Tuesday, September 22, 2009

Chaos Reigns (almost 24 weeks)

First, some utterly boring musings:

I have been on the fence about the flu shot (I never get them, and I've never gotten the flu), and when I brought up the issue at my doctors appointment last week, my doctor admitted that she never gets them, either. And, she has kids, so I assume that means she didn't get one while pregnant, either. She did say, however, that the death rate in Australia has been 6 times higher for pregnant women due to pneumonia complications, basically because late pregnancy already interferes with breathing, and severe pneumonia just leads to complications. She said that she and her partners still have to decide if they are going to get them, and they may force her to get one this year. I still have to do more research. I don't really want to get it (particularly the H1.N1, which seems to have been so rushed), but feel like I should.

I also had an appointment last week with my G.I. dr, who has wanted to see me more frequently due to the pregnancy. I have been having some pain on my lower right side for the last 3-4 weeks. It is probably just due to baby plus digestion, but it gets to be fairly severe, and I still have a long way to go in my pregnancy. She took some blood to run liver and pancreas function tests, which she said can go haywire during pregnancy, just to be sure there's not an issue, and told me to call if I had any fevers, as it could be signs of an appendix issue. That's all I need--to get appendicitis while pregnant! She wasn't overly worried, though.

I think I was still up only about 12 pounds when I hit 23 weeks. Tomorrow is the day I do my weight check, and I'll hit 24 weeks tomorrow. I think I've actually gained a little bit of weight this week, which is good.

And now, for the (also pretty boring) drama:

On top of work being a complete whirlwind (major deadlines moved up by a week (!!) unexpectedly; minor projects due; major projects due; and, my primary assistant quit and left last week because she didn't want to deal with office politics any more), I also leave tomorrow for 5 days for my interview. We're combining it with a visit to my mom's, which I'm excited about, but when we planned this trip and I scheduled my interview, I had no idea that life was going to be so absolutely crazy right now.

So of course, in the midst of all of this chaos and drama, I got a cryptic email from my doula asking which OB practice I am seeing, and then telling me she needed to talk to me. After a few emails back and forth, she said she thought she'd better come see me to talk about the issue in person. Huh?

It turns out that she was talking to a group of other doulas, and the conversation just happened to turn to my OB practice. It turns out that my practice has a very bad reputation for being high-intervention. . .routine episiotomies, 2 hour pushing limits before c-section is required, etc.--all things my doula knows I don't want. My doula is amazing, and is completely supportive of whatever I want to do, but she didn't want to keep information from me. The list of issues went on and on, but one doula apparently even told my doula she won't take clients from my OB's office any more, because women have uniformly had such negative birth experiences. She said that there were three doulas there talking about their former clients' negative experiences, and all said that their clients were happy with the practice and the care they received, until they got into the delivery room. She said the doctors told the clients that they were on board with birth plans, and encouraged them during prenatal visits. . .only to completely ignore them in the delivery room. In fact, my doula said that my doctor has the very worst reputation of all (and she just gave me my doctor's name, as being the one with the worst reputation--she had no idea who my OB actually was).

I am not some overly crunchy earth-mother type. In fact, I am pretty mainstream, and happy with a lot of medicine, generally (um, this pregnancy has clearly been evidence of that--you think I need 7 ultrasounds during my pregnancy. . .by all means, do them! Chorionic Villus Sampling? Sign me up!). But I really, really don't want to be cut open. I've never had to have surgery, and I don't want to start now. The US C-section rate is so many times WHO standards and those of many other nations that I have to believe that there is something wrong with the American system, and not American women's bodies. I know so many women who blythely talk about their c-sections like they are no big deal, and even women who have sought them out on an elective basis. I am not one of those women. It's major surgery, with major recovery needed. And then there is just the increased risk of dying. . .simply intolerable to me.

I feel like I've thought about the birth more than some women seem to. Perhaps I've intellectualized too much a thing that isn't meant to be intellectualized, but. . . When I read other womens' blogs and talk to women about their births, many women just seem to fly by the seat of their pants and go with what their local establishment recommends. While they may be worried about the birth, or have had what they consider a tough birth, they just seem to go with it, and not stress about arranging any of the details for themselves, or wonder whether they could have done something to avoid their "bad" birth. I sort of feel like a lot of women just kind of show up in L&D and take it from there, and deal with whatever comes. Maybe this isn't the case, but it seems that way to me.

I wish I could do that, but I am not hard-wired that way. While I don't see this as a be-all, end-all pivotal life event (the birth. . .the baby's arrival, on the other hand, actually is), I want it to physically go well for me. I don't need to have a positive life experience that I will forever carry forward with me in that earth mother way; I need to have an experience that isn't frightening and horrible physically. I know it will be painful, but I'm not talking about normal labor pain--I'm talking about all of the other stuff that needlessly happens that causes needless pain, like episiotomies and c-sections. And, I feel like by making certain choices now, perhaps I can avoid complications and unnecessary procedures.

That was why we hired a doula. I read the studies that suggested doulas facilitated shorter, easier labors and much lower c-section rates, and that was it for me. It's also why I decided I wanted to deliver at a hospital with a birthing tub, so I could labor in it. It just seems natural to me to labor in water, since it's my usual stress go-to relaxation technique, and it tends to make pain better for me. Plus, it seems to me like lots of warm water MUST help in stretching tissues. Unfortunately, at my appointment last week with my doctor, she also told me that they just got rid of the birthing tub at the hospital I am supposed to deliver at (which is one of the reasons I chose the hospital in the first place) largely because her practice didn't allow their patients to use it, as they felt waterbirth wasn't safe.

I really like my doctor, and I really trust her and all of the other doctors in the practice. It's a small practice with only four doctors. They all have 20+ years of experience, they all went to really good medical schools, and they all trained at top-notch faciliities. If anything were to truly go wrong during my labor, I have every confidence they would get me through it okay. I have received very, very good medical care during my pregnancy, including the referral to a world-class MFM for the genetic testing.

This is where I am struggling. I know that the practice has the medical ability to make things turn out okay if anything goes wrong. But it's that same medical ability that may also turn a perfectly normal birth into a surgical event, simply because they are very conservative in how they practice. It's a double-edged sword: the thing that attracts me to them (the confidence in their medical ability; my feeling of safety) may also result in me getting more medicine than I need or want.

So, at six months pregnant, I am considering whether I should switch to another OB practice, at a different hospital which still has a birthing tub. I have been doing a ton of research again and asking around. It's a little easier to talk to people about now, since people know I'm pregnant. When I was looking before, people didn't know I was pregnant, and it made it hard to ask questions without outing myself to people I didn't necessarily want to be "out" to. My second choice practice, from when I originally chose my OB, was located at a different hospital that is equally far away from my house. I chose my current OB's office because a) a friend had gone there and liked it, and b) my second choice practice was a bit bigger, with about 5 doctors and a bunch of midwives, and some of the doctors had less experience and did not seem quite as highly qualified as my current practice.

The hospital affiliated with my second choice practice has an all-new birth center. They are affiliated with a major children's hospital. They have a much-touted birthing tub, promote waterbirth, have jacuzzis, etc. From what I've picked up so far, local women who are concerned about truly having a "natural" birth (which is sort of my concern, although I think most women want a natural birth for reasons a little different from my own) deliver at this hospital, as opposed to one of the three others that are available.

My doula has been terrific about working to get me more information, too. She's reached out to additional doulas and L&D nurses that she has for contacts. All highly recommended my second choice practice. All highly recommended the hospital affiliated with my second choice practice. One of the women she talked to said that she's never heard a birth story from someone satisified with my current practice. My doula also told me an interesting story about the doctor I happen to be looking at in this new practice (my doula has no idea I am even considering this woman). She said that the L&D nurse told her that the doctor had a patient who had serious high blood pressure issues, and was on mag. The patient was in labor, and really wanted a natural birth. The doctor personally sat with her for nine hours during her labor. Not once did the doctor mention a c-section, although at one point when things weren't looking very good, the doctor did talk about needing to talk about other options, if things continued down that path. They didn't, and the woman went on to have a healthy natural delivery. THAT's the kind of doctor I want--one who keeps me safe, and works with me.

It seems like this should be a no-brainer and that I should switch practices. And yet. . .there are a couple of doctors in this other practice that I don't love, at least on paper. I don't really want a doctor at my delivery who has only been practicing for 6 years, and is a D.O. rather than an M.D. Yes, I know credentials are not everything, but that doesn't feel like it measures up to 20+ years of experience, top medical school, top training. I can't control who ends up in L&D with me, because it's the luck of the draw on who's on call.

I'm going to try to tour this other hospital in the next week or so, and try to see if I can get a "consult" visit with this new practice, to sort of feel them out. I think in the end, I would probably be happier giving birth at this other hospital. But the neurotic part of me is reluctant to give up top-notch medical care, even if maybe it's too much medicine.


JamieD said...

Oh, goodness. That is a LOT to chew on. Especially at 24 weeks.

I haved to applaud your doula for sitting you down and being so honest with you. I can only imagine how difficult it was for her to discuss with you the difficulties others have experienced with your OB's practice.

I don't necessarily want a c-section but I told my doc she had a green flag to do whatever she needed to. I am still so scared of losing this baby. I pray I get to bring him home with me AND have a good birth experience. Is that too much to ask?

I have a friend who tried to switch OB docs toward the end of her first trimester because she was unhappy with her current doc. She had a lot of problems finding another doc who would accept her because she was so far along in her pregnancy. Is there a possibility the other practice would not accept you as a new patient?

I hate you are having to go through this. You have had such a difficult road these last two years. Why can't ~something~ be easy?!?!

Kristen said...

as a D.O. I feel like I have to pipe in and say that we're just as trained as our M.D. counterparts - and the additional training we have is all hands on treatment and diagnosis, which means we're better at many physical diagnosis skills. The rest of medical school is the same, we just learn more. Of course, there's no such thing as a given, and there are some awful osteopaths out there, but please don't discount someone because they're an osteopath!

(I'll step off my soapbox and go back to lurking now!)

publichealthdoula said...

As a doula you could probably guess what I would say...but it sounds like you already "intellectually" know what you "should" do and your gut is having a hard time going with it. It sounds like you are stuck between two places: you're beginning to not trust your current doctors, because what you're hearing about their practice. You are having a hard time starting to trust potential new doctors, because you don't know them and are concerned about their experience level. It's a tough place to be in! I don't envy you.

Something that might be helpful (if touring the hospital and talking to the docs hasn't made the choice easier) is seeking out some of those L&D nurses and talking to them. They see what happens in all kinds of situations, emergency and normal, and might give you a better feel for the practice you're thinking about.

I also just wanted to say that it's great that you are doing all this research, and that you are willing to even consider switching. No matter what happens, you can know you investigated all your options.

Bluebird said...

What a tough situation to be in! So, I don't know much about doulas - do they have much say/ control? In other words, could yours help things go the way you want if you say with your current dr.? Or (as I suspect), is the dr. totally in charge? Regardless, thank goodness for an incredible doula - sounds like you got a great one :)

Best of luck making your decision.