midwives & Drs- exams

[SpiralWoman]

hi all~
just wondering if you have any feedback on this situation. My Midwife is a CPM & licensed in our state. The state licensing requires her to have a "consulting" physician. This is an OB who she gets her scripts written thru (Eurythrymicin, Pit, Antibiotics, etc) & who she can consult with on OB issues. She has just had to develop a new relationship with a new one, & the OB is requiring all her patients to have an individual chart & a visit with him before he'll write the scripts.

I was ok with this until I found out he is requiring a vaginal exam as part of his "standard of care." I realize that the majority of PG women have vaginal exams everytime they see their OB, but I have specifically chosen *not* to see an OB, I have a homebirth MW. I could go on & on about how I am in principal opposed to this for so many reasons & that my midwife's & my autonomy are being infringed on, etc, etc. She & I had already discussed & decided it just wasn't neccessary to do vaginal exams.

I am also really emotionally uncomfortable with getting a pelvic from a man I've never met before & I also feel very protective of my "womb space" I guess you'd call it, still a bit insecure about the pregnancy (I'm 19 weeks, 1st pg, prev infertility issues). Negotiating out of the pelvic is not an option, she would rather we work out something else than cause conflict with him. It seems that this is a pretty fragile relationship for her, pretty hard to find any OB round here that will work with the CPMs.

I have already replied to my MW that I will go ahead & do the appt, mostly just to make things easy on her & me. I realize she has the need to work within the system as it is, & I still feel she is the right midwife for me. If I can just get thru this, it won't be that big a deal.

I guess I'm looking for reassurance that 1 vaginal exam isn't that big a deal, and maybe some advice from the professional side of it as to how to handle this to preserve my autonomy & not go off on this Dr. or go to pieces myself. I guess I probably have some anger issues with authority figures that are yet unresolved!:wink

thanks for any feedback, maria

[shelbean91]

I only had a vaginal exam the first prenatal appt (6 weeks pg) to do a regular pap and not again until 34 weeks. I've never heard of having one during the rest of the pregnancy unless something is wrong or they're checking for something. I would try to find out why he feels it's so important and what he's checking for.

[frogertgrl]

Ah, the system. The 'consulting' OB who turns out to have a helluva lot to do with a non-OB homebirth, eh?

Sorry. Lil rant there.

I live in CA, had a homebirth and the midwife I saw lied to the state about the supervising OB for precisely the reasons you are dealing with now. And I lied, too, fwiw.

Anyway, I would strongly, so strongly encourage you to protect your womb space as you see fit. Do not compromise your integrity in this for the sake of ease for your CPM. You will most likely regret that very much.

And I would also encourage you to not try to talk yourself into this pelvic exam. I do not agree that if you can just get through this, everything will be okay.

Listen to your heart on this and please, don't do it if you don't feel it is right.

You do not need a pelvic at any stage of pregnancy for prenatal care. For that matter, you don't even need one for birthing! I have a close friend who lost her precious baby early in the first trimester after a rough 'routine' pelvic by an OB. She sued and won but nothing can replace her baby.

I don't know the laws in TN, but I would bet that you can assert your right to DECLINE this exam, if the OB says it is part of his consulting role. In declining, you accept all possible ramifications for not having the pelvic. Which, imo, aren't a risk at all. But the OB could say that b/c he couldn't feel your pelvis, he couldn't verify if it was big enough for birthing (a stupid idea of most OBs) and therefore, couldn't say whether or not you 'could' have a homebirth.

Anyway, this is why I went with a Licensed Midwife, NOT a CNM or CPM.

You don't have to do this to have a safe, healthy pregnancy and homebirth! Be true to your heart - your baby could be sending you communication that he/she needs you to protect the womb space for your baby, y'know? You need to listen to that!

Let us know how you are doing...sending you thoughts of strength tonight.

P.S. Don't let the system scare you into doing something you know isn't right in your heart. The OB/CPM could say things that would scare you into hopping on the table for the pelvic and regretting that and I would again encourage you to decline this and accept that the OB might withdraw his supervisory role.

[loved]

I feel for your delimma. I know you want to help your midwife. I just wish she believed more in your autonomy.
She is in a rock and hard place. And it sucks. I don't know what to tell you except to follow your heart - it will not steer you wrong.

On a personal level, this just really burns me though. As a student midwife, apprenticing with two amazing midwives who always talk about and offer choices, it makes me sad to see how other midwives practice. Whether out of necessity or philosophy...compromising thier own beleifs in order to care for "the many".

Take good care. To thine ownself be true.

[loved]

O.K. in aswer to your question: how to preserve your autonomy during the vaginal exam you don't want:

Don't wear thier silly paper or cloth gown. Wear your shirt and use the gon to cover the rest of yourself.
Bring someone you trust with you.
Insist that he tell you what he is doing and why and how the findings will affect the course of your care..and what are the alternatives.
Don't ask these questions when you are naked and lying on the table - the power differential is to great! Talk to him when you are fully dressed and sitting in a chair.

Just some thoughts. I realized my first post did not cover what you orignally asked for.

Love to you.

[lilyka]

Could you hold off until later in the pregnancy? Can you find our own backup doctor? (I am not sure what the law is cocerning consulting Dr.s).

Make sure you ask the Dr. exactly what he is going to do, what he will be using and what he is looking for. There is a world of difference in a pelvic exam from one dr. to another. The ones my midwife does are quick painless and to the point. Not such a big deal. There are others I have had that left me in pain and feeling violated. Also there is no reason to wear a gown (just keep your shirt on and cover the bottom with a blanket) and no reason to use stirrups.

If it is this big a deal to you and no comprimises can be made you might want to start searching for another healthcare provider. What if something does go wrong and you get stuck with this guy? If he wn't respect your wishes here the likely hood of him respecting you later is slim.

[XmasEve]

I hope I don't sound like a freak, but I refuse the drape at all. I just take my pants and undies off. And I keep up a dialogue with the Dr. the whole time. I just do everything I can to make sure the Dr. doesn't forget that there's a real person attached to those parts.

And I share your yuck about pelvics. After an awful exam at 9 weeks, I didn't do another until 42 weeks.

I'm keeping you in my thoughts and hoping for the best!

Meg

[SpiralWoman]

hi all-
thanks for the great feedback, I really appreciate your support. I am still undecided about my decision if that makes any sense. I still have a great deal of faith & trust in my midwife, but we are going to have to have another talk about this. I definitely don't do a good job @ playing the compliant patient & she knows that. For her it's not a problem, but I think she needs me to be compiant with this Dr & I just don't know if I can deliver on that. In fact I know that I can't without suffering for it on the inside, and that's no good.

I am also thinking about calling my regular Drs office & checking things out there. He is a DO & pretty naturopathic, although for some reason we seem to have what I perceive as a personality clash. Ah, me and Drs. That's why I thought I would avoid them. Anyway, it seems worth a try, and I know he won't want to do a pelvic!

I will let you know what happens, thanks again for the feedback, blessings, maria

[jordmoder]

ooh, Maria - this is a tough one. I can understand that this is a fragile relationship with your midwife, however, you have to protect yourself, too.

Have you had a baby before? What someone else mentioned is probably the so-called "reason" for the ob to want to do an exam - having an "adequate" pelvis. If a baby has come through your pelvis - it's adequate!

If you decline the exam - absolutely your right - what are the repercussions? Will your midwife get grief from the ob? Will the ob refuse to be her backup for your birth? Yikes.

Keep us posted, but follow your heart. If you feel you need to protect your sacred space, then, you do.

Barbara

[KeysMama]

Originally posted by SpiralWoman
I guess I'm looking for reassurance that 1 vaginal exam isn't that big a dealhmm, well it is pointless. He has nothing to compare it to, nor will he in the future. It is just to CYA on his end. I would politely decline. "oh, I will just decline on that" or "Well, I decline, and I am happy for you to note that in your chart"... , something polite, that declines, respects that it is what he likes to chart, or just come up with a fib " I had sex last night and I am sore, so I am gonna pass on that today" or " my midwife just checked me so I'm set"

It has no purpose, and he obviously knows that MW pts have their own mind hence why you are not his pt.

[Angiemama]

could your midwife go with you to the apoingment, hold your hand.. expalin whats going on...???

[gurumama]

could you stall to buy yourself some time to process this? you're sick, have to go out of town, forgot, etc.? it's doubtful they'd chase you down, and that would remove some of the anxiety of feeling like this decision *must* be dealt with *now*.

good luck,

mel

[SpiralWoman]

hey everybody~ here's an update on my sit.

I talked to my MW again today about this issue & asked some more questions about this pelvic. Since this is my 1st pgnancy that has gone this far, & so many people have such a variety of experiences, I guess I was more in the dark than I thought. My MW will be going with me. We will not be having anything like a pap, no speculum needed. She described that he will palpate the size of my uterus just like she does, except instead of having a finger externally on my pubic bone, there will be internal contact with my cervix. It does not sound like a risky, rough, or uncomfortable process. So, now that I know more, I feel better. Life is always like that for me. Also, the OB will meet me & we will talk before we have the exam, & he may decide not to do it.

As far as the whole balancing act of trying to comply with "the system" and still feel autonomous, I am still juggling this. The bottom line is this is not a "back-up" Dr, but this is the only "legal" way for a CPM in my state to get prescriptions meds for her pts. My MW again stated that she can get the Pit & Vit K "on the side" for me, but that she prefers to do it legally. Of course, we'll only be using these meds if they are needed @ the time, but I do feel I want them available in her bag for sure. The real difficult thing for her to get is the IV antibiotics in case we do GBS testing & come up + & decide to do the prophylaxis. I'm still undecided & have about 10 more wks before I get into that decision.

I have also made contact with my regular Dr's ofc, he is a DO & might agree to be her consult on record for me. Again, all he has to do is read thru her protocols & write a couple of scripts, so we'll see. I also found out that here in TN, our Licensed Midwives Board is under the Doctors of Ostopathy Board. I thought that was interesting. Independent Midwifery seems to be at such an interesting point in its continuing development.
thanks again for all the feedback & good suggestions, Maria

[shine]

Hey, Maria

I just wanted to add -- not that this will be helpful or anything -- I know a little of the situation you describe and all I can say is this:

Informed Consent -- it's the Law.

You do not have to protect the midwife's relationship with her OB -- that's her job. You do not have to have ANY procedure done without your express consent unless it is a proven life-threatening situation (in which case consent is considered "assumed", but that's a whole different kettle of fish). Your midwife, wonderful though she may be, might not understand that while creating a relationship with an OB neither she nor the OB have the right to decide for you which procedures you will or won't have. That is YOUR decision. That's the law. Please do only what your heart tells you is right for you. Listen to reason, of course. Gather information like you have been doing. But don't let your midwife's fears about her business push you into something you are uncomfortable with.

And now I feel like I've been "telling you what to do" so I'll shut up. Informed Consent is a big issue for me. And I do know how hard it is for midwives to find OB's. Nevertheless, your rights are still your rights.

Good luck, and if you want to talk personally... you still have my number?

love sandi