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Friday
Jan142011

Going on the Offensive

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By ANaturalAdvocate


I was twelve weeks along with my third child when I was told that I was a “good candidate for vaginal birth.” A candidate? I was in good health, and had had two previous pregnancies, with two vaginal deliveries - why was I merely a “candidate” instead of it being assumed that I would birth vaginally? Two words: defensive medicine. Defensive medicine is when a provider acts for reasons other than the health or well-being of the patient, for fear of being sued or subject to other punishments or penalties. In my case, I have big, fast babies, giving healthcare providers nightmares of shoulder dystocia in the middle of the highway.

First, let me state that I am not a small woman. I am, according to the BMI charts, obese. Whether I think the BMI charts are accurate, well, you’ve heard from me before on that. I am well-pleased with what my body can accomplish (both in pregnancy and general physical feats), so I’m not too worried about it, especially given that all test numbers are “brilliant!” as my primary care provider says. On the other hand, I’m a Fat Mama. From a long line of Fat Mamas. Therefore I must be: 1) lazy, 2) stupid, 3) diabetic, 4) pre-eclamptic, or 5) ALL OF THE ABOVE AHHHHH! I happen to be none of these (yes, I’ve checked, thanks). Nonetheless, I began my birth history with the Fat Mama tag.

My first child was born as a result of a “successful” induction. Towards the end of my pregnancy, my midwife (whom I had chosen because that’s the best way to a natural birth, right?) began to become concerned about the size of my baby. I was over nine pounds at birth (and breech and sectioned two weeks after my mother’s due date, if we’re counting), and come from a family of larger people. Combined with a lack of vaginal birth in my family generally, she was concerned that allowing me to go full-term would mean an almost certain C-section. Besides, at 37 weeks, he was “ready,” right? After talking to my midwife, I agreed to the induction (for which I was told there were no risks, as opposed to almost certain injuries for a later term vaginal birth) and my son was born at what is now referred to as a “late pre-term” baby. He was a good size (borderline macrosomic) but was not ready to be born and suffered a lot from his early birth. Ten years later, he has finally overcome most of the physical issues, although he still suffers from growth and behavioral issues that his providers believe are connected to his birth and the years of treatment after for prematurity-related problems. In addition to the guilt from consenting to the induction, I now had the Big Baby tag attached to me.

My second child was born in a spontaneous vaginal birth at just over 40 weeks. I had decided to decline any interventions like those I had agreed to in my first birth, primarily because I was scared about the same complications arising. Therefore, I chose a very naturally-minded midwifery practice but also considered and planned for an unassisted birth (we did not know of any legal home birth midwives in our area), and we weren’t sure whether these midwives would switch into Intervention Mode towards the end, like my last. In an example of “the baby will tell you what it needs,” our daughter (a little over nine pounds) arrived after a precipitous labor of half an hour - there was no time for anyone to show up even if we had wanted them to do so. However, we did choose to transfer to the hospital after her birth to make certain that the speed of her birth was not related to a problem with either of us. At the hospital, we were personally attacked and the hospital’s desire to cover themselves legally led to demanding testing and procedures that were absolutely not called for, as my medical records would attest.

Rather than looking at us individually, we were viewed as a dangerous unit, a potential liability, and they felt they needed to attack us as totally unknown entities. I was told that I was either dumb or lying, and that they wanted the name of my homebirth midwife because they were “not going to be responsible for whatever she had done.” We were told that they would not allow us to leave, even though my daughter checked out perfectly (they did not examine me, other than attempting to provide cord traction, and did not request to do so) because “we do not want to be responsible for that.” We finally agreed, after nearly 12 hours of being told that would could only leave AMA and without out child and on the condition that they would not call CPS, to allow the chief pediatrician to examine our daughter; if she gave a clean bill of health, we could leave unimpeded. After a brief examination, the pediatrician said “unfortunately, [she] could find no reason to keep us in the hospital.” We received a nice call from Child Protective Services anyhow and had to spend the first few weeks of our daughter’s life proving our worth as parents. I also then received the Fast Laborer tag.

My third baby, my secretive little baby who pretended he wasn’t there for so long and then BAM! baby…he was conceived by someone with three big tags: Big Baby and Fast Laborer and Fat Mama. After weeks of testing and concern that I never, ever wanted in a pregnancy (or had received before), we confirmed that the pregnancy was viable, despite heavy bleeding. That’s when, at 12 weeks, I was told that I could “try” for a vaginal birth. Try? “Well, you have larger babies, and those are hard to deliver and we don’t like to let you try and end up having problems.” Really? A nine-pound baby came virtually flying out, and that’s really a worry? The plan was to closely monitor me throughout and induce - or maybe even schedule a section? - as soon as the baby was “ready” - much like my first. When we ended up moving cross-country in the middle of the pregnancy, I chose more naturally-minded midwives…I thought. My first appointment with them led to the suggestion of early cervical checks and “induction as soon as you are the littlest bit ripe.” See, they didn’t want to risk it. “We don’t like people having babies that fast. We don’t like people potentially having their babies outside of the hospital. And with as big as you make them…we should deliver you early. We don’t want to be responsible for a baby born at Target, or getting stuck.” Despite the fact that my body clearly makes nice, large, late but fast babies…I was told I should kick them out early and on schedule. Again. No thanks. Instead, my fat little third baby was born a little over 8 months ago, at home, weighing not-quite ten pounds. He did cause a little fuss, choosing to be born with his hand up instead of tucked neatly down, but he was born on his own time (almost a week late - why do they keep getting later?) and his own speed (fortunately with more notice than his sister) and perfectly healthy.        

Defensive medicine not only affected how I birth my babies (no chance of finding me in a hospital short of a major issue), but also affected what I do for a living. After the birth of my second child, I knew that something needed to change. I was tired of hearing stories about what happened to women in labor, as well as hearing about the restrictions placed on providers by hospitals and states for fear of being sued. I went to law school, after previously teaching high school, not to sue people (although I will if necessary) or to make the giant bucks (although that’d be nice, if my fairy godmother is listening), but to defend choice and the ability of women, and families, to make their own, educated decisions regarding their care. In doing so, I also will defend providers who desire to make evidence-based and autonomy-respecting decisions, not litigation-based decisions, and allow their patients the ability to make informed consent and refusal. because everyone - physician and client alike - is hurt by defensive medicine.

 

 

 

ANaturalAdvocate is an activist, a soon-to-be attorney, mother of a small herd, hoarder of books, and self-described “techno-crunchy.”

 

 

 

 

 

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Reader Comments (8)

So excited to see your post! What great, if maddening, stories. Especially after your second child...I don't get it really. Do women who accidentally give birth at home, the ones you hear about in the news, get treated this way too? Or did they decide that doing it on purpose is what made you so suspect? If you weren't the official responsibility of any OB there, and your baby was already out and healthy...why were they so afraid? What did they think you were going to do? I remain mystified.

January 14, 2011 | Unregistered Commenteremjaybee

"Ten years later, he has finally overcome most of the physical issues"

I didn't realize this, by the way. I'm glad really glad to hear it and sorry for everything that you went through over the years.

January 14, 2011 | Registered CommenterJill

I'm sure they decided she did it on purpose, what with her being obsessed with wanting babies to come of her vagina instead of letting them cut it out in a civilized manner. I'm joking. Well sort of, I do think the medical community does feel the need to attack women that dare question them and don't want to be managed as though they're diseased.

I understand exactly how you feel. Only my first birth was an emergency section after two days of failed induction for preeclampsia. So I got stuck with the fat mama, preeclamptic(in spite of me complying and getting a negative test for it every single week), probably has GD even if the tests say no(THREE times), probably wont have a vaginal birth(but never did get a solid reason why that was so), uterus is a ticking time bomb(cause ya know they just explode ALL the time, right?) tags. Which is damned ridiculous and made me so angry that I fought that much harder to have an intervention free VBAC last year. Had to fire my perinatologist at 36wks, beg a seriously overbooked natural birth advocate to take me, sign a massive pile of medical releases and after all of the buildup had a pretty uneventful birth aside from having a nurse screech at me that I wasn't allowed out of bed for no apparent reason, and then having the same nurse *break my water* without asking me. At 41w1d, after all the foretellings of doom and swearing I would have a big baby and my uterus would explode and I would suddenly develop preeclampsia and shouldn't 'risk' it ... 6lbs8oz. lol. Can you imagine how small my son would have been if I had agreed to a c-section two weeks earlier?

The medical machine is seriously broken in this country. And the blatant prejudice towards any woman who is not the size they prefer really needs to stop, doctors need to start looking at the whole patient.

January 14, 2011 | Unregistered CommenterMariah

I think that many women and men can say exactly what you did in your last paragraph, perhaps with a few differing words, in regards to a variety of mishaps that occur because of medicine.. Defensive medicine (and, more accurately, defensive medicine in combination with disenfranchised and over-medicalized and under-personalized ritualistic medicine, not to mention, disorganized and difficult to even ACCESS when they need it for a good portion of our population!) has had a role in many women, and men, straying away from the current system at least in philosophy if not in career path.. in a variety of the medical fields.

In this arena, I know many women who had shitty experiences in the hospital who later became doulas or midwives or lactation counselors because of that experience.

I personally have thought about pursuing something in the field...

Anyway, thanks for sharing your stories. They are exemplifications of why this system is broken. Babies that were NOT destined for doom, were labeled as such, prematurely, because the mother had "risk factors" that should've only predicated perhaps caution - perhaps CAUTION - but not action.. particularly after you'd already spontaneously delivered a perfectly healthy, largish, kiddo at home.

But, using caution and only acting when it really becomes necessary, being logical, "it gets you sued". Nevermind that doing the opposite hurts untold numbers of women, children, and future children of that woman - who REALLY didn't need to be harmed at all.

I have a hard time with the idea that they think they're sacrificing so many women's intact uterus's, women's birth experiences, and women and children's health (that will recover, usually, sometimes fought hard to do so though) to really save a few lives. They seem to think that in the end, they end up with the plus sign on their side for reducing harm with this. But, I don't personally think that's true.

And, I'm amongst a growing number of women, right with you there, who will stay the hell away from the hospital should I become pregnant/birth again unless it were of dire necessity. And yes, it's because of what happened with my last.. My eyes are not eyes wide shut like I feel many women's eyes are.

Again, thanks for sharing :)

January 14, 2011 | Unregistered CommenterFogedaboudid

I wish we had a lot more lawyers like you!!!

January 15, 2011 | Unregistered CommenterKimberly

Thank you for sharing this. As a doula, I recently accompanied a client (and dear friend) on her birth journey for her first baby. A planned homebirth with a wonderful CPM ended in a hospital transfer for maternal exhaustion and dehydration. She had been 9 with a lip for hours, cervix was swelling, baby was OP. But baby was fine. Mom was fine. No emergency.

House doc examines her very roughly, and treats her like she's scum of the earth. Rude beyond belief. The OB on call - not even in the hospital - said if he came in to see her, he was cutting her. But he ordered an epidural for her (at her request), and some pit to get her contracting again. (It's no wonder her labor had stalled by this point!)

Next doc takes over 4 hours later. Comes in to see her and check her - also roughly. Tells her he's going to a funeral, and when he comes back, if she's not changed at all, he's going to section her. And he wants the names and relationships of everyone in the room (midwife, me, and husband). Midwife had brought all prenatal history - when he got back, he gave her the third degree like she was some intern who wasn't worthy of being in the room with him. Then, in the midst of pushing, he's accusing mom of being a gestational diabetic (she weighed all of about 115 lbs when she got pregnant, and gained a completely acceptable amount of weight). Mom recited back blood sugars. When that didn't work, he accused them of hiding a big, late baby. No....her ultrasounds all matched dates and she was measuring right on. She was 40+3. Started attacking midwife again for mismanagement of labor. I have never wanted to smack someone like I did right then.

He leaves the room to do lord knows what. Probably call his lawyer. I told mama that he didn't believe she could push her baby out, and if she wanted to prove him wrong, now was the time to do it. He came back, and within 10 minutes, we had a baby. 7 lb 4 oz. Practically perfect in every way.

I will say that the nurses at that hospital were amazing. They believed she could do it. They didn't think she had done anything wrong, and that her transfer was totally appropriate. They protected mama from as much of the intervention as they could, even standing up to the on call doc and telling him that she was not going to consent to a section no matter what. Her nurse partnered with the midwife and asked lots of questions and wanted the midwife to be hands on (she declined b/c she doesn't have hospital priviledges and the situation was already tense). She wanted to learn as much as she could from the MW. It was awesome.

But I was appalled by the doctors. My client was treated rudely, like she was dumb and uneducated and uninformed about something her body was perfectly capable of doing. I was half-expecting them to call DFS and suggest that by attempting a home birth she had somehow abused her child. This was a woman who, prior to conceiving, thought scheduled sections were the way to go. Then she watched Orgasmic Birth with me and started doing her own research and asking a TON of questions. She conceived, hired a CNM, and was planning a NCB in a hospital, but the CNM's doc was too interventionist and so she transferred care to a homebirth CPM. (We don't have a birth center here.) She made every decision thoughtfully after much research, and in partnership with her husband. This was not some 13 year old girl who had watched a movie and decided to give birth in her bathroom with no one home. She is a college graduate, she has lived all over the world, and she knows and trusts her body.

The maternity system in this country is so flawed. So many women are being railroaded, even ones who have done their research and know that what's being done isn't necessarily right or best, because there are women who have resisted and been punished by calls to DFS and babies have been taken away. The Establishment is afraid of what it doesn't understand, and so it goes on a full court press with nothing but fear behind it.

January 15, 2011 | Unregistered CommenterBirthSister

Emjaybee: We did not tell them that we were planning a home birth, because we knew they would be hostile. We didn't lie, either, though, just reiterated that her birth was precipitous and we wanted to get checked out before returning home. They were immediately hostile upon our arrival and continued to ask "what really happened." While we were cleared on all counts, the official complaint by the hospital indicated abuse and neglect of our newborn (they said I had received no prenatal care - contrary to my medical record, which my CNM sent over as soon as she heard I was there - and they were concerned about possible defects and GD as a result of that, as well as stating that we refused required procedures - which we didn't) AND neglect of our son, 6 at the time, because he had been present during the birth (well, he was in the hallway). I do have to admit that I wasn't the most pleasant patient, especially after the OB called in continued to apply cord traction after I shouted that I did not consent. So, I will admit that my own behavior may have contributed to their opinion of me, although I did not decline anything necessary, did not curse or scream, or otherwise behave "inappropriately."

Jill: Thanks. He's still considered in a higher risk group for catching respiratory illnesses, and has some growth issues related to the massive amount of medicines he needed for the first few years of his life, but physically he seems to be doing well. Behaviorally is a bit different, but it's undetermined whether those are entirely connected to the prematurity or other issues.

Mariah: My goodness! What a struggle you had to go through to achieve your second birth experience. Isn't it interesting how we're continually told that we have problems, despite all tests reading to the contrary? If the tests are so important that providers have fits when we refuse them, then why don't they believe them when we take them? So confusing! :)

Fogedaboudid: I think it is common for a bad experience, or even lukewarm, to force someone to think about moving towards birth work. Midwifery and the like just aren't my cup of tea as a career, but law...I've always loved law and been the persnickety sort, and family members had encouraged that route, but I chose teaching because, well, I loved it. However, after my experiences I realized that there were much better teachers than I out there, but perhaps I could be a unique sort of attorney. Call it narcissistic, but hopefully I'll do some good with that.

Kimberly: There are more lawyers like me! You've heard from some in this series, and there are others, with NAPW and Big Push for Midwives and that work independently. Circumstances have perhaps allowed me to be a little more independently vocal, thanks to Jill, but we're out there! One of my Dream Goals is to help broadcast the names of attorneys around the country, willing to be "on call," as it were, to help families in need. I've heard of a few, but still too many, stories of women threatened with CPS or court orders who comply because they don't realize that there's another option, or even some when hearings take place where the parents have no or inappropriate representation. :/

BirthSister: I'm sorry to hear that your client and friend was treated so roughly during her birth. I am glad to hear, though, that she had many advocates in the hospital - including you. :) I think it's important to reiterate, though, that ALL women deserve respect, access to appropriate care of their choice, and informed consent/refusal. I know of many teen moms who have also done their research and are treated almost punitively as a result of their age. Just yesterday I heard about a local in-hospital provider who tends to delay access to pain medication for teen moms because "then maybe they'll think twice about opening their legs again." Horrendous!

January 15, 2011 | Registered CommenterANaturalAdvocate

You are telling my story almost to the T... so tired of not being looked at as an individual with a brain.

January 17, 2011 | Unregistered CommenterMychel
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