Major RANT here -- call from OB office this a.m.

[txbikegrrl]

Okay, this is rather long, so please bear with me...

I was forced to do the GD screening at 28 weeks. I say forced because I had asked about mandatory procedures at my very first OB appt but was told everything would be based on medical need so imagine my suprise when I was told I had to take this screening (that I had not been told about ahead of time) and that I could not decline the test. Basically, they make all of their patients do it but when I questioned them about why I hadn't been informed about it when I asked months ago about any "standard practices" they hedged and reminded me that I was obese and over 35 yo so it was medically necessary for me anyway. DH felt like I was making a big deal out of nothing but I felt completely deceived at that point. I realized that all of the bloodwork I agreed to (such as typing and checking for immunities) probably wasn't ever really optional.

Anyway, at my next appt I asked a TON of specific questions about the labor and delivery process. I was assured that there were no standard practices or mandatory procedures of either the OB group or hospital that I couldn't live with personally such as no routine IV but must accept a heplock in case of emergency. I even specifically asked about Pitocin use to deliver the placenta. Then I submitted my birth plan for their approval, and a "minor issue" came up when they had to sign off on it...

They said Pitocin is given after the birth of the baby and placenta (so I guess my question wasn't specific enough -- or maybe TOO specific -- last time) to prevent against hemorrage (Sp?) even after a "completely natural" birth.

I was already feeling like a completely natural birth was going to take a miracle -- but now it doesn't matter because even if I make it through labor without any intervention(s), and manage to deliver without any interventions, I would HAVE to have "a little medication" to prevent something that has a very remote chance of occurring to me.

I am so SAD and ANGRY right now. It seems overwhelming to switch docs now. I'm going to try, but what if I can't find anyone better...

I have an HMO so we are pretty limited with what we can do or where we can go for care. If not on the approved provider list, we have to pay 100% out of pocket.

Please send me positive vibes and helpful advice that does not include HB because we can NOT birth at home due to a major remodel project that will probably not be completed before the baby is born. I'm going to check but I don't think any birthing centers are on our plan.

I'm feeling like I'll just have to hold out my arm at this point and accept the stupid Pitocin. In fact, I'm starting to feel like maybe I should just give in and accept all of the routine procedures and not fight so hard for a natural birth only to end up disappointed in the end...

[saratchka]

And what do they say the'll do if you refuse? Will they terminate your care, or what?

Definitely look into other providers. I know it can be hard with an HMO, but there's a good chance you can find someone better. Get a list of *all* OB's, MW's, and FP's in your area who are on the approved provider list, then sit down at the phone and get started. You might also want to get in touch with whatever provider you would want if you didn't have to worry about the approved provider list and ask him/her to give you recommendations for likely candidates from the list you get from your insurance company.

I'm sending good thoughts your way!

[CityChic]

Originally Posted by txbikegrrl

I'm feeling like I'll just have to hold out my arm at this point and accept the stupid Pitocin. In fact, I'm starting to feel like maybe I should just give in and accept all of the routine procedures and not fight so hard for a natural birth only to end up disappointed in the end...

Don't feel this way! Hang in there! You can and WILL do it your way! Fight, Fight, Fight! It will be worth it for you and your baby!!!!!

I felt this way around 30 weeks and then again recently. I just kept talking and I am getting my way (so far!). You can do it!!!!

[txbikegrrl]

How are you getting your way? These docs say I don't have a choice. If I want to refuse the Pitocin then I just need to transfer my care. It seems so overwhelming at this point. There are a TON of docs, it's just that most of them are worse than who I'm with -- at least from what I've heard.

I'm going to call my insurance company right now and ask if any birth centers are covered and if not find out if any CNMs are covered that deliver near me.

I don't know what else to do right now...

[Jilian]

If you cannot or do not want to find another provider then just flat out refuse the pitocin. Say the words "I do not consent" and keep repeating if you have to. They CANNOT legally give you something that you do no consent to. Just be careful about what kind of forms they have you sign upon admission, some hospitals have a "blanket consent" form that pretty much consents you to everything. Feel free to cross anything off that form that you want or modify it to fit your needs. It is YOUR body and noone can force you to have a substance injected into it that you don't want. But the medical staff can make you pretty miserable for arguing with them. I've heard cases of OBs lying and telling a woman she was starting to hemmorage just so she would consent to the shot.

[mammal_mama]

If your remodeling project is the ONLY thing keeping you from having a homebirth -- it might be worth your while to re-think that. Seriously. If you're capable of LIVING in your home right now, there's no reason you can't birth a baby there.

I know this isn't what you asked for, so please forgive me for bringing it up. I had an easy, uneventful first pregnancy -- and ended up with induced labor and unwanted interventions, simply because I went the medical route and went 2 weeks overdue.

Our second baby was born at home, in a tiny, tiny duplex. We had to crowd our dining room table into our living room to make room for the birthing pool. VERY cramped living quarters, but PLENTY of room to push out a baby.

I wish we'd listened to some homebirthing friends with our first. I was so stressed at being told, "If you don't go into labor over the weekend, you have to report to the hospital to be induced" -- and one friend was saying, "You really don't have to go along with this" -- but we felt so pressured and disempowered.

That said, we still got a beautiful, healthy baby girl -- and I'm sure you and your little one will be fine, too, whichever route you go.

[mataji4]

Um, yeah, I had my first baby in a remodeled chicken coop with a dirt floor and NO running water, and it was fine.

But as to the consent issue...there was a great show on NPR the other day about birth in America. There was a lady on the show (missed her name) that was explaining how women in America don't realize, understand, or know that they don't have to consent to any medical procedures!!!! It's such a medical scandal that docs can threaten to terminate your care if you don't go along with them!!!!!!!!!

What about writing a clear birth plan with a NO PIT UNLESS... statement? What about a doula who can watch for that needle and advocate for you, asking them at that point to refer to your birth plan and nudging you so you can chant your "I do not consent to getting a shot of pitocin at this time" ?

[wombatclay]

It will also be easier to turn down the pit after the birth if you only have the heplock. With a full IV in place they can add the pit to that and in the hustle/bustle of the immediate after birth scene (and your attention being happily on your babe) it would be difficult to notice.

If you're worried about being dropped by this practice then simply don't make an issue of it till the end...read every single word in the paperwork you fill out (and cross out anything that sounds like you're giving "general consent" and replace those sections with the need for verbal consent or written consent FROM YOU at the time of the procedure). Then make certain you have a few copies of a letter in which you decline routine pit and require written consent from you or your partner before pit is given (even in an emergency situation). Turn in a copy of this letter to the hospital records office/legal office as well and let the nursing staff and your care provider know when you check in that these are your wishes and that the legal formalities have been observed.

It sounds like a pain in the butt, and it is, but it should cover things. And you may want to check out some of the resources (here and in places like the ICAN site) to see how some VBAC mamas have had to word things in order to decline "routine" interventions or repeat c/s. It's sad, but as a group of women, natural birth VBAC mamas tend to be very informed on the whole topic of consent and medical legality since getting the VBAC you want can be a real battle these days.

[willoLevin]

I don't know if we have any lawyers in our DDC, but I believe that those who say you can refuse consent for that pitocin are 100% correct.

If you were refusing some kind of care for an ill newborn, there might be state laws that would force medical intervention, but, for yourself, as an adult, I think you can do what you want.

I think I might STOP discussing it with the OB now, then, after the birth, just refuse consent for the shot. You can check yourself out of the hospital against medical advice at any time, even before they give you your "mandatory" shot.

--willo

[txbikegrrl]

Thanks for all of the support. I'm afraid I really won't be able to refuse the Pitocin since I've made an issue of it now. The docs will be looking for any sign(s) of dissent on my part. They've made it clear that they do not think it is safe to risk hemorrage (Sp?) when there is a perfectly good way to prevent it so if I want to be so silly as to attempt to refuse treatment I should seek services elsewhere.

Since they are the ones who will complete my "orders" at the hospital it just does not seem likely that at the last minute I can decine it. Plus, I don't want to ruin my whole birth experience by fighting thru-out or at minimum after giving birth. I envision(ed) a calm, peaceful birth. Do you think it's possible given this scenario I'm facing?

We really can not consider HB right now. There is too much chaos here, and where exactly the reconstruction is occuring changes on a daily basis. Also, I'm worried the best MWs are booked already -- my due date is only 6 weeks away...

I'm going to re-read your posts and see if I can come up with a solution that may work for us. Please feel free to provide more input and/or offer positive vibes. I really need them because I'm about ready to give up (in) and just go along with whatever is necessary. I have a sleep disorder and have not been able to take my meds since TTC so my body and mind are completely exhausted at this point. On top of that, this is the busiest time at work for me -- from now until mid-May so it seems impossible to switch providers since I can barely function to do the bare minimum.

I did call a few supposedly "better" docs today but no luck -- they aren't taking new patients. I contacted one birth center but their fee is at least $3000 out of pocket and we just dug out of debt and will have to get a new car so I just can't see that as a real option right now.

Thanks for listening...

[willoLevin]

Originally Posted by txbikegrrl

Thanks for all of the support. I'm afraid I really won't be able to refuse the Pitocin since I've made an issue of it now. The docs will be looking for any sign(s) of dissent on my part. They've made it clear that they do not think it is safe to risk hemorrage (Sp?) when there is a perfectly good way to prevent it so if I want to be so silly as to attempt to refuse treatment I should seek services elsewhere.

You're right that it won't help you have a good, peaceful birth to argue.

My point was, once your baby is delivered, so what if they refuse to continue your care? Some other doctor at the hospital will just come in and see you. They can't ignore you. The can't jail you. If they are so afraid you'll bleed out, they won't even WANT you to go.

But, yes, they could give you nasty looks and try to bully you if you refuse the pitocin after delivery. I think, by then, you will be so into your baby--who will be in your arms!--you won't give a hoot what they are saying or doing. That means you may stop caring about that dose of pitocin. Or, you may stop caring what they say/do if you refuse it in the last second.

Unless you've already signed a consent for it, and maybe even then (lawyers?), they simply aren't allowed to force you to take any kind of intervention IN THAT MOMENT.

God bless America!

I really do hope you can find a better provider or solution. (I'm struggling with the likely loss of my birth center birth for no valid medical reason right now myself, and it has got me mad and fighting. Beaurocracy sucks.)

--willo

[Jilian]

How it is supposed to work, is that if you refuse something and a doctor is so angry he wants to drop you from his care, he has to find another doctor willing to take you on before he drops you as a patient. But you are right that they will give you a really hard time if you go against the doctor's orders. Some doctors are nastier than others, but I've seen some pretty bad things as a Doula. The fact that he is telling you all of this BEFORE the birth is a blessing. Now you know what you are up against and it won't be a surprise after the birth. You still have time to decide. I can't tell you what you should do, but just do the research and decide what you feel is best.

Is this doctor willing to look into other means of preventing a hemmorage? Is he willing to monitor the bleeding before administering the pit? Is he willing to give you a tiny does of pit and then go from there? Is he open to nursing and or pumping so your body can release natural oxytocin to control a hemmorage? After all pitocin is just a synthetic form of oxytocin, you can stimulate your own body to make oxytocin through nipple stimulation.

[txbikegrrl]

I was so upset yesterday that I couldn't discuss it rationally with them, but I did call today and leave a message stating that I wanted to speak to the doctor because I have some more questions for her.

I've called the few docs who've come highly recommended from the FYT area and they are not accepting any new patients right now. That really hit me hard. So I may be stuck dealing with this issue.

I'm trying to look at this as one big learning experience and not freak out too much. I was so upset yesterday -- last night and this am baby is really wiggling around so I think I need to settle down. Getting this upset may be worse than the Pitocin after birth.

Speaking of that, can anyone point me to research about the down side(s) of having Pitocin only after birth (which still seems incredibly stupid to me) in terms of side effects for mom and/or baby?

Thanks again everyone. No one IRL understands at all...

[Ks Mama]

Firstly, you have the RIGHT to DECLINE ANY PROCEDURE you want to decline, at any point. No one can MAKE you do something you don't want to do. That being said, my personal opinion, based on my experiences so far, is really pick your battles, be very informed, and be polite & open to explanations, even if they aren't the ones you want to hear (in other words, give your doctors/nurses the respect to hear out their point of view - it makes it much easier then to have them hear out YOUR point of view).

Secondly, I would recommend hiring a doula, if you haven't already. A doula will help you focus on the positive, will help you remember what's most important to you on your birth "plan" which will help you stay firm on those issues, will help smooth over any rough edges. And she'll assist you in staying home as long as you're comfortable with, which will help you have a delivery with less interventions

Thirdly, think about what's MOST important to you, and focus on making sure those things go right. For example, if you really don't want an IV, is a heplock acceptable (for me, this is a good compromise, but I certainly understand if you don't want either), and if so, can you let your doctors, nurses, etc. know this, then the really important stuff is easier to decline... in otherwords, if you're not declining everything, I believe it's easier to take a stand on the really important stuff.

Lastly, no birth can be planned. You can & should be as prepared as possible, and make sure everyone around you is as much on the same page as you as possible, but you never know what will happen in the end... and you should be open to understanding this, so that you're not as disappointed if things don't turn out exactly as you hoped. I'm not saying that things CAN'T turn out the way you want - and that there are lots of things you CAN do to help things go in the direction you want - they certinly can, and there certainly are! I'm just saying that you should try not to get bogged down in the worries over the details - and what will or won't happen, when sometimes things are out of your control.

I think positive thinking, planning, and preparation go a long way... good luck to you in whatever you decide, but this late in the game a positive outlook is so important! Do whatever you need to do to get right in your mind & body for this baby.

[zion]

I would state in my birth plan that "I would PREFER not to have the pitocin injection/IV after birth unless I am showing signs of hemorrhage and other techniques such as nipple stimulation/breastfeeding and fundal massage fail." The practice can't drop you for making this statement in a birth plan...that would be abandonment. I also wouldn't bring it up again until after 35 weeks. Again, they would be abandoning you if they dropped you then.

After the placenta is delivered I would have DH/doula gently remind the doc that you would like to see how much you are bleeding before pit is used. You have the right to refuse ANY intervention at ANY time even if you sign a general hospital consent unless you are not for some reason able to speak for yourself and have no one available to speak for you. It is considered assault if they inject you with anything against your will.

It may cause you more stress than it's worth to try to find another provider at this point. If this is your olny issue with this practice I feel like this one is pretty managable. More than likely you will be able to work through this with them even if you just have to "go along with what they say" and refuse it at the last minute. Like PP said who care if they get pissed then. They can't legally walk out of the delivery room and drop your care then. Especially if they were about to perform an intervention they thought was so medically necessary.


Take a deep breath mama. You'll get through this one.

[MCatLvrMom2A&X]

There is no reason you cant say "No I dont want the Pit" when they go to give it to you after the birth. It isnt like they can forcibly inject it. Have your dh or someone you trust there to back you up as well. They cannot do anything to you that you refuse. If they try to tell them OK but be expecting the call from my lawyer. That should be enough to make them back off.

[txbikegrrl]

I really hope these suggestions work, because so far I have not been able to find a provider who will take me at this "late" date -- and I'm "only" at 34 weeks. My last resort hope is that one of DH's coworkers is an OB so maybe she will accept me just because of the relationship. But she isn't one of the docs who are recommended by the FYT group or anyone I know IRL who's had a natural birth, which is only 2 people anyway.

Especially now that my docs have decided my BP is "too high" at 128/72 it's probably impossible for me to switch. I thought this was a pretty good number, as did my bf who is an MD but not OB, as did the school nurse who took it this morning (follow-up) so I wouldn't have to go into my docs office just for BP reading.

Oh well, if I can't switch providers then I'll just tune everything out during labor, use my hypnobirthing techniques, etc. and tell DH he is in charge of making sure they don't give me Pitocin at the end since my job will be to birth and nurture our new baby...

Any more comments and/or suggestions are welcome though. You all have definitely helped alot, just in knowing I have support somewhere even if not IRL.

[scrappingmom]

first off... 128/72 too high??? that sounds to me like a doc wanting to be controle freak and seeking reason to pull out all the stops.. does your due date happen to land near his/her vacation by any chance???..seriously! if my bp is in that range my doc is quite happy... not that mine goes super high but it likes to hang out around 135-140/85-90 while preg. And mine IS one to jump for the medical excuse!!! hence seeing a new OB for the first time at 34/35 wks.

This is only a random musing/suggestion .. perhaps you could "as a freind" ask your DH coworker if the pit is hospital standard or what... also you could try simply calling the L&D dept. and ask.. esplain how far along you are and you're trying to decide on your birth plan but would like to know what hospital standards are.. you could even lead saying something like "someone told me that pit after delivery, even for completely natural birth was mandatory, thats sseems odd to me.. is it true?" you dont have to say it was your doc who said....they can assume it was a friend who thinks they know everything! Personally I"ve found that sort of questioning to be most useful in ALL medical situations... ask someone who ISNT getting paid to BS you!

Think of other things docs and other will say are mandatory but when you really question or show you know better you get teh truth..... Vaxs are a great example! Most people you ask will say yes they are mandatory...uummmm.. yeah right!

HOWEVER... it COULD become somehting you MAY want to, in the back of your mind, say well this is a battle that i'm not AS hugely set on, so as to not stress yourself so bad thru labor that you wind up so tense baby wont move and you have to have LOTS of other intervention, possibly even emergency C-section. I mention this only because it nearly happened to me, long story short, we moved at eh end of pregnancy from out of state, i called teh Family doc i had growing up, who also delivered my first(not the best experiance) so at least i'd have SOMEONE as a doc.... well i was so tense worrying about how the delivery wouldnt go how i wanted that baby wouldnt move, i wouldnt dilate past about 5cm for the whole day and contractions were so strong i only got more stressed and tense with each one and wound up nearly haveing a c-section, doc gone to scrub and nurse coming to take me to the OR kinda close.. i relaxed knowing baby would be out shortly and boom! she moved and was crowning in less than a minute... but the stress was what nearly made it go as wrong as it could have(short of baby dying of course)

for your health physical and mental/emotional.. you need to have a doc who cares about your feelings so continue trying to find another... do research.. and inform your Dr you DO NOT want the pit .. perhaps your DH co worker if cant take you would be willing to be on call for second opinion??? say you wont consent to pit unless 1 its obvious to your or dh you need it OR you have second opinion by this other doc???? It would at least hold the Dr you have accountable to another doc and they may be less likley to "force" or BS you into having it unnecesarily.

[mammal_mama]

I also think you'll find it easier to relax if you follow a pp's suggestion to get a doula (or maybe even a midwife) to be with you and speak up in your behalf.

[Ks Mama]

Originally Posted by txbikegrrl

Oh well, if I can't switch providers then I'll just tune everything out during labor, use my hypnobirthing techniques, etc. and tell DH he is in charge of making sure they don't give me Pitocin at the end since my job will be to birth and nurture our new baby...

I know I already posted this suggestion, but if it is within your means (and often, you can find doulas who are in training - for free), I would HIGHLY recommend a doula; she can help you construct a birth plan, and a plan of action for the hospital (can help you guys through a "dry run"), can help you decide what's REALLY important to stand up for, and what can be put aside, and can act as a go-between during/after labor - so no one feels put on the spot (though she can't tell the doctor what to do/not to do to your body - that's your responsibility).

In my opinion and experience, it really isn't all that realistic, nor fair, to put that full responsibility on your husband. He needs to be able to enjoy his new baby too... and if ANYTHING doesn't go as "planned", I'm afraid putting that responsibility on him sets you both up for disappointment and potential blame issues. It's really YOUR responsibility to make it clear to your doctors/nurses ahead of time that you will not accept pitocin unless it is absolutely necessary - it is your body, and from what I understood while in labor myself, though the doctor & midwife would talk to us BOTH (DH & I) about medical decisions, the final word laid with ME, not my husband.

I am sorry if this came across harshly, please feel free to dismiss it if this just doesn't fit you!

Just wanted to share because DH & I are getting a doula this time - was the first decision we made after finding out I was pregnant again... we really wished we had one the first time around, even though we had a wonderful midwife... it can get overwhelming in a hospital setting, and we both want my husband to be able to focus on ME & our BABY not acting as a referree.