From: A former client of a large OB clinic practice
Using a doctor was not my first choice overall. I had read Ina May's Guide to Childbirth, Misconceptions, and several other books that all confirmed what I wanted originally: to use a midwife. We decided against this option for several reasons: (1) Insurance fully covered a doctor and did not cover a midwife because midwifery is unlicensed in Alabama, (2) My first choice of care providers, The Farm midwives in Tennessee, were two hours away and we didn't have any experience of birth to know if that was a reasonable drive, (3) I thought, and was told by my doctors, that my preference of a natural birth was a realistic option in Huntsville Hospital, our birthplace of preference. I thought that I did everything right to prepare for the kind of birth I wanted - to stand up for myself in case anyone wanted to steer me in another direction. I took a Lamaze class in Nashville (a two-hour drive, but I got lots of information), I kept reading about natural pregnancy and childbirth, and I hired a doula to support me and be my advocate during labor and delivery. The only variable left was what kind of care I was going to get from my physician and the hospital. CfW seemed like a really great practice and I liked that they were located in a building attached to the hospital. I switched to them midway through my pregnancy because I didn't like the service I got from another doctor at another practice: my former doctor was rude, kept looking distracted when I asked questions, disregarded concerns of mine when I brought them up, etc. This didn't happen with most doctors at CfW, but I mistook their better listening skills for being interested in giving me what I wanted from birth. When all was said and done, paying attention to patients' wishes and/or giving truly informed consent was just not practical. They were too busy, too overwhelmed with patients, or too used to routine practices to really concern themselves with what I wanted. When I brought up my birth plan and preferences for birth (written down in the Lamaze class), I was told by my doctor at CfW that almost everything I wanted was ok. I requested having only intermittent monitoring, NOT being induced unless absolutely necessary, moving around during labor, and other naturally-motivated items. I was told to type up the list and show it to all the other doctors I'd see in prenatal rotations before my due date. I did that, and all the other doctors also seemed ok with the list. The exceptions were getting a Strep test (required), getting a Hep lock or IV (I was told a Hep lock was required at a minimum), and a couple other things. I was willing to concede these points for the greater good. Everything was fine until I reached 40 weeks. I was then actively encouraged to set a date for induction. When I tried to delay, I was warned that many more problems occur with a long pregnancy and that continuing the pregnancy would increase risk of the placenta degrading. I was not told the actual risk, just that the risk increased. I sometimes wonder if that doctor even knew the actual risk of the placenta degrading at 40 weeks. Because of a small amount (a couple of drops) of amniotic fluid on a test strip, I was sent to the hospital at 40.5 weeks to have labor induced. Once I got to the hospital, I was told I was NOT leaving until the baby was born. There were no other signs of pending labor and no signs of distress of any sort. My cervix was only minimally dilated and hardly effaced. I seriously thought that my birth plan would help my case once I went to the hospital. Having the birth plan did almost nothing except give the nurses an idea of what I wanted so they could talk me out of it. Because there were no signs of imminent labor, I made the choice to use pitocin to speed up labor since I wasn't leaving otherwise. This was supported by the hospital staff, who started encouraging pitocin and epidural use as soon I was checked in. Handily, this required an IV that was finally put in correctly after four painful attempts. I elected to postpone the epidural, but my mind was changed after the one particularly long and horrible contraction, lasting almost an hour without any relief. The disinterested anesthesiologist kept talking with the nurse about a golf trip as he was putting a needle in my spine. After nearly 20 hours of labor, I was finally ready to push but kept falling asleep as the nurses counted - I was so exhausted. That baby was not ready to be born. There was no reason to induce. Yet there I was. Sure, the outcome was ok but I wouldn't call it a good experience. And having the doctors in a building adjoining the hospital? Did nothing to help me when I needed stitches for minor tearing. The doctor who delivered my daughter had to move on to one of the many other deliveries that Clinic was responsible for that day. I was laying on my back with my feet in stirrups for more than an hour. Almost everyone in the room got to hold my daughter before I did because I could not sit up. In the end, I was just not that important. All of my education and preparation went to waste, and the wonderful doula I hired ended up being nearly powerless to do what she could to help me get the birth I wanted. The pressure from the doctors and hospital staff to do the opposite was just too much for me. What's worse is that I should have known what I would get - standard service from a group that prefers doing things in a routine way. I know several women who wanted just that: routine service including pitocin and epidural as a standard practice. They were happy with what they found at the large OB Clinic Practice. After my daughter's birth, I often wished that I would have either changed my expectations or found a good midwife. The disappointment was just too exhausting.
Tuesday, January 6, 2009
A former client of a Tennessee Midwife
From: A former client of a Tennessee midwife
Having a midwife birth was everything I expected and more. I knew a lot about midwifery going into my second pregnancy and I knew that the service was going to be much different that what I could expect at a doctor's office. Not better overall maybe, but definitely better for me and what I wanted. I knew it was going to be a great experience when I did the initial interview and ended up talking with the care providers for more than an hour. Time constraints just didn't seem to be the top priority even though one of the apprentice midwives was in labor herself during the interview - she just calmly sat on a birth ball and breathed deeply, concentrating when she needed to. The midwives asked me as many questions as I asked them. They were really interested in what I expected birth to be like, what I wanted, and what I was doing to help make sure I had a successful pregnancy. They answered my questions like a teacher would and sometimes corrected me when what I thought was not really accurate. I learned a lot just on that initial visit. I knew then that I had picked the right place. My prenatal visits went great. The midwives were always quick to explain technical terms and gave really good descriptions of what they saw. The descriptions became better as the baby grew and they could feel its position. I asked many, many questions and always got thorough answers. When I was worried about things, they gave me reliable information and sources that could verify what they said. They encouraged me to read and study. The included my daughter on the visits and didn't really mind when she interrupted. I always felt like I was going to a friend's house. The highlight was the labor and delivery. I went to 42 weeks without a problem and with a doctor's ok that fluid levels were good and the baby was doing fine. At that point I was looking for relief and the midwives helped me responsibly use some natural induction methods. They watched my progress first-hand and took great care of me while we relaxed and waited for active labor to start in its own good time. It did and it went really smoothly. They watched me closely without interfering, helped me when I needed help, and reassured me by telling me what was happening and what I could do that might help. It was the midwife who told me the most encouraging words I have ever heard: "If you think you can't do it anymore, that means you're almost done." She said I was doing great, and she was right. I will always be grateful that I made the choice to use that midwife practice. I spent more money than I would have if I went to a hospital. I drove longer than I would have if I went to the hospital. But there was no way I would have gotten that high-quality and personal care at a hospital. A hospital would help me get a baby born, but the midwives helped me experience the true miracle that childbirth can be.
Having a midwife birth was everything I expected and more. I knew a lot about midwifery going into my second pregnancy and I knew that the service was going to be much different that what I could expect at a doctor's office. Not better overall maybe, but definitely better for me and what I wanted. I knew it was going to be a great experience when I did the initial interview and ended up talking with the care providers for more than an hour. Time constraints just didn't seem to be the top priority even though one of the apprentice midwives was in labor herself during the interview - she just calmly sat on a birth ball and breathed deeply, concentrating when she needed to. The midwives asked me as many questions as I asked them. They were really interested in what I expected birth to be like, what I wanted, and what I was doing to help make sure I had a successful pregnancy. They answered my questions like a teacher would and sometimes corrected me when what I thought was not really accurate. I learned a lot just on that initial visit. I knew then that I had picked the right place. My prenatal visits went great. The midwives were always quick to explain technical terms and gave really good descriptions of what they saw. The descriptions became better as the baby grew and they could feel its position. I asked many, many questions and always got thorough answers. When I was worried about things, they gave me reliable information and sources that could verify what they said. They encouraged me to read and study. The included my daughter on the visits and didn't really mind when she interrupted. I always felt like I was going to a friend's house. The highlight was the labor and delivery. I went to 42 weeks without a problem and with a doctor's ok that fluid levels were good and the baby was doing fine. At that point I was looking for relief and the midwives helped me responsibly use some natural induction methods. They watched my progress first-hand and took great care of me while we relaxed and waited for active labor to start in its own good time. It did and it went really smoothly. They watched me closely without interfering, helped me when I needed help, and reassured me by telling me what was happening and what I could do that might help. It was the midwife who told me the most encouraging words I have ever heard: "If you think you can't do it anymore, that means you're almost done." She said I was doing great, and she was right. I will always be grateful that I made the choice to use that midwife practice. I spent more money than I would have if I went to a hospital. I drove longer than I would have if I went to the hospital. But there was no way I would have gotten that high-quality and personal care at a hospital. A hospital would help me get a baby born, but the midwives helped me experience the true miracle that childbirth can be.
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