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The doctor isn’t always right

January 6, 2010

Not long ago, I wrote my birth story up, and I got a lot of web traffic from it because I turned down pitocin four times, believing it to be an intervention that wasn’t indicated for my labor and that having my labor medically managed would increase the bottom line cost of my birth and increase the chances that I would have a cesarean section.

A couple of weeks ago, I had my 6-week followup with the woman who _should_ have delivered my baby. She often shares anonymized birth stories with me, almost like case studies that help me better understand what is rapidly becoming my vocation. She told me about a recent night on call, when she had a woman with a scheduled cesarean successfully VBAC because she arrived at the hospital fully dilated and ready to push, and a woman having her fourth vaginal delivery go wrong because she had insisted on getting the epidural at two centimeters, well before the baby was engaged; when the baby finally did descend, it did so in a brow presentation, and got hung up, and she wound up having a c-section.

In other words, it’s not as important to have a birth plan as it is to be fully prepared. A birth _plan_, especially if you’ve never given birth before, quickly goes out the window when things don’t go to plan–and they usually don’t.

But by being prepared, you can spare yourself a lot of agony. One tip I don’t hear mentioned much, but one that helped me when I was fighting the OB for a natural birth, is to talk to other women in your family, if possible, about their birth experiences. One of the objections my OB had to allowing me to progress naturally was that I was clearly carrying a big baby. My retort was to list off the birth weights of my aunts and uncles, my own and my brother’s and several of my cousins. It hadn’t helped that K had showed up at a funny angle and gotten his shoulder hung up on my pelvis back in 1992–but not seriously so. Another objection she had was that if something *did* go wrong, she wanted it to happen during daytime hours when there were “a lot more people here.” Staffing issues on the late shift?

But as I continued to talk to my midwife at my 6-week checkup, she explained to me that the doctor–new to the practice–had never had a patient question her judgment. Remember her comment during my birth story, that she was accustomed to a certain process? During her medical school and internships in India, and her residency in an inner-city hospital, she had never faced a strong-willed, well-informed patient who was prepared to advocate on her own behalf.

So here’s where my birth “plan” went wrong. Not only did I get a stranger delivering my baby–I got a stranger who had never encountered a birth she hadn’t medically managed. Had I put blind trust in this woman, it was possible I’d have wound up with a c-section.

Now, for the post-script. It turned out that the OB called the senior doctor in the practice, the one that I thought would deliver me if my midwife wasn’t available, and asked her what to do with this stubborn patient who kept refusing treatment. The senior doctor responded, “Get used to it.” As my midwife explained, our community has a lot of intelligent, strong women who don’t want to be treated under an assembly-line process. By fighting the new doctor, I taught her something new about the kind of doctor she could be–one that listens to her patients, one that resists a rote process, one that doesn’t hunt down a pathology or use fear tactics to bully her patients into interventions they don’t need.

What of all the doctors who never get this lesson?

7 Comments leave one →
  1. January 7, 2010 9:09 pm

    Thank you so much for this! I really appreciate your story and perspective πŸ™‚

  2. January 7, 2010 9:33 pm

    Thank you so much for sharing your story and for educating the physician who took care of you. There is so much that you have stated in your post that rings true. Most importantly, you’ve captured the essence of a problem that I sincerely hope that all women’s health providers will learn to deal with.

    Medicine in general and childbirth in particular has always been about communication. Otherwise, women would just have their babies delivered by technicians who were knowledgeable regarding how to “get the baby out”. This type of technical approach to childbirth is detrimental to the health and well-being of women and their children and ultimately is bad for the soul of the medical practitioner.

    I’m happy to see that patients are reaching out to other patients and that they are sharing their appraisal of their individual pregnancies with caregivers.

    Such an important time should not be handled in a “one-size fits all” manner. Individualization results in the best outcomes. This not only goes for patient “birth plans” but also for physician “birth plans”.

    Thanks again.
    Chukwuma (Chuck) Onyeije

  3. January 7, 2010 11:03 pm

    We need to stop having surgeons deliver babies. It’s very rare that a woman actually needs medical intervention – I believe it’s around 5-7% of childbirths need a doctor to perform a procedure. If we quit thinking of childbirth as a medical emergency and instead look at it as a natural body function that a woman is perfectly capable of managing, we will see a direct impact on infant and maternal mortality, birth rapes, birth injuries, and more. We need midwives and nurses to be the only ones responsible for helping a woman bring a child into the world – if the woman wants that help. Surgeons are just that – SURGEONS. Trained to cut. That’s not childbirth.

  4. Kelly permalink
    January 7, 2010 11:49 pm

    Great story! So encouraging! Glad you had the birth you wanted!

  5. January 8, 2010 12:18 am

    Excellent story, thank you so much for sharing that! It’s cool to know that, that Dr. will most likely remember you for the rest of her career. You taught her *a lot*.

    WTG! πŸ˜€

  6. Q_T_Red permalink
    January 8, 2010 3:10 am

    Hehe, yep & I sure do hope she remembers ‘that stubborn patient’. For my last pregnancy, the practice I was going to use had just hired a fresh-out-of-school OB. I wanted to meet him face-to-face & get a feeling of him, yeah well, he still remembers me as the “only woman who refused to take off her clothes before meeting him.” I apologized that I was the only woman who’d done that πŸ˜‰

    We had quite a few good, deep discussions about things, many times he’d stop & TRULY consider what I was saying & my reasoning. I do admit though, I was very trying for him, but it looks like it’s affected him for the better in his communications with other women & that is what I was hoping for.

  7. hillary13 permalink
    January 8, 2010 4:39 am

    I completely agree! I think we will see a drastic improvement in our birth system when women start questioning doctors and doctors start having to answer and inform honestly. Right now there is a doctor on the pedestal thing going on and *way* too many drs use the, we don’t want anything to happen to the baby, which freaks the mom out and causes her to nod yes to whatever is being suggested to her.

    Women need to take responsibility for their births and not place it all on the caregivers and caregivers need to get used to the idea that they are hired by their clients meaning they are their as a support team member, they are not driving the boat.

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