Monday, April 26, 2010

The Pregnancy Backstory & Doctor Drama

Robbie is a month old today, and I’m just not getting around to writing his birth story. The first couple weeks after he was born, I was still processing a lot of feelings from the birth, and wasn’t emotionally able to write it, and I’ve just been busy in the past two trying to get used to taking care of him and balancing it out with everything else. I am so happy to finally have my baby boy with me, but the birth and pregnancy were both long and not at all what I had expected. Robbie’s birth story will be my next post, but I feel like I should also tell some of the things leading up to it, just so people know what the whole experience was before we ever even got to the hospital.

I had tried to get pregnant for over 8 years, been told I “probably” had PCOS (and do seem to fit the profile and symptom patterns I’ve read for it), then that I was infertile, so the pregnancy was a surprise. When I found out I was pregnant, I was happy, but was recovering from a car accident and had been out of work for 3 months on disability, while my husband had been unemployed going on 7 months. He ended up getting a job soon after, which was good, because I suffered from hyperemesis and blackouts (thought they were seizures, but all tests for those were clear), which ended up costing me my job around 7 months into the pregnancy. We were both very happy, but worried about finances, especially with the loss of my job and later realization that most other jobs I would be qualified for around here pay about 50-60% of what I was making, before deducting the cost of childcare. This explains some about the amount of stress we were both under during the pregnancy, and a major reason things were really tense between the hubby and I – during my pregnancy, I realized that a lot of the ways he talked and behaved toward me fit the definition of emotional abuse, so I spent a lot of time considering both divorce and counseling, neither of which we can afford, and even more time sitting at home alone and crying.

Since I hadn’t planned on having children, and hadn’t been able to afford preventative healthcare for several years, I did not have an OB I was seeing when I got pregnant. I started out at one office, because they had a big midwife program, but was immediately “risked out” and told I’d have to see the OBs, because I was overweight and have a past history of leukemia. They also told me they did not do waterbirths, and that the closest hospital that allowed it was in Asheville, an hour and a half away. I later found out that all of the local hospitals allow them, and a few have tubs right in the labor/delivery rooms. My husband did not like them from the start and after 2 visits where we were pretty much brushed off and ignored for asking questions, I ended up being taken to the hospital for the first blackout/seizure episode at work. The ER doctor there referred me to the OB office and, even after that, I did not see a doctor, just a CAN who took my blood pressure and checked my sugar, and scheduled my for a 3 hour glucose test because I was “probably going to have gestational diabetes” due to my weight. The GD test was negative, but I passed out again a few weeks later, and my husband took me to our local hospital, where the doctor recommended another OB and made me an appointment with them, after my husband told him how our current practice was handling it. After I told them I switched doctors, the first practice called my parents twice trying to reach me, instead of calling me, which had my dad worried to death because he thought I was sick. I still don’t know what the point of that was.

The second OB practice seemed better. I had gone there for GYN work when I first moved to Morganton, so I was a little familiar with them, but concerned that they never did manage to locate my records from when I’d been a patient the first time (aggravating because they had copies of my charts all the way back to age 16, from 3 other doctors in 2 other cities, including much of the lab results from early PCOS/hormone testing I’d love to see now, in relation to some of the breastfeeding issues I’ve been having). The first doctor we saw was great – very understanding, listened to our concerns supportive of natural birth and waterbirth, and took his time. The second doctor was OK, but I didn’t like him as much as the first; of course, he ended up doing most of my prenatal visits. He said things were OK, but kept putting me off when I asked about bringing a copy of my birth plan to discuss, and always seemed to be in a hurry. When I started asking about specific things later in the pregnancy, he dismissed many of them as “against hospital policy”, even when he’d said he was OK with them early on. This made me nervous, but it was meeting the third doctor in the team that made me leave that practice for good – I had never met him before, yet two of the first things he said to me were comments on my weight and history of cancer, and why I “thought” I could have a natural birth. With no medical reason other than his own prejudice, he gave me his opinion that I should just schedule and early c-section, and told me that if he was on call when I had birth I’d be in the bed on my back once he got there because he “wasn’t going to get on the floor to deliver a baby”. He also informed me (not asked) that he’d be starting vaginal exams and my next visit and would sweep my membranes, then recommended scheduling a cesarean section at 38 weeks, telling me I’d be “required” to have one at 40 weeks if not, because he didn’t “let” women go past their due dates. I was too shocked by the whole appointment to say much, but I freaked out when I got home, told my husband about it, and he was pissed. That night, I started looking up information on local midwives (Office #2 used to have midwives, but I never met the one who was still there, and the other 3 were no longer with them. Besides, the one CNM left was in rotation with the on-call doctors, so there was no guarantee she’d attend my birth even if I chose her as my provider).

Looking online, I found only a few practices in my area with midwives (CNMs), but one came very highly recommended for water births in particular, and the OB she worked with also had a lot of recommendations and positive comments from local women – both seemed to be very supportive of natural birth and to follow the woman’s wishes for her care. They did not have privileges at the local hospital, but worked at one about the same distance away, so I figured I’d tour that hospital first to see if I’d be comfortable giving birth there. The hospital was older and not as fancy, but I had been there for surgery once and the care I received was very good. The labor & delivery tour also made me think it was better suited to my plans for birth – they had tubs in the rooms for labor, but said it was OK to bring my inflatable pool if I preferred, and seemed much more laid back and open to letting labor and birth happen on their own, where the previous hospital had a more crisis-oriented approach to birth (like they were expecting problems & complications), and the focus of their tour was on their NICU and cesarean facilities, rather than on the experience and standard of care the mother could expect for herself and her child. Finding that I was OK with the hospital, I was very optimistic going to meet and interview the midwife.

When I did interview the midwife, I knew within a few minutes that I would probably be transferring my care to her. One of the things I loved is that she took her time instead of seeming rushed, and asked question that showed she cared about me as a person and the whole experience of my birth, rather than just the medical side of things. I really appreciated that we started out just talking in the office, to see if our expectations and experiences would be compatible, and if we would be on the same page regarding the birth (if the previous doctors had done this, it would’ve saved a lot of wasted time and stress, because it would’ve been clear things weren’t going to work out). She asked if I had a copy of my birth plan when I mentioned that my other doctor has said it was unrealistic, and we talked about why I wanted certain things done, but she said it all looked fine to her and that the hospital would be OK with all of it as well. She encouraged me to meet her backup OB as well, just in case, and told me he was also very laid back and hands-off toward natural birth, which made me feel better. She also told me any procedures were up to me, and that we could skip the cervical checks during pregnancy and labor, unless I just wanted to know. Overall, my instincts just told me this was the right choice, and I really liked the feeling I got from her and from the whole office staff, like birth was something natural that we were working together in, not some big scary thing that was happening to me where I was supposed to give up control and decision making to someone in authority. When the birth ended up not going the way I had hoped for, this became really important to me, and I think it made all the difference in how I view to overall experience.
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