Can my m/w drop me as a client...

[mama to 2 girls]

for NOT wanting a PAP smear? I went for my first appt. with my m/w and she asked me when my last one was and I told her in Jan. this year. She said well then you will be over due and need one....BUT she changed the policy of the FSBC (which she took over, she is new and NOT the m/w that caught DD2) and she will not do one until I am 20 weeks!! She said she doesn't like messing with the cervix early in pregnancy.

She said it wouldn't cause any problems..but I just DO NOT feel comfortable with this....With my other 4 pregnancies my OB did one at my first appt. and I was ok with that. Is it REALLY ok to do one that "late" in a pregnancy?...and Can she drop me as a client if I refuse? I don't know if maybe it is the "law" here or what.? I live in FL.

Why can't it just wait until after I have the baby? I have never had an abnormal PAP.

Any help would be greatly appreciated!

[sarahn4639]

It can wait until after you have the baby. I am well overdue for one and will have mine at 38 weeks when we do Group B just so I don't have another vaginal after the birth. I can't imagine that would be a valid reason for a drop but to be honest with you, if she were to go to those measures over a PAP then I wouldn't want to deal with her for anything else in a pregnancy! That sounds like a huge over reaction on her part. Did she just recommend having the PAP at 20 weeks rather than now or did she insist it be done then?

[heartandhandsdoula]

I hadn't had a pap in over 2 years, my mw said it was fine to wait until after.

[sevenkids]

After 20 weeks is a weird time to do a pap, the cervix swings way posterior and makes paps very uncomfortable and difficult to visualize the cervix.

You wouldn't be "due" for a pap until after the baby is born, personally, I think 2-3 years between paps is close enough, especially since you have never had an abnormal result.

It's not the law in Florida.....we have to offer one, but you don't have to accept it. If she wants to have pap results in your chart, send for the results from your last one.

[SublimeBirthGirl]

I think the bigger question is, should you stay with a midwife who is pressuring you to do something you don't want to do? If you're not comfortable with it, don't do it. If she becomes a bully about it, find someone else.

[kltroy]

The new guidelines that have come out say if you've had 3 normal paps in a row, they only recommend one every 2 years now. That said, you need to decide whether you want to stick with your MW - if she's like this about a pap, how will she and you handle other disagreements/differences in philosophy during your birth??

[mwherbs]

is she threatening to drop you?
why are you due for another PAP if you had one this year?

women under 30 the recommended schedule is once every 2 years unless you have had HPV or suspicious pap..
now there is also cultures that are done to rule out stds -

[mama to 2 girls]

No she isn't threatening me, it was almost like she was asking me if it was ok...but not really giving me an option. IYKWIM. This isn't the only issue either....with dd2 after 3 hrs. and 3 shots of pitocin, still no placenta...so she said well to avoid all that (I guess the call to 911) I'll just go ahead and give you a shot of pitocin as soon as you deliver (her words not mine) the baby. I just don't feel comfortable with any of it! She couldn't give me 1/2 hr. to see what happens before she does the pitocin.

I guess I shouldn't expect to much different from her...she is from England and was a m/w in a hospital.

I am going to have a talk with her and see where I get. I just wish I had more options....the area where i live this FSBC is pretty much my only option aside from a hospital and an OB.

Thanks again.

[mwherbs]

well England - they have active management of 3rd stage-- in and out of the hospital-- unless you find a radical one...probably need to discuss delayed cordclamping as well--

[3daughters]

Recent thread on this topic:

http://www.mothering.com/discussions...d.php?t=800327

[jul511riv]

Homebirth. Homebirth. Homebirth. Homebirth.

Did I mention HOMEBIRTH?!?!?!?!?!?!?!??!

Even for people TOTALLY BROKE there are ways to manifest that in your life. Look around, get creative. Don't get bullied into things. This is your red flag. The birth will NOT be any more respectful or in your control. You will be in a vulerable place while birthing...

Really. I'm SURE there is an alternative out there. Hang in there mama!

[momileigh]

Kinda OT: I've been trained NOT to give pit until the placenta is del. b/c giving it beforehand can close up the cervix. If this is correct, the 3 shots of pit could have contributed to retained placenta. A good reason NOT to do pit right away. If she's from the UK she may have been trained to give syntometrine (sp?) upon delivery of the anterior shoulder.

Thoughts from midwives on this?

[Jane]

I think you just have to remember your power in the situation. At least in my experience, midwives are often comfortable with a LOT more than they're comfortable recomending. For example:

Midwife: Your membranes have been broken for 24 hours and you've had no contractions and our induction attempts have failed to get you into labor. At this point, I suggest we start calling around to find a hospital midwife to take you for pitocin induction.
Client: You know, I hear what you're saying, but I am not ready, since everything is fine. I'm staying here.
Midwife thinks: Cool!
Midwife says: Alright. We'll just keep monitoring you.

Remember your power!

As far as paps - I don't like doing them early b/c I hate to do something I know will cause some spotting in some women - it's terrible to make women with a healthy pregnancy worry they are miscarrying.

[mwherbs]

Originally Posted by momileigh

Kinda OT: I've been trained NOT to give pit until the placenta is del. b/c giving it beforehand can close up the cervix. If this is correct, the 3 shots of pit could have contributed to retained placenta. A good reason NOT to do pit right away. If she's from the UK she may have been trained to give syntometrine (sp?) upon delivery of the anterior shoulder.

Thoughts from midwives on this?

this is not true-- pit is not going to close the cervix-- methergin will close a cervix acts more on lower segment- if you think about induction pit will help a woman to dilate- but effacement is something else entirely and gel or other things are used-- I have no idea where this myth started but I have not seen this to be true in any of the medical settings where I have seen pit drip not shut off until after the birth nor where active managment is practiced and they give a shot with the shoulders of the baby-

[ZoeyZoo]

I had my last pap in January too and my MW was fine with that. It's not even a year yet. Even the current recommendations for OBs are no longer every year unless you have a history of adnormal paps.