labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, April 20, 2009

Keeping My Mouth Shut

I've taken to keeping my mouth shut when family members and friends discuss their personal pregnancy goings-on. But its really difficult, particularly when I completely disagree with the management or decisions being made. I am very aware that many people may view anything I say in response to these things as being a radical moonbat. Even just telling some people that I am a midwife evokes images of a patchouli smelling, hairy legged, Birkenstock wearing freak who waves chicken feathers and tries to summons Goddesses to help in the birth of babies. (And on any given day, they might get this notion confirmed if they saw my legs....but they aren't hairy because of my profession).

For instance, my cousin is pregnant with her first baby. She is due in several weeks. Her pregnancy has been uneventful in terms of medical issues (because no pregnancy is ever uneventful for the mom!) but interventions were being discussed as early as 12 weeks. Even when she had her 18 week ultrasound- the fetal survey, or as parents like to think of it as "the ultrasound so I can find out the sex of my baby"- her doctor was talking c-section because the baby was breech. I really, really, had to walk away from that one because diagnosing a breech at 18 weeks for a c-section is just freaking ridiculous. (This I am sure will illicit responses of readers that had 18 week ultrasounds showing a breech position of the fetus who ultimately ended up with a c-section for a persistent breech position- I realize that this can happen- but why even set someone up to thinking that is ultimately going to happen when there is plenty of time for that baby to turn vertex?????)

Now, my cousin is 36 weeks and was found to be 3 centimeters dilated. Her doctor is going to induce her in two days because of this. She is very excited about this. Again, something I had to walk away from because I think it is a bad call. First off, why was she even checked at 36 weeks? Turns out, just because. Next, why is a physician going to induce at 36 weeks and some change just because she is 3 centimeters dilated? She is a primip, this baby is not going to fall out at any random moment. And women walk around in the late third trimester all the time with a some dilation...doesn't qualify for a medical indication in any of the books or research I have come across. Not to mention babies at 36 weeks are considered premature. Sure, most of them do very well transitioning to extrauterine life....but they are at increased risk of breastfeeding difficulties, blood sugar stabilization problems, jaundice, and respiratory issues to name a few!

So... I guess I get to just vent here instead.

28 comments:

womantowomancbe said...

Argh! I don't know if I *could* keep my mouth shut! Sometimes I've said my say and nothing has changed, so I've felt like it was just wasted words; but many times I've said nothing and a mother or baby suffered ill consequences, and I wonder if it could have been prevented had I just offered the mom an alternative viewpoint, or some "food for thought."

Sometimes using the Socratic method -- of asking someone questions, rather than just spouting information, can yield good results. For instance, "I'm not sure I understand -- why is your doctor inducing you before you even reach term?"

But the "C-section for breech at 18 weeks" just takes the cake. It sounds like a bad joke. The stats I remember are that 75% of babies are vertex by about 30 weeks, and only about 3-4% are not vertex by term and/or the spontaneous onset of labor. Why couldn't the doctor just look on the positive side of things?? Or even on the "likely" side of things? Sigh...

Kathy

Mama K said...

Yes, keeping the mouth shut is hard, and often, we KNOW that speaking up will only make for trouble. Especially with relatives. I have a hard time with this, too.

I really like the other Kathy's "Socrates Method" and I will have to develop that skill.

There is sort of a pull between wanting to spare them from the grief you expect them to encounter, and respecting their choices even though we disagree. Sometimes, they have to go through the process before they will be ready to learn. And if we have been supportive they are more likely to ask for out input the next time. Maybe. Hopefully. Or at least maybe we can refer them to a CB instructor we trust.

Laura said...

Kathy, great idea. I use the Socratic method with my students all the time and I never thought about using it in this kind of situation. I definitely am all for respecting people's personal choices but it just pains me to no end when my friends are basically being told that they have no option but the pit-epi-section route!

Herb of Grace said...

I've been lurking here for some time, but this post is bringing me out of the woodwork with a resounding "Me too!!!" I have learned through some unfortunate hurt feelings in friends in the past to keep my mouth shut, but boy is it HARD. The worst for me was a friend who, with her first, declined my offer of books my saying that she planned not to read anything about birth and labor, so as not to "freak herself out" ahead of time. She trusted her caregivers to "tell me exactly what to do and take care of everything". Yes, she had a c-section. And. She's pregnant again. Having a reeeeeally hard time not shoving the books into her hands these days....

publichealthdoula said...

It is so hard!! The best I can do at the moment is try to get friends educated before they're pregnant, because once they are - I have to shut my mouth (or try).

The Socratic method is a good idea. I have such a hard time playing the innocent though! I worry that even my tone will sound judgy.

Induced at 36 weeks...vaginal checks "just because"...ARGH.

Jill said...

Oh wow. I think I would have an ulcer if I had to keep my mouth shut when faced with information like that. Yikes.

jill said...

Ugh! Wow, I don't know if I could keep my mouth shut either. What a bunch of crap. (I don't have any children but have forever been fascinated with pregnancy, birth, & child raising practices. I research and read anything I can get my hands on.)

I love your blog and am a faithful reader! :)

Labor Nurse said...

Never heard of the Socrates method, but must look into this! However, I also would be afraid of coming off as judgmental when asking questions in response. I guess this will take practice!

Renee said...

That is outrageous! I don't think in that case that I could not say anything, I don't know. I would not be surprised to even hear other OB's shocked at an induction for the heck of it that early. Sounds like someone is going on vacation.

Jennifer said...

Seriously??? Wow. Just...wow.
A friend of mine had a scheduled section for "CPD" diagnosed by u/s. She was a primip, and her section was scheduled at 38 weeks because the dr was worried the baby would get too big! Dr threatened should dystocia (because of a too big head...?) and other scary-sounding things to convince my 22yo, single, scared friend to go against her better nature.
Baby was born with no complications to her or mom (well, I could argue that mom now has added risk with any subsequent pregnancies esp. if she doesn't VBAC). Baby's head measured 50th %ile.
This is one reason of MANY to keep me motivated to become a midwife!

Jenn said...

I feel your pain!

I have a cousin who is due the end of this week with her second baby. Her first baby was born vaginally after just 4 hours of labor at 41 weeks and was 6 lbs 10 oz, so you would think she would be a shoe-in for a vaginal birth this time.

But no. She had a lot of tearing the first time (44 stitches) which I'd guess was an episiotomy extension and bleeding (she doesn't define what "a lot" is). Her OB convinced her last week that she should schedule a cesarean for 3 days before her due date because "ultrasound says the baby is 3 lbs bigger than your first was, so given the tearing you had with her, this one could kill you."

Right...

Alicia said...

Oh I hear you! Well I'd hope that some people would at least consider your opinion since it's your profession. How frustrating! I feel like what I say has no weight since I don't have any professional titles behind my name. This is exactly why I started my blog because if I don't vent somewhere, I'd go nutty. I'm working on a post right now titled, An Open Letter to my Friends, Family, and The Random Pregnant Woman I Encounter on a Daily Basis. I figure if I type out everything I want to say to them and put it out to the universe somehow that I won't have to bite my tongue as much. We shall see. Love your blog, btw!

Veronica said...

I honestly don't know how you keep your mouth shut.

At 22 weeks, my baby was breech. At 28 weeks he was transverse. At 34 weeks, he was breech again. By the time I went into labour at 39 weeks, he was firmly head down. Babies change around lots.

Oh and with my first child, I was 3cm dilated at 37 weeks and ended up giving birth at 41 weeks.

It makes me pleased to be giving birth in Australia, in a baby friendly hospital, with midwives. Even the doctors over here won't induce without medical necessity.

Amy said...

I had my baby at 36 weeks and it was HARD! The first few months went by in a daze of sleeplessness and hours spent at hospitals & doctors offices because of complications. I do not recommend it...she is not being correctly informed and that is sad.

I say OPEN your mouth...she should hear the truth from someone.

By the way, I developed a horribly painful ovarian cyst (larger than my baby's head!) and had to be kept on bedrest and medicated just to reach the desired 36-week mark so they could take the baby. My doctor said this is seldom seen during pregnancy. I ended up having the baby by C-section and my dead ovary and cyst removed.

Sheridan said...

First off planting the idea of a breech baby at 18 weeks could cause the mom to worry a LOT about it and then that could potentially cause a breech baby. Our ideas can help create our reality.

Then inducing before 37 weeks becuase mom is 3 cm is so dangerous. First off, too early for the baby! Not to mention the other dangers of induction. I walked around at 3cm for weeks! Baby never fell out and I was a 3rd time mom!

It is hard keeping your mouth shut. I love it when friends call WANTING my advice.

I had a friend who called and said her OB wanted to induce and what did I think. I was very non-comittal with my answer, asking her questions, etc. She finally said, 'I called YOU because I wanted the truth! Everyone else is saying just do it and I knew you wouldn't!" I was SO excited! It was great to just reinforce what she already intuitively knew, that it was smarter to wait until her baby chose to be born!

Julia said...

Induce at 36 weeks? Really? Sounds like that doc needs to do some reading on all the issues that 36 week baby can have. We don't even do inductions before 40 weeks at my hospital unless there are some sort of medical indication.

Ciarin said...

I too like the questioning method.

I know how hard it is to keep your mouth shut. My cousin had a baby at a later age and never asked my imput about all the things they wanted her to do. I didn't offer. I just gritted my teeth and vented to my mom.

Routine vag exams starting at 36 weeks are just something docs do. Patients ask me all the time if I am going to check them or when will I start doing that every week. I just tell them why I don't do it (no important info) routinely and we can do that when she and feel it's really necessary. I tell them they could be 3cms for three weeks or they could be closed thick high and come in, in labor that night. The current exam does not predict delivery time!

BonnieBelle said...

I honestly don't think I could keep my mouth shut. It was because I was so uneducated (and unsupported) that I ended up with my c-section. I wish, wish, wish I had had a friend to call like you, when my doctor started talking induction at 38 weeks, started pushing hard for it at 39, and finally told me at 40 that it was too late for an induction, and I needed a c-section. I only had family who were all of the opinion that doctor knows best.

I would at least try to and bring up the subject with your cousin. She is putting so much at risk, and if it were me, I would want someone to say something, even if I didn't end up agreeing with them.

Keep us posted on how things turn out.

Reality Rounds said...

I am going to call a "Code Bull S**t" on your cousin's doctor. This is borderline malpractice. Being dilated is not an indication for induction, especially for an infant who is not term. Due dates are plus or minus one to two weeks. Your cousins baby could very well come out to be 35 weeks gestation. I see babies like this in the NICU all the time. Ciarin is right in that she should not even be getting vag exams. Oh my God, I would open up a can of whoop ass on the doc. I wish your cousin luck.

womantowomancbe said...

Jenn,

FWIW, I had a 2nd degree tear with my first baby who weighed 7lb 5 oz (oh, and I had him in water, hands-and-knees position, plus had done perineal massage prenatally, 40-minute second-stage); and only "skid marks" with my second baby who weighed 9 lb 1 oz (on the floor, hands-and-knees, no perineal massage, just a few pushes). Sometimes size *doesn't* matter! :-) Actually, I've heard many women say that it was easier giving birth to their larger babies than to smaller ones. Recently, I read one person's explanation for it being that when birthing a larger baby, it usually takes longer which gives your tissues time to expand more gradually. That doesn't explain my not tearing in my 5-minute (or so) second stage! :-)

I was thinking a bit more about the "asking leading questions" bit -- just to make clear that sometimes when people have to explain in their own words what is happening, it can give real insight into their thought processes, what they heard their care-provider say (which may not be exactly what the person actually said), and why they are agreeing to the course of action. While some people will say, "I'm not really sure -- my doctor just said that would be best," and effectively shut down the conversation, others may basically say, "Hmm, y'know, I'm not really sure why he said to do that; I'm going to ask him next appointment." Either way, it tends to clarify it for the person as to why *she* is doing it.

-Kathy

Labor Nurse said...

so glad to read that I am not the only one who would be having a hard time with keeping their mouth shut!!

On a side note, ironically, my friend called me to bitch about her SIL who is in her third trimester. It's the SIL first baby. Anyhow, my friend was just beside herself because the SIL was discussing how her doctor was planning a c-section. It sounds like my friend used the Socrates method discussed earlier, and as it turns out the doctor is not planning a c-section but rather the SIL is asking for one for various reasons. It's driving the friend crazy that she would want major abdominal surgery. Sounds like I've rubbed off on someone here! At least she has me to vent to, and I concur!

Ethel said...

Good Lord I never keep my mouth shut, however I do ask leading questions with information in them (ala Kathy). It gets me in a whole lot less trouble then spouting, and be careful to not get emotional - stay totally cool when asking the question. I know I have helped folks by being careful in how I relate information, not necessarily about birthing but a multitude of other things.

womantowomancbe said...

In thinking more about this topic, I wonder if some people approach others (particularly those who are recognized as knowledgeable in their fields - in this case, birth, but it could just as easily be auto mechanics) with a certain scenario *so that* the expert will give his or her best opinion, without being directly asked the question. I'm sure some people "just want to talk" but I wonder -- I just wonder -- if some are subtly asking for help, opinions, or advice when they are telling their stories or discussing their situations. Perhaps they are waiting for a CNM to say, "DO WHAT?? That is completely ridiculous!" But think that by silence, that the course recommended by the doctor is actually the best course.

I could see myself doing something like that -- perhaps feeling like I "shouldn't" ask the person's advice/opinion since the person is a professional but I'm not paying him/her. Or, "I'll just bring it up to her and see what she says." Certainly many people are blunt enough about asking questions, but sometimes they like to be obtuse.

-Kathy

Mount Belly Mama said...

Hey, if you get a chance read my post on my hospital tour... you might find it, uh.. interesting.

http://hotbellymama.blogspot.com/2009/04/am-i-high-or-low-photos.html

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Joy said...

I was at 3cm and effacing quickly over a month's time (maybe longer because the exams didn't start until week 36). I just DO NOT GET IT. Why on earth would a doctor induce someone just because they're dilating?! Is he a moron? You should find out who he is and scope his practice out.

RVtravelerRN said...

I agree with you completely!
By the way, I am currently on a travel assignment where I have had my first experience with midwife deliveries......I think she is fantastic, freshly shaved and she wears closed toe shoes;) I am super enjoying your blog by the way!

Judy said...

Our chief of obstetrics would have your cousin's doc for breakfast. The latest research shows that elective delivery (for non-medical reasons) prior to 39 weeks pretty much doubles the risk that the baby will end up in the NICU.

We get far fewer 37-38 week babies in our NICU lately since C-sections and inductions can no longer be scheduled prior to 39 weeks or the onset of labor without medical reason.

We did get one electively delivered at 35 weeks because mom had 2 prior unexplained fetal deaths at 36 and 37 weeks. Until we got the rest of the story, we thought people were nuts. Once we'd heard, we were much more sympathetic. That one even got the chief of OB's blessing.