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Forum: Natural Childbirth

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  • 2 Post By Surrounded
  • 2 Post By therevslady
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  #1  
October 18th, 2012, 11:33 AM
Dee
Join Date: Feb 2012
Posts: 1,753
I was reading the skipping ultrasounds thread, and could use some advice on this very issue.

Background:
I'm considered "High Risk" because of bleeding in August, which led to a Level II ultrasound with a MFM specialist who then found some neurological issues, unrelated to the bleeding but still disconcerting. A follow up fetal MRI confirmed the issues and clarified the extent of them, and a later ultrasound determined that the risks were now reduced by had not disappeared. The upshot: I'm still High Risk, but I don't currently need to consult with a neonatal neurologist or consider switching to a hospital with a higher level NICU. Cool! Great news, right?

No. Since there are only two choices: normal pregnancy or high risk, I'm still high risk and expected to be monitored heavily, including frequent ultrasounds.

I have had five... FIVE this pregnancy so far (plus the MRI). And I'm only 25 weeks.

Current Situation:
My midwives' office (where I'm still going for routine appointments) has been working with the MFM's assistant in an attempt to reduce the frequency of ultrasounds since we are no longer making decisions about my delivery or early infant care, we're just monitoring the situation. The MFM's assistant won't budge, since in this situation they recommend ultrasounds every two to four weeks.

Question:
How do I get them to leave this baby the heck alone? I don't want "crazy lady" written all over my records, but I feel like opting out of so much testing is a reasonable and informed choice on my part. I get "standard of care," I do, but shouldn't there be some flexibility within that?

My next appointment is on November 12th. Usually I see the u/s tech, who does an extensive u/s, then I wait and a doctor comes in to have another look and we talk. I'd like to speak with the doctor first and explain my desire to reduce the number of ultrasounds.

Any tips on how to handle this without being kicked out? Any magic words that make doctors believe in you a little more, or buzz words to be sure to avoid in this situation?
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  #2  
October 18th, 2012, 07:15 PM
Super Mommy
Join Date: Sep 2012
Location: Texas
Posts: 584
I am not really the best with or known for my tact. I just tell my dr how I would like things to happen at every single appointment. The way I see it is it's my body and my baby. You have to have my.permission before you can come near for any medical procedure whether it be invasive or not. Since all they want to do is look at the baby and aren't having any say in the delivery or care then it really is 100% up to you. If they have made it clear that they are not concerned about the well being of the baby (as far as imminent threat to the baby) then it seems they may just be covering their butts. Should something happen or the issue return and it wasn't caught when it could have been due to lack of u/s it could possibly leave them open to malpractice suit. Medical places and personnel would rather "over doctor" than "under doctor" people. That being said, you aren't a crazy lady trying to avoid care for your child based on you don't feel like getting an u/s today. You, along with your midwife, are making an informed decision on the prenatal care of your child. As the child's parent and guardian (not to mention they have to have access to your body) you feel you have taken the time to gather all the knowledge you can on this issue concerning the risks and benefits to constant u/s and how those risks and benefits pertain to your unborn child. Having gone over this information with your midwife you are going to reduce the frequency of the u/s.
I put that particular part in red and bold because I find if I tell a dr (or anyone else who feels they have the authority) "I want" or "I feel" or "I would like" it isn't taken seriously and they continue as if I never opened my mouth. Using stronger statements or phrases like "I am going to have fewer u/s" or "We are making an informed decision" puts a bit more oomph behind your words and makes them more of a statement than a question, suggestion, or idea.

One other thing. If you are under the care of a midwife and the specialist no longer has any say over delivery or care due to reduced risk to the baby, who keeps ordering the u/s? Is your midwife in a practice with doctors? I don't understand why she doesn't have more say in your care if she is your attending person.
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  #3  
October 19th, 2012, 10:47 AM
Dee
Join Date: Feb 2012
Posts: 1,753
This is really helpful, thank you. What you said here boosts my confidence that it's not crazy to not want them poking and prodding my baby... and me... just because it's standard procedure. And it's okay to not want to be poked all the time, that doesn't make me a bad mom. (Though hell if they don't make you feel crazy and irresponsible for not wanting to be poked.)

Quote:
Originally Posted by Surrounded View Post
One other thing. If you are under the care of a midwife and the specialist no longer has any say over delivery or care due to reduced risk to the baby, who keeps ordering the u/s? Is your midwife in a practice with doctors? I don't understand why she doesn't have more say in your care if she is your attending person.
My midwives are overseen by OBs who are affiliated with the high risk MFM overseeing the high risk aspect of my prenatal care. I think the midwives see my point, but aren't willing to override or strongly advocate for fewer interventions. And I get the feeling that once you're high risk, you're just high risk, and the midwives defer to that.

It probably sounds like I'm making a big deal over nothing. But this is the most out of control I've felt over my body, ever. (Both being pregnant and being in the care of doctors who deal with pregnancy.) I called and requested that the last MFM doctor I spoke with call me back. He seemed to find me amusing, and maybe a little over the top with my notebook tracking the series of appointments... maybe he'll be more helpful.
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  #4  
October 19th, 2012, 11:44 AM
Super Mommy
Join Date: Sep 2012
Location: Texas
Posts: 584
Talking to the last MFM doctor to gather as many details and bits of info as you can may be the way to go. One thing I have noticed cruising the boards on here is depending on where you are in the country or what country you are in depends on how midwives are perceived/accepted. If they aren't very popular or common in your area or openly welcomed by OB's (even being associated with an ob office) then midwives may feel more of a need to be cautious and defer to the dr's wishes so they don't offend anyone.
I have heard of one town where there are not any midwives because the OBs didn't want them and used their combined influence to cause the hospital to not allow them. with no place other than home to deliver, which not everyone is comfortable with and some places do not allow, they had to leave to find work elsewhere.

No, it doesn't sound like you are making a big deal over nothing. With my first I was blessed to have a fantastic dr. who didn't order tests for the sake of it and was very relaxed and patient. It is good she was like that because I just went with the flow of whatever I was told to do. I opened my eyes a bit for my second son which is good because I had a different dr and I had to be firm with her on what I would and would not allow to happen to my body. Example- I told her I would not be having an episiotomy no matter what. She looked right at me and said "Well, you have delivered once so it should be ok but we'll see." That was at my second appt. with her. So I made a point of telling her at every single appt after that "I am not having an episiotomy, induction, c-section, or epidural."
I got the crazy woman look a few times but it was worth it. I felt more in control of not just what was happening but what was going to happen. That left me feeling much more confident especially when it was time to take baby home. I didn't feel like I was taking back charge of my life while taking charge of another life all at once. It was more relaxed, more welcome to the family.

Btw, good for you for keeping the notebook with appt details. Thats awesome. I am not nearly as organized even though I like to think I am. I hope your talk with the MFM dr helps get a few things straightened out.
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  #5  
October 20th, 2012, 12:09 AM
Dee
Join Date: Feb 2012
Posts: 1,753
Thank you so much. This is really helpful to me as I sort through what to do next!
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  #6  
October 21st, 2012, 12:49 PM
therevslady's Avatar Built for Birth
Join Date: Jun 2008
Location: Atlanta, Ga
Posts: 6,194
I think she did a great job of helping you. The only thing I can add to using strong language is to keep reminding them that you have control of the decision making, not them. Using words like, what are my options? I consent, I do not consent, etc can go a long way and help put doctors in their place without being rude and keeps you in the decision making seat.

I had a similar experience with my last pregnancy. The office kept ordering more ultrasounds at the OB's office. I went in once. I asked as many questions as possible to decide whether or not I wanted any more ultrasounds to see if they could actually help anything (they couldn't). I told the OB that I appreciate his help so far and that I felt there was no need for any more than three consecutive ultrasounds for my particular issue and that I will not consent to any more ultrasounds following that. He simply said ok and left it at that. His office moved on autopilot and scheduled me again anyhow. I simply just called and canceled the appointment.

You should not be disqualified as a patient for refusing a test. People refuse tests and treatments all the time, that is your right to care for your body and your baby the way YOU choose.
http://www.childbirthconnection.org/...ring_women.pdf
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  #7  
December 3rd, 2012, 11:33 AM
Dee
Join Date: Feb 2012
Posts: 1,753
Quote:
Originally Posted by ~~Que~~ View Post
I simply just called and canceled the appointment.
That's what I ended up doing, and rescheduled for today. I'm so glad you posted this, it definitely helped me figure out how to handle it.

The advice you both offered here was very helpful as I sorted out what to do and how to handle, and what language to use. I rescheduled by November ultrasound for today, which was eight weeks in between ultrasounds, a more reasonable time in my mind especially since they saw an improvement between the two previous tests. It turns out, the problem went away. They don't know why or how, the doctor had never seen that before, but the areas that were too large are now within normal range, and I've officially been dismissed from the high risk practice and can return to a boring, i.e., "normal," pregnancy.

(Today's MFM did keep referring to an OB I saw for 5 minutes, whose name apparently ended up somewhere on my chart and is now considered my health care practitioner by all other doctors. So the fact that my care is handled by the midwife group continues to be missed, or perhaps they don't have a way of coding that internally, I don't know? Still some progress needs to be made in that area, it seems.)

In addition to the strategies suggested above, I used some of the approaches I learned in my Bradley class:
-The high risk facility is interested in giving me excellent care, so even if we have different ideas of what that looked like, I showed that I was grateful for the time and attention to my case.
-I made sure to ask "why" or "what do we hope to learn/accomplish" before consenting to anything.
-I tried to state things positively. Rather than "I won't," I used, "I would prefer."
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  #8  
December 4th, 2012, 01:47 PM
therevslady's Avatar Built for Birth
Join Date: Jun 2008
Location: Atlanta, Ga
Posts: 6,194
That's a WONDERFUL update! I'm glad things are getting better!
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