not telling the whole truth........midwives

[roadfamily6now]

midwives,
What happens if a client does not tell you the whole truth about previous pregnancies and in the end, it could get you in trouble?

[Midwife Kris]

Scenario? A little hypothetical sitch please?

[mwherbs]

what like I can't see the previous uterine surgery scar because it is in the pubic hair line-- or one of the folds ? has happened--
drug addict that has lost her other kids- and is hiding out to keep this one-- if she is straight through out pregnancy- then what will trip her up is the birth certificate- that we will file-- still using drugs we will find out usually--don't want a sick baby at home and more likely than not serious drugs = sick baby even if only temporarily -- also have to worry about stds-- do you have a different senario?

[Valerie]

Originally Posted by mwherbs

what like I can't see the previous uterine surgery scar because it is in the pubic hair line-- or one of the folds ? has happened--
drug addict that has lost her other kids- and is hiding out to keep this one-- is she is straight through out pregnancy- the what will trip her up is the birth certificate- that we will file-- still using drugs will find out usually--don't want a sick baby at home an more likely than not serious drugs = sick baby even if only temporarily -- also have to worry about stds-- do you have a different senario?

OR..."really -- I have cut back to only one or two cigarettes a day!," when, in fact, the mother was still smoking a couple PACKS a day. And this little bit of information didn't come out until her extremely sick baby was transferred to the hospital, where the poor child subsequently died of meconium aspiration.

Please don't lie to the midwife. Nobody wins.

Valerie
Illinois

[Jane]

I've found that stuff comes up when it needs to ---please, be honest, it's so much easier/simpler to navigate, but sometimes mamas don't know the truth.
Only after a scary waterbirth dystocia does she say that "oh, they did that last time, too" meaning 4-5 manuevers taking several minutes. She honestly didn't know it was unusual. It would have been nice to have some more towels and a pre-talk with the dad to let him know where we wanted her if she had to get out.

[roadfamily6now]

sorry, that was a horribly vague question

If you, the midwife, were not allowed by state regulations to take on a VBAC patient for an out of hospital birth.........
but your patient never disclosed the fact she had a c-section but only told you she had vaginal births.

The truth would be she did have a c-section 13 years ago and 4 extremely successful VBAC's.

Just curious. I am NOT seeing a midwife.

Thank you.

[JSerene]

Off topic, but this reminds me of something. We've had patients who have said they are 1st time mom's, but have visable episiotomy scars. In the absence of a drug or CPS history, I can't figure out the point of lying

[sevenkids]

Originally Posted by JSerene

Off topic, but this reminds me of something. We've had patients who have said they are 1st time mom's, but have visable episiotomy scars. In the absence of a drug or CPS history, I can't figure out the point of lying

Maybe she had an adoption and her new partner doesn't know?

I never ask for a Hx with the partner present; pregnancy, birth, abortion, STI Hx's are not always disclosed to the present partner and if we put mama on the spot, we're likely to get an un-truth.

[BetsyS]

I used to work in a clinic with lots of new immigrants. We'd ask about their history, they (this happened numerous times) would say it was the first or second baby, then later on we'd find out they also had 4 babies "back home." They didn't think to count the babies they'd left in the old country with grandma. Thought we were only asking about how many babies they had right now. :

[Jenlaana]

I wish I could lie about my cesarean. Boy how life would be easier if I could erase that. There are no records anymore (Fla doesnt keep them after 7 yrs) but it still haunts me every time I walk into the OB's office. (since midwives cant see VBACs in SC)

[pamamidwife]

If you want to lie to a provider, see an OB. I would be willing to go out on a limb for a client that was honest and had integrity. I feel totally unwilling to work with clients who are not honest.

[Jenlaana]

Its really sad that we live in a birthing environment where its so much like walking on egg shells. I obviously couldn't lie about my cesarean, but the ringer I was put through because of the laws and attitudes in place in my state, all because of a 10 yr old uterine scar was unbelievable. I was actively persuing a career as a doula and eventually a midwife (have all of my training package/books/etc and had a doula lined up to mentor me), until I got entangled in the web of garbage that surrounds birth in my state. I just knew that I would be unable to sit by and watch it all happen, without "fighting the system" and as a doula, my role would be to support mom even if she was doing something I didnt agree with, and even worse, as a midwife, it would be to follow the rules, stupid as some of them are, or risk persecution. As I said elsewhere, I don't blame midwives, but the system is screwed UP. After awhile it feels like banging your head into a brick wall trying to elicit change.

As for lying about smoking/drinking/etc... Honestly if I'm paying someone to be my care provider, I would want to get the most I possibly could out of it, and I would want to be able to trust them. I don't see that happening if there are lies on either side. The biggest problem I've had with OBs and CNMs that I've headbutted with, is that they lied to me in order to elicit the response they wanted and after I found out about the lies, I could no longer trust them with my care.

[christyc]

Jenlaana--

I also had a cesarean in Florida, and now live in SC. The VBAC climate here just really sets women up for failure, and ties midwives hands in ways I can't even imagine...

[crayon]

If it is in your questionnaire- like # of prev. births, or # of abortions or cervical operations or uterine surgeries- or in your umm... case.... a c-sec. Then the MW can not be held responsible. It seems that if there has been successful vbac's then I am sure there is a MW that would take see someone in that situation- even if vbac's were not leagal. I think MW's tend to be more on the side of the human body than on the side of the hard book laws. I would fear more about not telling a MW and in the end it came out during labor- because not only does/would that MW look bad for not knowing, so will the mother for not disclosing. It is better in the case of safety to be honest.

I have heard of mothers not saying things to their MW's on many occasions, only in the end to need medical assistance that could have been foreseen or prevented if only they had been honest.

[Mrs. Cheerful Face]

Or my personal fav. an undisclosed LEEP. Dr. Friendlyob missed it too. Four days later....

[1stimestar]

Originally Posted by crayon

I have heard of mothers not saying things to their MW's on many occasions, only in the end to need medical assistance that could have been foreseen or prevented if only they had been honest.

Can you give me an example of this type of situation?

[crayon]

Originally Posted by 1stimestar

Can you give me an example of this type of situation?

Sure, how about a previous pelvis fracture that was not disclosed. Or what if a mother had a biopsy on the cervix that was not disclosed, yet caused scar tissue to build up. I am sure even when people have non-pregnancy related uterine procedure- such as a cyst removed had some scar tissue build up. All these things a woman could easily no see relevant to pregnancy- or to birth and not disclose it. The problem is they do not understand that scar tissued area can be weak- or that scar tissue on the cervix can stop or prevent dilation- or that a pelvic injury when they were a child could cause problems later in life. They just bypass these things as old history and I can see some women no disclosing it- not because they are trying to hid it, but honestly (in most cases) because they didn't think it of a pregnancy issue.

[1stimestar]

Originally Posted by crayon

I have heard of mothers not saying things to their MW's on many occasions, only in the end to need medical assistance that could have been foreseen or prevented if only they had been honest.

Oh I know a lot of things should be disclosed. But which things do you think could be PREVENTED if only the midwife knew about them beforehand? They can't prevent scar tissue or do anything about old fractures. Not saying that it isn't nice for them to know about beforehand.

[crayon]

Originally Posted by 1stimestar

Oh I know a lot of things should be disclosed. But which things do you think could be PREVENTED if only the midwife knew about them beforehand? They can't prevent scar tissue or do anything about old fractures. Not saying that it isn't nice for them to know about beforehand.

I am sorry, what I meant by prevented was that mass panic at a birth could be prevented. Scar tissue on the cervix can be dealt with if it is known. A previous pelvic injury could be addressed instead of a mother laboring for hours and hours and hours with no chance of a baby coming down.

I would rather women feel like they were informed and educated than feel like their bodies failed them after a long drawn out labor that could gone different if a MW would have known.

I do feel that many times women do not even view these things as "pregnancy" issues, and that is why at the birth- when they come out- there is panic and letdown.

[mwherbs]

so for cervical scar tissue- which we see more often now because of the discovery and treatments available for HPV that can prevent cancer- so the treatments are great but the scar tissue can prevent dilation -- and with our typical hands off approach and we don't check mom until days into laboring-- and we find a closed cervix- she is too worn out to do anything but transfer care- and if the hospital doesn't see progress nor have any more history than we have- she can end up with a c-section or a rupture-- if we know that a woman has had a procedure- cone, laser, frozen, cauterized- chemically removed HPV we should be checking early in what would be considered active labor by contractions and then a second time and if we did not find any changes we could do something similar to stripping membranes that would break up the scar tissue and allow mom to dilate-- often what I have felt and seen is mom is 2 cm and after the scar tissue is broken up she jumps to 6 or even 8 cm so I don't think that we have been doing it none too soon-- I also know of women who have been transfered for failure to progress/worn out mom or baby--
as for broken bones there may be some positions that are better than others-- also there are massage and moxa points that can be used to help loosen the scar tissue around a break--