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When not to listen to your care provider

post #1 of 17
Thread Starter 

I'm 20 weeks pregnant with my second, due in February 2014. My first was born in spring 2012. My first birth was very traumatic for so many reasons. Basically i was pressured into Oxytocin/Epidural, then a c-section, starved for 2 days, and ultimately ended up with forceps delivery while being abused and assaulted.


Last time i fought off my mw who wanted me to have an "emergency" c-section for 8 hours. For 8 hours she kept saying cryptic things like "i don't feel good about this" and "sometimes nature needs a little help" but could offer no evidence as to why i could get a c-section other than that it was taking too long. There were no problems with the hb other than one quick acceleration which the nurse assured me was normal, nothing wrong. But my mw kept saying that something could go wrong, but nothing actually was going wrong, so i couldn't bring myself to listen to her. I mean, something can always go wrong, right? I am very happy that i didn't listen to her as if i had i would've ended up with an evidently unnecessary c-section.


After birth i spoke with several women who had her as a mw and more than 1/2 of them had c-sections. Apparently she's the c-section mw.


So now I'm trying to figure out when you shouldn't listen to your care provider. Does anyone have any ideas about that? I know so many women who just listened to my mw and then were very upset afterwards when they realized they had a c-section for nothing. I'm happy i didn't listen, but at the same time isn't it dangerous?


Also, my current care provider is a practice group of 4 mw's, any one of who could be at the birth, just depends who's on call. One of them kind of reminds me of my previous mw, she kind of looks the same, is much older, and stern. Not to be ageist but i worry with the older ones that sometimes they get this "I've seen it all" attitude and really have no interest in working with the patient and instead want to take control. My last mw would get very angry if i challenged anything she did. This new mw, i don't know, i just don't feel good about her, but i feel guilty saying "not that one" plus i worry that there could be repercussions if it upsets the other mw.



post #2 of 17

Listen to them when they give real info and analysis, but always make your own choice if it is possible. Use that "BRAIN" tool asking questions: Benefits, Risks, Alternatives, Intuition, Nothing (what if I wait or do nothing). Make it clear you are getting their input so you can make your choice. I've known older midwives who roll with the client's wishes too, though I had one who told me what to do out of some habits but was fine with it when I roared "No!" and did what I wanted instead (in second stage labor I get really direct!)


When it's all negative talk with no reason and you don't trust/agree with their intuition, think "bubble of peace" let their nonsense bounce right off and never reach you. If you can avoid having them around at all that's best of course.


A good relationship of respect and trust is important, if you don't have that you are justified in saying no they aren't a good fit, they all should understand that deeply it's at the heart of their profession.

Edited by JamieCatheryn - 10/9/13 at 5:20pm
post #3 of 17
Thread Starter 
Thank you. Last time I was screaming NO and they just applying super painful monitoring belts while denying me pain medication and starving me and calling me selfish. My mw was clearly very perturbed that I wasn't listening to her, but I'm so glad I didn't now. I'm just worried about a repeat. I detest being that vulnerable as look what happens
post #4 of 17

Yeah...my DH may have punched somebody if they did that to me and words didn't work.

post #5 of 17

I really think the question is not, how do you know when not to listen to your care provider, but how do you know your care provider is worthy of being listened to?


Ideally, you are hiring them to give you guidance and help you make decisions, in addition to stand by as a skilled attendant.  But that only works if you feel you can trust them and you feel they respect you.  For one thing, you want to be sure you are on the same page regarding safety and risk.  But you also need a sense of emotional safety.


What about sitting down and freewriting about what you would need in your prenatal care in order to feel like these midwives respect you?  What would you need to know, to know you could trust them?   You shouldn't have to be your own midwife and do your own risk assessment.  In a worst case scenario, they say, "We think it's time to transfer to the hospital." What would you need to know from them to feel like it was the right decision, for you to feel ok with it?  What do you need them to do? Be very expansive with your wants, because this would be so scary for you.  Write down things you think aren't possible.


And in a best case scenario, the birth goes off easily.  What do you envision?  What do you want to have?


Basically, you're trying to find out what, to you, would prove someone trustworthy to you.  Is it acknowledging the trauma you suffered at your last birth?  Is it always acknowledging, "This is your choice.  We recommend x, for these reasons, but it is up to you"?  Is it always asking, "May I....."   And so on.  


It sounds like your previous midwife failed you in a lot of ways (a LOT of ways - why was she not being your advocate and protecting you??) but one thing that stands out to me is she was never able to give you a good explanation for why she thought you should have a c-section beyond "I have a bad feeling about this."   There are many good explanations involving the health of the mother, the baby, or both.  None of them involve the midwife's "feelings."

post #6 of 17
Thread Starter 

I wish my DH would have stood up for me. Sadly he didn't, he just stood behind me, feeling helpless and afraid. Now, 18 months later, i still feel bitter that he didn't advocate for me when i needed him most. We're currently in marriage counseling.


PP, the thing i really need is objective evidence that there's an emergency. For example, if there's a problem with the heart rate i want to know, his heartrate is X, not "we don't like what we're seeing". If there is objective evidence then i am far more likely to be amenable to suggestions. Last time they treated me like a child, wihtholding information from me, thinking somehow that would help get me to do what they wanted, which totally backfired. I've reviewed my medical records several times and i know that there was no actual emergency for 7 or so hours when i was being pressured into the unnecessary c-section. The heartrate was fine (other than the one non worrying blip), everything was fine, the mw just didn't want to wait becuase the chances of something going wrong go up as time goes on (just like the chances of getting into a car accident go up if you drive more). The mw was so mad at me for not listening but the nurse was sweet and didn't seem concerned. Then there was a shift change and my mw obviously briefed this new nurse and told her i was being awful because the new nurse came in and demanded that i labour on my back wiht my knees pinned to my chest, which i refused to do for reasons that are very personal. Then the mw and the nurse just kept abusing me, demadning that i do various things, and when i'd refuse they'd say "but it's best for baby, why don't you want what's best for your baby" and look at me like i was a monster. Then the monitors started beeping and i guess maybe at that point it was the start of an emergency, and i wanted to know what was going on, but they woulndt' tell me, just kept demanding a c-section, telling me there were no risks, and i just couldn't agree because i had no idea what they were talking about. Also I was terrified at that point. My son was born with forceps and was covered in mecomium and wasn't moving, but he moved right after and his apgars were 8 and 10. So anyway, all of that is ot say that the evidence in my chart suggests that everyhing was going okay until the new nurse came on at which point, according to the documents, my son's hb started to fluctuate quite widely over the next hour, until he was born. I think the utter terror that i was experiencing as a result of being "birth raped" is what caused my son's distress, so i really don't trust care providers at all at this point. I think they jsut do what's best for them. Afterall, that's why teh mw wanted me to get the c-section, because they're taught at any sign of anything potentially wrong, or if it's taking too long, go to the knife since if they don't and something does go wrong the first thing they'll be asked is why they didn't do a c-section.


Also, my mw told me afterwards that she beleives that she advocates for babies, and that means doing things that mothers don't like. She said "all that matters is a healthy baby", and when i told her that she doesn't have the right to do things to women's bodies against their will, she said "yes i do". Absolutely horrifying. This time i will not call the mw until it's close to birth time. I just want them all to stay away.


Obviously if there is a bona fide medical emergency (cord prolapse, hemorrhage, bona fide evidence of fetal distress), i will go to the hospital and have a c-section. But i will not agree to a c-seciton or anything else simply to assuage someone else's fears.

post #7 of 17

It sounds like you are very clear on what  you need from your midwives. Have you shared these thoughts with them?  What was their response and how did you feel?

post #8 of 17
Thread Starter 
Yes I should share my thoughts very clearly.
I haven't done that yet but i will. I hope they listen this time
post #9 of 17

I hope they listen and are trustworthy.  :hug:  Do you have other thoughts on what you would need to have during a "non-emergency" labor situation and what would help you feel most comfortable if everything is going well?

post #10 of 17
Thread Starter 
To be honest I don't really know what u want during the labour from my midwife. Last time I thought I wanted to be left alone and while we were at home and my midwife was there she did leave me alone and I felt kind of lonely.
I think last time I wanted someone to rescue me and now I know this is something I have to do myself, so that should hopefully help.
post #11 of 17

Honesty is the best policy. Just be honest and tell your providers what you are currently struggling with. Talk about your issues with broken confidence and the subsequent feeling of betrayal. Explain how you felt abused, lied to, and manipulated. Explain how this has affected your marriage. Trust comes through open communication and honesty. Don't bottle this up and withhold your private pain. If you are hoping that you won't be mistreated, but don't actually talk about what that looks like, than you are setting yourself up for disappointment. Your midwives need to know how you need to be treated. 

post #12 of 17
Thread Starter 
The mistreatment last time all took place in the hospital. We were at home for 24ish hours and everything was fine there. I mean, i don't have any complaints about my midwife while we were at my house, even though I wish she would have been a bit more encouraging it was really quite fine. I suspect the issues will come up if there's a transfer. I'm ordering some buttons to wear during the birth that say "I matter too" and "my body my choice", which wil hopefully let them know where I stand. Thanks for all to suggestions and support
post #13 of 17

The buttons sound like a good idea, but csb is right.  The best way to ensure you get the treatment you want, in or out of a transfer situation, is going to involve talking about what you need, explicitly, repeatedly.  Simply putting on a button doesn't ensure that you and your caregivers are on the same page about what you need.


So, treating me well looks like........  Respecting my body looks like.......  


For a person with a history of trauma, this can be very, very difficult, and forgive me if I am wrong, but it sounds like you have a history of trauma that doesn't stop at your birth experience.  Your concerns about hurting the midwives' feelings, concerns about being retaliated against for having your own needs and boundaries.... well, that all sounds familiar to me.  People who have been mistreated repeatedly or who have had their trust betrayed by caregivers, or people who have been abused by someone in a position of power often find it difficult to express their own needs and boundaries because it feels dangerous.  Probably because at some point in their past, it was dangerous to have any boundaries or any wants or needs of their own.


Truly professional midwives will not retaliate against you.  They will not punish you for being honest about your hopes.   They will be honored that you have shared your heart and your deepest fears and hopes with them and they will work to respect you and do what you need to feel safe, in or out of your chosen birthplace.  It can be scary to take this first step, but it can also be very healing and empowering.  In the past, I have found it helpful to write a letter detailing what I need. Sometimes I have handed the letter over, and sometimes I have used it as a cheat sheet for discussions.


I remember shaking with fear when I told my new midwife that I found vaginal exams extremely distressing if I didn't have total autonomy to choose.  I thought she would scold me.  Instead, she told me that of course it was my body, and that many of her patients chose to have one or no vaginal checks during pregnancy.  She and her coworkers always ask me in a way that is clear it is my choice, if I would like an exam or not, although I could have asked them not to ask me at all if I found it distressing.  Over time this has built my trust.  The first step can be the hardest but it does get easier.


If you had to pick one thing to tell your midwives, what would it be?

post #14 of 17

Oof, I have the same problem- although my birth was less traumatic.


Repeating yourself is the best you can do- but it's also not enough. I told the midwives that I wanted to be able to breastfeed with an at-breast supplementer (which I had) for my entire pregnancy and they never gave me the chance. (this wasn't what was traumatic, a lot of things happened, if anything)


I'm so terrified of giving birth again. I don't feel comfortable having an unassisted birth because my partner adamantly refuses to catch the baby (STILL don't know why! :irked), and I'm concerned about complications. I don't trust healthcare providers. They can make all the promises in the world before labor- but during labor we are so vulnerable and at the mercy of those around us and I simply don't trust them to keep their word when it comes down to it.


Also, the midwives you described (4, one older)- sounds like the people I saw. I'm in New England, could it be the same group? Let me know over PM if you don't want to talk about it on here. If it is the same group, I'd like to send you my experiences.  Especially after the traumatic birth you had.

post #15 of 17
Thread Starter 

^^ It''s not the same mw's here. I also agree that sometimes it's not anything that I (or you) could do, I know that i can't control other people's behaviour. Last time i tried everything to get them to let me eat and nothing i said or did worked. I don't think there's anything i could have done differently that would have made them treat me better, other than maybe having a lawyer with me to keep records of everything that was happening.


I am afraid of all the care providers at this point. I've delayed my one u/s two times already and I just pushed back my mw appointment to November so that it'll be 8 weeks since my last appointment. When i was re-scheduling the mw appointment the receptionist was like "this is around the time for the gestational diabetes test" and right away i was like "i'm not doing that" in a defensive tone, even though she explained they have to offer and i can decline. It should be interesting to see what happens if i have to go to hospital. Basically at this point i've decided the only way i'm going to hospital is if it's for a c-section, I won't go for additional monitoring or anything else, i'll only go if it's to have a c-section. I guess i should tell my mw's that.


But yeah, the notion that if i do X or Y the care providers will do Z, although nice, in my experience isn't necessarily how it goes. In reality, a woman can be screaming don't do X or Y and the care provider will just do it anyway. Like PP said, the mw's can be so sweet and seem like they are on your side throughout the pregnancy, then turn into total beasts when you're at your most vulnerable.


One of the positive things that came from my previous experience is that i've already decided i will not go to a hospital to die when i'm older, i will instead definitely self-euthanize. I will never put myself at the mercy of a hospital for any extended period of time. I can only imagine how horribly elders get treated, at least we bounce back and can complain, the elders generally pass on.

Edited by Viola P - 12/19/13 at 10:01am
post #16 of 17

Nothing you said or did or didn't say or do caused your previous midwife and the hospital staff to mistreat you.  And it's true that communication is no guarantee that anyone else is will do anything.  But it can give you the information to make the decisions you need to feel safe.  It's not a formula, if you just say or do x, y will be the result.  But it can still be worth it to try and it sounds like you are really doing that.  It takes a lot of courage to do what your are doing.

post #17 of 17
I would reccomend finding some great labor support who can advocate for you if needed. A doula is great, but if not available a close friend/sister can be a good substitute. Someone who is less emotionally involved in the birth than your DH, but willing to go to the mat to fight for you during labor, get you that sandwich AMA, and help you know if the provider is making reccomendatoins based on medical fact or some other reason. A great labor coach can make all the difference in your feelings of safety as well. Good luck and keep us posted.
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