What the hell? No interviews?

Allright doctors, listen up! Obstetrics is a competitive, consumer driven field. Allow yourselves to be interviewed. As a mom, I want to know that we'll get along, you will after all be looking at my girly parts and providing a service to me. As a childbirth educator, I encourage my clients to interview all potential health care providers. You as an OB, encourage your patients to interview prospective pediatricians, don't you? Then why can't I interview you? Oh and why are you charging me for a consult? You have the potential to make thousands of dollars off of me, provided you pass my quiz. I would think you would want interviews/consults, after all it would give you, the obstetrician, the chance to weed out the mothers you don't want to work with (You know us, whiney, natural childbirth obsessed mothers?)'
I'm only a week into knowing I'm pregnant, and already, I'm ready to give up on the obstetrics profession.
Please, someone send me an angel.

March 18, 2009

So today I had the fun task of calling every Family Doctor in the area that's covered by my insurance. I must say that the majority of receptionists didn't even know that a Family Doctor could catch a baby. Ugh. I called 10, and all were a no go. Finally at physicians office #10, they gave me the phone number for the SE Missouri Medical Association (I wonder if I can research individual doctors statistics through them), and THEY gave me the number for a Family Doc who catches babies. I also set up an interview with the Doctor who my client delivered with. I'll probably also set up an interview with the OB who I let check my girly parts. I liked his candor, and that he didn't talk to me like I was a moron.

Oh and double UGH...
http://www.cdc.gov/media/pressrel/2009/r090318.htm

"The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States."

To quote The Price is Right, "THAT'S TOO MUCH".

Let the Adventure begin!

So, I find myself in need of a midwife, or a NCB friendly prac that'll let me labor/birth the way I need to. I hate that I even need to say "let me". I'm the one pushing a baby out my vagina, they're working for me, but I digress.

So I'm compiling a list of questions to ask my prospective docs...provided I don't find a midwife willing to travel.

Some of these questions come from here and there are more questions there than are listed here (there'$s even a cool print out).

1) What are your philosophies and beliefs about birth?
Answer I'm looking for: Birth is an awe inspiring force of nature, that I am happy to be a part of. I like to let things unfold as they will. Not the answer I'm likely to get, but if I get it, you'll be able to knock me over with a feather.

2)I am firm proponent of informed consent and refusal. How much choice do you feel I should have in the decision making process?
Answer I'm looking for: We'll work together as a team. I will tell you everything I know about whatever decision needs to be made.

3) I'll roughly outline my wishes for birth (i'm not so big on birth plans, unless you're going to a hospital that actually reads them), and see what's negotiable up front... I'll probably ask about management of third stage as well.
Answer I'm looking for: Doc supports my wishes for an as un-intervened birth as possible, ie, hep lock in place of IV, laboring/birthing in positions that suit me, NO EPISIOTOMY, etc. I don't know how I'm going to get around the insane requirement of constant electronic fetal monitoring.

4)What is your induction rate, and when do you feel induction of labor is necessary?
Answer I'm looking for: A very low induction/augment rate, similar to that suggested by the WHO, induction for medical reasons such as PIH, post-dates of 10 days or more, toxemia (but even then doc should be offering nutritional counseling well before toxemia sets in), etc.

5) What is your preferred method of induction?
Answer I'm looking for: Anything but Cytotec!

6) What is your Caesarean rate? And in what situations do you recommend a C-section?
I'm naturally looking for a very low answer, but honestly don't think I'm going to find anyone with a rate lower than 30-40% here. I'm actually going to interview a couple of nurses from each of the hospitals before I settle on a doctor.

7) How do you feel about vaginal births for breech presentations or twins?
I don't know what answer I'm looking for there, honestly if doc's never attended either, I don't want to be his guinea pig. I'll go to the Farm for that!

8) I am hiring a doula for my birth. Do you work with doulas?
If the answer is no, then he/she is not the doctor for me. I am a doula and a natural childbirth educator. And because there is a distinct possibility of birthing in a hospital, I will most definitely hire a doula.

I know I've got some pie in the sky answers I'm looking for, and I'll probably settle for answers that are less than what I'm looking for if the doc will look the other way when it comes to my stubborness.
There are tons more questions you should ask of your HCP if this is a first baby for you, or you are not a birth junkie, like I am. I suggest looking for a practitioner that meets the definition of Mother-friendly as outlined by the Coalition for Improving Maternity Services. Believe it or not
BabyCenter has a great print-out as does BabyFit.

Anyone want to pay for me to go?

http://www.birthconference.org/ShowPage.asp?id=187

In particular I'd like to sit in this discussion...

Do Natural Birth Advocates Hurt their Own Cause?
Karen Fennell RN MS
Normal (natural) birth advocates are often very passionate about their belief that a non-medicated, non-induced, non-interventionist and undisturbed vaginal birth is “the best way” to have a baby. In their zeal, many advocates accuse physicians of having ulterior motives, not following best practices, and not giving good care. This session will focus on the methods of persuasion used by the advocates and whether or not these methods have assisted or inhibited gains in natural/normal childbirth and breastfeeding.

There are many, many more I'd like to sit in on. But at the moment we don't have a spare $1K to go.

A Consumer Driven Birth Culture? One can only hope...

http://www.bellaonline.com/articles/art58521.asp


g Pregnancy Site
Angela England
BellaOnline's Pregnancy Editor

g

A Consumer Driven Birth Culture

Alan Huber, CFP has been involved with the birthing industry for well over a decade and is in a unique position of seeing things from a neutral ground position. In an interview with Angela England, Pregnancy Editor at BellaOnline, Huber said, "The real issues are not being addressed". And Alan is right.

His brisk accent added an underscore to his words as he spoke to me with enthusiasm. He talked about how this conference could be the opportunity for the consumers, for women like you and I, to change America's birth culture in a positive way.

For many years now we have had knee-jerk reactions to the changing birth culture in America. Bradley's Husband-Coached philosophy rose in reaction harsh and restrictive hospital environments. Now, we currently have AMA and ACOG setting their sights on stamping out midwifery and homebirth completely, in reaction to recent popular movie releases like "Business of Being Born" and "Orgasmic Birth". Huber continued, "We have all these organizations talking at each other, but no one is talking to each other. Nothing is truly being resolved."

As the Controversies in Childbirth Conference website points out there are a lot of problems facing the general birth climate in America - and it is ultimately the women, and their babies, who suffer as a result. "Rising costs and reduced reimbursements have caused many OBs to stop delivering babies" and "Malpractice insurers regulate birth and limit women’s options by prohibiting practitioners from attending VBACs, water labor, and home birth . . . even though exercising these options may lower costs." are just two examples of the catch-22 reasonings that are negatively influencing a pregnant woman's choices today.

So the idea of a neutral ground meeting place was born. Controversies in Childbirth Conference will be the first place where practicing American physicians, midwives, doulas, malpractice insurers, financial planners, and more will be able to come together to truly work towards solving some of the problems women face within the current birth model in America.

My personal hope is that many average citizens will attend the conference as well. I feel it is time for us to stop accepting what large, interest-group organizations say is best for us, and time to decide for ourselves! Alan Huber remarked towards the end of our interview, "This will be a place for women to speak up! It will be a place to create a birth culture of mutual respect in America."

The Controversies in Childbirth Conference will be held in Dallas, TX March 27-29, 2009. A free Baby Fair Expo will run simultaneously, allowing women to attend both events. More information can be found on the Conference Website listed below.

I personally plan to be there and see whether we can force the broken, multiple-system currently in place, to work together and reach some agreements that won't leave the women, and their babies, without choices! I hope you can make it too.

Would love to hear your thoughts on the subject in the Pregnancy Forum Thread about this article.

Want to learn more about the current birth climate in America, how we got there and what steps we can take to change? Check out these two books for some well-researched opinions:


The article ends there... but I sincerely hope that our paternalistic medical society will realize that they are really doing women a great disservice with the current status quo. The best thing women can do for themselves is be an informed consumer. You research, research, research before you buy a new TV, why not do the same for the most important day in your baby's life?

Win a Medela Freestyle Hands-Free Breastpump from Nature's Child - Wholesome goods for Mothers and Babies

Birth Trauma affects breastfeeding,,, tell me something I don't know.

Impact of Birth Trauma on Breast-feeding: A Tale of Two Pathways.

FEATURES

Nursing Research. 57(4):228-236, July/August 2008.
Beck, Cheryl Tatano; Watson, Sue

Abstract:
Background: Up to 34% of new mothers have reported experiencing a traumatic childbirth. Documented risk factors for delayed or failed lactogenesis include stressful labor and delivery, unscheduled cesarean births, and psychosocial stress and pain related to childbirth.

Objective: To explore the impact of birth trauma on mothers' breast-feeding experiences.

Methods: Phenomenology was the qualitative research design used to investigate mothers' breast-feeding experiences after birth trauma. Fifty-two women were recruited over the Internet through the assistance of Trauma and Birth Stress, a charitable trust located in New Zealand. Each mother sent her breast-feeding story to the researchers via the Internet. Colaizzi's (1978) method was used to analyze the data.

Results: Eight themes emerged about whether mothers' breast-feeding attempts were promoted or impeded. These themes included (a) proving oneself as a mother: sheer determination to succeed, (b) making up for an awful arrival: atonement to the baby, (c) helping to heal mentally: time-out from the pain in one's head, (d) just one more thing to be violated: mothers' breasts, (e) enduring the physical pain: seeming at times an insurmountable ordeal, (f) dangerous mix: birth trauma and insufficient milk supply, (g) intruding flashbacks: stealing anticipated joy, and (h) disturbing detachment: an empty affair.

Conclusions: The impact of birth trauma on mothers' breast-feeding experiences can lead women down two strikingly different paths. One path can propel women into persevering in breast-feeding, whereas the other path can lead to distressing impediments that curtailed women's breast-feeding attempts.