Meeting with the Midwife: Appointment 3

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Last week I had my third midwife appointment, and I admit I walked in with my “tail between my legs” as some might say, because so much of the midwifery care model revolves around nutrition and I had been rather indulgent over Christmas. Sarah laughed and said she never expected anything different from her pregnant mamas and I felt happy to move on to other subjects. As with all of my appointments she measured my blood pressure (97/72 if you are wondering), checked the baby’s heartbeat with a doppler (136 bpm), and I stepped on the scale to see the number 190.6, which meant a gain of 8 lbs since my last visit. I tested my urine and saw elevated leukocytes, but I have no burning during urination or kidney pain so it doesn’t seem to be an infection. I was diagnosed with Interstitial Cystitis about 7 years ago and some reading on message boards has me thinking that it’s possible my elevated leukocyte level can be explained by that condition.  Sarah also noted that elevated leukocytes can occur because of vaginal discharge that has come in contact with the urethra (and is excreted with the urine), and anyone who has been pregnant or is pregnant currently has probably experienced that lovely pregnancy side effect as well.

At my last appointment I asked about heartburn, swelling, rapid weight gain, and gestational diabetes. My heartburn has been tolerable (still avoiding Tums, although a reader named Lala has me thinking that acid inhibitors like Zantac and Prilosec are the harmful ones to avoid and not Tums) and I’m mostly combating it when it appears by drinking extra water. The swelling stopped as soon as I got my carb intake under control and started focusing on high protein levels in my diet, and although my weight gain hasn’t slowed down much, at least it hasn’t increased, right? RIGHT? Gestational diabetes… let’s save that one for a bit later as it still depresses me to talk about it.

The only question I had this time around concerned an ugly rash I’ve developed on my legs (see iphone documentation here), but since I don’t have it anywhere on my body it doesn’t seem likely that it would be pups. It doesn’t itch, burn, or hurt,  just looks rather atrocious and so I’m planning on making a dermatologist appointment soon.

Sarah said that my blood test results had revealed I am RH-Negative (most people are RH-Positive so I guess you could say I’m “special” in this way), which in very clinical terms means I don’t have a protein called the RH factor on the surface of my red blood cells. If That Husband is RH-Positive then my chances of having an RH-Positive baby are about 70 percent. When baby and I have a different RH Status it can mean trouble. If my blood mixes with baby’s blood I will start producing antibodies that could be harmful for future fetuses as it increases the risk of developing Hemolytic disease.  If That Husband is RH-Negative I have nothing to worry about, as I’ll be having all of my babies with him and we’ll keep producing RH-Negative babies each time so he is going to get tested since I’m hoping I don’t have to get the shot!

There are many who will say “I had the shot and it was no big deal.” First, it is a big deal to me, shots are always a big deal. When I had surgery on my back you know what I was most concerned about? Paralysis? Someone cutting me open and poking around near my spinal cord? Nope. I was almost hysterical when they had to put the needle in my hand to get the IV started. Second, even if our insurance pays for it, shots still cost money. It costs the insurance money, which costs the employer providing us the coverage money, which costs us money. I’d like to avoid contributing to the mountain of unnecessary and expensive medical procedures if I can. Third, though the complications are rare there is still the possibility that an allergic reaction could happen or that it could adversely affect the developing fetus. I’d like to avoid any interventions possible as long as I feel assured that such avoidance will do more harm than good for both baby and myself. It is my understanding that for most women seeing OB/GYNs the shot is administered automatically if the woman is found to be tested as RH-Negative, with no testing being done on the father, a practice I deeply disagree with. Yet again another great reason for me to be working with a midwife rather than a doctor!

The shot commonly given to pregnant women is called the Rhogham shot. If I choose to have the shot it will be offered at 28 weeks, but I will be having it at 30. The shot is only good for 12 weeks, which means it will “expire” at the 40 week mark, and since I intend on taking this pregnancy all the way through until 42 weeks if baby decides to cook a little bit longer I’m going to have the injection a bit later than usual to cover me all the way through the full gestation period. I’ll also have a second shot within 72 of hours of any event that could cause my blood to mix with baby’s including miscarriage, stillbirth, bodily trauma (such as a car accident), or labor/birth. The little bit of research I’ve done indidcates that the FDA banned the use of mercury in the Rhogam shot in 2001, and as almost 9 years have gone by I doubt there are still contaminated doses sitting at the doctor’s office. Even so, I’ll be asking lots of questions before the shot is administered to ensure that the dose is mercury-free. If the doctor’s office can’t leave me feeling assured that the shot I’m being given is mercury free I’ll be asking for a dose of WhinRho SDF instead.

Last but not least (this post has become impressively long!), we talked about the gestational diabetes test once again. A quick note on the difference between the midwifery approach to GD and the medical approach to GD.  I’ve lamented many times in the past that I think I will have to get the test, and many people have spoken up to assure me that the test isn’t that bad and that it is nothing to worry about. I agree, the test in and of itself is not a big deal and I don’t really have an issue with it. The reason why I would like to avoid it if at all possible is due to the midwifery care model. In the world of US medicine, procedures such as the glucose tolerance test are done on ALL women, regardless of their personal health or history. Thus, the test becomes “no big deal” because everyone does it. With the midwifery care model, the test is only administered to those women who are exhibiting warning signs and actually need it. Thus, being told I need to take the test is very bad news for me because it means that my midwife, who has personally cared for hundreds of pregnant women, suspects that it might be an issue for me. I think the subject of gestational diabetes needs it’s own post, but the biggest reason why I am hoping that the results are very, very, negative is that very, very positive results could mean a transfer out of the care of my midwife and the sad, sad news that I will be denied my much desired home birth.

I’m taking the test on the 21st of January, which means that beginning a week from now I’m going to be focusing on making sure I have the BEST DIET EVER. I don’t want to deal with anything close to a false positive. The only positive thing I can say about taking the test? I don’t have to drink the awful orange drink! Midwives administer the test a little differently than a doctors office and I’ll write about the whole experience in my post about Midwife Appointment 4.

Overall though, I’m doing great, feeling great, and according to you kind friends (thank you thank you thank you) I’m looking pretty great as well.

*I am not a doctor (duh), and it’s quite possible that this perception I have developed regarding the administration of the GD test is inaccurate, but my current understanding is that all women seeing an OB/GYN in the US are subjected to this procedure as part of the routine that has developed in regards to prenatal care.

62 thoughts on “Meeting with the Midwife: Appointment 3

  1. From what I understand, the glucose tolerance test is administered differently depending on the physician’s preference. Throughout nursing school, I’ve seen plenty of doctors who are on the same page as your midwife, in that it is only given if symptoms warrant. Obviously that could be very different depending on your doctor and location. Just what I have seen! :-)

    Jenna Reply:

    SOOOO great to hear this, as I haven’t felt yet like I’ve heard a single woman express that the GD test was anything other than standard for her.

  2. I had to drink the nasty orange drink….not fun. I agree with you though- i think it was kind of unnecessary considering i was underweight and pretty healthy. However, it was the first “test” that came back fine. I think u remember my triple screens, right? Did u do those?

    Jenna Reply:

    Nope, we are planning on having the baby no matter what so we felt it was unnecessary, and we also didn’t feel that the risk of misdiagnoses was worth the results. Not enough would have changed because of the results to make it worth it in our eyes.

  3. I think the reason that so many OBs automatically give the Rhogam shot is because there is sometimes a question of paternity. Unforuntaely, even in married couples. Rather than assuming that the husband is the father of the baby, they give every pregnant woman the shot. It is “CYA” medicine–give to every woman to minimize risk of being sued if the husband is not the father and there was a hemolytic incompatability. Unfortunately, as a NICU nurse, I have come to realize that, at least in my area (and I live in a relatively conservative midwest area), question of paternity isn’t that uncommon.

    The weight gain-don’t worry about it. Eat smart and it’ll take care of itself. And, at least for me, I found breastfeeding to be a VERY effective way of losing weight :-)

    Jenna Reply:

    I suspected that might be the case, although I wish more doctors would vocalize why they are doing the test (just be honest with patients!) and if the patient wants to refuse because they know who the father is, then let them do so.

  4. Let us know how the test turns out. I hope you still get to have your home birth so we can all hear about your experience! But if not, you still will get a beautiful baby!

  5. You are looking great Jenna, and your baby will be as well, regardless of the GD test outcomes. I hope for your sake it comes out very negative! I love the pregnancy posts, can you just write these every day? There is so much to learn and study…

    Jenna Reply:

    I would if I had the time! I certainly have an incredible amount I want to write about, and many topics I know I will never get to.

  6. I love these posts! How on earth do you remember everything little thing you talk about with her?! I’m thinking when I go through this I’m going to have to bring a recording device and then listen to it later…over and over again. Haha. I hope all goes well with the dermatologist. As well as the GD testing!

    Jenna Reply:

    I take notes at our appointments specifically for the blog post (she knows I am a crazy blogger!) but this time she sent me home with a cheat sheet that talked about the Rhogam shot so I was able to pull from that and do a bit of googling to put this all together.

  7. You know I think that in France (and some USA States) require an automatic Rhesus test before marriage so that both spouses know ahead whether their rhesus is compatible or not.
    I’am AB+ (I used to give blood in France that’s how I learned), and my husband will probably have to get tested so we know what his is to be sure as well. Because he could be R- well that’s when we’ll decide to have kids mind you.

    Again interesting updates and information about the whole pregnancy process.

    R Reply:

    I’ve always read that compatibility is only an issue if the mother is Rh-. So you should be set, no matter what his blood type.

    Jenna Reply:

    I am RH-. All of this talk of rh- and rh+ made it difficult to write the post without being confusing. :)

    R Reply:

    I followed that you were Rh-, but I was responding to Cecy’s concern that she would need to find out her husband’s blood type. My understanding is that she does not need to since she is AB+. So I guess that I was the confusing one with responding to her comment rather than your post. :-)

    Jenna Reply:

    Sorry! I was replying from my dashboard in WP instead of going to the site to see who you were writing to. (I can’t see which comments are nested unless I visit the site like everyone else) I had worried my description was confusing and so I just assumed that I didn’t explain myself clearly. :)

  8. Good luck going to the dermatologist – I’ve done a lot of that lately myself. I hope you get some definitive answers!

  9. I did automatically get the Rhogham shot, but I knew my husband was Rh Positive, however, I am sure if you requested that your husband be tested, they would probably do it.

    I must be weird but I didn’t think the drink was all that nasty. It was like an overly sugary orange soda. Maybe it was because everyone made a big deal about it that I was almost pleasantly surprised. Orange soda has been a major pregnancy craving that I’ve been working tirelessly to avoid, though, so maybe I am weird. It’s not always orange. Glucola comes in other flavors, but my office only carries the orange flavor because the doctors tried the others and decided that one tasted the best. I have heard that the other flavors are really not pleasant, but I won’t make a judgement because I haven’t tasted them myself.

    As far as GD goes, I’ve known a couple of ladies who didn’t really show the signs, but failed both the one hour and three hour tests. Considering that GD can lead to oversized babies and prematurely age the placenta along with other complications, I think it’s good that they err on the side of caution. While I am all for not getting unnecessary treatments, for me drinking the Glucola and getting blood drawn seemed like a small price to pay to know that GD was ruled out.

  10. My cousin got PUPPS in the last week or so of her pregnancy and she was miserable. Bleck – glad it doesn’t appear to be that for you.

  11. Have you talked with your midwife about the reason for the 28-30 week rhogham/anti-D immunoglobulin shot? I know that it is standard, but the explanation that I have gotten is that it is simply a random time in hopes that it will help some women/babies in case they don’t know about blood mixing. My understanding is that the shot must be given within 72 hours of birth, trauma etc. because otherwise the antibodies have formed and it is too late. So I am curious as to why a CPM would administer it without known trauma or birth. Did your midwife present you with evidence that it actually protects against antibodies for 12 weeks, or is that just the standard medical determination of how long you can go without having it at the end of pregnancy?

    I ask all this because I am Rh- (I know because I donate blood) and I have always assumed that I would have the shot. I don’t think that the shot is a big deal compared to everything else associated with pregnancy and birth, but anything that involves another’s blood & my body seems worth thinking about! Since you’ve done so much research on these things I’d love to know what you came up with for answers about the need for the 28-week shot.

    Evelyn Reply:

    I’m also Rh- and as I understand it, the reason why the RhoGam shot is given 12 weeks (or so) before due date is:

    1-if blood does intermix and the baby is Rh+ the mother’s immune system may begin making the antibodies right away and administering the shot soon after can’t really backtrack & protect when it wasn’t there,
    2-a small percentage of women develop antibodies to their child’s RH+ blood during the 3rd trimester (which of course causes problems) so administering the shot is the action to prevent that from happening just in case it might.

    Jenna, when I was pregnant with Addie I was administered both the glucola and the RhoGam without there really being a conversation about if I wanted them. I didn’t know enough to have a voice (or desire) to say no to either, but I do feel a little differently now about the glucola, at least. I was definitely NOT at risk last pregnancy, and don’t seem to be with this one either, so I don’t plan to do it. So, far I’m going to do the RhoGam shot again, but I’ll be looking into it a little more first. I do plan to say no way to the STD tests, because I do feel it’s ridiculous how everyone is arbitrarily given them, and I know it’s unnecessary in our situation… I figure I’ll save my insurance company the dough. Maybe the premium will go down $5 (instead of up $5) next year?? ;)

    Jenna Reply:

    Thanks for the info Evelyn! While I still wouldn’t have the shot because of #1 (I almost never leave the house so my chances of getting in a car wreck and blood mixing are incredibly low), but I think I’ll have to look into #2 a bit.

    Re the saving money (dontevengetmestarted): http://www.youtube.com/watch?v=ZrAkbAaDt4Y&feature=player_embedded

    Evelyn Reply:

    And I’m going to look into the WhinRho SDF, thanks for mentioning it in your post.

    Loved the video… the more I have thought about access to midwives for prenatal care and childbirth care the more I have felt that it really is a huge answer to the soaring cost of medical care… many of the points I’ve pondered were addressed by the economics speaker. Why is it that something that seems so common sense-based is so difficult to fathom?? (rhetorical question, I already know various answers for both sides of the argument… I’m just sayin’.)

  12. Hmm..now that I think about it, I didn’t get that orange drink with Baby 2. With Baby 1 I think I remember the drink, and if it’s what I’m thinking of, I drank it the day before I had the baby. Maybe I should I have done it this time too and I wouldn’t have gone over so much! (Actually, I’m glad I didn’t have to in reality!)

  13. I think the GD test is administered differently by different practitioners. My sister is 34 and pregnant with her first, and her OB/GYN, who is fairly low-intervention for the most part, is having her take the test because she’s over 30.

    Thanks again for these detailed posts. I learn something new every time you write about your experience!

  14. How do they test the father for the RH factor? Is it a blood test?–Maybe it’s more commonly practiced to administer the Rhogam shot b/c it’s cheaper than the lab work. I truly don’t know–just speculating!

    R Reply:

    It’s actually very easy to test for the blood type. The Red Cross workers who run blood drives can tell very quickly what type of blood one has with a simple finger prick. That way they can determine whether it is appropriate to take a double red cell donation if the donor desires. If you donate blood you automatically find out your type (including Rh factor) for free.

    Jenna Reply:

    Maybe I can convince TH to donate blood so we do a good deed AND find out his Rh status!

  15. Haha! Yes, the discomfort of getting an IV is much scarier to me than the pain of child birth. I get woozy just thinking about things in my veins! (other than the blood that is already there of course!).

  16. I remember learning about the Rhesus factor in my high school biology class. I thought it was interesting. I assume I’ll have to get the shot since I’m B- and my husband is B+.

  17. I hope that your next test/appointment goes well!

    You’re not the only one who is afraid of needles. I have this wonderful tendency to faint when I’m around needles. I’m also really afraid of getting diabetes because I don’t think that I could manage to inject myself with stuff every single day. Ick.

    Bean Reply:

    Sorry. I realized what I said may have not been very helpful – I feel quite badly. I guess I wanted to convey that you’re not alone in your extreme fear of needles.

    Take Care!

  18. boo, I just wrote a comment and it didn’t post. so here is the short version…

    i think it would be silly not to test the father’s. everyone I know who has the negative blood has had the daddy tested too.

    Good luck with the GD test. that test ALWAYS makes me nervous. I am interested in how they test without the drink. (it really isn’t that yucky) hopefully it comes back negative for you.

  19. Jenna, you are so unbelievably organised. I don’t know how you find the time to do all this research! You have to one of the most well-informed pregnant ladies I’ve ever known.

    I remember learning about the RH thing in biology at school. I thought it was so crazy that a mother’s body could attack her own baby – are we only supposed to mate with people who have the same RH factor as us? Luckily hubby and I are both positive. My mom is plus and my Dad minus, though, but my sister and I both came out positive, so that was all right.

  20. I’m terrified of shots as well! I think you’re so brave for taking charge of your birth experience like this. Your knowledge astounds me sometimes, I can only imagine how much research you’ve had to do to get this far.

  21. For terrible heartburn, I take papya extract tablets and a cup of distilled water in the morning – the tablets are delish and can be taken throughout the day. Not sure what the distilled water does but it seems to work for me – good luck!

  22. Hi Jenna,

    I’m a long-time reader, but this is the first time that I’ve commented.

    I work in a laboratory, and we administer glucose tolerance tests (both for GD and otherwise) every day. Every practioner is different in how they want the test administered (and often want it administered differently for different cases). Many of the docs in my area have pregnant women take a blood test two hours after they eat a sensible breakfast in the morning. If the results of the first test are off of “normal,” they have the women go back for a full two or three hour test where they arrive fasting and drink the glucola (it comes in many flavors).

    I guess that the main point that I’m trying to make is that most pactioners are different, take into account the individual patient, and many in my area don’t blanket order glucose tolerance test for all pregnant women. It’s all a matter of the practioner’s preferences.

    Just a quick perspective from inside a lab!

    Jenna Reply:

    Thanks for the insider perspective. There is no way for me to write this out in every single post but most of my perceptions of the way OBs handle things come from the things I hear from other pregnant women/mothers. I’m happy to hear that the things I had come to believe based on those anecdotes may not be the case the majority of the time!

  23. I only had to drink the orange drink. I just put a straw in the back of my mouth and it wasn’t so bad. Like otterpop juice. :)

    I was “borderline” Gestational Diabetic (I know, what does borderline mean anyway??) and I didn’t have to take the big test. Just had to control my diet. But It was nice to know that some of the weight gain was contributed to that fact and not because of me. Because I was exercising and eating so well.

    I hope you get your home birth like you want.

  24. Ask to see the package from the shot. I was a lunatic with the swine flu and regular flu vaccines not having mercury- the thimerosol (the mercury compound to worry about) is a preservative and is used in multiple use vials (meaning more than one dose is in a vial, so it needs to be preserved). A shot without the preservative will be a single dose shot, usually more expensive, and there shouldn’t be any problem with the doctor (or whomever is administering the shot) showing you the package insert from your shot showing exactly what is in it.

    Also, I don’t know what is normal or not, but my ob definitely only tests for GD if she thinks you are at risk- I haven’t been tested, and she doesn’t plan on ever testing me (as long as I continue not to be at risk of course). None of my friends who have recently had babies have been tested either (and all were in different doctor’s care). Just an fyi that not everyone in a doctor’s care gets tested…

  25. Hey – I think you’re right. Most people seeing a Dr. will get the glucose test regardless of indicators. I am not seeing an OB/GYN but I am seeing a Family Practice Dr., and she ordered up the test for me at ~29 weeks. I just had the test on 12/28 – right after gorging for 2 weeks straight!

    You might guess how my results came back… yup, not so good, and I had to go in for the 3-hour, 4-blood test test earlier this week. I am needle phobic big time (hyperventilate, sometimes faint/throw up) so it was traumatic for me, let alone the implications of actually having GD! But I got the results back yesterday and the results looked good so I am free and clear, so to speak.

    Good luck with it – coming from a fellow needle-phobe, I can TRULY empathize.

    -Lindsay

  26. Jenna, you are truly an inspiration to all women with how thoroughly you have researched this. I am a long time lurking reader (followed you over from WeddingBee!), and though I may not always agree with your POV, I do always respect the thought you put into arriving at it. I wish I knew more cool women like you!

  27. Jenna I am not quite sure why you make it a point to rip on doctors? You are constantly trying to prove your point by saying why doctors are bad. However, trying to convince me that midwives are better than doctors is like trying to convince me that the players in the WNBA are better than the players in the NBA (sexism not intended). It is not true and probably will never be true.

    R Reply:

    I am glad that you are aware that there is sexism in your statement, even if unintentional.

    Have you actually read Jenna’s other posts?

    In the US doctors are trained to help pregnant women with complications. Midwives are trained to help pregnant women without complications. For pregnant women without complications, it makes sense to consider a healthcare provider who is trained to deal with them, rather than one who is trained to treat problems that they do not have. As a woman, I would much, much rather have an 8% chance of c-section than a 30% chance. And it is the training of the provider that makes all the difference between those numbers. I don’t care if a doctor is better at surgery if the point is to avoid unnecessary surgery!

    Patrick L Reply:

    Of course I have read jenna’s other posts, I hope you don’t see her as an authoritarian on the subject. Have you ever gone to medical school? Pretty sure they are trained to help pregnant women of low risk also. I also love that you cited the c-section “risk” I much rather have someone there to cut open if needed. Also what training do you have to determine if a surgery is “unnecessary”? Obgyns on the other hand have 9 plus years of training before they even practice on their own. Pretty sure that if they are going to cut, there was a necessary reason to cut based on their training. So stop trying to pretend that you know what is necessary and what is not.

    R Reply:

    Well, sometimes Jenna is a bit pushy in her beliefs, but I wouldn’t call her authoritarian. ;-)

    I haven’t studied to practice medicine. I did not realize that you had. Since you’re bringing that up as a criteria for discussion, how many healthy, non-invasive births have you assisted as primary medical provider?

    My knowledge of this subject comes from studying it under a professor who was formerly on ethics boards for hospitals etc. and would help determine what was appropriate for doctors to do to reduce their own risks of lawsuits, versus what they really had to do to protect their patients.

    You honestly believe that American women are in such poor condition that we need c-sections 30% of the time? If so, then there is something dramatically wrong with our medical system since they aren’t bothering to try to cure us so that we can have fewer of these “necessary” cesareans. Either way, something is wrong with the system, and it is horrible that people feel the need to continue repressing women and implying that “everything is good” with their medical care and that it is wrong for them to seek better options.

    Taylor Reply:

    R.

    I might have agreed with some of your points, up until the sentence that said “it is horrible that people feel the need to continue repressing women”. Knowing you are a bra burner gives a little less credibility to anything you might say. You imply that it is the medical system who is keeping women from seeking other means. How do you know that? Who is keeping women from getting a midwife? It seems that many women opt for a c-section to know their delivery date, preserve sexual function, and maintain bladder control. Do you think these reason are imposed on them? Probably, because once again, you hate men. But to me, it just seem like selfish reasons.

    Jenna Reply:

    This response is ridiculous and (as I assume it is meant to be) inflammatory. R doesn’t hate men.

    Katherine (a.k.a. Sparkles) Reply:

    You know I really don’t like this disagreement what-so-ever. It’s like a tit for tat. Let’s go back to being neutral for a moment.

    PERSONALLY I understand where Patrick is coming from. I feel as though TW has been speaking fairly negatively about the medical establishment. But I also see where R is coming from. I personally don’t like the c-section rates either. I do believe you can find a medical provider who will respect their patient to not do invasive treatments. Just because the national c-section rate is high, does not mean a specific provider’s rate is similar to it.

    But personally to constantly go to say that c-section rates is a way to justify why one is having a home birth is a weak argument- I don’t agree with. But the philosophy of why TW wants a home birth is right for her personal needs. But I agree with Patrick, I am discouraged and disheartened by TW repeated comments that make me feel she has a distrust with the medical community, because honestly individuals who go into health care aren’t there to be dictators of what should or shouldn’t be done. They go through a regimented amount of time, brutal training to get educated and obtain experience to help people. The medical establishment is there to partner with their patients as far as what medically may work best for them (& hopefully) in conjunction with preventative and less invasive methods.

    But seriously, it does make me disheartened to hear TW focus so much negativity on the medical establishment. I trust my husband’s medical expertise as he is a pediatrician and has a masters in public health in women’s and childrens health, I also trust 95% of the physicians I have been blessed to work with as a Pediatric Registered Nurse and now as a dual major Graduate student in a Pediatric Nurse Practitioner & Pediatric Clinical Nurse Specialist. The other 5% I can tell are bullshitters and money mongrels or are just POS and shouldn’t have gone into the field. But that 5% should not be the main focus to say that ALL providers represent that 5%.

    I don’t like hearing how a recommendation is bashed, or seriously queried to the point where it seems as though all the research in the world by the worlds leading specialists is minimized to the point of non-existance. At least that is how it feels.

    You can do your research to make you feel comfortable with the decisions you make, but I am with Patrick when I say I tend to sway more towards it FEELS like TW is minimizing a physician’s ability and role in birthing a low risk pregnancy without invasive means, because I have seen it with my own two eyes- it is entirely possible.

    But I also honor and respect TW for finding a philosophy of birthing that brings her peace, comfort and speaks to her personal needs. I just personally wish the medical establishment wasn’t constantly brought into it in a negative light because frankly it’s getting old, it’s discouraging to what healthcare providers are trying to do… and I know provider’s out there that don’t do every single test under the sun just because it’s available and they can.

    I think it’s over-generalizing the positive things other medical providers do accomplish who try to reduce C-section rates and the other aspects providers try to do (such as RESEARCH in evidence-based practice which is how providers should be basing their care, and that is the current model practitioners are trending towards to provide care that has been proven to work) to reduce the over “medicalization” of America.

    R Reply:

    Here is the problem as I see it: this post was not about bashing medical professionals. It is about the fact that Jenna is having serious symptoms which might mean that she won’t have a home birth at all. I stayed out of the discussions on other posts, but I was under the impression that other commenters took Jenna to task for some of her more inflammatory anti-doctor statements.

    So now that Jenna has gotten to the point where she is explaining why certain tests and shots are a big deal for her, it seems like the time to be supportive rather than picking apart every statement for anti-doctor bias. I don’t know whether Patrick L knows Jenna in person, or whether “he” is a random troll. But I do know that if I have time to counter pointless criticism with something that might make a worried woman smile, I am going to go for it. And if the person ripping into her is using shallow arguments that set himself up for shallow amusing retorts, I am probably going to go for it.

    If others are interested in setting facts straight and presenting valuable information, I highly suggest starting a blog and posting there. That way there isn’t the issue of ripping into someone on her own blog for very personal choices.

    Katherine (a.k.a. Sparkles) Reply:

    Really R-
    I totally saw the point you were making and I do agree with you on a number of points. =o) I really do. And I do understand the whole troll thing. I was just playing devils advocate in between the replies, because I can’t help but feel sometimes like there is a slight focus on disliking the care from medical professionals. Why can’t the focus be on the beneficial conversations she had with her midwife that makes her feel so comfortable with the care rather than consistently saying “yet another reason why I didn’t go to a doctor”. But see I say that, and then I understand TW’s intent in her statement… but on a personal level since I provide care too at the bedside I can’t help but feel like saying “but wait! I know TONS of great providers that don’t go overboard on tests and will honor your request to have a natural birth and let you move around the room while you’re in labor…” That was the only reason why I chimed in, though I am regretting I said anything in the first place now…

    Jenna Reply:

    Katherine, I think it’s important when you read these posts that you don’t self-identify or place the names of your friends in for “doctor” or “OB”. I dont’ have a problem with any one particular doctor per se, but I don’t think anyone can argue that the system is seriously screwed up. Telling women they have to deliver on their back? A national average c-section rate of 30%, sometimes as high as 60-80%? The use of cytotec for any birth related reason at all? Hospitals forbidding women outright from attempting a VBAC? These are big, big, big problems, and I feel sad that so many women accept these as facts because they have been led to believe that the system only wants what is best for them. The system doesn’t care about them, the system cares about itself. There are most certainly individual practitioners who are striving to practice evidenced based medicine and are working very hard to treat their patients as individuals, but that doesn’t mean that the doctor-hospital-insurance-medical establishment system is even close to working that way.

    Thus my problem is not with Dr so-and-so-, it is with women being told it is okay to induce (before 39 weeks!) because they want a certain doctor to deliver their baby. I have a problem with a system that places monetary needs above the health and safety of mothers and children, which in America seems to overwhelmingly be the case right now.

    Katherine (a.k.a. Sparkles) Reply:

    I know you would like for me not to self-identify or name a “doctor” or “ob” that I know of- in place in your posts when you speak against “the system”. But don’t you understand how that can make a reader like myself who understands where you are coming from feel- when I do know plenty of esteemed people who work for the system but are attempting to fix the system? Because the rates you are defining are not the reality I see in practice currently in my area.

    And TW, you know I have sided with you multiple times. But I think now that I am pregnant, and am in the throws of this myself… I have shared with you in the past that I do not have the negative experiences you have had.

    I shared with you before, I walked into my doctors office to talk about my pregnancy and what to do next and my doctor said “so would you like names of an ob/gyn or a mid-wife or both? Here at Kaiser, we provide both…” Then when I met my Nurse Practitioner MidWife she told me I could move freely in the room, I could walk up and down the halls, be in any position I wanted when I am in labor and that every provider there encourages this. So to me, hearing repeatedly why not to go with a doctor because of a national rate (which is not stratified by the way- many of the C-rates and other things you notated etc) do not distinguish between low risk vs high risk, multiple births (I could go on but won’t) -is not true or representative within my region of the nation. I was told California’s C-section rate is 17% and repeat C-sections AFTER C-section is 12%. This is lower than the national norm and is continuing to trend down as I have been assured by my professors who are publishing current articles on this topic as we speak at UCLA (which surprised me as we have so many individual in a higher socio-economic bracket that request elective C-sections, but the rate in California speaks for itself) . So it’s disheartening and discouraging to continue to hear negative things- when I am not experiencing that in practice myself.

    I have been bleeding ever since I became pregnant, I vomited for over 24 hours one day- and when I went to get followed up I wasn’t shoved on a stretcher and felt like I was being dictated to have a multitude of tests, I was respected and given therapeutic non-invasive treatment (no IV, no IV fluids, no over the top labs outside of the prenatal screening). So this is contrary to what you’re depicting.

    To end on a lighter note, and to end my participation in this discussion- I would rather hear the positive interactions you have had with the Midwife who you have chosen that further makes you and the care you receive meaningful to youand less of the asides. Because when I hear someone who is constantly going and making negative comments- to a reader who is a provider it’s turns me off and hurts my feelings too, even though I know you don’t mean to. Because I see how hard the other providers are working to fix this said ‘sick’ system to which you refer. And it minimizes the current attempts that are being made so that people like you can try to have a better experience, outcome, and have access to more midwives who can deliver at homes and in hospital affiliated birth centers if they so choose. Because it’s a turn in care here in California. Maybe certain regions in California is the exception? I see where you are coming from, but do you see where I am coming from?

    Evelyn Reply:

    One of my dearest friends is in her residency for OB-GYN and when she was in medical school she was taught something that showed her the way the medical field, in general, views pregnancy, labor & birth: “Pregnancy (and birth) is a life threatening condition.” She laughed at it but also felt/said, “Duh, of course women would be a little mistrustful of doctors if they are looking at a natural condition as if it’s a catastrophe.” If someone studying medicine who ended up in that field could understand the reason why many women feel the way they do about obstetrics & gynecology, I’m sure you should be able to as you seem to have similar experience.

    Consider that a midwife is trained to help a women through pregnancy and birth without turning to a knife, so she must know multiple ways to manage a low-risk woman’s care to achieve the outcome of healthy mom & healthy baby because surgery is not an option [except it really is, in cases of change of risk and other emergency situations] compared to the fact that OB’s in general assess the situation with surgery always being an option, if there is any type of indicator that doesn’t look favorable to a vaginal birth, cesarean often becomes the most favorable or even the only option. A very simple example of this would be breech babies. Midwives, in general, are trained to not only manipulate a breech baby in the womb to change position, but are able to deliver babies who are breech… as in the baby comes out feet first and they know how to manage the birth so no complications ensue (like not wiping the mother if she defecates as it will cause the vagina to contract and could strangle the baby). Many/most OB’s are trained to manipulate the baby in the womb, but if that doesn’t work cesarean is the only option. Those are some very true dynamics of the differences in the outlook of a midwife versus an OB and it’s a contributing factor to the divide in their outcomes. Those aspects alone mean there are perks to being treated by a midwife rather than a doctor. Hopefully you can see that as easily as most people seem to.

    One of the points R made was that women are seeking care from U.S. doctors trained to treat complications… her statement was overly broad, but rather accurate if a notation is made… OBs are trained to treat complications and, in GENERAL (I am very much aware that not every OB treats every woman as if she is high risk), they do often give each woman the same care with those needed even more getting even more. Most women find out they are pregnant and go to an OB when their care could be easily managed by trained and capable family practitioners or midwives. As I understand, even with a family physician expectant mothers would not have many of the tests done which are performed when treated by an OB. This is one of the main problems with our system in the US, whether it’s the healthcare system or the culture, we all immediately turn to a specialist when a general practitioner is more than sufficient.

    Another point R made in her response to this comment was that, “Either way, something is wrong with the system, and it is horrible that people feel the need to continue repressing women and implying that “everything is good” with their medical care and that it is wrong for them to seek better options.” You seem to have the attitude that midwives are unnecessary and not good enough to compete in the game. A lot of people seem to feel the same and that is why in some states midwives are illegal. Many people who make statements like you have regarding supposed/assumed “inequality” of care seem to think it’s perfectly okay to limit a woman’s option to choose a midwife so that she can’t… but unfortunately those opinions are not based on fact and in trying to correct misinformation, show the related facts, and explain a little about the option of midwifery, Jenna’s stepping on toes. I don’t recall any outright rips** on doctors in Jenna’s post, she mostly highlights the differences in care as she understands them. Perhaps it’s similar to a comparison of a Granny Smith to a Fiji. They are very similar, but pretty different too, and I don’t think Jenna is a doctor-hater (the girl had breast reduction surgery and major back surgery!), she’s simply trying to inform her audience of the non-traditional (that used to be traditional) form of care she has chosen.
    **Yes, Jenna said this, “Yet again another great reason for me to be working with a midwife rather than a doctor!” But, I think her intent is to simply highlight her desire to be more involved and have more choice in her care and the fact that that freedom comes with greater accessibility and less conflict because she has chosen a midwife rather than a doctor. This gives her great satisfaction and she expresses it in the way she writes. Jenna has an audience that is somewhat varied in opinion and experience and when she says one thing she often has to explain it, she can’t just say she’s glad she can choose, because she’d have a ton of comments from readers wanting to know what and why… and then the comment forum becomes a massive discussion of all that… so she tries to explain those reasons in the body of her post all without writing a novel (like this comment…). Try to give her a break for getting a little emotionally involved… I don’t think many think she’s a doctor-hater trying to spread the wealth & educate on the hate; perhaps when you see an opportunity to feel offended you can step back and try and see intent? I’m sure we can all see, if we desire, that there is no malice to a profession (or field) intended.

    Katherine (a.k.a. Sparkles) Reply:

    Evelyn,
    Sorry. [You seem to have the attitude that midwives are unnecessary and not good enough to compete in the game...Many people who make statements like you have regarding supposed/assumed “inequality” of care seem to think it’s perfectly okay to limit a woman’s option to choose a midwife so that she can’t… but unfortunately those opinions are not based on fact] –>That’s a BALONEY statement to say to someone like ME.

    Seriously. I’m a Registered Nurse I know the pros and cons and differences in delivery of care. I never disputed the use of a midwife. I don’t need to be lectured on it. I’m not a first time reader to this site, I have been a watchful participant and supporter of every one of TW’s decisions. Because I respect her decisions. And there are plenty of times when I did not participate in the harsh criticism TW has received because I understand that something she said was taken out of proportion and out of context from the intent.

    I totally understand and agree with a lot of what you said. No where in this did I say I disagree with a Midwife care. No where. And no where have I ever taken the opportunity to feel offended just for sake of taking it as an opportunity to be.

    I have been reading with an open mind for a long time and supported a lot of what TW has said. But there are times where I am just like enough is enough already with the “another reason why not to go to physician” because to me it’s disheartening to hear that- I have seen so many good ob/gyns and other physicians in other specialties NOT do certain things just for the sake of doing it just because they can. It’s sad that TW didn’t find someone to show her how good an Ob/Gyn or Family Physician could be in care— But that doesn’t mean I minimize her decision to go with a midwife. Not at all.

    And as a provider myself, there are TONS of things I read that I do not necessarily agree with in the medical literature like that one statement in the book your friend shared with you (“Pregnancy (and birth) is a life threatening condition”). That is why we go to school, to utilize critical thinking and to synthesize data.

    And if you read my comment carefully . I understood both sides of the argument between R/and Patrick. I just didn’t like how it was becoming a tit for tat between R and Patrick.

    But as a provider- I feel bad that TW has not had a good experience with a physician. It shouldn’t be that way. But no where did I minimize her decision or disagree with her decision to go with a midwife. I am using a Nurse Practitioner MidWife for my birth. I understand the difference in care philosophy. But when I tell people why I am going for a multi-disciplinary team approach ({my Primary Care Provider is a Family physician and has delivered babies- I would trust her to help me in my birth, likewise I have also have an Ob/Gyn following me who I am also ok with having at the bedside during my birth… my insurance carrier allows me to have a team- so should either of them not be available during my birth I have someone who has been following me to be there from those three- but my SOLE provider for the birth of MY CHILD is a Nurse Practitioner Midwife}) to my birthing plan it’s not because of the multitude of valid points TW stated. I don’t go out of my way to say “and yet another reason why not to go with a doctor.” It’s just a philosophy of care approach that is different. But it’s not just this post, it’s the combined posts ever since she has begun to describe why she is doing one thing over another… that makes me feel like she is minimizing the good things that Ob/gyn’s or Family Physician’s can do for low risk birth mothers and do actively do. But just because I said that, I am not intending to minimize what midwives do either. I love my Nurse Practitioner Midwife. I love every experience I have had with the midwives who have come to lecture my classes since I have been in the program. THAT was what turned me on to Midwives care, was their approach at the bedside and philosophy.

    I was balancing the views between R and Patrick. And I was trying to include how it disheartened and discouraging to hear repeatedly how the medical establishment is innately flawed. Yes, I know it is. But I choose to be a participant in actively being the catalyst for change from within. But I also don’t want to hear day in and day out how people think (for example) I provide less than adequate care. Balance the good and the bad. And all I hear is the negative and nothing positive from TW about births from MD’s as a whole. I would prefer instead to have the discussion shifted to how great TW’s conversations with her midwife have been, how positive and resourceful the midwife was rather than the continued “and I won’t be subjected to this or that because I am with a midwife instead of a [dreaded] PHYSICIAN”.

    That’s all I was saying. But I have never, ever, ever in any of TW’s posts ever for the sake of opportunity spoken up about my thoughts on this until R and Patrick did. I was simply being the imbetween because, like you, I do agree there are pluses and minuses to ob/gyn care. But it’s disproportionately negative in most of TW’s posts. And that’s why I could see Patrick’s perspective. I have stepped back and seen the intent on a multitude of occasions. This was merely a situation in which I decided to speak up.

    I, too can give a butt load of percentages and cite innumberable amount of studies from UCLA’s database- but I choose not to get all academic in each and every one of my comments. But I know the data, I access the data daily, and I synthesize the data because I am involved in it.

    But flat out. I am glad and support TW’s use of a midwife. But I am tired of the “and another reason why I didn’t go to a doctor” statements. Because it makes me feel like it minimizes the quality of good care that I know many do provide-. Midwives and MD’s for birthing can provide good quality of care to a low risk pregnancy mother without people blatantly overgeneralizing why one is better than the the other. Which is basically what Patrick (until the discussion became less than constructive) was saying.

    Don’t take my reply to R and Patrick out of context and overgeneralize it. I was replying to their comments. But don’t tell me I think midwives are unnecessary. Because I know they are, they have their place just like other healthcare providers. And don’t tell me I’m “limit[ing] a woman’s option to choose a midwife so that she can’t…”… because you clearly don’t know me, don’t know my background and couldn’t even give me due diligence to step back and see the intent in my response.

    I feel like I am ranting… it must be my pregnancy hormones. Sorry Jenna- I had a pregnancy meltdown moment…. stepping away from the computer….

    Evelyn Reply:

    I was somewhat surprised by the reply coming from a woman’s voice and realized you must have thought I was responding to your comment… I was actually responding to patrick’s it just looks like it’s a response to your comment…

    thought i’d clarify that… and then I’ll actually get to reading your comment. ;D

    Evelyn Reply:

    Ok, having now read your comment, I hope you will see with my previous notation to you, that my previous comment was not directed to you…

    My previous comment was an attempt to address the perceived attitude of Patrick and make some references (revisions/clarifications, if I may be so bold?) to R’s comment…

    Hopefully you feel a little less offended now?? It certainly was not my intention to cause a feeling of personal attack–to anyone–but most certainly not to you!

    Katherine (a.k.a. Sparkles) Reply:

    Yeah I thought you were replying to me. So it makes me feel better. Sorry for the misunderstanding on my part… =o)

    Jenna Reply:

    Even the state of Ohio has recognized that “Research has found that many of these C-sections can be related to inducing labor and early admissions.”

    http://www.theunnecesarean.com/blog/2010/1/5/ohio-releases-hospitals-2008-c-section-rates-for-low-risk-fi.html

    I am, as is probably expected, in love with this statement: “Lower percentages are better.”

    Amen!

    Jenna Reply:

    Again, this is a macro/micro argument> I don’t have a problem with any particular doctor per say, I have issues with the system. Giving out ultrasounds like candy, administering tests that aren’t medically necessary, inducing before 39 weeks (http://www.thefamilyway.com/home/archives/140)or inducing “because the magical number 40 weeks has been reached”, the use of the cheaper drug and much more dangerous drug cytotec instead of pitocin, c-sections due to fear of litigation, and many other such practices which are not evidenced based are what I have a problem with.

    Almost anyone who endures 8 years of medical school to deliver babies is going to have wonderful intentions, unfortunately I think our current medical professionals are being trained in an environment

    Also, not to be downplayed, is the effect a hospital administration has on the birth process. Hospital administrations have their own best interest in mind, and often set policies to protect themselves, not the patient (such as no liquids during labor: http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm)

    So no, doctors aren’t bad. The system as a whole is rather sick though.

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