Sister/doctor dilemma

[barefoot mama]

Apparently I have agreed to something pretty stupid.

One of my sisters is our family practice doctor. They do pregnancy/birth at the office she works in- her partner delivers the babies.

When she heard I was pregnant, she had a suggestion. Because I had so much trouble with my blood sugar being too high during my last pregnancy, she was concerned. She presented an idea to me. I would give her basic info about how my pregnancy was progressing and she would chart it. But she would keep it on paper and not make it official. If I ended up needing to go to the hospital, she would then make it official. If not, she would shred it.

At the time we talked about it, basic information was weight and blood pressure and nothing more. She thought this was a good idea because she said if I showed up at the hospital with a blood sugar issue, they would probably call CPS for negligence if I hadn't seen a doctor. I thought about it and figured it would be OK, because really, she had a point. I know there is a real possibility of something like that happening, even though it's a fairly small chance because of the way I am taking care of myself. I also thought since I am the one giving the information, I am still doing it myself.

So last time she visited, she "just happened" to bring a bunch of paperwork. You know, the standard intake for all pregnant women. It made me uncomfortable, but I told her I would fill it out myself because I knew it would look odd if I had a doctor, but no intake had ever been done. So I filled it out and kept it myself.

Then she called me last night and told me it was time to get my bloodwork done. : I said "Um, NO, why would I do that?". She wanted to know what the big deal was because "all" they test for is blah blah blah (I don't remember anything but Syphilis). I said "I don't have Syphilis!!". So I told her to write down that I refused the bloodwork. She said nobody does that. Do you see where this is going??:

Then she goes on to say that I should really deliver at her hospital, because Dr E (the one she works with) will tell everyone they can't go in the room at all and it will be just great. Uh huh. Sure. Fantastic. Yup.

I tried explaining to her that the whole fricken idea of having a UP/UC is to NOT see the doctor!! I literally could feel my power and intuition being taken away just talking to her.

What have I done? I thought she had a good point about the whole hospial/CPS thing, but now I don't know if this is worth it. She apparently can't separate her sister self from her doctor self. Ugh!! This feels SO wrong to me on so many levels!

What do you think? Would the hospital really call CPS? It is documented by my insurance company that I've had hyperglycemia because I used a script to buy my glucometer (STUPID idea, I should have just paid out of pocket!). Will that information be available to the hospital, should I end up there? Should I tell my sister to leave me alone? Or is all this crap worth it? I think she and I may have a continual argument until the day the baby is born. This is my SEVENTH baby for pete's sake! My FOURTH UP/UC! Do I not know what I'm doing??:

[MsBlack]

Oh, woman, what a silly, draining mind-boggle...so sorry this has happened. Ah, family!

There is just one thing that strikes me about your post that might help you more than anything else...

you said, "I literally could feel my power and intuition being taken away just talking to her."

I know this feeling you express...well do I know that Doctorly attitude of complete assurance and belief in their way, that attitude of 'we know best for you', and the way that they can seem to appropriate all the personal power in the relationship. In THEIR minds, they DO and they SHOULD have all of that power; it's a 'kindness and a necessity' for patient safety' for them to have that power :. They use such words and tones to help us believe that they now have all the power. To me, this gets at the truest meaning of 'enchantment': using words and tone to cast a spell over someone (which is really only a form of persuasion wherein the 'enchanter' convinces their subject to give over their power and intuition).

But...I just want to remind you...NO ONE can take your power or your intuition! Fight that feeling that it's already been taken, cuz that's a lie.

Right now, I guess you are feeling betrayed since you trusted your sister and you thought you knew the plan--now, she is changing her tune and acting like this always was her tune. Surely this sudden change also lends toward a sense of uncertainty that you'd rather not have to deal with--having the rug yanked out, mentally and emotionally.

But no, she *can't* take your power or your intuition and you don't have to give them up...just reminding you of this. You can let her know that this isn't really working out the way you'd planned, that you need some space and time to rethink what you're going to do. Whatever you decide (and I don't mean to say what you *should* do, just naming what springs to mind--taking space is a personal fave of mine in such situations)...whatever you decide to do or say, all the choices are still yours. Your intuition is still entirely intact! As is your power, as much as you want it to be.

And I trust that you will use both to figure this out and have another great birth

[rmzbm]

THIS is exactely why I decided against midwife or shadow care. I know myself...and I know one little intervention would snowball into more, until I was in the OR yet again. Not worth it.

ITA with everything MsBlack said. (I really am starting to adore her! LOL!)

Take your power back, re: CPS - you already HAVE the info. she said would be needed for that (rare) situation, right? So rest easy & tell her to scram. Good luck!

[MeepyCat]

In your shoes, I would talk to your sister and strongly question how appropriate it is for her to be providing medical care to family members. Point out that it's one thing for her to track your blood pressure and weight, but it's another entirely for her to attempt to refer you to her partner for delivery (and there's no guarantee he would be available anyway), to have you fill out intake forms for a hospital delivery that you don't want, and to do - or offer to do - bloodwork on you.

Suggest that the state licensing board would probably frown on it.

You can track your own weight and blood pressure. Keep your own records, and if things start to go haywire, seek help. I have seen other mamas on these boards suggest that, since the ER staff may assume that pregnant women who aren't under medical care are mentally ill or drug addicted (which ,to be fair to ER staff, is generally the case when they see pregnant women who don't have OBs), you do as much as you can to differentiate yourself from that stereotype. Have records of your weight and blood pressure and other measures you've taken for general health throughout pregnancy (your own notes are fine), and bring them with you if you go in.

Functionally, there's really nothing to stop people from calling CPS on you at any time. CPS gets a whole bunch of nuisance calls with no rational basis. I'd like to believe that a reasonable doctor, confronted with a mama on her third (or fourth?) unassisted childbirth, who seems well-informed and all that, would not call CPS. There are a bunch of unreasonable doctors out there. Were you to choose an obstetrician, you would want to choose one who agrees with your general philosophies, because you're just as likely to hear from CPS because an obnoxious doc called you in for refusing bloodwork in the course of general care as you are to hear from them because someone in the ER freaked out.

[barefoot mama]

Originally Posted by MsBlack

But...I just want to remind you...NO ONE can take your power or your intuition! Fight that feeling that it's already been taken, cuz that's a lie.

Of course you are right! How did I forget this?

Right now, I guess you are feeling betrayed since you trusted your sister and you thought you knew the plan--now, she is changing her tune and acting like this always was her tune. Surely this sudden change also lends toward a sense of uncertainty that you'd rather not have to deal with--having the rug yanked out, mentally and emotionally.

Originally Posted by rmzbm

THIS is exactely why I decided against midwife or shadow care. I know myself...and I know one little intervention would snowball into more, until I was in the OR yet again. Not worth it.

That happens to SO many women! I agree, not worth it! I guess I was thinking since it's my sister, she would be different. Wrong.

Originally Posted by MeepyCat

In your shoes, I would talk to your sister and strongly question how appropriate it is for her to be providing medical care to family members. Point out that it's one thing for her to track your blood pressure and weight, but it's another entirely for her to attempt to refer you to her partner for delivery (and there's no guarantee he would be available anyway), to have you fill out intake forms for a hospital delivery that you don't want, and to do - or offer to do - bloodwork on you.

Suggest that the state licensing board would probably frown on it.

I know they would. I'm sure they would frown on the whole thing, even just writing things down for me. But I'm afraid to go there because her practice is the only one anywhere around where I feel comfortable. No one bothers me about vax, no one makes me bring my kids in, etc.

You can track your own weight and blood pressure. Keep your own records, and if things start to go haywire, seek help. I have seen other mamas on these boards suggest that, since the ER staff may assume that pregnant women who aren't under medical care are mentally ill or drug addicted (which ,to be fair to ER staff, is generally the case when they see pregnant women who don't have OBs), you do as much as you can to differentiate yourself from that stereotype. Have records of your weight and blood pressure and other measures you've taken for general health throughout pregnancy (your own notes are fine), and bring them with you if you go in.

I think this is a good idea, and one that honestly hadn't occured to me! I actually have been writing everything down for the last month or so. I guess as long as I continue that, they would suffice if I needed them. My own care is far more complete than any "care" (OMG, I just wrote "scare" accidentally and had to retype! Freudian slip?) any doctor could give me.

I think I will tell my sister to scram. But nicely because I love her.

[rmzbm]

Originally Posted by barefoot mama

I think I will tell my sister to scram. But nicely because I love her.

[Intertwined]

: to MsBlack. Doctors are taught in medical school that they DO know best. Their biggest complaint? Non-compliant patients. Everything ABOUT the modern medical model is about power, control, and subversion.

I am so sorry you have to deal with this, and especially because it's also your sister. I agree that she has too many personal conflicts here.

[mrskennedy]

Originally Posted by rmzbm

THIS is exactely why I decided against midwife or shadow care. I know myself...and I know one little intervention would snowball into more, until I was in the OR yet again. Not worth it.

ITA with everything MsBlack said. (I really am starting to adore her! LOL!)

Take your power back, re: CPS - you already HAVE the info. she said would be needed for that (rare) situation, right? So rest easy & tell her to scram. Good luck!

: And if CPS hasn't been called for other UCs, why would this one be different? Yes I get the bloodsugar thing. But presumably you've had this "issue" all along. The only difference now is that your sis is involved, which is deceitful of her... I bet she knew she'd try to get you to deliver their way, just didn't tell you. Don't let her have the power. If she gets too bad--i.e. mentions calling CPS herself (not saying she would, but you don't know what people'll do when you take their perceived power from them!)--then go somewhere else to birth. mama! You'd think she'd realize you know what you're doing by now! Come to think of it, why don't you have that convo with her?

[barefoot mama]

The blood sugar issue was actually new as of last pregnancy. And it did get pretty out of control a couple times. But I managed it at home. And this time I know even better how to keep it under control from the get-go, so I really don't anticipate that it will become a serious problem later.

My sister and I have talked at length about birth, my births, her births, UC, why I hate interventions, etc. I think she just slips into doctor mode far too easily. I think giving her any power at all was a big mistake because it made the sister dynamic secondary to the "I'm going to doctor you" dynamic. I can't imagine her threatening CPS. I can't even go there. That would. be. very. bad. on a whole bunch of levels.

ETA: MrsK, I don't think I quite answered your question.

I have never transported for a UC, and my sister's concern was that should I have to go in for high blood sugar, high blood pressure, or whatever, that someone at the hospital would call CPS because the blood sugar has been a problem for a while.

[MsBlack]

barefoot--sounds like you're getting your head back on and your power back in your own hands...yay.

this emotional family stuff can really throw ya for a loop, eh? btdt--not with any 'medical'-type family, but certainly similar kinds of episodes with the everlovin knowitalls I'm related to!

others...I do very much appreciate your appreciation. very much!

[~Mamaterra~]

Originally Posted by MeepyCat

In your shoes, I would talk to your sister and strongly question how appropriate it is for her to be providing medical care to family members. Point out that it's one thing for her to track your blood pressure and weight, but it's another entirely for her to attempt to refer you to her partner for delivery (and there's no guarantee he would be available anyway), to have you fill out intake forms for a hospital delivery that you don't want, and to do - or offer to do - bloodwork on you.

Suggest that the state licensing board would probably frown on it.

This is an important "trump card" to keep in case the discussions with your sister head south. Very important and very true.

I also have a sister as a Dr. and she is VERY clear about the delineation between being a sister and a Dr. and constantly (almost to the point of irritation) makes a point of explaining it to me.

Jen, what I am going to say is in no way meant as disrespect to your sister but more to the general status of Dr. vs family. As a statement of fact, it is unethical for any Dr. to treat/advise a family member as they cannot be impartial in their care/advice.

If anything, a doctor treating a family member has more of a potential for an abuse of power than a traditional scenario as the related Dr. has the emotional baggage and knows which buttons to push as opposed to a non related Dr.. As well, a related Dr. has a more difficult time swallowing a refusal of care than a non related Dr. as they may internalize the refusal as a personal slight than what it is...a refusal of care.

FWIW, I would make the suggestion that, on second thought, you politely refuse this arrangement as you are concerned about it's implications for your personal relationship with your sister because you love her so much that you would (wink wink, nudge nudge) "hate to jeopardize her professional standing by having her offer shadow care to you" and then leave it at that. That way you don't have to get into any of your other concerns and have the unimpeded UP that you desire.

HTH!

[jenP]

Originally Posted by barefoot mama

So I told her to write down that I refused the bloodwork. She said nobody does that. Do you see where this is going??:

Bah, tons of people refuse bloodwork! I delivered with midwives twice, and both times refused any and all blood tests, ultrasound, amnio, etc. (except the glucose tolerance, 'cause it seemed pretty easy and noninvasive.) Oh, wait, I did have the GBS test first pregnancy, refused it the second. Anyway, my point is it is not rare at all for pregnant women to decline testing.

Come to think of it, I got married in another state partly because my home state then still required a blood test to get a marriage license. I find that soooooo incredibly offensive! My partner and I will decide if we want to be screened for anything prior to marriage, thank you very much. Someone said it was instituted to "protect" women from spouses who might give them syphilis. How freakin' patronizing is that?!

Some great advice from the others. Good luck with the situation!

Jen

[mama in the forest]

Jen - I agree with everyone here. I think that you are perfectly and beautifully capable of taking care of yourself...even if your sugars get off. You handled it at home last time, and you will handle it if it happens again!

Also, if you do decide to measure & chart yourself for documentation, you could always use that data if you needed to see a doc during your pregnancy...and I'm betting you could see your sister too, if that's what you wanted. (though you could see someone else instead) If she knows you are taking good care of yourself and recording your findings, she might be willing to see you.

[katiesk]

Where I live, CPS is far too busy with life and death matters of child welfare to investigate your prenatal care - or lack there of. If they were to investigate, it would most likely be to ensure that you had access to care and that it wasn't being with held from you for some reason.

But thats where I live - and I'm sure things vary from place to place!

[guestmama9944]

I can't imagine CPS being called over something like that. Maybe it's different in other places, but in the po-dunk hospital I work at, I can't imagine anyone involving CPS (DFS here) for blood sugar issues. I've seen major complications to a baby because of mom's high blood sugar (uncontrolled, uncompliant diabetic - certainly not how you describe yourself) and not a soul mentioned involving DFS or anyone else.

IMO, if you could call CPS because a pregnant mom had uncontrolled diabetes, then you could call CPS because a pregnant mom smokes or does something else that's been proven harmful to the baby. OTOH, I've seen a mom take home her baby twins even though she'd tested positive for cocaine multiple times while pregnant. It boggles the mind, but blood sugar? Never heard of anyone getting their child taken away for that.

[hbmomof5]

CPS has no controll over you recieving medical care...I was an OB nurse for years and many women came in with no prenatal care, we did do urine drug screen on admission though(just a warning, they wont tell you they are doing it, just call CPS if it is positive)
Dont be scared into any more care than you desire...all the reasoning they give you just hides the fact that they sometimes end up causing more harm than good.
I just read your daughters story...very sad. I remember when my 10yo was born I refused the oral polio (we did the shot however, I was in the medical community and not brave enough at the time to tell them to shove it) and the nurse had a heart attack "I cant believe you would do that, cause your son to get another shot!" Well 6 mos later the oral polio was taken off the market because it was causing children to get polio. I felt like going back in there and shoving the recall in her face.

[AugustineM]

Originally Posted by katiesk

Where I live, CPS is far too busy with life and death matters of child welfare to investigate your prenatal care - or lack there of. If they were to investigate, it would most likely be to ensure that you had access to care and that it wasn't being with held from you for some reason.

But thats where I live - and I'm sure things vary from place to place!

:

But I live in the same place Katie does! My aunt is a social worker here for CPS and she told me there is no way they'd investigate for something like that.

[SublimeBirthGirl]

I wouldn't worry about CPS. You probably won't transfer anyway. Tell her you won't be continuing care and thanks anyway (very nicely).

[barefoot mama]

Thank you for all the replies and reassurances! They made me feel better when I talked to my sister today.

She actually had her nurse call me a few days ago. She left a message on my voice mail saying "J says you are supposed to make an appointment and you didn't do it! So you have to call the office and set one up." I couldn't call my sister right away because I was too MAD.

I finally called her at home today. I think she knew I was feeling rather pissed. I haven't spoken to her since our whole bloodwork conversation. So I guess it went OK. I was extremely firm and said I will not be coming into your office, I will not be doing bloodwork, and in fact, the whole thing is making me uncomfortable and I have decided I don't need a back-up paper trail. She just said OK, that's just fine, and didn't argue with me at all. Weird. I don't get how we went from here to there and back again.:

[mrskennedy]

Yeah, that is weird... But at least she isn't trying to run your pregnancy anymore. I still can't believe she had her nurse call you! : Anyway, I'm glad it seemed to go ok and hope you don't have any more problems!