Wednesday, July 1, 2009

Another post about what I'm REALLY thinking

For the past 32 weeks, my impression (perhaps a naive impression) has been that my midwife is pretty low-key and down to earth and on board with as intervention-free of a birth as possible. At my appointment on Monday, I pinned her down with some nitty-gritty questions, her responses to which made me sob hysterically all the way home and for the rest of the day (didn't get much work done on my dissertation, needless to say). To make matters worse, I am blaming myself for not previously being a “difficult patient” and not wanting to seem accusatory by bringing up these topics and voicing my opinions.

I asked her how long after my due date I would be “allowed” to go before they told me I "had" to be induced. I basically just wanted to confirm that it was 42 weeks (that seems to be the going standard, even in the more conservative childbirth books/websites). But my midwife replied that the OB in charge of the practice would not “let me” go past 41 weeks. FORTY-ONE WEEKS. Why the whole week early, I asked, given that the 40 week “due date” is really only an approximation and can vary as much as 2 weeks either way. Meaning, that realistically, the baby could be ready as early as 38 weeks, or not until 42.

And she played the “dead baby card.” She gave me this spiel about how after 40 weeks, the placenta deteriorates, the baby stops getting nutrients, stops growing, and will die without the heroic intervention of an obstetrician.

Okay. These things are legitimately terrifying and can happen. But the information I have found about it (including an article published in Obstetrics and Gynecology by the American College of Obstetricians and Gynecologists, for crying out loud) at least say that it’s not a risk until after 42 weeks, and there are no benefits to inducing labor (in an otherwise healthy pregnancy) prior to that point. Even at the 42-week mark, it’s not like these terrible things are necessarily going to happen. You can be monitored with NSTs (non-stress tests) to see if the baby is doing okay or not. If the placenta starts to show signs of deterioration, then fine, go ahead and induce. If not, then there’s no reason to.

Plus, as I was saying, the estimate for 40 weeks is a total crap shoot. It’s not a magic number. In fact, the average gestation length for first time mothers who go into labor without medical intervention is 41.5 weeks (I've found the abstract for this article, but unfortunately the library will not allow me to access the entire publication: Mittendorf et al, 1990). An option, I will, apparently, not be given.

My midwife may have gotten her first indication that I could end up being a “difficult” patient. She seemed sympathetic, yet bound to clinical protocol outlined by the OB in charge of the practice. She said that “if” I make it to 40 weeks, I could legally decline the induction that Dr. T would surely press, but once I got to 41 or 41.5 (what is apparently the norm for first time mothers), Dr. T wasn’t going to like it, and there wouldn’t be a possibility of going a day over 42. Plus, my midwife admitted she had never actually seen a woman go over the 41 week mark and wasn’t entirely sure of the protocol beyond that point. Which is an even bigger what the %@#$ than everything else she had told me. She said that most women are very uncomfortable by that time and are eager for induction. THE HELL. I have been uncomfortable and vomiting for the last SEVEN AND A HALF MONTHS. And I would take any amount of “discomfort” over A SINGLE DROP OF PITOCIN.

She went on to mention the various “natural” induction methods that I could begin trying AT 37 WEEKS. 37 weeks? Are you #*&^%$# kidding me? Of course I am familiar with the natural induction methods; I have made it my responsibility to educate myself about these things. But it’s not going to work at 37 weeks if the baby is not ready!

One of the quasi-natural methods that she said we could do would be to strip my membranes. “But can’t this cause the water to break sometimes?” was my response. And she admitted that yes, it could, especially if she herself wasn’t available and Dr. T did the stripping (apparently Dr. T is “rough”). At which point I would be given only 18 hours to go into labor and have the baby. Because after your water breaks, that increases the risk of the baby getting some infection, so they only give you a certain amount of time before they cut the baby out. “But wouldn’t the risk of infection be very low if I declined having repeated cervical exams during that time?” I asked. Well yes, she said. But still. To Cover Her Own Ass, the OB would have to get the baby out (my words, not my midwife's).

The appointment concluded with her telling me not to worry about all this stuff… I still have plenty of time (though apparently less than 5 weeks before I need to start trying to “induce” myself “naturally”). Plus, she said that because I am so physically active, that would probably help speed things along. That’s a nice thought and all, but if Fig doesn't come "early", I am not looking forward to the stress of an arbitrary deadline being breathed down my neck during my final weeks/days of pregnancy.

The bottom line is, I don’t want to be induced for no reason. Supposedly about 1/3 of all pregnancies these days are induced, but the thing is, if the baby is not ready to come, it is not going to come—no matter how much pitocin they jack you up with. That’s why about 50% of inductions supposedly end in c-sections. In my own experience, I know a lot of people who have been induced, or at least augmented with pitocin, and for the most part, it went pretty well and a c-section wasn’t necessary. And even if it was, everything still turned out okay. So I realize that the natural birth advocates can be just as fear mongering (i.e., pitocin/epidurals are evil and will mess up your baby and you’ll end up with a c-section that doesn’t heal properly and you’ll never be able to breastfeed) as the Cover Your Ass OB’s. So it’s hard to sort out the truth in all of this. I realize that the scary stuff doesn’t always happen once you begin the cascade of medical interventions… it just makes it more likely. And I'm not saying that there aren't legitimate medical reasons to induce labor sometimes... of course there are conditions that make induction the best course of action for the baby. But 30% of all pregnancies? It needs to be considered on a personal basis, rather than a blanket policy. As long as Fig and I are both healthy, just let Fig come when Fig wants to come. Even if it’s past 41 weeks.

You know what’s pathetic? Health care practitioners don’t inform you about the risks associated with unnecessary inductions. Not even that the supposedly innocuous tactic of “stripping the membranes” could cause your water to break and end up with you “needing” a c-section for “failing” to give birth within their specified time frame. They certainly don’t tell you what jacking your body up with pitocin will do. So there is no way that women can be expected to make an informed decision about their health and the health of their baby when they haven’t actually been informed. Thankfully, I have access to a plethora of medical journals and I can look up this information myself (even though some of it is drastically biased), but most people don’t have that kind of access. The way I feel, if there truly is a medical emergency, then absolutely, do what is necessary. But if the medical emergency was created by a cascade of completely unnecessary and entirely avoidable interventions, then that is inexcusable.

I’m trying to decide if I should switch health care providers (if that is even possible this late in the game) or if it would even be worth it (i.e., the one other practice our insurance covers may very well have the same non-evidence based policy as Dr. T). I’ve finally calmed myself down enough to decide to wait to do anything until I talk to my doula (who is unfortunately out of town for a few days) because she definitely has the low down on all the local health care providers and can help me sort through my options.

I just want to make it clear that I am not intending to be judgemental of anybody's personal experiences and I really hope that I haven't come across this way. The whole situation makes me very angry, but certainly NOT at anybody who has had the type of medical interventions I've described as wanting to avoid. I wouldn't EVER tell anybody what to do about their body or their baby, and I wouldn't pretend to know what is best for another woman in another situation. Ultimately, I think that health care practitioners need to provide ALL the appropriate information to women who are trying to make a decision for themselves and their babies and to actually do what is in the patients' best interest. I know that I'm cynical and jaded, but it just doesn't seem right that sometimes what is the "safest" (or perhaps most convenient?) course of action for the health care provider is not necessarily what is best for the mother and baby. And I really don't understand why that is.

Thanks for reading.


Anonymous said...

as your mama, I have to express my concern just a little!!!!! Stress is NOT good, ever.... and at the present time your stress level is waaaaay over the top!!!!! as hard as it is, try not concentrating so much on WHAT may happen, and what MORON's the MEDICAL system is,,, and more on, Fig will prove them all wrong, and come out with out their intervention!!!!!! because, right now, NOBODY but FIG knows when that time is gonna be. You know how I feel about the medical profession and how very very few, even make my list of GOOD dr/s.......... soo, I can not give you data stating how listening and believing to dr/s is the ONLY way to go, since I totally agree with some of what you say!! however, again, the more you stress, the more difficult you are making it for yourself.... the next few weeks try to CHILL, and concentrate on SOMETHING less irritating to you-- read a good book, just not any medical one...... just know I'm in your corner, and will wait UNTIL you call me to come see FIG!!! this special time is for you and Rob only,,,,,,, no one else needs to be around. there will be plenty of time for that, ONCE you and FIG are home and settled!!!!! thinkin of you with prayers and hugs,,,,,,,, luv you foxymama

Melissa said...

Nan, I might need you to come be a Mother Lion.

Anonymous said...

I'll be in my corner, luv you , foxymama

amypfan said...

My last OB desperately wanted to induce Shay because he didn't want to face the good chance that she would arrive on Thanksgiving and interrupt his family festivities. I refused that. A few days later, he told me I "had to" induce because the baby was getting "too big" for me and that waiting until she came on her own "wouldn't be safe." Because I do not know all the stuff you know, I grudgingly agreed. And she weighed in at 1 more ounce than her big sister had. I was really pissed about the induction right up until it happened, but I had a hard time being mad about it when holding the new baby. Stand your ground though--no one can force you to have any of those procedures.

Melissa said...

Amy, I want to smack your OB upside the head!

Glad everything turned out okay with Shay though!

Cathy said...

The only major prep I remember I did with Chris was watch bazillions of Baby Story episodes. I was induced with Chris for Pre-eclampsia. They pumped me up full of stuff (only thing I didn't get was an epidural). Once my water broke, things changed, they 'lost my cervix', and found strange things, those laboring cervical exams HURT! avoid them if you can) did an ultrasound and found that Chris had turned sideways, they'd found a spine.( They did the 'pinch test' prior to that and assured me was head down, he wasn't he was Back Down.) So the induction didn't work and I ended up with a c-section. Wanted VBAC for Sam, but started contracting strongly with NO response from cervix, it was stressing him out, so we had to do repeat C, no baby entry if the door won't open.

It's a great thing you're so informed. But it will be a lot easier on you if you are Informed and Flexible instead of stressing out about the method. And at this point, if you stress, Fig stresses, so just relax, trust your gut, and stay flexible. Most important thing is that Fig gets here healthy, however that happens, well, that's just the birth story.

Unknown said...

I didn't want induced at all. I was super lucky that Michael decided he was ready the day before my due date and labor started naturally.

O'BoyMom said...

Yes-watch out for the stripping of the membranes. I had this done at an ob appointment because she read my due date wrong in my chart! It didn't work- but still- I was like "oh no you didn't" Hopefully you can put your ob off if you go past 41 weeks. Ethan was a good two weeks late in VT, and even there I was not being induced yet, but I had to go in for stress tests starting at 41 weeks. Grrrr!