[doctorjen]

How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?

 

[Persephone]

For me, it was an innate thing. I was told once when I was younger, that I would HAVE to have an IV when I gave birth. (I hate needes.) I thought, "NO I won't!" They made two erroneous assumptions: a) that I would birth in a hospital, and b) that I would be required to have an IV if I DID give birth in a hospital. I also was told that epidurals were needles in your SPINE. Ack. Eek. No! And that with one, I would have to be TOLD when I was having a contraction. Uh, ain't NOBODY telling me when to push! All of those were things I thought at a very young age... like high school and younger. I had also heard about water birth from somewhere, so I googled it one day, and found my way to Laura Shanley's site. From there, it was easy to make the jump to homebirth. So, basically fear of needles, and extreme distrust of docs (ironically, my distrust of docs came mainly from the fact that every time I visited the doc, it was time for another shot... and all he did to make me well was give me penicillin when I had strep.) led me to do my own research. I also think that it's in my nature to look things up and research them. Birth happened to be one of those things... and it ended up being life changing.

 

[Jenne]

For me the choice to do the research and take responsibility for these decisions was not a choice. When I make decisions in my life--be it what car to buy, whether or not I bought a house or rented, where to go to school, what to see when I travel--I talk to friends, family, read books, go online and research, ask questions, figure out what I want and then formulate a plan. I think there are a lot of people, not just women, in the world who make decisions spur of the moment and off the hip or *don't* decide and therefore don't have any responsibility if their decision turns out different then they wanted, sort of a "whatever" attitude. Why should pregnancy and childbirth be so important that you spend more time thinking about it then choosing a car? (joke) I don't think there is anything you can do beyond providing booklists, actual books, and asking/answering questions in an honest and open manner. People have to come to their own realization that they need more information. It also occurs to me that *most* women have had some exposure to pregnancy/babies/children either from family or friends and think that healthy pregnancy and successful, happy motherhood just happens. How hard can it be? (also joke) Also, lots of people have blind faith in their Drs. and are concerned about being "good" patients. There was a post here about "doing what the Dr. says" which is a mainstream thought all the way. If you are dealing with mostly mainstream patients they probably have this idea too. I imagine that there are some women who read the books you recommend and take to heart your open ideas which leads them to a wonderful birth. You should congratulate yourself on reaching out--even if it isn't always received.

Just my thoughts.

Jenne

 

[Kabes]

I had my first baby at a birth center (w/ a MW) and my second was a planned hospital birth with a midwife. I'm preggo w/ #3 and I really want to go for UC (attended is not an option due to finances), dh wants to go 'somewhere'.

My mother had two c-sections. W/ me (her first) b/c labor had lasted almost 48 hours and I wasn't engaged. My brother's delivery I'm assuming was b/c thats the way things were done (Once a section always a section).? I'd ask her but she passed away when I was 18. I know my mom always said c-sections are major surgery. - #1 reason to avoid this at all cost (in my mind).

During paramedic school I saw 2 sections and about 5 vaginal deliveries.
-The first section was with an epidural. Not so bad but she was draped and it almost seemed like she wasn't there!!! Then they pulled her uterus out onto the sterile field to start closing her up - 'NO WAY! NO WAY! I'm never letting that happen!' They took the baby to clean it up before they ever showed it to the mama- 'nope thats my baby, sorry I want to see/hold/touch it before anyone does anything to it'.
-The second section was w/general anesth. and it was horrible. The baby was very flacid and they had a hard time getting him to breathe. I don't know when that mama finally got her baby but I do know MANY people had seen/touched/held him first - 'no thanks'.
-The 5 vag. deliveries all went fairly smoothly, I'm almost positive everyone was w/ an epidural. I don't remember any complications (cord prolapse, hemmorage). No episiotomies either but a few did tear, none severe. All were delivered in stirrups-'no way does that look right"

Then I delivered a baby in the back of an ambulance. Just me and the mama. No meds of course. She was so scared (so was I). I talked her through it - I was praying HARD! I was the first one who ever touched that baby. (crying now at the memory) That experience is on my top 10 for sure. (too many thought & emotions to get into but they were all great)

When I got preg the first time I knew I wanted the "back of the ambulance" type thing rather than the delivery room or OR thing. The more I researched the more I began to understand what I had seen in the hospitals and what had happened in the back of that ambulance.

My MWs both ended up being more into interventions than I would have liked. I know I can handle this myself at home. Now if I could only convince DH.

This is soo long- sorry. I'm not sure how you can apply it to your practice either. Maybe if mamas to be could watch different kinds of labor & deliveries on a video. Maybe a you or another Dr. could write short commentaries about what is happening to go with it??

 

[oceanbaby]

I've always had this approach with medical care, and like another poster mentioned, with almost all decisions in our life. I guess it comes from the basic belief that no one else is going to care as much as I will. Kind of like "If you want the job done right, do it yourself." Plus, my parents were like this with medical care - always questioning docs if it didn't sound right, doing their own research, etc., so it's just second nature for me to do it. Dh on the other hand, didn't grow up like that. He grew up with parents who just did what the good doctor told them to. It was a real mind twister for him to look at it from a different angle.

It's kind of like the lesson dh and I learned when we bought our first house. It was a fixer upper, and we knew nothing about home repair. We would hire these 'experts', and as they were working, we'd say something like "That doesn't really look right" and they'd say "Oh, don't worry, it will be fine when it's done." And we thought, well, they're the experts, what do we know? And each and every time, it was screwed up, and by then it was too late. When we had the hardwood floor guy refinish our stairs, he asked if we wanted oil or water based finish. When he was done, we complained that the stairs didn't match our floors. He said "Well, that's because your floors were done in an oil finish, and you chose water finish for the stairs." Well jeez, why didn't you tell us that?

Why? Because it's not HIS house. He's not a bad person, but he just doesn't care as much. So now dh and I try to do as many jobs ourselves as possible. Even if we don't know much about it, just the fact that we care enough to research our options, talk to different people, try out different samples before doing the whole room, change approach in mid-job, etc., means that it almost always turns out better than if we had turned it over to the 'expert.'

And that's how I feel about my body. Some things you need an expert for. Rewiring the house, putting in new plumbing, dealing with pregnancy complications, or surgery - call in the expert, that's what they're there for. I'll still be there asking questions, but will hopefully hire someone that I feel confident about trusting. But for painting the wall or caulking the sink or which position to push the baby out or whether I can eat during labor - I am more than happy to take responsibility for this. I know I can do a better job, simply because it is more important to me that it is done right.

Am I making any sense? I think it's kind of a general approach to life, just more critical when it comes to medical care, IMO.

But I understand why people don't do it - because it sucks to be the person left holding the bag. It's so much easier to just close your eyes and hand over power to someone else. That way, if something goes wrong, it's their fault, not yours. Plus, you don't have to think about it. Thinking is hard. Thinking is unnerving. It makes you question yourself, doubt yourself, challenge yourself, face issues that you don't want to face.

I personally don't know how to do this way - couldn't do it even if I tried. But there have certainly been times that I have been a little jealous of people who are happy living in such an ignorant state. Ignorance is bliss, right?

 

[Mamid]

I've done the "whatever you think is best doc" and ended up with a permanent split in my right labia minora. I also lost a baby because of that.

The next one, the doc got down right beligerent when I was educating myself telling me that the internet is full of liars and theives who don't know a thing about childbirth. That it was his way or the highway. That the books I brought were worthless (Goer's for one). That "he didn't feel comfortable" catching a breech even in a multipara because of "some study" (the hannah one) but my refusing to do a section because of that was yet another way of saying that he was fired. No wonder I was skirting the edge of pre-e by the end. One leg had swollen up to look like an elephant's and the other one was threatening it. And I couldn't wear my rings AND my BP was rising...

This time.. I have a midwife and so far she's borrowed one mothering mag and I think my copy of The Thinking Woman's Guide. She's just radical enough for my liking without being too radical.

If I ever have to go back to docs for births it'll be snowing in Hell.

 

[Aura_Kitten]

: doctorjen.

So, what motivates you mdc mamas to assume responsibility?

i guess i tend to take responsibility for my own education in all aspects of my life. i very rarely ever go head-first into anything without fully researching it. (example: although i had wanted a pet rat my entire life, before i committed to adopting one, i researched rats and rat care for about six months.) i've always been a bookworm, and a geek, sharing the "hacker personality" with my best friends ~ the drive to question everything and seek knowledge constantly.

growing up, i had a great deal of very bad doctors. the HMO we were with was complete crap. i had a number of very bad experiences during hospital stays as well as regular doctor visits. even when i was old enough to start researching health issues and trying to get into a good discussion with my doctor(s) they didn't listen. five minutes into the appointment and they'd shoo me back out the door.

finally i got different insurance, moved, and started seeing two new doctors ~ one at a family practice, and my current OB ~ and i was, by then, so fed up with doctors and so jaded toward the medical industry as a whole that i made it clear (loudly clear :LOL) that i wasn't going to take any bullsh*t. i let them know that i was taking charge of my own health care and that i knew my own body better than anyone, because i had lived with it for a pretty long time. i made my beliefs known from the beginning.... and they actually finally listened to me and took the time to discuss my health problems, my history, questions i had... and finally they said that they were happy to have someone who seemed so knowledgeable and was so willing to play an active role in their own health.

the experience i had with my new doctors reassured me that not *all* doctors are awful, but also that patients have a huge responsibility to themselves, to educate themselves before they ever step into a doctor's office.

with respect to birth, i think ~ in this country at least ~ that since it's such a cultural norm for women to just do whatever their doctor(s) tell them during pregnancy and birth, and give birth in a hospital and put themselves and their children at the complete mercy of the medical industry, it really doesn't occur to most women to even question anything. think about the best-selling "guide" to pregnancy and birth -- What to Expect When You're Expecting -- which only reinforces that women should not ask questions and should do everything their doctor(s) tell them. even the relatively progressive (yet still mainstream) pregnancy magazine Fit Pregnancy advises women to obey their doctors and do whatever they're told, because ultimately "doctor knows best."

i think the only reason i really started questioning the standard medical model of birth at all was because i had been through so many bad things with my doctors already, and because my sister had at that point had one very horrible experience with our HMO hospital during her first birth. i really think that if i, and my sister, had been through nothing but great experiences and had nothing but great doctors, my choices would certainly be different and i'd have very little problem accepting whatever the doctor(s) told me to do.

also, after reading all of the birth stories on Laura Shanley's site, i really began to see that labor and birth really isn't a medical process. pregnancy isn't a disease ~ if it was really something to manage and freak out about, the human race would not have survived.

What do you think I could do to encourage mamas IRL to do the same?

short of reinventing how this country views labor and birth.... i don't think you can do anything more than you already are. if you are providing them with the resources to educate themselves, and they are not... there isn't any more you can do.

maybe get them all subscriptions to Mothering magazine?

eta ~ Mamid

s i am so sorry to hear about your injury + loss.

 

[applejuice]

Ditto to all of the previous posts.

Oceanbaby, you are making total sense to me!

ITA with everything you say.

DRJEN, I am sorry that your clientele just wants to arrive at your office and let you take charge...that is the American culture, and I am sorry that women feel that way. I know I ran into this thinking when I was first pregnant and most people just told me to leave everything to the doctor and "they'll take care of everything; that is their job. They know what they are doing."

I did NOT want them to take care of everything!

The reason I had my children at home is because I knew I would have to live with the decisions for a lifetime made for me at the moment of my baby's birth.

I like Oceanbaby's analogy of "experts" doing things for you. "Don't worry. I've done this a thousand times!"

:

No one cares as much as you care about your own house, your own car, your own body, your own family as you do. This is why I had my babies at home, breastfed them, cloth diapered them, homeschooled them, and made my own clothes when I had the time. I took full charge and full responsibility for all of the big events in my life. I have also done my own house repairs when I had the time and $. I also know my own body better than anyone else since I have lived in this skin for all of my life. so if something is going wrong, I should know first.

Lastly,

I did not want my child to get mixed up with another baby in the nursery. I wanted my baby! People make mistakes and I do not want any made with my baby!

 

[doctorjen]

I think I personally am a lot like a lot of you. When I was expecting my first, even though I was 16 when I got pregnant with him, I read everything I could get my hands on about birth. It was actually this reading and learning that developed my interest in medicine. I don't think I would have ever gone to medical school if I hadn't had a baby first and learned so much preparing for that birth. I didn't have the confidence then that I have now, so that birth didn't go 100% the way I would have liked, but overall it was an empowering experience.
I think that is what bothers me the most - I know that childbirth is a momentous life experience, and that you are never the same after you have created another human being. Birthing my children affected my whole life! It bugs me to see women think of pregnancy and childbirth as just some thing you get through to have a baby.
Occasionally, I have a well-prepared mama, and it is a joy to work with them. One lady was so defensive at our first interview visit, that it was great fun to see how shocked she got every time I agreed with her about things that every other doc in town had told her were crazy (you know, really radical things like no episiotomy for a primip, or laboring upright, sarcasm intended.)
Then recently I had a mama bring that danged book (What to Expect . . .) into the office and read it to me, to argue that my extremely restrictive use of episiotomy was wrong, because it says so in that book

If I could just convince everyone to read just one different book, maybe?

 

[mamalama2 2]

I think a lot of it stems from the fact that a lot of us are brought up to believe the "Dr God" myth. We tend to allow our doctors and hairdressers to yell at us (did you trim those bangs yourself??

) They're the experts...

My journey began after the horrid birth of my 1st. The typical cascade of intervention began with induction at 41 weeks at 0cm/0% due to low fluid. I thought we'd prepared by reading a few books (not the good ones, I know that now) and taking a lamaze class, which ended up being a "how to be a good little girl in labor" class. I missed a C my the skin of my teeth, and vowed to never have more children because of the experience.

Well, four years later, dh changed my mind, and there I was, pregnant and staring down the barrel of labor - that's how I felt even though it was 8.5 mo away. So I began my own education. Went toe-to-toe with a couple of the OBs in the practice, and did things my way in the end because the hospital was respectful of my birth plan, and the doc only came in to catch and stich (tore - long story). Lauren was born (on her due date) as close to what I wanted as possible in a hospital, based on what I knew then. (dh insists) (BTW - I delivered at the hospital that Amber Marlowe ended up delivering vag. with no problem after leaving two Wilkes Barre hospitals that were insisting she have a C!)

Enough rambling LOL!

 

[jplain]

doctorjen, I'm heartened to read your post. Your attitude is exactly what I'd want in a physician, and I completely understand why you'd practice more interventively with women who won't take an active role in their pregnancies. Out of curiosity, how do you take it when well-informed women wish to skip routine procedures that you are personally in favor of?

Like many of the previous posters, I took responsibility for pregnancy and birth because that's the way I do everything. However, I wasn't quite so independent-thinking going into my first pregnancy. Sadly, that pregnancy turned out to be a partial molar. The experience changed me a lot. I really wanted my next pregnancy to be a 9-month long celebration of my body doing what it is supposed to do. What better way to achieve this than to learn all about what is going on?

But I think it'll be an uphill battle with your patients for cultural reasons. Taking responsibility for pregnancy/birth is just not the norm here. Just flip on any of The Learning Channel programs involving pregnancy and L&D, and you'll see what I mean. I wish I could suggest a short, insiring reading that would encourage your patients to inform themselves, but none come to mind. Just keep pushing your favorite reads! Oh, and maybe it would be worthwhile to highly recommend childbirth prep classes that you think would best prepare women and their partners. If classes are taken earlier in pregnancy (ie. in early 2nd trimester), they might have a profound effect on decision-making in both pregnancy and birth.

Carolyn

 

[ebethmom]

doctorjen - I'm sorry to say that I could have been one of those patients for ds's pregnancy. I thought that I was on the right track when I picked an all female OB/GYN office. Then I was surprised to find that I would need to rotate through TEN doctors during my pregnancy. I never did meet one of the OB's. And the youngest, most abrasive OB had the honor of telling me that I had preeclampsia and they would need to induce immediately.

Sure, I read their handout that stated "if you choose the Bradley Method of childbirth, you should find another practice." But I didn't know that meant I should run the other way!

I thought that I was reading and getting ready for my baby. I didn't even know what books to look for. I hadn't discovered MDC. I didn't even realize that an unmedicated birth was desirable until my third trimester. Thank goodness we had a Childbirth Class instructor who believed in natural childbirth!! She invited a group of doulas to one of the classes, and I knew that was the way we would go.

I wish that I had the midwife care then that I have now. There are so many different choices that I would like to go back and relive.

I do think that I was educable! I wish I'd had the type of care that you offer your clients. A book list would have been so welcome. My OB's recommended the "What to Expect" books.

 

[2+twins]

I took responsibility for my births I think in large part because I am a control freak and, well, knowledge is power, right? Of course the more I learned the more I realized that it was for ME to be responsible for (not anyone else). But also I think that a lot of it had to do with the fact that I was desperate to be a mom - and a good mom at that (didn't love the way my parents parented so I had to do better). I had been real diligent to wait until I felt the timing was right for me to be a woman prepared to give her all to a child - emotionally, etc. I dunno - it was just something that had been so incredibly important to me every waking day of my life from the time I was about 14 that when I finally got the opportunity to BE pregnant (after awhile of infertility to boot), I jumped all over it. I think the infertility was part of the reason I took charge - gave me lots of time of baby-wanting in which - to fill the void of lack of pregnancy - I looked at anything baby related I could get my hands on. It was all very mainstream research until I was actually pregnant though, but it was still a lot more education than I see from a lot of moms-to-be.

On how to help motivate your patients to be more hands-on with their pregnancies, I think that you should stress to them that this is THEIR pregnancy & birth and you are there to help see them through it. But ultimately they are the boss and you'd love to be presented with their questions, wishes, and concerns so that you can help shape their experience into what THEY want it to be. Really try to put the ball in their court. You said you give them the reading list which is just wonderful, so maybe a reminder that you have those books available in your waiting room would be a good nudge. Also, maybe just by asking each woman if there's a facet of birth that she's particularly interested in or fearful of - you could recommend a specific book or even a chapter in a book and get her to read at least that. Really, there's probably not a whole lot you CAN do, but I think that it's great that you want to try. Most of your patients are probably just not accustomed to having any say in their medical care, so perhaps it hasn't dawned on them that you WANT them to have a say in it! If only they'd understand how much this birth can/will impact the rest of their lives! It makes me sad when women take such a passive role to life's greatest event. I think you said it well here...

Quote:

Originally Posted by doctorjen I know that childbirth is a momentous life experience, and that you are never the same after you have created another human being. Birthing my children affected my whole life!

Share that with them and let them know how this stage of their lives is what helps prepare them for parenthood! Good luck - you sound like a wonderful birth attendant!

 

[Breathless Wonder]

For me, it took stuff going "wrong", and being mistreated.

Now, it just blows my mind. Yesterday, I was talking to my neighbor. Her neice is pregnant, and had the quad screen a few weeks ago. Got a false positive.

I told my nieghbor, "You know, most people take the test for the following reasons...and I declined the test because..."

And my neighbor said, "The test was mandatory!"

I said,
"None of the tests are "mandatory".

 

[Mamid]

I might have lost that one, but I was smart enough at 18 to say no to a "mini-c" when they wanted to take the baby because of placenta previa and placental abruption. Saying no saved me from future ceseareans and I didn't even know it at that time!

 

[Kiki Runs]

Well, I was lucky enough to have found MDC and have learned a bit about natural childbirth before the knowledge became necessary. I became "militant" (my husband's words) during my pg b/c at nearly every pre-natal appt, the OB gave me wrong information (Thank you, MDC, otherwise I wouldn't have known it was wrong).

Every appt that I receive erroneous info encouraged me to come home and research THAT specific topic and whatever else I could learn about.

In the end, I ended up w/a c/s, which I also take (partial) responsibility for.

I think it's pretty ironic that as a result of my (s)OB's "excellent care", I am now determined NEVER to birth in a hospital or under an OB again.

 

[doctorjen]

I think I'm going to rewrite my welcome to pregnancy letter that I give at the first prenatal to include some of these ideas. Maybe emphasize more that I expect moms to be thoroughly involved in every aspect of decision making.
About procedures that I routinely recommend, but moms don't want. I don't have any problem going along with any well-thought out plan. I don't "allow" my patients to do want they want, they allow me to be involved in their pregnancy/ birth and hopefully beyond. I don't use the phrase "patient refused" either. I often write in the chart "after counseling, patient declined" x, y, or z procedure. I have a much harder time with the "whatever you think is best" type of person. I have rarely in my practice run into a situation where I thought something was absolutely essential to the safety of mom or baby and not been able to explain it to the mom, and come up with a plan we could both agree on. I try to build that trust so that if I really feel something must be done, they can trust that I am doing what I'm paid to do, give good advice, and not just in a hurry to get somewhere.

 

[MelKnee]

For me it was the death of my first baby.

My OB was on vacation, her partner refused to believe I was in labor for 15 hours when I was 24 wks along without seeing me. Then, when he finally admitted I was in labor it was too late to do anything about it. He did various things to cover his ass and I believe one of those things lead directly to my son's death.

When I saw my regular OB about a year after ds's death, I was TTC so we discussed how she would manage my next pregnancy. She said, she would do everything she could to get me to 34 wks.

Shouldn't the goal be 40 wks!? She had no interest in finding a cause for my premature labor. In my own research, I found several factors that I know contributed. But, all she would say was "these things happen" and "no one knows why". She seemed like the stupiest, most uncaing person I had ever met. I have no doubt that I would have delievered at 34 wks with her. So, I found a wonderful midwife.

Together, we got me to 40 wks 4 ds with a perfect baby boy.

My first experience made me realize that no matter who is providing care for me, I am the one that is ultimately responsible for my pregnancy and birth. I am the one that has to live with the outcomes.

 

[JayGee]

I think researching things before I do them is in my personality

! Before I got married I was a research associate for the organization that writes the physician board exams so I spent a ton of time researching all things medical. One of my special projects was to review all the questions pertaining to evidence based medicine. Because my background is in statistics, I really enjoyed looking at the articles and reading meta-analyses of various medical subjects (yeah, I'm weird like that...)

Anyway, pairing my love of research with my interest in natural living, I did a ton of research on birth while pregnant with my first. Unfortunately, I ended up with a section in spite of all my research. The next pregnancy I started researching VBACs from the beginning and all the evidence I found in reviewing the literature strongly favored an all-natural VBAC ~ which is what I had

!

I often wonder how women can just trust so blindly what is being done to them. My SIL was due with her second just after me and planned a repeat C-section because "that's what her doctor recommended". I asked what kind of anesthesia she would be having and she replied, "I don't know. The doctor will decide that." No research. No questions. Just blind faith in the medical profession. And this is a woman with a master's degree, married to my brother who is a scientist

. I don't get it...

 

[Mamid]

My GF decided to have an audience and ended up stuck at 2cm and got a section. When she got pregnant with no 2, the doc said her pelvis wasn't "shaped right" and she would have to have another section. She went into labour the day before her scheduled date and lo and behold, she once again got sectioned.

Me? I'm arguing against antibiotics in labour unless my water has broken for ages. Antibiotics don't prevent the spred of GBS and can actually be detrimental to the mother/child bond and really, they aren't needed unless your water has broken on its own. It can also lead to creating antibiotic resistant forms of GBS and what the world really doesn't need is another superbug!

But did my sOB listen to me about any of that _last_ pregnancy? Nope. I had the antibiotics, both of us ended up with postpartum fevers and I was loopy for a good three weeks after the birth while the pill form of the antibiotics worked their way out of me. I also had massive thrush, mastitis and almost lost my milk - and I make enough for twins!

So, no antibiotics for me. I've done my research.