What makes you want to take responsibility for your own pregnancy and birth? - Page 3

[yeah yeah yeah]

I'd say all it takes is witnessing a single hospital birth (my sisters) where the nurses only care about:
1.) When Sis wants the drugs. Won't you talk some sense into her? Won't you tell us when whe wants something? Is she ready for it? Etc.
-and-
2.) What the fetal monitor says, regardless of the fact that it changed output every time the woman moved in the slightest, prevented any sort of walking or position changding, and seemed utterly useless for anything except reccommending drugs, drugs, drugs... did i mention drugs?

To decide that maybe I should actually read up what the whole bit should be about. *Shrugs*

I'm still TTC#1, but, I still can't believe what I witnessed at that hospital. They didn't care about the patient. They cared about machines. About getting her out of the "birthing room" in a timely fashion. About "fetal distress" based on a machine that seemed entirely unreliable. It was just... awful.

[Aura_Kitten]

About "fetal distress" based on a machine that seemed entirely unreliable.

this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped. yet they still rely on that more than anything else.

[yeah yeah yeah]

Originally Posted by klothos

this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped. yet they still rely on that more than anything else.

Well, when they are in the room, that's all they care about. The thing slipped off at one point, and the kid could have been vaporized, but I guess no one was watching at the nursing station, 'cause they still only showed up on schedule, once an hour to two hours, to offer pitocin and pain-relievers. It was like she wasn't important enough to warrant any attention until she let them dose her up, and then they were in there all the time messing with IV bags, and playing with equipment.

I could rant for hours. Grr.

[applejuice]

Originally Posted by klothos

this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped. yet they still rely on that more than anything else.

ITA, klothos. However, this is the "evidence" that stands up in court of law in a malpractice case.

A mother's feelings are too subjective and therefore not reliable and do not stand up as 'evidence" in a court of law in a malpractice suit.

You and your feelings do not count.

Sad, but true.

Our culture is so screwed!

[doctorjen]

"ITA, klothos. However, this is the "evidence" that stands up in court of law in a malpractice case. A mother's feelings are too subjective and therefore not reliable and do not stand up as 'evidence" in a court of law in a malpractice suit. You and your feelings do not count. Sad, but true."

Unfortunately, this is very true. As much intervention as possible has become the standard of care, and in a malpractice case, having done "everything you could" definitely helps you defend yourself. This is a lot of the reason I tend to practice more interventively with moms who expect to come to doctor, leave all decisions up to them, and be handed a perfect baby at the end. Courts are reluctant to hold patients accountable for their own health, just as much as many people are reluctant to take responsibility for their own health.

[CairaJade]

I think this is an excellent question, and I hope nobody minds that I'm dragging this month-old thread back up.

For me, it is four distinct things that I can identify.

1. My overall personal philosophy and personality. I'm a researcher, an anthropologist, and have always been a tree-hugger. My family use to make fun of me for digging out their recyclables out of the trash for years, and still make fun of my homemade bathing and cleaning stuff, soymilk (not that I even drink it regularly, sheesh), and organic stuff.

2. Growing up in a military environment with seriously deficient health care. My mom used to tell us our birth stories, and how I was a scheduled c/s because at that time in that particular Army hospital, all first deliveries were automatically c/s. : Add to that I was footling breech. Well my mom went into labor and called the L&D nurses station to see when she should come in. They told her she wasn't in labor and hung up on her. And did it again a few hours later. Finally, when my mom and grandma (who was a RN and obviously knew her daughter was in hard labor) knew they couldn't hold out much longer, they got to the hospital and my mom had me right away vaginally without any complications, feet first. Fast forward throughout my teen years, and it's just story after story of poorly run hospitals and inept doctors. The various post and base hospitals lost my medical records four seperate times, never found. I have no documented medical history before the age of 20 except for the copies of vaccination records that my mom saved. There's more about my mom and her hip replacement, but I grew up with a huge mistrust, for good reason, of both doctors with their own agendas and schedules, and terrible hospitals. Most of my opinions formed about the medical establishment during this period was subconsious.

3. Incidents with my best friend who had an eating disorder and was also in a devastating car crash, in which she broke her back and required reconstructive face surgery. These incidents were small but numerous, but the worst was after the car accident and I was with my friend plus two other friends in the accident day and night for a week. No account at all was given to their personal comfort, even when they were moaning and crying out in pain. They were ignored. At least they never kicked me out of the rooms, that's the only good thing I can say. Unnecessary procedures were performed without informed consent, that set my friend's back recovery back by months. It was horrible, and the doctors and nurses made it worse than it had to be.

4. This is the moment when it all clicked - watching birth shows in TLC and Discovery Health. When I saw labors being managed and treated like a trauma, I knew it was wrong. Every single thing about those shows ran contrary to what I've learned and what I felt was a normal human process. We are the only species on Earth that "require" assistance during birth. There is a reason for it, bipedalism being the largest culprit, but we are not so different from our fellow animals that we are unable to birth naturally, which is a growing misconception we must keep fighting.

[MommytoTwo]

I did the 'whatever you think is best' and for it I got just about every intervention in the book. Cytotec, Pitocin, AROM, Stadol, Epidural, Cesarean.
Which led to the NICU and breastfeeding failure.
Like someone else said- no one cares as much as I do. Just curious - the women you speak of in your practice who want you to make the decisions- are they first time moms? I would think moms who have had a baby before would have very definitive ideas on what they want.

[Peppamint]

Hi Tina! Wanted to say welcome... and I noticed your baby's name is Elaina! My dd's name is Elana (ee-lay-na), but we call her Ellie most of the time.

[MommytoTwo]

I also heard a few doctors on the phone to wives/girlfriends/friends saying they'd be home in an hour so as not to miss out on their tickets to the opera or Lakers game and then head off to do a "failure to progress" c-section.

:Puke

My son was born at 4:58 pm via c/s for failure to progress. DH & I joke that at least my OB got it done just in time to get home for dinner. Not that I find it funny at all.

[Mamid]

That's pretty much the same time >I< was born in 72. 4 minutes to 5, just in time for the doc to go to dinner.

My mother never made it clear if I was a section or a vag. She did say that I pissed pretty soon after birth and that I was born "so blue you were black" and was a child who was "watched" by the doctors closely while growing up.

I should check with my dad about that. He might know although he wasn't told that I was born for several days. My mother had left my father well before I was born.

[AmandasMom]

For me it was finding this site! When dd was born, I had the "typical" birth.. you know, C-section, etc. I didn't think twice about it till I by accident found MDC. DD was due for her first round of shots, and I don't know what it was, but something in my stomach told me to read more about it. I did a search, found MDC, and well, here I am with an unvaxed 4 year old This site has been the basis of all my parenting. Before here, I didn't even know there was anything different then what I had been doing. It opened a whole new world for me. That was 4 years ago, back when there wasn't really a board here, just 1 long thread. Now I'm 21 weeks pregnant with #2, have a new OB who so far I really like and I really feel like I can trust her. I'm taking responsibility for ME this time around. I've refused all testing and all internal exams (cept the pap the month before i got pregnant). She is perfectly fine with all that. My blood pressure is unfortunately high again, so if its still high next week I have to go on meds. I've been researching PIH and I do feel meds are the best thing. What's most important is that I've been researching it, not just taking a doctor's word for it.

[*~*SewHappyNow*~*]

I do think it takes a certain personality type to want to learn about things.

For me, I've always jumped into anything that has taken my interest and researched and explored. I always have to know EVERYTHING possible until I am satisfied with my level of understanding. That's just the way I am. I love investigating and gathering knowledge. Perhaps being a control freak has a little to do with it

When I was expecting my first daughter I knew from my mom and I talking that she was a strong believer in BFing and natural childbirth and also had agreed that children could be born at home.

Finding this community was what really got me motivated and helped empower me to take responsibility for my own birth expirience and mine and my baby's well being.

I think that is probably key to motivating women.. empowering women They need to know that they are the real experts when it comes to their body and their birthing of their baby.

I agree, there will be women out there who have no desire to learn or explore or take responsibility. Their whole life is probably a reflection of this attitude, either stemming from laziness or ignorence or a little of both. Perhaps handling these women in a more interventive manner is wise, based on the belief that they will probably be the first ones to sue when something goes wrong. Sad, but true.

[aquarianangela]

this is an interesting thread!
i wish my patients were more like the people here. unfortunately the practice i was able to find a job with is very much like this - the hospital has a 95% epidural rate and cs rate is about 30%. my practice has recently stopped accepting bradley method patients or clients of a certain doula. "they are just too difficult to work with". most of the patients want an epidural before they hit the door practically.
i am actually glad we don't take bradley pts because they would be extremely disappointed.
and even though i am pretty noninterventionist when i go off call the next person on usually is interventionist.it is pretty upsetting. i have always been pretty "alternative" minded and in mississippi where i used to practice a lot of people were afraid of epis and didn't get them so i saw a lot of normal labors without the epi and i wish people here wouldn't get them.but i am a small voice. i don't even want to attract my kind of patient because i can't guarantee them i will be there. i think that is problem - a lot of women want o work parttime or not be on call 24-7 because they have kids and so it's hard to find a solo practioner who does ob anymore like you drjen.
my dream once my dd is older and my dh has a stable job situation is to have a solo ob only practice, see pts in my home or theirs, labor with them at home and have privileges at the hosptital and deliver them there. i am trying to figure out a way to do this and still have malpractice insurance and still be able to charge a reasonable amount and actually make a living at it. i can't imagine what my malpractice would be if i did homebirths! in miss it was approaching 100000 a yr for obs who hadn't been sued. here in sc it is around 35000 but is going up by 300% a year or something. so where we end up could determine if i can ever practice like this or not.
in order to keep my home life reasonable i would have to limit it to about 8-10 people due a month i think. do you have a limit dr jen?

[CJ 5]

This is exactly the practice my midwife has 8-10 patients a month. Maybe to spread out the malpractice insurance you could get another OB and two midwives and the four of you could pay malpractace togeher since theirs is so much lower you might make it but if the rates keep climbing I don't see it happening.

I am a first time mom with too many friends who had C-sections. I have never had a surgery and was very concerned about getting a "failure to progress" C-section.

I like most first time moms was naive and started at a hospital. Two condencending visits later I started shopping around. I contacted a Bradley instructor and before you know it I was interviewing 6 different practitioner until I found one I liked. I wanted someone who was not going to rotate and who was going to show up for more than the catch. I was naive to say the least because the health care system sucks but I have become educated and If feel a great empowerment in being the advocate for my body and my baby

[biberin]

Motivating moms--an idea

Drjenn,

What if you did what some websites do with birthplans: have a list of options for each point, and have them check off what they want. Like, for pain control I want
a. epidural
b. narcotics
c. a jacuzzi
d. a doula

It would give you a ton of talking points, anyway, and make them aware of options.

[OnTheFence]

Originally Posted by doctorjen

How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?

Dr. Jenn,
Its great to know a DR is out there encouraging patients to educate themselves. In my early 20s I felt like I had planned and educated myself and took responsibility for my pregnancy and birth, but then so many eventful things took place that were out of my control: like getting chicken pox at 12 weeks, getting the flu and having to be hospitalized for high fever, and having a transverse baby due to a uterine anomaly. I had a really green doctor because she was willing to give me my all natural Bradley Birth, free of intervention -- I ended up with a torturing, painful, emergency csection after a failed ECV.
With my last pregnancy, I definitely took a more responsiblity and talked a lot more with my doctor about my risks, my uterine anomaly, and what I wanted in a planned csection. In those five years I had done a lot of research about the anomaly, about cesareans and my OB was so impressed she thought I had a medical degree. She freely shared literature with me and sat me in her office several times to pull out her medical books to show me things. I let her know right up front that I was looking for a cooperative effort in having a safe pregnancy, safe birth, and healthy baby. She was also candid with me about my risks and her own risks (malpractice).
In my experience, women unfortunately are easily led -- whether is be the all natural granola route or the all medical intervention and let my dr make the decision route because they went to med school after all. There really doesnt seem to be a balance and there really doesnt seem to be enough education and the way statistics and studies are used to back one or the other up are often misused and abused. Just looking at the internet for information is confusing because there seems to be no middle ground. The closest I think there is, is the Dr. Sears series and I like Sheila Kitzinger (sp) for a more balanced approach.
I could say so much more, good question.

[Marlet]

Originally Posted by doctorjen

How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?

My main reason is I watched what my sister went through in regards to not getting what she wanted. She had a birth plan but they didn't care and that pissed me off. Who knows my body better than I do? I would like to honestly know how a doctor can look at me and say, "Oh this needs to be done" JUST by looking and poking!! They have no idea what's going on inside that is not acessible to them, kwim? I am also VERY controlling. Obsessivly so, not like I have to have control but when I do it HAS to be done a certain way.......I wash dishes in the same pattern EVERYTIME I do them my obsessiveness. I don't like the idea of having someone else take control of my body during a time when it knows what to do. Very scary to me.

[eilonwy]

I'm a geek.

I've never been someone to take a doctor's word for it just because they were a doctor (though I was more trusting with my first than I should have been). I've never been one to take *anyone's* word for *anything*. I will question even though it makes me unpopular and makes other people uncomfortable or unhappy; I've always been this way.

I've been lucky, I suppose, to have doctors who, for the most part, were totally on board with that. My last pregnancy, I talked to a nurse and she said "I'm not worried about you at all, I know you'll make an appointment if you need one." And so I did! I went to get weighed and have my belly measured because it was fun (and I don't have a scale at home), and then my dr. and I would talk about what I was reading that week. :LOL I had a great experience, and I am seriously considering not only planning an "accidental" UC but telling my dr about it in advance (my only concern is liability issues... but I've got several years before it's more than theoretical).

If you want to encourage people to take a more active role in their health care, my suggestion is that you ask them why they don't. In my experience, most people just haven't thought about it, they've simply assumed that the doctor/nurse/midwife/teacher/whatever is in charge because "they know more than I do" and they feel unequal to the task. Ask them about it: why are they willing to let someone else heavily manage so intimate a moment of their lives?

[mwherbs]

Originally Posted by blueviolet

Exactly. You can't have have it both ways, i.e., patients who trust you implicitly, and who also take responsibility for their own care. People simply are not going to see the need for taking responsibility for their own care until they begin to face up to the fact that medical professionals are not infallible, perfectly wise, and all-knowing.

I do have people who trust and question both. They are a blend and are probably the best clients. I can work and do work with extremely questioning untrusting clients but they are a lot of work and I usually worry how they will handle labor which is not controllable at all. And I have people who have done their own research and know what the want or don't want to a degree and then they say ok I will trust you to either inform us or let you take this part because we don't know. Stitching and resuscitation , heart tone assessment are a few things that come to mind.
On the other hand clients saying to me you decide is not something I let pass, I want to be sure that they understand what is going on and why something is offered and the advantages/disadvantages are. Some things say eye salve, we talk over and they can read over why it is used, and I go with what they decide most don't have eye salve but I don't question it if this is what they want after delivery.
I also agree that consumers need to understand that care providers are people, they may know many things you don't but they do not know everything.
the centering birth program is great, the birth center in town has taken this on as the way they practice. The only complaints I have heard is that some people feel that things are not presented as choices but rather this is what we do and why.

[Felicitymom]

Hi Dr. Jen...

I think a good way to have women become more involved in their own birth is to present them with simple, clear information. (I am assuming you already do some of this, but thought I would put my two cents in)

Give them a questionaire to find out what kind of life they live outside of pregnancy... are they passive and impassioned or are they a go getter. (I think most women follow the trend they see and hear about in the mainstream medical society, ie: birth is a medical proceedure. If they are told differently (and made to believe it) then they will actually get it that they have an option.

YOu could present them very simply and clearly that if they choose a passive/epidural birth... the birth process is in the hands of the medical team. If they choose an active/natural birth (maybe even with an epidural) they will be in charge. Find out if they are interested in 'having a baby only' or are they at all interested in the 'birth experience' ? When posed that question some of them might actually think... and want a birth experience

Have them watch videos of natural births... women who take the chance and deliver without anestesia. I know the more women see other women doing it the more they believe they can do it.

Once they 'sign on' to be an active participant there are a ton more things to do... at our BC we had group prenatal visits for the last 3 months of pregnancy. 6 couples who were all due within a month or so of everyone else. This made huge differences in our attitude. We all wanted natural births to begin with (all but 1 gal), but asking questions, hearing birth stories, seeing videos, and approaching birth in a more casual (as opposed to medical) way was very supportive and informative. By the way, the one gal who said she would not want a BC birth and wanted to deliver at the neighboring hospital with an epidural... had her baby naturally with NO intervention

You need to approach these women in a completely new way... get off the beaten path and forge a new one. Women will listen... most of them probably would want an awesome birth experience... they just simply don't know they have the option.

Hope this helps.
Nancy

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