Why bother?

[bfoster2000]

I'm not being snarky here, I'm really trying to work this out in my head. There seem to be a lot of people on this board (myself included) who have a strong distrust of the medical establishment in general. Personally, I feel that distrust is justified, at least to some extent. So I hear people saying "I refused all prenatal testing" or "I refused all newborn testing/procedures" or something like that and I'm wondering, do you get any "prenatal care" at all? Why? I mean, if you believe that your doc/NP/midwife/whoever is an expert, then I can understand consulting them for advice, care, and treatment. But if you are going to disregard 90% or more of what they say, why bother talking to them at all? Does that make sense?

I really am asking this as a sincere question. I have my next CNM appt coming up and I know she's going to discuss my u/s results, measure me, weigh me, test the urine for who knows what, and try to schedule the GTT. I can measure myself but I really don't care...I'm pretty sure she'll tell me I'm big for dates and I'll say "so what" and go on with my life so there's no point to that. I can weigh myself but I'm not going to freak out about my weight either way (my CNM doesn't either) so again, not a big deal. I'm not sure what they're looking for in the urine but I'm pretty sure that if she did tell me anything was out of whack, I still wouldn't be terribly alarmed...the baby's obviously growing and I'm feeling the kicking and I feel fine so I think everything is ok. And I'm probably going to decline the GTT for a couple of reasons...I know she'll fight me about that but I still plan to decline. So why am I even bothering to go in at all?

I wish I could find a doc who was open minded enough to discuss my situation with me and give me personalized advice that I can trust, but if I know that most (if not all) of her advice will be based on "standard practice", financial considerations (the insurance company will pay for it so we may as well do it), or CYA, and I know that I'm going to ignore much of her advice, or at the very most take it with a few grains of salt and do my own research, what's the point?

The prospect of an unassisted birth scares me because I am still new to this and I want the comfort of knowing that there is someone else there who knows what's going on, but if I'm ignoring the advice of the "assistants", what's the difference? Hopefully that won't be as much of a problem with a homebirth as with a hospital birth, but still, every homebirth midwife I've interviewed has disagreed with me on at least something. I'm trying to rationalize that she is an expert in childbirth and I'm an expert in my own body and that makes some sense to me...but still? Am I the only one to wrestle with this?

Am I making any sense at all? Dangit this was not supposed to be this long and rambly!!

Barb

[lotus.blossom]

I'm catching your drift...... :)
Since this is my first pregnancy I'm all in awe of the whole process and am excited for my prenatals to get to know my midwife. Everything is new and exciting for me. I've refused most of the standard tests and procedures.....and now I'm finding my prenatals to be a bit of a bore. Its not like they actually do anything except check the heartbeat.......

I would really like to opt for a homebirth midwife next time around. I almost wish we could do it with this one but my dh refuses. With the cost of my insurance and our HUGE deductible it would probably cost the same to pay a midwife out of pocket. But dh is adamately against homebirth at this point.

Next time around we will be in a different state where homebirth is more prevalent and hospitals/birth centers aren't so local so it will make more sense to me, and hopefully to dh once he realises that birth is a natural process.

So I guess my answer to your question of why bother? For my husbands sake. I would be perfectly fine without the (cnm/medical) prenatal care. I trust my body. :wink

[Jish]

I don't feel that my doctor is a god. I feel that she is a person that shares the responsibility for the care of myself and my unborn baby. Overall, I'm a pretty laid back person and I don't get my undies in a bundle about the testing. I do the GTT and the GBS because my doctor feels those are important, but I refused the amnio (I'm AMA) and the triple screen and she's fine with those. As for the procedures done to the baby, again, I'm pretty laid back and don't take issue with the pku or the eye gunk. Frankly, I'd rather have a nice experience that feel like I'm fighting all the time, and I don't see these things as huge issues that will scar my child for life if they are performed.

I have had three hospital births and this one will be too. I've had two wonderful experiences and one that was less than great. That one was with a different doctor and I hope to never see her again. Imagine how you feel when you are pushed into having procedures done that you don't wish to have, even though you are educated about them. Perhaps that's how the doctors and nurses feel when they feel that their advice is being ignored. They don't know how informed you are and their goal is for a healthy baby and mom outcome. I'm not saying that you should give up what you want, but perhaps there is a different way to go about it. I read your other post, and that was awful. It's unfortunate that you went into early labor because I bet if you had gone to term it would have been a much different experience. I would go over it with your current care provider and talk to them before hand about how you feel and give your informed reasons why. The idea is to have both sides open to the other. You may learn something, and your hcp will certainly know you aren't making your decisions uninformed.

Personally, I'm all for homebirth, but I wouldn't do it unassisted. I have one friend who has had four children, but only the first and the last are living. her second ds died during birth from complications, and the third died from a heart defect that was detected hours after birth. I have a friend who developed severe preeclamsia at 35 weeks and had to be transfered to a hospital an hour away. I just feel more comfortable knowing that there is someone there who has experience greater than mine to help me if things go wrong, and sadly, they sometimes do. I want to know that doctor and have the doctor know me. I don't want their focus to be "why didn't you get prenatal care" in an emergency situation. My doctor is my partner, not my boss.

As for the appointments, my friend with preeclampsia had no idea she had it. She went in for her regular weekly appointment and the doctor caught it. It was severe and she was immediately taken to the hospital. Thankfully she was okay, but it was a very serious situation that she didn't catch on her own.

[turtlemama77]

I don't feel that my doc is the end all be all of all medical knowledge, either. This is why I choose to inform myself and have tried to learn as much as possible about pregnancy and birth. It certainly is a weird position to be in when I'm explaining something to a doctor (breastfeeding during pregnancy, for example) that he/she doesn't seem to have much knowledge in. My doc didn't know that I was as informed as I am about pregnancy and birth (and I'm not saying I know everything either), but as soon as she found out, she changed the way she presents things. We talk together about issues, she gives her opinion based on what she knows, and I ask questions based on what I've read. If I didn't have this kind of trust with this particular OB, I'd have switched by now. We've already discussed my birth plan, and I feel confident that we're on the same page.

For me, I don't know that it's so much a distrust of the medical community as a realization that I as a medical consumer need to be informed. I have in my mind the kind of birth (hospital here, too) I'd like to have, and am taking steps to make sure that my wishes are followed as much as possible. With my first birth, I was pressured into induction because my water broke. At that point, I didn't know things that I do now about being able to wait safely for labor to start, the risks and side effects of pitocin, and that I can say "NO" to things that I don't want done. When you know better, you do better, right?

Personally, I don't disreguard what my doc says lightly. If she tried to tell me something that sounded funny to me, I'd ask to see some information backing up her opinion, or I'd look for information on my own.

I don't know if I've answered or addressed your questions properly...I see the doc and my dh and myself as a team. The doc has certain knowledge, I have certain knowledge, and dh has certain knowledge. It's okay to question any of the above parties, I think. It's okay to make a choice not to have certain tests or procedures. Just because those tests are standard doesn't mean they're right for everyone.

[UnskulinMama]

For me, I don't know that it's so much a distrust of the medical community as a realization that I as a medical consumer need to be informed.

I think this is more the vibe, deep down, that I get from the MDC community as well. That plus the frustration that even when we *are* informed and educated... often when someone chooses to decline tests/procedures or do things differently they're treated by the medical community as if they're irresponsible and uneducated.

With my first pregnancy, I had no idea I even had the right to say no to treatment/tests/procedures :bang I love MDC for the fact that it's taught me that *I* am the customer and no matter where I give birth... in a hospital, home, wherever... I'm still in charge. I have the right to make my own decisions. I'm not anti-doctor or midwife. I will still seek their services, but it's because I value their knowledge or experience, not to just blindly follow orders.

Going to stop rambling now... :lol

[Gabe_n_Pippas_Mum]

With my first pregnancy, I had no idea I even had the right to say no to treatment/tests/procedures :bang I love MDC for the fact that it's taught me that *I* am the customer and no matter where I give birth... in a hospital, home, wherever... I'm still in charge. I have the right to make my own decisions. I'm not anti-doctor or midwife. I will still seek their services, but it's because I value their knowledge or experience, not to just blindly follow orders.

Me too! For the first birth, Ihad an ob/gyn who was a very nice lady. I wanted a hospital birth so that everything would be there in case something went wrong. I had NO IDEA how many things could/might/were done to me that didn't have to be done (breaking my water, the heart beat thing, no eating, etc) in teh hospital.

I'm a lot more informed this time. i do trust my midwife, and my doula. I also trust myself a lot more. We're having a home birth this time (God willing) and I have no doubt that I'll be able to do it w/o the epidural I had last time when I had my water broken and was lying flat on my back confined to a bed. I know it's a bit different in Canada b/c health care is publicly funded so the hospitals are not for-profit, but I think that western culture in general has followed a male-based method of "fixing" things that don't need to be fixed.

I don't think my ob/gyn was evil or stupid, she was just of a different philisophy than me and also has to cover herself from rising malpractice insurance. She was kind but very calculating. My birth was something that needed to be on a schedule for her. I don't personally think that's the best way, which is why we're going with a Midwife and Doula this time around.

I fall somewhere in the middle about other health stuf. I would rather get treated my my naturopath than my gp if possible, and we're into chiropractic as well. I think that medicine has become such a business, largely controlled by the pharmacutial (pardon the spelling) industry who seem to be the main educators of the doctors post med school! I'm not comfortable with that, but I do take perscription drugs for a condition that I haven't found another treatment for so I'm not sure what to think about all of that.

Just my .02.... :)

Beth :belly

[PancakeGoddess]

I view my midwife as the eyes and ears of experience. She knows normal birth in all its forms, and can recognize a problem when she sees one. I hire her because I can't do that when I'm in labor. She's got a wealth of information about pregnancy and she's fun, kind and motherly to me at a time when I need that.

She offers me many prenatal and birth options but requires very few. The things she can't offer, I can seek out through the local CNM practice, but again, I pick and choose what I need as I would a consumer of any other product. I trust their advice when I don't know enough to make my own decisions.

For some people who are just refusing left and right, my guess is they are dealing with inflexible caregivers and have no other options. I am fortunate to have a provider who is an expert on normal pregnancy and birth. I am an expert on my own body. Together we are good team, IMO.

Hope this helps :)

[mamacarla]

I go to my midwives appointments because I love that hour each month of visiting and bonding with them. Totally focussed on me and the new baby. Also for me it is just so reassuring to hear the heartbeat. I got the 20 week ultrasound because there are so many things you can find out and be prepared for and if there is no "bad news" then all the more to relax about. Unfortunately I am a worrier and these few things really help.

[ma_Donna]

For me, I don't know that it's so much a distrust of the medical community as a realization that I as a medical consumer need to be informed.
This is wonderfully stated.

I absolutely believe that the periodic checks and opportunities to ask questions and the development of the relationship with your care giver are important things leading up to birth. There isn't a big chance that something will crop up in the urine check, measuring or doppler, but on occasion, they do. But that's only a part of your appointment. I spend much more time talking to my midwives.

But, the biggest thing with having someone that attends births regularly is that there are just things that present themselves during labor and birth than having that experience can make a big difference.

Barb, I hope that you can find more comfort with a caregiver before your birth. The person that is there with you should be there in a partnership because birth is intense. Maybe read some more birth stories with a mind to how the Mom felt about their birth attendants.

[Quagmire]

I think this is more the vibe, deep down, that I get from the MDC community as well. That plus the frustration that even when we *are* informed and educated... often when someone chooses to decline tests/procedures or do things differently they're treated by the medical community as if they're irresponsible and uneducated.

With my first pregnancy, I had no idea I even had the right to say no to treatment/tests/procedures :bang I love MDC for the fact that it's taught me that *I* am the customer and no matter where I give birth... in a hospital, home, wherever... I'm still in charge. I have the right to make my own decisions. I'm not anti-doctor or midwife. I will still seek their services, but it's because I value their knowledge or experience, not to just blindly follow orders.



:nod

Two more things to add to this:

1. I think a lot of people here are angry because of past experiences. That is certainly the case for myself. I think a medical professional should be a lot more ... well... professional! Finding out that you had a negative/ traumatic/ painful experience due to the stupidity or ignorance of someone who should have known better can be really frustrating! Especially when we're talking about something as important as your body or your baby. It can lead you to question a profession as a whole, certainly, especially when you hear the same story over and over.

2. I think a lot of people are limited by financial circumstances as to the type of care they can seek. We all know that skipping out on prenatal care can raise some questions about your fitness to be a mother (forgetting that gee, that might be an educated decision!) and when it comes to homebirth or birth centers, a lot of people are forced to pay out of pocket. Some people simply can't manage it, so they are stuck with whatever care provider is in their network. And thus, the cycle of distrust begins :irked:


I think in general too many people treat doctors as though they know everything. They don't! They are supposed to know more on certain topics but they are only as good as the research they continue to do and the knowledge they continue to gather on their own specialty. I constantly hear stories from friends and acquaintances about things their doctors have told them that not only I disagree with but that even the mainstream community has proven to be incorrect or outdated. Perfect example: my dental hygienist told me this morning as she was cleaning my teeth that she was so glad her OB had prevented her getting a 4th degree tear by giving her an episiotomy. Gah! Even WebMD and BabyCenter say episiotomy is like, not a good idea, and tends to cause the very problem it purported to prevent. Yet here's an OB at a well-respected hospital telling all his/her patients that episiotomy is the way to go.

So while I've found a midwife that I feel will support my birth plan and decisions, it really irks me that other people continue to abide by silly advice from their doctors without questioning it, and that by doing so they are continuing the spread of misinformation.

Interesting thread!

[JoyofBirth]

As a student m midwife, I have a different view. I've been on the other side. The midwife i work with is very trusted and very trustworthy. She is very adaptable. IF the couple is hands-off, then she is hands-off. But for people who need her really in there, she is really in there. For our last baby, she agreed to pretty much just stand in the room and let dh and I do everything. And she would only jump in if things went terribly wronng or if dh freaked out. I think a big key is that you h ave to find a provider who fits you and your ideals. And like a pp said, who will see how eduicated you arer and communicate accordingly. I had to transfer care to CNMs and have a hospital birth with my last. I have seen many bad transports and heard many horror stories so I was quite frightened, but they were great and we had an awesome birth. I have assisted at many, many births and with even more pregnancies. There are soooo many things that can go wrong. They rarely go wrong all of the sudden. That's why there's prenatal care. Baselines are established for you and your baby (that's why there are things done at every appt, FHTs, BP, etc) and then these are used as a guide, along with general pregnancy knowledge. Slight variations can mean huge things are not right, but they can also mean nothing. For one mom, measuring ahead can mean nothing at all, but for another, it can be a sign of numerous complications. I have seen many babies born safely because they were watched while they were growing. I am not a supporter of UC, so you may want to take what I say with a grain of salt. When they check your urine, they are generaly checking for glucose, protein (which can indicate that you are not getting enough, as well as other problems), ketones, nitrates and leukocytes. These are early indications of p roblems in the body. What exactly is checked varies according to the practitioner's preferences. You should be able to ask what the test are and they should tell you. I think it's important to be educated and not just do whatever your doc or midwife says to. But they are coming from a very different place. Most complications have little red flags that are raised along the way, but it is shocking how quickly things can wrong. And it's not always obvious.

[SillyMommy]

I totally hear you on this. Which is why I've decided to have a homebirth with the best damn midwife I've ever met. :)

[midwestmom]

Like Jessica, I can see both sides as I am an NP, although I am mostly a SAHM since I am only working 2 half days a week:) .

As a person, I tend to be alot like Jish and Turtlemama77. I am fairly laid back and don't get worked up about many of the more noninvasive tests and do see the value in many of them. Although my specialty is not in prenatal care, I consider myself a very informed consumer and have been very comfortable in refusing certain tests like the quad screen. I trust in the medical team that I have hired to assist me in my pregnancy and birth. If I didn't, they simply would not be asked to participate. I don't expect them to agree with me 100% on everything. How many people do you know that agree with you on absulutely everything under the sun? I do expect to have a lengthy discussion on the things we disagree on in order for me to make a completely informed decision. If I feel my very valid thoughts are being completely disregarded or belittled, then I look to someone else to help in my care.

I have worked with many many drs, nurses and other health care professionals in the last 13 yrs and I agree, some really suck. Some really have their patients best interests at heart but don't have the same philosophy as I do. Some practice more similarly to me. I do find it unfortunate that one bad experience pushes one to disregard the medical community as a whole. There are many different types of people with many different philosophies that make up the 'medical community'.

Unfortunately, it is my experience that MANY people in America are not informed and don't care to be informed. I really appreciate all of the mamas here that are informed and willing to do their research. We may not all agree on everything and that is OK!

I am not willing to deny myself any prenatal care at all. I had severe pre-eclampsia with my first pregnancy and also had BP problems of less severity with my second. I had pre-term contractions with both as well. I really valued the prenatal care at that time even though I did recognize the signs of my conditions right away. I would also not be willing to do UC for a whole bunch of reasons, but that is a personal decision. I am all for homebirth, but it just hasn't worked out for me. I am so glad that many of you are able to do it. I really valued the sono I had b/c it diagnosed my twins and it is comforting to me to know that they were able to determine that the babies had their own placentas and I wouldn't have to worry about twin to twin transfusion syndrome for example. This condition can be treated in utero, but has a high rate of fetal demise if not detected and treated. The benefit of the things I learned via sono outweighed the risk to me. Others feel differently, and I respect that too. We all do what we think is right for us individually.

I know I rambled, but I also wanted to add that I really appreciate all of the respectful posts in this thread. I have watched other threads on other boards go sour on this subject very quickly and we just don't seem to do that here:love .