pdoc wants me to have a hospital birth and stay to monitor baby - Mothering Forums

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#1 of 13 Old 03-05-2010, 10:41 AM - Thread Starter
 
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I am on two types of anti-depressants and although the chances of baby having a withdrawal syndrome are approximately "4-30%" that means there's a 70-96% chance there will be no withdrawal syndrome.

I was one Prozac when gestating my dd2 and she was born without any problems whatsoever. So beautiful, lovely, everything wonderful.

I have planned a home birth for baby #3 and was happy to meet a new pdoc yesterday.... but she conservatively wants me to birth in hospital and stay there for 2-3 days to "get a few nights of good sleep and have the baby closely monitored".

My midwives and I have already discussed this. We will still aim for my home birth and if baby requires medical care we will transfer to the hospital. I understand then that we may then have to stay for 2-3 days with baby in NICU or with me in a mommy/baby ward.

But what if, like last time, everything is just fine? I told the pdoc that with all due respect, this has already been discussed, my MWs are trained to look for the withdrawal symptoms and have already discussed a transfer of care will be required should they appear. I informed the pdoc that the MWs are govered by the Ontario College of Surgeons and Physicians, the same body that governs physicians like her. They have a strict protocol for transferring care -- this would be one of those circumstances. They are trained to look for what's normal... and for what's not. They too want medical assistance if the baby needs it, they are not going to block it. I am 100% on board if baby needs it, then we're there.

But if it's not necessary.... I don't want to be there. Grumble grumble. I am not being totally closed-minded about it, and dh more conservatively prefers a hospital birth but ... The pdoc said she knows it's vastly different from what I planned for, and we still have lots of time to talk about it.

I still don't see why I can't have a HB and we transfer baby if it is required. The baby's needs will NOT be neglected. I am grateful for the psych care and referrals for Trauma Therapy and upping my happy pills but man.... grumble grumble grumble.

I am not sure if I should call my MWs before my next appt on March 29th to discuss this, or just wait it out. Grrr.

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#2 of 13 Old 03-05-2010, 10:49 AM - Thread Starter
 
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I will also add that I realize that I may require a hospital birth anyway due to transfer-of-care policies such as meconium in the water, distressed fetal heartrate, maternal exhaustion etc etc etc.

My last labour was 3 hrs long and I was breathing through/holding back pushing through the urge to push for close to an hour. It was really ridiculous to travel to the hospital, she was born 20 mins. later. I figured next time I could just push this baby out at home as my body wished. Yk?

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#3 of 13 Old 03-05-2010, 11:10 AM
 
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Its a hard call too me...to me PERSONALLY if those stats and everything were in my case and there was a 4-30% chance baby was going to need immediate medical attention from trained pediatricians I would have to say I would not be comfortable birthing at home. you could say its a 70-96% chance of no help needed but idk...to me it seems pretty high....I don't know dear it seems like its going to be a really hard personal choice for you and dh. I know if it was my hubby he would want the hospital birth (lol, he already does, but he is a stresser/hypochondriach type!!). And for me even though its my birth my body etc...Its still his child and I am his wife and he only has our best intrests at heart so his opinion has the same count as mine in decision making like this....
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#4 of 13 Old 03-05-2010, 11:40 AM - Thread Starter
 
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This article gives the stats as "about 6 to 12 cases per 1000 women"
http://womens-health.jwatch.org/cgi/...ull/2007/426/1
which is significantly lower than what that pdoc said off the top of her head.

I am going to talk to my midwives.

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#5 of 13 Old 03-05-2010, 11:55 AM
 
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i've had 2 hb's on ads. no issues. your mw will be able to tell if babe needs more intervention before itt's an issue.

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#6 of 13 Old 03-05-2010, 12:00 PM
 
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My psychiatrist is not amused with my homebirth plans either. However, I stopped taking my meds as soon as I suspected I was pg so that won't be an issue for us. If you can find more info/studies supporting the much lower %%% then I'd rest easy with your homebirth decision.

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#7 of 13 Old 03-05-2010, 12:08 PM
 
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DDC crashing.

Would you be able to see another pdoc, just for a consultation regarding this issue?

It is awesome that you live in a state where MWs are able to practice like that!

SAHM to a crazy little boy (4.5) and a silly little girl (3) and my VBA2C babe
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#8 of 13 Old 03-05-2010, 12:43 PM
 
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How urgent is it to get the baby to the hospital if the baby is going through withdrawal? Minutes? Hours?

To me, that would make all the difference. Something like maternal bleeding or fetal distress needs to be taken care of within minutes. You may not be able to get to a hospital, get evaluated, and get to an operating room before damage has been done in the worst of cases.

But if you have hours and the midwives are trained to look for symptoms of withdrawal, it doesn't seem so scary.
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#9 of 13 Old 03-05-2010, 12:57 PM
 
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The most commonly observed symptoms were tremor, increased muscle tone, sleep disruption, gastrointestinal disturbance and high-pitched crying. In the infants who exhibited severe symptoms, the symptoms were most severe within 2 days after birth. No infants with symptoms required any specific medical treatment.
http://www.womensmentalhealth.org/po...osed-to-ssris/

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#10 of 13 Old 03-06-2010, 06:59 AM
 
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Where exactly do these percentages come from? In all of my reading (I'm on an SSRI), I've yet to come across any real hard facts. Mostly just anecdotal evidence here and there which all points to little of concern. Now, I'm sure some of it depends on what exactly you're taking, but I know my midwives were 100% not concerned. And my therapist supports me as well (though different than a pdoc, I suppose).

I also agree that I'd like to know WHAT exactly is the concern. Maybe he's really worried about you (the "good night's sleep" comment and all, which is a "yeah right" no matter where you birth). In which case, wouldn't you be more comfortable at home? I'm not trying to persuade you here, but that's just where my thought process went. You just have to do what you think is right.

Weirdo Mama to amazing Aurelia, age 9 & Ember Roslyn, age 3!
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#11 of 13 Old 03-06-2010, 12:25 PM
 
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I have been on prozac or zoloft for all of my pregnancies and no one has ever been concerned about medical attention for withdrawal symptoms. I certainly wouldn't let those symptoms keep me from having a HB. The PP is right, they don't seem to require any medical attention.

Christina, loving being a Mama to three and serving as a Co-Leader of the Holistic Moms Network, Tri-City Area, CA Chapter.

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#12 of 13 Old 03-06-2010, 07:28 PM - Thread Starter
 
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Originally Posted by bjorker View Post
Where exactly do these percentages come from? In all of my reading (I'm on an SSRI), I've yet to come across any real hard facts. Mostly just anecdotal evidence here and there which all points to little of concern. Now, I'm sure some of it depends on what exactly you're taking, but I know my midwives were 100% not concerned. And my therapist supports me as well (though different than a pdoc, I suppose).

I also agree that I'd like to know WHAT exactly is the concern. Maybe he's really worried about you (the "good night's sleep" comment and all, which is a "yeah right" no matter where you birth). In which case, wouldn't you be more comfortable at home? I'm not trying to persuade you here, but that's just where my thought process went. You just have to do what you think is right.
She gave me the "4 to 30%" off the top of her head. For my next appt with her I was considering attending with some studies printed out and with some real data and evidence.

Over here, the current research advocates to prevent PPD and/or treat it by protecting sleep -- making sure a mother can sleep at night and have someone else help with the feeding.

I do not WANT to do this, after my babies were born I always stayed with them, nursed them, etc. I will say that after dd1 was born she was colicky, we had horrible nursing problems, I hardly got any sleep because of pumping around the clock as well as feeding and trying to nurse. This was horrible for my mental health and I had some serious problems with rage. It was quite damaging for my family for awhile. I never want to go back to that situation again. The difference I am medicated now while I wasn't then. When dd2 was born she was really chilled out, we had some nursing challenges but overcame them. We slept WELL (as well as you can in the early weeks with frequent nursing).

After dd2 was born, we made sure dd1 slept over at gma and gpa's house for a couple of nights, so dh could just focus on mommy-care and that worked out well. This time I intend to have both girls at gma and gpa's for a couple of nights after this baby is born, so I won't need to be at the hospital for peace and quiet, and to be mothered.

The psychiatrist asked me, "What if this baby also has colic?" Now, I know me -- if I don't get enough sleep I have horrible problems with irritability and rage. *IF* it got to the point that things got ugly ugly ugly, then YES, I WOULD consider some nighttime help. I don't want to put my family through life again with me not functioning well, yelling too much, freaking out, etc. NOT good. With dd1 I was determined to do things by the AP book, but there was a cost.

Anyway, I'm rambling. I intend to stay home if it is not medically necessary.

This is the thing that pisses me off about the medical establishment. They worry about the Worst Case Scenerio and then treat everyone the same, as if it IS going to happen to them.

Okay that's me done now.

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#13 of 13 Old 03-07-2010, 07:51 AM
 
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This is the thing that pisses me off about the medical establishment. They worry about the Worst Case Scenerio and then treat everyone the same, as if it IS going to happen to them.

Okay that's me done now.
Right, and it's very similar with pregnant women. Everyone gets treated like a moron and told exactly what to do, just in case you happen to BE a moron. I was just going through old papers, including some of the baby-related pamphlets and papers I received with dd from insurance, the state, the OB's office, the hospital, etc... and I find them all to be almost offensive. I know some people really are clueless and need prenatal and infant care spelled out for them, but treating everyone that way is ridiculous. Anyway, my point is that you're dealing with both at once... the helpless pregnant woman and the medical patient. At least you have midwives on your side that hopefully know better.

Weirdo Mama to amazing Aurelia, age 9 & Ember Roslyn, age 3!
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