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My client's practitioner is INSANE. No, really. I have a bad feeling here. VENT.

740 Views 10 Replies 8 Participants Last post by  Emilie
I've posted about this client before, the one whose midwife wants to induce on her due date because she's SURE it's a big baby (how she's so sure, I have no idea.)

A little history: client is a very large woman, at least 5'9" and probably 300lbs. Measuring about 4 weeks ahead, u/s only shows one baby, a lot of amniotic fluid but not polyhydramos. Again, this client is a big girl. I weighed 275lbs at the birth of my #3 and I measured 2-3 weeks ahead and dd was only 8lbs4oz.

Anyway, my client saw a backup midwife for her 38w appointment. This midwife INSISTED that my client needs a c-section even though (1) the baby is LOA (2) she is already dialated and effaced (3) the fht's were perfect (4) she told my client that she has a large pelvis.

WTF?!?!?! Why does she need a c-section then????? If everything is fine, and she has a nice large pelvis to birth a possibly-but-probably-not large baby, what is the problem?!?!?!

She also INSISTS that my client see the doctor in the office, and not her usual midwife, for her next appointment. She actually went up to the receptionist and told the receptionist that this client was ONLY to be scheduled to see the doctor.


My client is REALLY upset. I asked her what she thinks. She thinks she CAN birth this baby vaginally, and she does NOT want to see the doctor. I suggested she call the office tomorrow and cancel her appt to see the doctor, and schedule an appt to see the midwife.

*Throwing hands up in the air* All I can really say is WTF?!??!?!?!
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Why is your client staying with this practice? Ultimately, its her choice but it sounds like this practice has their mind made up...which means they'll be more likely to call 'fetal distress' or 'failure to progress' or 'too big of a babe to fit' in labor right away.

I think letting your client know she can refuse anything is impt, as you're doing. Based on her body type, measuring ahead is normal for women of size.

To me, the situation feels like, unless she stays home until she's pushing, a cesarean waiting to happen.

I'm sorry she's going through this.
It sounds like this backup midwife has some prejudices and is trying to keep your client from seeing the slightly less insane midwife because of that. Unfortunately I don't know what you could do other than pointing out to your client that she's being bullied and doesn't have to take it.

I'm so sorry for you. I mean, I'm sorry for your client too, but at least she could take more action, you're the one stuck knowing what's going on and not being able to do much about it.
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Thanks ladies.

I talked to my client and encouraged her to trust herself and the process of labor and birth, and that if she believes she can vaginally birth this baby then she CAN! And guess what -- she believes she can do it!

We discussed how there seems to be no medical indication for a c-section, so why on earth is a midwife suggesting it to her? I reminded her that she has the right to say no to any medical procedure, to ask about the pros/cons, ask WHY, and ask if there are other options. And a doctor or midwife has to explain it! Assuming a big woman is having a big baby is not a reason for a c-section.

She is calling tomorrow to cancel her appointment with the doctor and to schedule an appt with her usual midwife, who is slightly less insane.

I'm more calm now. Sigh. Sometimes I feel like Chicken Little, yelling, The sky is falling! The sky is falling! and everyone thinks I'm crazy. It's so frustrating -- I'm in this really small town where the midwives don't even TRULY practice the midwifery model of care. I wouldn't give birth here unless a gun was held to my head.
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Geesh! I hope everything works out wonderfully for her!! What a crappy midwife!

Namaste, Tara
That's so crappy! I was 300lbs with DD1 and nearly that when I had DD2, both had no problems being born naturally, and both were small babies (5lbs 10oz and 6lbs 12oz) despite *measuring* big. With DD1 I was told by my OB when I was only 8 weeks along that IF I managed to carry to full term I would HAVE to have a section because I was so fat. WTH?! Needless to say I switched to a midwife and went on to have a picture perfect pregnancy and birth.

I'm glad your client believes in herself... that's the first step!
of course a 300 pound woman is gonna "measure" big..She's got a huge ole' bunch o'FAT on top of her uterus........(not that im fat bashing, I'm ...uummm.."squishy" myself)...WHY doesn't the midwife know that? Seriously? Does she not understand that FAT TAKES UP SPACE??? My midwife understood that. Anyone with half a brain understands that, right???

This sounds like a FAT-PHOBIC practitioner who should certainly NOT be hired/used and who should be ASHAMED of herself.
ugh... i am so glad you are there for her! good for her! she will just have to prove them wrong.... can she go in with some facts for them? so sad.
Pam/midwife (and those who want to know what crappy town I live in):

I am in Yuma, AZ, which is a very small town. A small town is fine but there's really nothing else around here. You have to drive 3 hours east to get to a big city (you hit outlying Phoenix after about 2.5 hours) and 3 hours west to get to another big city (outlying San Diego) and there is literally NOTHING in between (unless you count two little gas-station towns that are even smaller than Yuma).

We are a one-hospital town, and lemme tell you about labor/delivery triage.

Women who are in labor are evaluated for at least an hour in the "labor lounge" -- and are allowed only one visitor until they are assigned to a room! Which means I cannot practice continuous care, because my clients usually want their husbands with them in the "labor lounge." So I'm separated from my client for at least an hour, during which time she's getting checked, "traced," evaluated, given an IV, etc. If she happens to go in while she's crowning, then she has the baby in the "labor lounge" without me present, because you can only have ONE PERSON in there with you. No exceptions. *Le sigh*

When she finally gets assigned to a room, she can only have 3 people with her at a time. No exceptions. I'm lucky I get any clients at all, in my opinion!

So: we have only 5 ob/gyn offices here, all of which have at least one midwife on staff, but we do not have ANY midwife groups who aren't attached to an ob/gyn. So, every midwife works with a doctor. I have yet to see a midwife who truly practices the midwifery model of care as it has been explained to me, and as I've read about.

We have one midwife who attends homebirths -- but verrrrrrry quietly. She does not advertise. I only know she attends homebirths because she happened to be with a client when I mentioned that I want a homebirth someday for #4 and afterwards she pulled me aside and WHISPERED "call me."

I'm re-reading this and realizing that I'm really venting about the "system" in which I have to do my life's calling, and how frustrating it is for me. So thanks for reading it and allowing me to vent about it. I feel a little better now.
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it is so important you are there. i too have been in a small town much like what you describe in appalachia---- no good,......
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