd just like to say that this socialist nonsense drives me up a tree.

If I want my neighbor to privide surgical treatment to me in his garage...back off.  Last I checked I lived in a free country, and all this licensing, and "true" scientist stuff has gotten out of hand.  If I want to be a moron and die from it, I ought to be allowed.  Thank you very much.

And, my lack of true scientist status does NOT mean that I can't read, and that I'm too stupid to understand that I am taking some significant risks with said neighbor in said garage. 

Nor does it mean that I can't handle making my own decisions surrounding the birth of my babies and my care.  Or that I should be denied the right based on someone's arbitrary educational status.   That smacks of arrogance and foolishness to no end.

And, evidence based to one is not to another.  I've yet to find a document concerning ANY aspect of health care where ALL doctors/obs/etc agree in the best model of care.  So, to act like there is THE way to handle a birth is ridiculous.

I do NOT support the NBC and their movement.  Movements lack thought and are dangerous. 

But I absolutely support health rights, and parental rights. 

[holly6737]

Originally Posted by Storm Bride 

What makes those "apppropriate"? I had GBS screening with my doctor (not in my last "birth", as that was a schedule c/s) for two babies. Both times, she commented that it was protocol, but she was unconvinced it was necessary or useful, and wasn't really supported by research. So, the doctor did screening I didn't like, that she didn't believe was necessary, because that screening was "appropriate".

GTT? I've had the GTT with all my hospital babies. I've passed with flying colours every time. Three of my babies have been over 10lbs. and my last was 9lb. 15oz. I'm obese. I've heard comments about "missed gestational diabetes" multiple times. So, the doctors apparently don't trust that test, either. Why is it appropriate? What is appropriate bp management? I have a friend who checks her own blood pressure regulary and it's fine. When she goes to the doctor, it's through the roof. White coat hypertension  - most doctors know, intellectually, that it exists in at least some people. So, is it "appropriate bp management" if a woman gets a blood pressure reading at every prenatal, but never checks it otherwise? Is it "appropriate bp management" if she checks it regularly herself and shows it to her doctor, but refuses to check at the doctor's, because she knows she's prone to white coat hypertension? (The only high blood pressure reading I ever had - during a pregnancy or otherwise - was when the doctor was discussing labour management with me, and when she re-checked it 10 minutes later, when she wasn't piling on stress, it was back well into the normal range. At least she was smart enough to realize that one reading didn't necessarily mean anything.)

I've done all the tests, because I'd given up caring about myself at all by the time I had dd2, and when trying for my VBAC and VBA2C, appearing to be a good patient was important.

And, the woman I know irl (from outside the NCB community, I mean) who had the worst time of it, medically was doing everything "right", by your standards. None of the screening tests caught anything - she showed up at the ER (in the hospital where she worked - she's a nurse) because she had symptoms that concerned her. She had her c-section that night, once her HELLP syndrome was diagnosed. (Her second baby was in the care of an OB, and they thought she'd go full term...but she had another emergency c/s a month early when symptoms flared again.) So...what good did all those "appropriate" screening tests do for her? Her condition was caught, because she noticed symptoms...both times. She probably would have had exactly the same birth experience if she'd been planning a UC.

1) What makes them appropriate are screening recommendations by evidence-based organizations. These are all determined by the literature. Look to the AMA, ACNM, WHO and ACOG for appropriate screening test recommendations.

2) You are not understanding how the GD works. To simplify, GD is a disease that gets worse the farther along in your pregnancy you go. This is because GD is triggered, mostly, by a hormone called human plancetal lactogen. As human placental lactogen increases as your pregnancy progresses, your glucose intolerance increases. So, when we screen woman at 24 weeks gestation, we have the benefit of "catching" GD sooner, but missing women that would have screened positive at 28 weeks gestation. Likewise, if we screen at 28 weeks gestation, we are going to "catch" more GD, but we aren't going to diagnose it earlier, leaving those women who would have screened positive at 24 weeks without treatment for the 4 weeks it takes to get from 24 to 28. What's the answer? It depends on the doctor. Most CNMs I've worked with will screen at 28 weeks to catch more women. However, if there are GD risk factors (such as history of diabetes in a first line relative, history of GD or obesity), some would screen earlier (even in the first trimester) and then screen again at 28 weeks. It's not that the test is inaccurate. It has to do with the process of disease progression.

3) White coat hypertension can make your bp go up by maybe 10 points systolic, but it's not going to make a woman go from a normal bp to 150/100. If a woman is consistenly have pre-eclamptic bps in office but reports that she is not having pre-e bps at her home, I would consult with my supervising doc and probably continue to bring her in for bp checks while also running regular HELLP labs (which include liver function tests, uric acid and a CBC) with a 24 hour urine. At some point, you would decide to induce depending on how the bps are trending and what the labs look like. However, I wouldn't make that call, my consulting physician would make that call and that's why it's so important to have a consult doc to work with.

4) HELLP is a disease that comes on suddenly. You can feel fine one day, but be very not fine the next. You can look good at 12:00 and look like shit 24 hours later. You can even have a good bp and have HELLP. It's something that's diagnosed by lab work (hemolysis- so reduced RBCs, elevated liver enzymes- so increased ALT and AST, and low platelets (decreased platelet counts). In other words, there is no screening test for HELLP other than serial labs and the number to treat on that is too high to make it plausible. If her bp's had been trending well in office then there's no reason to run HELLP labs on her. It sounds to me like your friend was a medical community success story. FURTHER, I'd be willing to bet that if she would have been a UC woman, she would have just stayed home and chalked up her symptoms to being a "variation of normal" as all UCers seem to do for everything.

[holly6737]

Well I am a socialist (like an actual socialist), so it's natural you wouldn't agree with me then.

Originally Posted by Just1More 

Oooookay.  I've been reading along, and I'd just like to say that this socialist nonsense drives me up a tree.

If I want my neighbor to privide surgical treatment to me in his garage...back off.  Last I checked I lived in a free country, and all this licensing, and "true" scientist stuff has gotten out of hand.  If I want to be a moron and die from it, I ought to be allowed.  Thank you very much.

And, my lack of true scientist status does NOT mean that I can't read, and that I'm too stupid to understand that I am taking some significant risks with said neighbor in said garage. 

Nor does it mean that I can't handle making my own decisions surrounding the birth of my babies and my care.  Or that I should be denied the right based on someone's arbitrary educational status.   That smacks of arrogance and foolishness to no end.

And, evidence based to one is not to another.  I've yet to find a document concerning ANY aspect of health care where ALL doctors/obs/etc agree in the best model of care.  So, to act like there is THE way to handle a birth is ridiculous.

I do NOT support the NBC and their movement.  Movements lack thought and are dangerous. 

But I absolutely support health rights, and parental rights. 

[stik]

Quote:

If you, as a midwife, do not offer space for women to make their own decisions, then they will find someone who will support them, and the person who will do so may not be the best choice for their situation. And the responsibility for that will be partly on you.

How would this even work?  What is the practitioner supposed to do when faced with a patient who wants something really dangerous?  I agree that patients should be making their own medical decisions, and that the responsibility of a hcp is to provide them with information about risks and benefits of various options.  But there is also a point at which a provider needs to acknowledge that what a patient is asking for is outside the provider's scope of practice.  Not all providers have the knowledge and skills to handle every single situation in every single environment.  I don't think it's responsible for any hcp to support a patient through a situation that they aren't actually prepared to handle.  They have to communicate the limitations of their practice and be honest about how those limitations affect the patient's choices.  It's not responsible for anyone to pretend they can handle every imaginable situation.  If a hcp commits to supporting all patients in all their decisions in all situations regardless of the limitations of their skills and resources, that hcp is just as bad as the worst choices available no matter how much they wish the patient would follow their advice.  

If an OB or midwife is facing a situation in which a patient is asking for something the provider feels is unsafe, I think they have to be honest about that, about the options, about what they can and cannot do.  If a patient responds by finding some quack somewhere who promises that prayer and smudging and homeopathic remedies in a non-interventive environment ensure the health and safety of mom and baby in all possible situations, the responsibility for the outcome of that situation lies with the quack, not with the practitioner who was honest about their concerns and limitations.

Which is a pretty strong argument in favor of licensing hcps, in my opinion.  If you cannot recognize that some situations are too dangerous for natural birth with a hands-off appraoch, you should not be in the birth business.  

[Just1More]

Fair enough.

[stik]

Quote:

If I want my neighbor to privide surgical treatment to me in his garage...back off.  Last I checked I lived in a free country, and all this licensing, and "true" scientist stuff has gotten out of hand.  If I want to be a moron and die from it, I ought to be allowed.  Thank you very much.

That's nice for you.  I want to have a simple criteria that I can use to figure out which practitioners have undergone training and which have not.  Licensing helps with this.  It's not the alpha and omega of identifying great care providers, but it helps distinguish between providers who have education and providers who don't.  Legally protecting the use of certain titles (like MD and CNM) also helps.  Historically, caveat emptor has not helped people identify good options, it's just allowed society to shrug its collective shoulders when people get hurt by someone else's con.

[Just1More]

I'm not saying licensing, or, perhaps, accrediting, doesn't have a place.  And, I'm not saying that garage surgery is a good idea.  But, I am saying that it shouldn't be illegal, and that I ought to have the right to chose it if I wish.  It doesn't make me wrong, or stupid.  It just means that I have a different decision making criteria than you do.

Originally Posted by stik 

That's nice for you.  I want to have a simple criteria that I can use to figure out which practitioners have undergone training and which have not.  Licensing helps with this.  It's not the alpha and omega of identifying great care providers, but it helps distinguish between providers who have education and providers who don't.  Legally protecting the use of certain titles (like MD and CNM) also helps.  Historically, caveat emptor has not helped people identify good options, it's just allowed society to shrug its collective shoulders when people get hurt by someone else's con.

[holly6737]

Word.
 

Originally Posted by stik 

How would this even work?  What is the practitioner supposed to do when faced with a patient who wants something really dangerous?  I agree that patients should be making their own medical decisions, and that the responsibility of a hcp is to provide them with information about risks and benefits of various options.  But there is also a point at which a provider needs to acknowledge that what a patient is asking for is outside the provider's scope of practice.  Not all providers have the knowledge and skills to handle every single situation in every single environment.  I don't think it's responsible for any hcp to support a patient through a situation that they aren't actually prepared to handle.  They have to communicate the limitations of their practice and be honest about how those limitations affect the patient's choices.  It's not responsible for anyone to pretend they can handle every imaginable situation.  If a hcp commits to supporting all patients in all their decisions in all situations regardless of the limitations of their skills and resources, that hcp is just as bad as the worst choices available no matter how much they wish the patient would follow their advice.  

If an OB or midwife is facing a situation in which a patient is asking for something the provider feels is unsafe, I think they have to be honest about that, about the options, about what they can and cannot do.  If a patient responds by finding some quack somewhere who promises that prayer and smudging and homeopathic remedies in a non-interventive environment ensure the health and safety of mom and baby in all possible situations, the responsibility for the outcome of that situation lies with the quack, not with the practitioner who was honest about their concerns and limitations.

Which is a pretty strong argument in favor of licensing hcps, in my opinion.  If you cannot recognize that some situations are too dangerous for natural birth with a hands-off appraoch, you should not be in the birth business.  

[slmommy]

Quote:

Originally Posted by holly6737 

Word.
 

I agree with *some* of Stik's post too. Hcps shouldn't be forced to practice care they are not comfortable with or knowledgable in, as neither should women be forced to use hcps they aren't comfortable with. But we aren't talking about a breech momma with pre-eclampsia asking to go to 44 weeks and give birth standing on her head. The original topic was expectant vs. active management and the interventions involved in active 3rd stage management.

cpm licensing talk is a whole other can of worms, but if you guys wanna turn it into that, have fun.

[Just1More]

I agree with stik that a hcp is accountable to their own conscience, and ought to be honest about their abilities and comfort levels.  I do not believe a provider should be forced to provide care.    However, a woman should also not be forced to accept care.  That's the issue.  And, there is a significant difference between life saving measures, and "the way I think we should do things". 

[womenswisdom]

Originally Posted by holly6737 

If she desires something other than what her hcp offers, she either should change her stance or she should go elsewhere. If there's no where else to go, then she should either conform to the hcp's recommendations or she has the right to choose to go without care. I completely support firing patients for going against important recommendations. For example, I know of patients who have been fired from their hcp's for refusing the rhogam shot. Absolutely. I absolutely support that. And that's not the hcp's fault if the woman ends up without care. That's the woman's fault because she didn't accept the shot. I know of kids who have been fired from pediatric practices for not getting shots. I completely support that as well. What I provide is a service. It's my license. I control what I provide. If you want something that I don't provide, you do not have the right to force me to provide it (unless you are covered by EMTALA). I also have agency.

Quote:

Originally Posted by womenswisdom 

Taking a chance and jumping in here. I have read the whole thread and been following along. Something you said, Holly, stuck out at me. I agree that you have the right to make decisions about how you practice, but what happens if a woman desires something other than what you have to offer? What if she goes into the community and finds that there are no options for hcps who will "allow" her to do what she believes to be best for her and her baby? There are areas in which, even though something is "evidence-based", or even more dubious, the "standard of care", the alternative choice is still a reasonable one. If a woman cannot find a hcp who will provide care, then she either has to consent to something she doesn't really want (not exactly "informed consent" if the alternative is to be dropped from care, right?) or take a chance with a type of hcp that might not be optimal for her situation but will respect her ability to make her own choices.
For example, in many parts of this country, there are vbac bans in all hospitals within a reasonable driving distance (I'm talking within, say, an hour). So what is a woman to do in that circumstance? Either she consents to surgery that she may not feel is the best and safest choice for her and her baby or she hires someone that you might consider to be inadequate to provide care for her. Another example would be antibiotics for GBS, frank breech presentation, induction at x weeks, the list goes on. The issue becomes that when most or all of the available providers in an area make a decision about what they will do, it directly impacts what choices are available to the women in that area.
There are benefits and risks and the only person who should get to say what course of action is appropriate is the patient, with full information. What you as a health care provider would consider the optimal choice for you, in your evaluation of the risks and benefits, may not be what your patient believes is the right choice for her. All testing and interventions come with both benefits and risks and a health care provider should be able allowed to dictate the course of care for the patient, even if the hcp truly believes that what the mother is choosing is detrimental to herself or her child. That's not their job. If you, as a midwife, do not offer space for women to make their own decisions, then they will find someone who will support them, and the person who will do so may not be the best choice for their situation. And the responsibility for that will be partly on you.

Wow. I'm a bit surprised that you don't see the connection between the attitude of "my way or the highway" and women choosing to birth with care providers you view as unqualified. Informed consent does not mean "I inform you of what I want to do and then you consent." If there is no option for refusal, then it's not informed consent. My post was meant to point out a problem with the line of thinking that care providers should just refuse to provide any care to women who make choices they don't agree with in that you wind up with women who are not consenting (in the legal sense) or are without care. That does not appear to be an ethical problem for you, though.

Originally Posted by stik 

Quote:

If you, as a midwife, do not offer space for women to make their own decisions, then they will find someone who will support them, and the person who will do so may not be the best choice for their situation. And the responsibility for that will be partly on you.

How would this even work?  What is the practitioner supposed to do when faced with a patient who wants something really dangerous?  I agree that patients should be making their own medical decisions, and that the responsibility of a hcp is to provide them with information about risks and benefits of various options.  But there is also a point at which a provider needs to acknowledge that what a patient is asking for is outside the provider's scope of practice.  Not all providers have the knowledge and skills to handle every single situation in every single environment.  I don't think it's responsible for any hcp to support a patient through a situation that they aren't actually prepared to handle.  They have to communicate the limitations of their practice and be honest about how those limitations affect the patient's choices.  It's not responsible for anyone to pretend they can handle every imaginable situation.  If a hcp commits to supporting all patients in all their decisions in all situations regardless of the limitations of their skills and resources, that hcp is just as bad as the worst choices available no matter how much they wish the patient would follow their advice.  

If an OB or midwife is facing a situation in which a patient is asking for something the provider feels is unsafe, I think they have to be honest about that, about the options, about what they can and cannot do.  If a patient responds by finding some quack somewhere who promises that prayer and smudging and homeopathic remedies in a non-interventive environment ensure the health and safety of mom and baby in all possible situations, the responsibility for the outcome of that situation lies with the quack, not with the practitioner who was honest about their concerns and limitations.

Which is a pretty strong argument in favor of licensing hcps, in my opinion.  If you cannot recognize that some situations are too dangerous for natural birth with a hands-off appraoch, you should not be in the birth business.  

My post was intended to point out that there has to be a balance and that following Holly's logic could lead to a hairy ethical dilemma. There absolutely are situations where a hands-off birth is clearly and without doubt not safe or wise, or is outside the provider's scope of practice, but there are far more situations where the situation is not so clear cut. Should I be denied all care during my pregnancy if I refuse to an ultrasound, the GTT, a GBS screen, induction or cesarean when the care provider decides? Do I have any right, in the end, to decide anything about my own medical care? Where do we draw the line? Does a care provider have a right to dictate to the patient what her choices will be?

[holly6737]

Originally Posted by Just1More 

I agree with stik that a hcp is accountable to their own conscience, and ought to be honest about their abilities and comfort levels.  I do not believe a provider should be forced to provide care.    However, a woman should also not be forced to accept care.  That's the issue.  And, there is a significant difference between life saving measures, and "the way I think we should do things". 

Who has advocated that women should be forced to accept care? I haven't seen that advocated anywhere in this thread.

[holly6737]

Of course you shouldn't be denied all care during your pregnancy. You have the right to find another health care provider to provide you care. You have agency to do so. If you are "fired" from one practice, what is to prohibit you from finding another that might be more in line with your philosophy?

Originally Posted by womenswisdom 


Wow. I'm a bit surprised that you don't see the connection between the attitude of "my way or the highway" and women choosing to birth with care providers you view as unqualified. Informed consent does not mean "I inform you of what I want to do and then you consent." If there is no option for refusal, then it's not informed consent. My post was meant to point out a problem with the line of thinking that care providers should just refuse to provide any care to women who make choices they don't agree with in that you wind up with women who are not consenting (in the legal sense) or are without care. That does not appear to be an ethical problem for you, though.
My post was intended to point out that there has to be a balance and that following Holly's logic could lead to a hairy ethical dilemma. There absolutely are situations where a hands-off birth is clearly and without doubt not safe or wise, or is outside the provider's scope of practice, but there are far more situations where the situation is not so clear cut. Should I be denied all care during my pregnancy if I refuse to an ultrasound, the GTT, a GBS screen, induction or cesarean when the care provider decides? Do I have any right, in the end, to decide anything about my own medical care? Where do we draw the line? Does a care provider have a right to dictate to the patient what her choices will be?

[Storm Bride]

Originally Posted by holly6737 

1) What makes them appropriate are screening recommendations by evidence-based organizations. These are all determined by the literature. Look to the AMA, ACNM, WHO and ACOG for appropriate screening test recommendations.

Okay - so there are recommendations, and doctors (those oh-so "safe" professionals) are doing them, even when those doctors don't believe they work. That sounds like a seriously screwed up system to me. I thought I was supposed to go to a "safe" professional, because of said professional's expertise, but you're telilng me that I should go to them, because they're drones and will do what they're told, even if their own expertise says that another course is better.

2) You are not understanding how the GD works. To simplify, GD is a disease that gets worse the farther along in your pregnancy you go. This is because GD is triggered, mostly, by a hormone called human plancetal lactogen. As human placental lactogen increases as your pregnancy progresses, your glucose intolerance increases. So, when we screen woman at 24 weeks gestation, we have the benefit of "catching" GD sooner, but missing women that would have screened positive at 28 weeks gestation. Likewise, if we screen at 28 weeks gestation, we are going to "catch" more GD, but we aren't going to diagnose it earlier, leaving those women who would have screened positive at 24 weeks without treatment for the 4 weeks it takes to get from 24 to 28. What's the answer? It depends on the doctor. Most CNMs I've worked with will screen at 28 weeks to catch more women. However, if there are GD risk factors (such as history of diabetes in a first line relative, history of GD or obesity), some would screen earlier (even in the first trimester) and then screen again at 28 weeks. It's not that the test is inaccurate. It has to do with the process of disease progression.

So, when is the "appropriate" time to screen? It depends on the doctor. So, in this case, it's about the doctor's expertise, not about screening standards?  How is a patient supposed to know if they're getting expertise or a drone?

I never said the test was inaccurate. I said that the doctors talk about missed gestational diabetes, because I'm obese and have big babies. (Mind you, my MIL, who is tiny, also has big babies, and I had a smallish baby with my ex, even though I was quite overweight then, too - nobody thinks she had GD.) There has never been any evidence of GD in my case, except that I'm big and have big babies. I can't remember how far along I was when I was screened...I want to say 26 weeks, but I'm not sure. This "appropriate" screening tool can completely miss the condition its meant to catch, and the "experts" are convinced that they can diagnose, based on one risk factor (obesity) and one possible result (large babies), more effectively than the "appropriate" test can. (Of course, my third baby was also assessed - by "expert" nurses - as having jaundice, which he never had at all. Another nurse confirmed the diagnosis, in the dark, based on "it's too dark to tell, but if he was jaundice this afternoon, he still will be". (I wish I were kidding, but I'm not.)

In any case, you're addressing something that has nothing to do with anything. I'm addressing your horror at women not having "appropriate" screening done, even though those screenings aren't necessarily going to help.

3) White coat hypertension can make your bp go up by maybe 10 points systolic, but it's not going to make a woman go from a normal bp to 150/100. If a woman is consistenly have pre-eclamptic bps in office but reports that she is not having pre-e bps at her home, I would consult with my supervising doc and probably continue to bring her in for bp checks while also running regular HELLP labs (which include liver function tests, uric acid and a CBC) with a 24 hour urine. At some point, you would decide to induce depending on how the bps are trending and what the labs look like. However, I wouldn't make that call, my consulting physician would make that call and that's why it's so important to have a consult doc to work with.

Pre-e wasn't an issue with my friend. She's not pregnant. Her bp jumps way more than 10 points. It does so consistently at the doctor's office, and nowhere else. It's been doing so for a long time. (I am interested in your assertion about 10 points, though. Could you point me to a study on that? I'm interested in the methodology.  My friend, for example, would probably have at least some "whitecoat" increase, just from knowing she was in a study.)

4) HELLP is a disease that comes on suddenly. You can feel fine one day, but be very not fine the next. You can look good at 12:00 and look like shit 24 hours later. You can even have a good bp and have HELLP. It's something that's diagnosed by lab work (hemolysis- so reduced RBCs, elevated liver enzymes- so increased ALT and AST, and low platelets (decreased platelet counts). In other words, there is no screening test for HELLP other than serial labs and the number to treat on that is too high to make it plausible. If her bp's had been trending well in office then there's no reason to run HELLP labs on her. It sounds to me like your friend was a medical community success story. FURTHER, I'd be willing to bet that if she would have been a UC woman, she would have just stayed home and chalked up her symptoms to being a "variation of normal" as all UCers seem to do for everything.

I thought you were all about evidence? There is NOTHING evidence-based about the part I bolded. Nothing at all. If I made a similar comment about medpros, you'd be all over it. Lots of people, including UCers, choose to see doctors when they're sick, but not when they're well.

My friend was a medical community success, in a way. She was sick, not just pregnant, though. I've never suggested that doctors and nurses have no place. They definitely have a place when someone is pregnant. My issue with you is that you want to deny people autonomy over their own bodies, and you won't even admit it. (And, I can tell you, from very sad personal experience, that the attitude of doctors and hospitals is part of why some women do hesitate to go in when they have a problem. This never gets addressed - the medical industry just keeps putting it all on women for making bad decisions, instead of looking at their contributory role in making that happen. I'd have transferred earlier with Aaron, if I'd thought I had a snowball's chance in hell of getting decent care and real information at the hospital. FWIW...I didn't. They did a competent job of the surgery, but pretty much every other aspect of the way they handled me sucked.)

[Storm Bride]

Originally Posted by holly6737 

Of course you shouldn't be denied all care during your pregnancy. You have the right to find another health care provider to provide you care. You have agency to do so. If you are "fired" from one practice, what is to prohibit you from finding another that might be more in line with your philosophy?

We want the right to choose a provider who isn't hampered by licenses and regulations.  You don't want us to have that right.  To work wtih the frequently used restaurant analogy, this is basically "you can choose your restaurant, but only if you want the kind of cuisine they're allowed to serve - we've decided that Thai and Italian aren't on the menu, and if you want either of those, here's some nice Indian or Greek...your choice, of course - you should be able to choose".

[Storm Bride]

Originally Posted by stik 

If an OB or midwife is facing a situation in which a patient is asking for something the provider feels is unsafe, I think they have to be honest about that, about the options, about what they can and cannot do.  If a patient responds by finding some quack somewhere who promises that prayer and smudging and homeopathic remedies in a non-interventive environment ensure the health and safety of mom and baby in all possible situations, the responsibility for the outcome of that situation lies with the quack, not with the practitioner who was honest about their concerns and limitations.

Which is a pretty strong argument in favor of licensing hcps, in my opinion.  If you cannot recognize that some situations are too dangerous for natural birth with a hands-off appraoch, you should not be in the birth business.  

I've had two providers who were honest with me. One of them was my unlicensed midwife. The other was the OB I went to see when I was having dd2. I liked her well enough, but my experience with OBs leads me to believe that the only reason she was honest was because I was scheduling a c/s, anyway. She didn't have to lie and omit to make me get on the table, so she didn't. Licenses don't create honesty. Informed consent is a joke. And, my non-licensed midwife never even remotely suggested that prayer and smuding and homeopathy would ensure my health or that of my baby. Actually...she's the only care provider I ever had who admitted that there are no guarantees in birth. According to the OBs, a c-section guarantees that there will be no problems. No - they don't say it in those words. But, they strongly imply it, and use that implication as their entire argument (ie. "you must have a c-section, because a healthy mom and a healthy baby are what matters" - if they don't know that such statements are implying a guarantee of both, then they're too stupid to practice medicine).

[thegoodearth]

I've been following this thread for quite awhile... And I have to say that never have I wished more for a thumbs down sign than when reading some of your posts Holly, not just the one below. You come across as very pompous. I would never choose a hcp with your attitude: OB, CNM, CPM or whatever.  Maybe you don't realize it but you have a "holier-than-thou" air that comes across your posts and makes you seem like a "know-it-all" that can't consider things from another perspective. Not even for a second. Your dogma (or pride) won't allow it - not sure which.

Originally Posted by holly6737 

If she desires something other than what her hcp offers, she either should change her stance or she should go elsewhere. If there's no where else to go, then she should either conform to the hcp's recommendations or she has the right to choose to go without care. I completely support firing patients for going against important recommendations. For example, I know of patients who have been fired from their hcp's for refusing the rhogam shot. Absolutely. I absolutely support that. And that's not the hcp's fault if the woman ends up without care. That's the woman's fault because she didn't accept the shot. I know of kids who have been fired from pediatric practices for not getting shots. I completely support that as well. What I provide is a service. It's my license. I control what I provide. If you want something that I don't provide, you do not have the right to force me to provide it (unless you are covered by EMTALA). I also have agency.

Quote:

 

Edited to add: 

I think womenswisdom made some very valid points to which you response was very much "my way or the highway" 

[holly6737]

Not true. You can choose anyone you'd like to attend your birth. You are not doing anything illegal by birthing at home with a lay midwife. However, you do not have the right to have whomever you wish to attend your birth be licensed by the state. And the lay midwife that attends your birth does not have a right to advertise and practice as a midwife, when in fact she is not, according to the state. For example, Storm Bride, for you full term loss during an attempted HBA4(or3?)C's, you used Gloria Lemay, correct? You had a right to choose to birth at home, despite your risk factors. No one arrested you. You had a right to ask Gloria Lemay to be present at your birth, despite her history. No one arrested you for asking Gloria Lemay to be at your birth. However, you did not have the right to force the state to endorse or license Gloria Lemay, considering she doesn't meet any criteria for licensing. And, you did not have the right to ask the state not to bring up charges against Gloria Lemay for practicing midwifery without a license, considering she was acting as a midwife when in fact she was not one. But no one said you weren't allowed to birth at home with anyone you wish in attendance. No one wants to get the laboring woman in trouble. The laboring woman can do whatever she wants. It's the dangerous "provider" that should be regulated and fined for pretending to be something they are not.

Originally Posted by Storm Bride 

We want the right to choose a provider who isn't hampered by licenses and regulations.  You don't want us to have that right.  To work wtih the frequently used restaurant analogy, this is basically "you can choose your restaurant, but only if you want the kind of cuisine they're allowed to serve - we've decided that Thai and Italian aren't on the menu, and if you want either of those, here's some nice Indian or Greek...your choice, of course - you should be able to choose".