Tag: Birthing large babies

OBs vs. Midwives

by Ashley filed under Pregnancy

AshleyWilly-160mattandtishWhen I begrudgingly agreed to have an OB deliver our third baby instead of a midwife, I called the local birth center and asked for a few names they felt comfortable recommending. We interviewed an OB they suggested and given the fact I had already been defeated on the decision to birth with a midwife, I agreed with Willy that the OB recommended to us was fine. He didn’t blow me away, nor did he send me running out his door with the nervous energy to continue the interviewing process with additional OBs. And, as I’ve mentioned in posts prior, I’ve been going through the motions and jumping through the hoops ever since.

Each time I leave his office, I leave with the same frustration; it’s like a copycat performance of the visit before, starting with the appointment itself and concluding with me calling Willy on the way home referring to our OB by adjectives that aren’t so nice.

It sucks to be in the care of someone you don’t really feel comfortable with. I’m sure most would say, “why not just find a new doc that you like” and the answer is because I’m tired. And perhaps a little cynical. Probably more of the latter than the former. The fact he was recommended by a birth center truthfully means more than his horrible bedside manner. The other challenge inherent to the place we live is that many of the OBs are part of a medical group; meaning you may see a different doc each time and whoever is on-call when you go into labor is who you get. I suppose there is some comfort in the fact that my guy is a sole practitioner and that come the day of my labor I won’t have to guess who will be there.

In any event, I interviewed a few doulas in hopes of finding the comfort that all along has been lacking and all three of the fabulous individuals I interviewed supported my choice of OBs. They said things like, “Oh I’ve been at a birth where he let the laboring women labor on her hands and knees” and though it was said with zero amount of sarcasm, I couldn’t help but think (with all the sarcasm I could muster), “wow, this is what it’s like when you move away from birthing with a midwife? You celebrate things like a laboring women birthing on her hands and knees?”… I’m still having trouble grappling with the idea of some doctor dictating how a women can or cannot labor and the fact that some insist on a women staying in bed to push just makes me scratch my head.

We have our first appointment with our doula coming up and thus far, I think it’s the best decision I’ve made and perhaps the closest I’ll get to building the birthing experience I not so badly want, but feel that I need.

I left my last OB appointment thinking about the differences in being seen by a midwife versus an OB. I can sum up my appointments with my OB more quickly than I’d like:

-Pee in a cup
-Have same elderly nurse copy my weight down on a post-it and check my blood pressure. Last appointment, she left a snag in my dress from the velcro part of the blood pressure cuff. She’s slightly cold and continues to tell me whether my blood pressure is okay, ignoring the fact it says I’m a registered nurse in my chart.
-Doc comes in and asks the following questions in the same order, every time, without fail and rolls through them in the same intensity as a military drill sergeant: Any bleeding? Any cramping? Any headaches? Any water leaking? Belly getting bigger? He throws the last one in there to try to fool me into the repetitious “no” that precedes the obvious “yes” answer and every time he smirks like he thinks he’s clever and nearly fooled me.
-He performs an ultrasound that literally takes less than a minute, asks me if I have any questions, reminds me to make an appointment in another month, and leaves the room.
-I brought the boys with me to one appointment. Not one person even said hello to them, there was nothing there to keep them entertained, and I got the general feeling that they were expected to be quiet and not touch anything.

I started timing my appointments because I get some (sarcastic) joy in calling Willy and confessing that the entire appointment, including wait time, took 6 minutes and 8 seconds. That’s 30 seconds longer than the appointment before, where he also performed a vaginal exam within the 5 minute and 30 second appointment that included all of the aforementioned in addition to the vaginal exam.

All my appointments with midwives averaged somewhere in the ball park of 30 minutes to an hour and included the following:

-Peeing in a cup and using a urine dipstick to check my own urine. This may seem minuscule and perhaps there are some that prefer not to have that kind of responsibility, but I like that there was a feeling of trust; it built a different kind of relationship where the control was more-or-less shared. I’d also weigh myself, because who needs someone else to follow you to the scale and write the number down when you’re capable of reporting such yourself?
-They’d check my blood pressure, measure my belly using a tape measurer, and use a handheld doppler to listen to the heartbeat. They’d palpate my belly to determine the baby’s position. I remember my midwife with Hooper commenting on how long he was… just by palpation (and, indeed, he was long).
-We’d go over my diet and what foods are good sources of protein. I think I may have received a handout in my “welcome packet” from my OB that had some vague mention of changes in diet during pregnancy, but nothing that has ever been enforced or asked about. In fact, I ate very differently during my previous pregnancies as a result to the constant checking in with the midwives; this pregnancy? Not so much. Of course that’s on me, but it is nice to know the person in charge cares about your overall well-being and is making the connection between healthy mom and healthy baby.
-The remainder of the appointment was more psychosocial related and allowed for time to discuss fears or issues or “what happens if” sorta questions and to fine tune the birth plan, my birth plan. The time spent talking was longer and more in-depth during my first pregnancy and more to the point with the second, highlighting the fact it was all individual and catered to my needs (we needed more time to discuss fears and issues with our first than we did with our second).
-I’d have new reading material to take home after each appointment, along with the reminder to keep doing my kegel exercises… which is a word I haven’t even heard throughout this entire pregnancy, which is unfortunate because it’s kinda a funny word and I like saying it.
-I’d see my midwives once a month until about the 8th month, when the time between visits would lessen to two weeks and by the ninth month, I would see them once a week.
-If I brought Hooper to my appointment, he was always included. He’d get to hold the doppler or play with the stethoscope or hung out in corner where they had toys and books for the siblings they anticipated to be tagging along during appointments.

I asked my OB during my last appointment if research proves that having gone past your due date in the past is any indication that it will happen again (I was 10 days late with both boys), to-which-he-replied, “did you go late with your prior two?”. Going past my due date is one of my biggest fears, given the fact that I fear having another big baby and that more time in the womb equals more time growing in that damn warm and comfy womb of mine, and I felt sad that this (insert negative adjective here) OB has no idea what my fears are or even what my past experiences are comprised of despite conversations we’ve had in the past. To make matters most, he went on to offer inducing me before my due date to “ease my fears of having another overdue, big baby”. And then he was dumbfounded when I told him I’d downright refuse pitocin unless he were insisting that it was something that I’d have to have. Again, forgetting that the induction via pitocin with Hooper led to unrelenting titanic contractions that ultimately landed me on the operating room table. Considering an epidural is not even an option for me this go-around, I felt like saying “you (insert many mean adjectives here)” for even suggesting such (contractions resulting from pitocin are much stronger than your regular, though still unrelenting, contractions). I told him I fear pitocin ten times more than I do being overdue or having a big baby. And I’m hoping I said it with enough stink eye that he remembers such and that we don’t have to have the conversation again, because where is the trust in that?

A few weeks back you may recall that I was experiencing horrible neck pain. I had pulled a muscle in my upper trap so bad that it pulled so taut over a screw in my spine and presumably caused damage to the tissue overlying the screw. Every time I lifted my arm or moved my arm, that injured tissue would rub over the screw and it felt like, because it was, an open cut being rubbed over a metal screw. I got the okay from the pain doc I’ve seen in the past to take something for the unrelenting pain and reluctantly, I took half of the dose I would in the past on three separate, most desperate days. I sent my OB an email informing him of the situation because I felt like he should be involved in my care and the decision to take a narcotic while pregnant. Not only did I never hear back from him, but he also didn’t ask anything about it during my appointment. A midwife would have been all over that. Again, it just erodes the trust I think all of us pregnant women are looking for. And the feeling that we’re being well cared for.

On the flip side, he did agree that the glucose testing was not needed given the fact I have the tools to check my blood sugar from home and it did feel somewhat good that he trusted me to do so. He also agreed, after my coaxing, that the followup with the perinatologist I was dreading was also unnecessary and so, I canceled that appointment which surely would have me fretting even more over the size of this baby than I already am. So I suppose there are some things he’s worked with me on, on an individual level. But all in all, I miss the care I received while in the hands of midwives… hoping that this first meeting with our doula eases some anxieties.

What has your experience with your OB been like? Can you relate? What are things you like / don’t like about the care you’ve received? And curious to know if anyone else has been seen by both an OB and a midwife and has similar comparisons to mine? And lastly, any suggestions for lowering the birth weight of the baby growing inside me? I kid… but no really, the Marlboro man may be calling.

*Image by Tish Carlson, and don’t let the small bump fool it… it was taken back in November…

The difference between midwives and OBs

by Ashley filed under Home Birth, Pregnancy

I have a lot of conflicted emotions about medical care and for anyone that looks in through a window at my life, I’m sure they would be confused as well.

For starters, I work in the medical field as a registered nurse. I work with doctors, surgeons, case managers, social workers, physical, occupational, and speech therapists, dietitians, radiologists and so on and so forth. I seem to baffle a lot of my co-workers when I divulge the fact my first two children were planned to be born at home, in the care of midwives, given the fact that I should know what “could” happen and all that jazz.

If I’m being honest, I’m happy to be planning a hospital birth this time around. Two failed attempts is enough for me and while I support it wholeheartedly for other women, I’ve come to the conclusion that it’s just not for me. I wish it was.

This is the first pregnancy I’ve been followed by an OB, from the beginning. The OB that delivered Hooper was fantastic, fully knew and supported the midwives I was working with, and did a fantastic job navigating Hooper’s tumultuous birth (though I’m still against induction despite the fact I know it’s necessary at times — I blame much of the decline in Hooper’s birth experience on the pitocin I was given).

During my pregnancy with Van, I had to chose a different back-up OB (the previous OB suffered a sudden death heart attack, which hit many in the OB community like a ton of bricks). I met with the new OB one, maybe two times. Because Van’s birth involved an ambulance transfer to the closest hospital, the OB that actually delivered him had never met us before (and to-be-clear by delivered, what I actually mean is pushed on my belly until his 9.8 pound body literally popped out — it was, um, audible). Point being, I’ve had OBs that have had to intervene along the way, but this is my first pregnancy where I will have been seen by the same OB from beginning to end, and more-or-less, only by him (I can’t help but think as I type that how ironic it would be if he couldn’t make my birth for some unforeseen reason and baby #3 ended up being delivered by yet another, new-to-me, OB. Hashtag: funny not funny).

So in a sense, I’m merely jumping through the hoops this go-around. I’ve had more ultrasounds in the first half of this pregnancy than I had combined in my pregnancies with Hooper and Van. I’m taking my first ever glucose screening test (I opted not to with the midwives because I was checking my blood sugars regularly at work and knew that if anything, my sugars were running on the low side of normal — therefore ruling out gestational diabetes).

The one thing I did turn down was the genetic testing and that’s based on nothing other than the fact that finding out the results of the test would have no bearing my decision to go through with the pregnancy.

I had my first ever ‘comprehensive ultrasound / anatomical screening’, which I was surprised to learn is not performed by regular OBs but by perinatologists instead. The very definition of a perinatiologiat, by the way, is “a physician that works in conjunction with a patient’s obstetrician when pregnancy complications develop and is able to provide care for both the mom and unborn baby”. My eyes were already rolling before I even made the appointment because I understand the absurdity in involving a physician who deals with complications being involved in the care of an individual experiencing an uncomplicated pregnancy. But, alas, the hoops — I’ve agreed to jump through them (almost entirely for Willy’s sake; as he was rather traumatized from the first two births).

When I arrived at the perinatologists office, the receptionist pointed out where the bottles of water were; they sat on a fancy mirrored tray above the magazines that included none of the trashy stuff I only pick up in doctor’s office and in line at the grocery store, but instead “Travel & Leisure” and other sophisticated crap my burnt out brain cells didn’t feel like picking up. The sofa was oversized and included a large velvety blanket that I presume was there  in the event anyone felt like cuddling. Point being, it felt very spa-like. Very pampered. And this experience continued as I was shown to my room, which was dimly lit with a desk at the window like you would find in a hotel room; a desk I’m sure no one has ever sat at with a small cup of pencils I’m sure no one has ever written with. At the sink were special soaps and lotions and a basket of hand towels. I sat back in the large chair, with my feet up, and watched the ultrasound on the big screen tv placed in front of me. I was a bit disappointed the chair didn’t have one of those massage mechanisms like they do at the manicurists. I’m being facetious.

It’s funny because sometimes I want to remind the very patients I care for in the hospital that they are in fact in the hospital, because of medical necessity no less, and not in a hotel. But I found myself on the flip side, wanting to remind the staff that they are indeed in a medical office and not some kind of massage pallor. It made me question further if any of this were necessary as I assume things that are necessary contain less fluff and more, I dunno, latex gloves.

In any event, all checked out fine. I closed my eyes while they checked out the baby’s goods and met with the doc at the end who summarized the findings; “My only concern”, he said, “is the baby’s size. You’re measuring a week ahead of where your dates put you”. He went on to suggest I have an additional test done to rule out gestational diabetes (because gestational diabetes accounts for larger babies). We then had a conversation about the birth weight of the boys (Hooper was 8.15 and Van was 9.8) and how neither of those involved any gestational diabetes. He also confirmed that birth weight has a genetic component (both Willy and I were 8+ at birth). And despite all the exchange of information, and this is the part that makes me hate the medical field, he wrote me script for the additional gestational diabetes testing and said he’d like to see me back, at 32 weeks, to “see how the baby is growing”.

Surely at 32 weeks the baby will be growing. It isn’t rocket science. It also doesn’t take rocket science to make the prediction that I will be carrying another large baby. The best indicator of the future is to look to the past, after all. I also know that ultrasounds later in pregnancy are less accurate due to the fact the baby is taking up more room. Sometimes they say weight can be plus or minus a pound, which is pretty substantial when you’re talking about a being that is only a handful of pounds anyway. And what’s it matter? It bothers me that women are not trusted to birth babies anymore; that so many are encouraged to go down the planned c-section path or the planned induction path (and while I have no judgements toward woman that chose this path, I do have judgments on practitioners that lead their patients to this path based on some kind of instilled fear). I have no doubt that this baby will be big. I also have no doubt in my ability to work with my doctor to get it out safely.

I could go on and on. I could even jump over to the other side of the coin and defend certain arguments from that side as well but all in all I think the take home message that I want to remind myself is this: Trust your gut. The care you receive is at times reflective of the larger population and fails to take the individual experience into account. Be your own advocate and ask questions that force your practitioner to see you as an individual.

And so, thus far I haven’t had many, if any, questions for my OB. I spend more time waiting for my food at the drive-thru window than I do in his office for an appointment. But when I did ask about the baby’s weight and his confidence level in delivering a big baby, he more or less shrugged off my concerns, boasted about the 9 pound baby he delivered that morning, and before-I-knew-it I was back in my car, on my way home.

I miss the care of midwives. I miss having my belly measured and touched. My OB appointments are exactly the same: pee in cup, stand on scale, check blood pressure, wait a minute for doc, doc comes in and asks “any bleeding, cramping, discharge, headaches?”, performs an ultrasound and listens to the heartbeat for maybe 7 seconds, asks if I have any questions, and I’m dismissed.

I remember listening to Kevin & Bean on the radio talk about that show ‘I didn’t know I was pregnant’, about women who actually go into labor and deliver a baby having never known they were even pregnant. They talked about how surprising it was that a lot of these women birthed healthy babies despite the fact they didn’t receive prenatal care. I’m not so surprised; prenatal care thus far has not impressed me. I feel like a cow being led through a corral.

Would love to hear from any mamas out there that also birthed big babies. I have a friend who birthed a thirteen pound baby at home and I always channel her in my pregnancies. Would also love to hear from any others about their prenatal care / OB experience.