# What makes you want to take responsibility for your own pregnancy and birth?



## doctorjen (May 29, 2003)

How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?


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## Persephone (Apr 8, 2004)

For me, it was an innate thing. I was told once when I was younger, that I would HAVE to have an IV when I gave birth. (I hate needes.) I thought, "NO I won't!" They made two erroneous assumptions: a) that I would birth in a hospital, and b) that I would be required to have an IV if I DID give birth in a hospital. I also was told that epidurals were needles in your SPINE. Ack. Eek. No! And that with one, I would have to be TOLD when I was having a contraction. Uh, ain't NOBODY telling me when to push! All of those were things I thought at a very young age... like high school and younger. I had also heard about water birth from somewhere, so I googled it one day, and found my way to Laura Shanley's site. From there, it was easy to make the jump to homebirth. So, basically fear of needles, and extreme distrust of docs (ironically, my distrust of docs came mainly from the fact that every time I visited the doc, it was time for another shot... and all he did to make me well was give me penicillin when I had strep.) led me to do my own research. I also think that it's in my nature to look things up and research them. Birth happened to be one of those things... and it ended up being life changing.


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## Jenne (May 21, 2004)

For me the choice to do the research and take responsibility for these decisions was not a choice. When I make decisions in my life--be it what car to buy, whether or not I bought a house or rented, where to go to school, what to see when I travel--I talk to friends, family, read books, go online and research, ask questions, figure out what I want and then formulate a plan. I think there are a lot of people, not just women, in the world who make decisions spur of the moment and off the hip or *don't* decide and therefore don't have any responsibility if their decision turns out different then they wanted, sort of a "whatever" attitude. Why should pregnancy and childbirth be so important that you spend more time thinking about it then choosing a car? (joke) I don't think there is anything you can do beyond providing booklists, actual books, and asking/answering questions in an honest and open manner. People have to come to their own realization that they need more information. It also occurs to me that *most* women have had some exposure to pregnancy/babies/children either from family or friends and think that healthy pregnancy and successful, happy motherhood just happens. How hard can it be? (also joke) Also, lots of people have blind faith in their Drs. and are concerned about being "good" patients. There was a post here about "doing what the Dr. says" which is a mainstream thought all the way. If you are dealing with mostly mainstream patients they probably have this idea too. I imagine that there are some women who read the books you recommend and take to heart your open ideas which leads them to a wonderful birth. You should congratulate yourself on reaching out--even if it isn't always received.

Just my thoughts.

Jenne


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## Kabes (May 17, 2004)

I had my first baby at a birth center (w/ a MW) and my second was a planned hospital birth with a midwife. I'm preggo w/ #3 and I really want to go for UC (attended is not an option due to finances), dh wants to go 'somewhere'.

My mother had two c-sections. W/ me (her first) b/c labor had lasted almost 48 hours and I wasn't engaged. My brother's delivery I'm assuming was b/c thats the way things were done (Once a section always a section).? I'd ask her but she passed away when I was 18. I know my mom always said c-sections are major surgery. - #1 reason to avoid this at all cost (in my mind).

During paramedic school I saw 2 sections and about 5 vaginal deliveries.
-The first section was with an epidural. Not so bad but she was draped and it almost seemed like she wasn't there!!! Then they pulled her uterus out onto the sterile field to start closing her up - 'NO WAY! NO WAY! I'm never letting that happen!' They took the baby to clean it up before they ever showed it to the mama- 'nope thats my baby, sorry I want to see/hold/touch it before anyone does anything to it'.
-The second section was w/general anesth. and it was horrible. The baby was very flacid and they had a hard time getting him to breathe. I don't know when that mama finally got her baby but I do know MANY people had seen/touched/held him first - 'no thanks'.
-The 5 vag. deliveries all went fairly smoothly, I'm almost positive everyone was w/ an epidural. I don't remember any complications (cord prolapse, hemmorage). No episiotomies either but a few did tear, none severe. All were delivered in stirrups-'no way does that look right"

Then I delivered a baby in the back of an ambulance. Just me and the mama. No meds of course. She was so scared (so was I). I talked her through it - I was praying HARD! I was the first one who ever touched that baby. (crying now at the memory) That experience is on my top 10 for sure. (too many thought & emotions to get into but they were all great)

When I got preg the first time I knew I wanted the "back of the ambulance" type thing rather than the delivery room or OR thing. The more I researched the more I began to understand what I had seen in the hospitals and what had happened in the back of that ambulance.

My MWs both ended up being more into interventions than I would have liked. I know I can handle this myself at home. Now if I could only convince DH.

This is soo long- sorry. I'm not sure how you can apply it to your practice either. Maybe if mamas to be could watch different kinds of labor & deliveries on a video. Maybe a you or another Dr. could write short commentaries about what is happening to go with it??


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## oceanbaby (Nov 19, 2001)

I've always had this approach with medical care, and like another poster mentioned, with almost all decisions in our life. I guess it comes from the basic belief that no one else is going to care as much as I will. Kind of like "If you want the job done right, do it yourself." Plus, my parents were like this with medical care - always questioning docs if it didn't sound right, doing their own research, etc., so it's just second nature for me to do it. Dh on the other hand, didn't grow up like that. He grew up with parents who just did what the good doctor told them to. It was a real mind twister for him to look at it from a different angle.

It's kind of like the lesson dh and I learned when we bought our first house. It was a fixer upper, and we knew nothing about home repair. We would hire these 'experts', and as they were working, we'd say something like "That doesn't really look right" and they'd say "Oh, don't worry, it will be fine when it's done." And we thought, well, they're the experts, what do we know? And each and every time, it was screwed up, and by then it was too late. When we had the hardwood floor guy refinish our stairs, he asked if we wanted oil or water based finish. When he was done, we complained that the stairs didn't match our floors. He said "Well, that's because your floors were done in an oil finish, and you chose water finish for the stairs." Well jeez, why didn't you tell us that?

Why? Because it's not HIS house. He's not a bad person, but he just doesn't care as much. So now dh and I try to do as many jobs ourselves as possible. Even if we don't know much about it, just the fact that we care enough to research our options, talk to different people, try out different samples before doing the whole room, change approach in mid-job, etc., means that it almost always turns out better than if we had turned it over to the 'expert.'

And that's how I feel about my body. Some things you need an expert for. Rewiring the house, putting in new plumbing, dealing with pregnancy complications, or surgery - call in the expert, that's what they're there for. I'll still be there asking questions, but will hopefully hire someone that I feel confident about trusting. But for painting the wall or caulking the sink or which position to push the baby out or whether I can eat during labor - I am more than happy to take responsibility for this. I know I can do a better job, simply because it is more important to me that it is done right.

Am I making any sense? I think it's kind of a general approach to life, just more critical when it comes to medical care, IMO.

But I understand why people don't do it - because it sucks to be the person left holding the bag. It's so much easier to just close your eyes and hand over power to someone else. That way, if something goes wrong, it's their fault, not yours. Plus, you don't have to think about it. Thinking is hard. Thinking is unnerving. It makes you question yourself, doubt yourself, challenge yourself, face issues that you don't want to face.

I personally don't know how to do this way - couldn't do it even if I tried. But there have certainly been times that I have been a little jealous of people who are happy living in such an ignorant state. Ignorance is bliss, right?


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## Mamid (Nov 7, 2002)

I've done the "whatever you think is best doc" and ended up with a permanent split in my right labia minora. I also lost a baby because of that.

The next one, the doc got down right beligerent when I was educating myself telling me that the internet is full of liars and theives who don't know a thing about childbirth. That it was his way or the highway. That the books I brought were worthless (Goer's for one). That "he didn't feel comfortable" catching a breech even in a multipara because of "some study" (the hannah one) but my refusing to do a section because of that was yet another way of saying that he was fired. No wonder I was skirting the edge of pre-e by the end. One leg had swollen up to look like an elephant's and the other one was threatening it. And I couldn't wear my rings AND my BP was rising...

This time.. I have a midwife and so far she's borrowed one mothering mag and I think my copy of _The Thinking Woman's Guide_. She's just radical enough for my liking without being too radical.

If I ever have to go back to docs for births it'll be snowing in Hell.


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## Aura_Kitten (Aug 13, 2002)

: doctorjen.

_So, what motivates you mdc mamas to assume responsibility?_

i guess i tend to take responsibility for my own education in all aspects of my life. i very rarely ever go head-first into anything without fully researching it. (example: although i had wanted a pet rat my entire life, before i committed to adopting one, i researched rats and rat care for about six months.) i've always been a bookworm, and a geek, sharing the "hacker personality" with my best friends ~ the drive to question everything and seek knowledge constantly.

growing up, i had a great deal of very bad doctors. the HMO we were with was complete crap. i had a number of very bad experiences during hospital stays as well as regular doctor visits. even when i was old enough to start researching health issues and trying to get into a good discussion with my doctor(s) they didn't listen. five minutes into the appointment and they'd shoo me back out the door.

finally i got different insurance, moved, and started seeing two new doctors ~ one at a family practice, and my current OB ~ and i was, by then, so fed up with doctors and so jaded toward the medical industry as a whole that i made it clear (loudly clear :LOL) that i wasn't going to take any bullsh*t. i let them know that i was taking charge of my own health care and that i knew my own body better than anyone, because i had lived with it for a pretty long time. i made my beliefs known from the beginning.... and they actually finally listened to me and took the time to discuss my health problems, my history, questions i had... and finally they said that they were happy to have someone who seemed so knowledgeable and was so willing to play an active role in their own health.

the experience i had with my new doctors reassured me that not *all* doctors are awful, but also that patients have a huge responsibility to themselves, to educate themselves before they ever step into a doctor's office.

with respect to birth, i think ~ in this country at least ~ that since it's such a cultural norm for women to just do whatever their doctor(s) tell them during pregnancy and birth, and give birth in a hospital and put themselves and their children at the complete mercy of the medical industry, it really doesn't occur to most women to even question anything. think about the best-selling "guide" to pregnancy and birth -- What to Expect When You're Expecting -- which only reinforces that women should not ask questions and should do everything their doctor(s) tell them. even the relatively progressive (yet still mainstream) pregnancy magazine Fit Pregnancy advises women to obey their doctors and do whatever they're told, because ultimately "doctor knows best."









i think the only reason i really started questioning the standard medical model of birth at all was because i had been through so many bad things with my doctors already, and because my sister had at that point had one very horrible experience with our HMO hospital during her first birth. i really think that if i, and my sister, had been through nothing but great experiences and had nothing but great doctors, my choices would certainly be different and i'd have very little problem accepting whatever the doctor(s) told me to do.

also, after reading all of the birth stories on Laura Shanley's site, i really began to see that labor and birth really isn't a medical process. pregnancy isn't a disease ~ if it was really something to manage and freak out about, the human race would not have survived.

_What do you think I could do to encourage mamas IRL to do the same?_

short of reinventing how this country views labor and birth.... i don't think you can do anything more than you already are. if you are providing them with the resources to educate themselves, and they are not... there isn't any more you can do.

maybe get them all subscriptions to Mothering magazine?









eta ~ Mamid







s i am so sorry to hear about your injury + loss.


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## applejuice (Oct 8, 2002)

Ditto to all of the previous posts.

Oceanbaby, you are making total sense to me!

ITA with everything you say.

DRJEN, I am sorry that your clientele just wants to arrive at your office and let you take charge...that is the American culture, and I am sorry that women feel that way. I know I ran into this thinking when I was first pregnant and most people just told me to leave everything to the doctor and "they'll take care of everything; that is their job. They know what they are doing."

I did NOT want them to take care of everything!

The reason I had my children at home is because I knew I would have to live with the decisions for a lifetime made for me at the moment of my baby's birth.

I like Oceanbaby's analogy of "experts" doing things for you. "Don't worry. I've done this a thousand times!"







:

No one cares as much as you care about your own house, your own car, your own body, your own family as you do. This is why I had my babies at home, breastfed them, cloth diapered them, homeschooled them, and made my own clothes when I had the time. I took full charge and full responsibility for all of the big events in my life. I have also done my own house repairs when I had the time and $. I also know my own body better than anyone else since I have lived in this skin for all of my life.  so if something is going wrong, I should know first.

Lastly,

I did not want my child to get mixed up with another baby in the nursery. I wanted my baby! People make mistakes and I do not want any made with my baby!


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## doctorjen (May 29, 2003)

I think I personally am a lot like a lot of you. When I was expecting my first, even though I was 16 when I got pregnant with him, I read everything I could get my hands on about birth. It was actually this reading and learning that developed my interest in medicine. I don't think I would have ever gone to medical school if I hadn't had a baby first and learned so much preparing for that birth. I didn't have the confidence then that I have now, so that birth didn't go 100% the way I would have liked, but overall it was an empowering experience.
I think that is what bothers me the most - I know that childbirth is a momentous life experience, and that you are never the same after you have created another human being. Birthing my children affected my whole life! It bugs me to see women think of pregnancy and childbirth as just some thing you get through to have a baby.
Occasionally, I have a well-prepared mama, and it is a joy to work with them. One lady was so defensive at our first interview visit, that it was great fun to see how shocked she got every time I agreed with her about things that every other doc in town had told her were crazy (you know, really radical things like no episiotomy for a primip, or laboring upright, sarcasm intended.)
Then recently I had a mama bring that danged book (What to Expect . . .) into the office and read it to me, to argue that my extremely restrictive use of episiotomy was wrong, because it says so in that book







If I could just convince everyone to read just one different book, maybe?


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## mamalama2 2 (Jul 22, 2003)

I think a lot of it stems from the fact that a lot of us are brought up to believe the "Dr God" myth. We tend to allow our doctors and hairdressers to yell at us (did you trim those bangs yourself??







) They're the experts...

My journey began after the horrid birth of my 1st. The typical cascade of intervention began with induction at 41 weeks at 0cm/0% due to low fluid. I thought we'd prepared by reading a few books (not the good ones, I know that now) and taking a lamaze class, which ended up being a "how to be a good little girl in labor" class. I missed a C my the skin of my teeth, and vowed to never have more children because of the experience.

Well, four years later, dh changed my mind, and there I was, pregnant and staring down the barrel of labor - that's how I felt even though it was 8.5 mo away. So I began my own education. Went toe-to-toe with a couple of the OBs in the practice, and did things my way in the end because the hospital was respectful of my birth plan, and the doc only came in to catch and stich (tore - long story). Lauren was born (on her due date) as close to what I wanted as possible in a hospital, based on what I knew then. (dh insists) (BTW - I delivered at the hospital that Amber Marlowe ended up delivering vag. with no problem after leaving two Wilkes Barre hospitals that were insisting she have a C!)

Enough rambling LOL!


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## jplain (Aug 17, 2003)

doctorjen, I'm heartened to read your post. Your attitude is exactly what I'd want in a physician, and I completely understand why you'd practice more interventively with women who won't take an active role in their pregnancies. Out of curiosity, how do you take it when well-informed women wish to skip routine procedures that you are personally in favor of?

Like many of the previous posters, I took responsibility for pregnancy and birth because that's the way I do everything. However, I wasn't quite so independent-thinking going into my first pregnancy. Sadly, that pregnancy turned out to be a partial molar. The experience changed me a lot. I really wanted my next pregnancy to be a 9-month long celebration of my body doing what it is supposed to do. What better way to achieve this than to learn all about what is going on?

But I think it'll be an uphill battle with your patients for cultural reasons. Taking responsibility for pregnancy/birth is just not the norm here. Just flip on any of The Learning Channel programs involving pregnancy and L&D, and you'll see what I mean. I wish I could suggest a short, insiring reading that would encourage your patients to inform themselves, but none come to mind. Just keep pushing your favorite reads! Oh, and maybe it would be worthwhile to highly recommend childbirth prep classes that you think would best prepare women and their partners. If classes are taken earlier in pregnancy (ie. in early 2nd trimester), they might have a profound effect on decision-making in both pregnancy and birth.








Carolyn


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## ebethmom (Jan 29, 2002)

doctorjen - I'm sorry to say that I could have been one of those patients for ds's pregnancy. I thought that I was on the right track when I picked an all female OB/GYN office. Then I was surprised to find that I would need to rotate through TEN doctors during my pregnancy. I never did meet one of the OB's. And the youngest, most abrasive OB had the honor of telling me that I had preeclampsia and they would need to induce immediately.

Sure, I read their handout that stated "if you choose the Bradley Method of childbirth, you should find another practice." But I didn't know that meant I should run the other way!

I thought that I was reading and getting ready for my baby. I didn't even know what books to look for. I hadn't discovered MDC. I didn't even realize that an unmedicated birth was desirable until my third trimester. Thank goodness we had a Childbirth Class instructor who believed in natural childbirth!! She invited a group of doulas to one of the classes, and I knew that was the way we would go.

I wish that I had the midwife care then that I have now. There are so many different choices that I would like to go back and relive.

I do think that I was educable! I wish I'd had the type of care that you offer your clients. A book list would have been so welcome. My OB's recommended the "What to Expect" books.


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## 2+twins (Apr 20, 2004)

I took responsibility for my births I think in large part because I am a control freak and, well, knowledge is power, right? Of course the more I learned the more I realized that it was for ME to be responsible for (not anyone else). But also I think that a lot of it had to do with the fact that I was _desperate_ to be a mom - and a good mom at that (didn't love the way my parents parented so I had to do better). I had been real diligent to wait until I felt the timing was right for me to be a woman prepared to give her all to a child - emotionally, etc. I dunno - it was just something that had been so incredibly important to me every waking day of my life from the time I was about 14 that when I finally got the opportunity to BE pregnant (after awhile of infertility to boot), I jumped all over it. I think the infertility was part of the reason I took charge - gave me lots of time of baby-wanting in which - to fill the void of lack of pregnancy - I looked at anything baby related I could get my hands on. It was all very mainstream research until I was actually pregnant though, but it was still a lot more education than I see from a lot of moms-to-be.

On how to help motivate your patients to be more hands-on with _their_ pregnancies, I think that you should stress to them that this is THEIR pregnancy & birth and you are there to help see them through it. But ultimately they are the boss and you'd love to be presented with their questions, wishes, and concerns so that you can help shape their experience into what THEY want it to be. Really try to put the ball in their court. You said you give them the reading list which is just wonderful, so maybe a reminder that you have those books available in your waiting room would be a good nudge. Also, maybe just by asking each woman if there's a facet of birth that she's particularly interested in or fearful of - you could recommend a specific book or even a chapter in a book and get her to read at least that. Really, there's probably not a whole lot you CAN do, but I think that it's great that you want to try. Most of your patients are probably just not accustomed to having any say in their medical care, so perhaps it hasn't dawned on them that you WANT them to have a say in it! If only they'd understand how much this birth can/will impact the rest of their lives! It makes me sad when women take such a passive role to life's greatest event. I think you said it well here...

Quote:


Originally Posted by *doctorjen*
I know that childbirth is a momentous life experience, and that you are never the same after you have created another human being. Birthing my children affected my whole life!

Share that with them and let them know how this stage of their lives is what helps prepare them for parenthood! Good luck - you sound like a wonderful birth attendant!


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## Breathless Wonder (Jan 25, 2004)

For me, it took stuff going "wrong", and being mistreated.

Now, it just blows my mind. Yesterday, I was talking to my neighbor. Her neice is pregnant, and had the quad screen a few weeks ago. Got a false positive.

I told my nieghbor, "You know, most people take the test for the following reasons...and I declined the test because..."

And my neighbor said, "The test was mandatory!"

I said,
"None of the tests are "mandatory".


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## Mamid (Nov 7, 2002)

I might have lost that one, but I was smart enough at 18 to say no to a "mini-c" when they wanted to take the baby because of placenta previa and placental abruption. Saying no saved me from future ceseareans and I didn't even know it at that time!


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## Kiki Runs (Oct 7, 2002)

Well, I was lucky enough to have found MDC and have learned a bit about natural childbirth before the knowledge became necessary. I became "militant" (my husband's words) during my pg b/c at nearly every pre-natal appt, the OB gave me wrong information (Thank you, MDC, otherwise I wouldn't have known it was wrong).

Every appt that I receive erroneous info encouraged me to come home and research THAT specific topic and whatever else I could learn about.

In the end, I ended up w/a c/s, which I also take (partial) responsibility for.

I think it's pretty ironic that as a result of my (s)OB's "excellent care", I am now determined NEVER to birth in a hospital or under an OB again.


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## doctorjen (May 29, 2003)

I think I'm going to rewrite my welcome to pregnancy letter that I give at the first prenatal to include some of these ideas. Maybe emphasize more that I expect moms to be thoroughly involved in every aspect of decision making.
About procedures that I routinely recommend, but moms don't want. I don't have any problem going along with any well-thought out plan. I don't "allow" my patients to do want they want, they allow me to be involved in their pregnancy/ birth and hopefully beyond. I don't use the phrase "patient refused" either. I often write in the chart "after counseling, patient declined" x, y, or z procedure. I have a much harder time with the "whatever you think is best" type of person. I have rarely in my practice run into a situation where I thought something was absolutely essential to the safety of mom or baby and not been able to explain it to the mom, and come up with a plan we could both agree on. I try to build that trust so that if I really feel something must be done, they can trust that I am doing what I'm paid to do, give good advice, and not just in a hurry to get somewhere.


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## MelKnee (Dec 5, 2001)

For me it was the death of my first baby.

My OB was on vacation, her partner refused to believe I was in labor for 15 hours when I was 24 wks along without seeing me. Then, when he finally admitted I was in labor it was too late to do anything about it. He did various things to cover his ass and I believe one of those things lead directly to my son's death.

When I saw my regular OB about a year after ds's death, I was TTC so we discussed how _she_ would manage my next pregnancy. She said, she would do everything she could to get me to 34 wks.














Shouldn't the goal be 40 wks!? She had no interest in finding a cause for my premature labor. In my own research, I found several factors that I know contributed. But, all she would say was "these things happen" and "no one knows why". She seemed like the stupiest, most uncaing person I had ever met. I have no doubt that I would have delievered at 34 wks with her. So, I found a wonderful midwife.







Together, we got me to 40 wks 4 ds with a perfect baby boy.









My first experience made me realize that no matter who is providing care for me, I am the one that is ultimately responsible for my pregnancy and birth. I am the one that has to live with the outcomes.


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## JayGee (Oct 5, 2002)

I think researching things before I do them is in my personality







! Before I got married I was a research associate for the organization that writes the physician board exams so I spent a ton of time researching all things medical. One of my special projects was to review all the questions pertaining to evidence based medicine. Because my background is in statistics, I really enjoyed looking at the articles and reading meta-analyses of various medical subjects (yeah, I'm weird like that...)

Anyway, pairing my love of research with my interest in natural living, I did a ton of research on birth while pregnant with my first. Unfortunately, I ended up with a section in spite of all my research. The next pregnancy I started researching VBACs from the beginning and all the evidence I found in reviewing the literature strongly favored an all-natural VBAC ~ which is what I had







!

I often wonder how women can just trust so blindly what is being done to them. My SIL was due with her second just after me and planned a repeat C-section because "that's what her doctor recommended". I asked what kind of anesthesia she would be having and she replied, "I don't know. The doctor will decide that." No research. No questions. Just blind faith in the medical profession. And this is a woman with a master's degree, married to my brother who is a scientist







. I don't get it...


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## Mamid (Nov 7, 2002)

My GF decided to have an audience and ended up stuck at 2cm and got a section. When she got pregnant with no 2, the doc said her pelvis wasn't "shaped right" and she would have to have another section. She went into labour the day before her scheduled date and lo and behold, she once again got sectioned.

Me? I'm arguing against antibiotics in labour unless my water has broken for ages. Antibiotics don't prevent the spred of GBS and can actually be detrimental to the mother/child bond and really, they aren't needed unless your water has broken on its own. It can also lead to creating antibiotic resistant forms of GBS and what the world really doesn't need is another superbug!

But did my sOB listen to me about any of that _last_ pregnancy? Nope. I had the antibiotics, both of us ended up with postpartum fevers and I was loopy for a good three weeks after the birth while the pill form of the antibiotics worked their way out of me. I also had massive thrush, mastitis and almost lost my milk - and I make enough for twins!

So, no antibiotics for me. I've done my research.


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## mattjule (Nov 6, 2003)

I don't have time to read all the replies to this, but for me it was a variety of things. Going to a psychiatrist and answering leading questions and given a prescription on the first visit. Having my dad be misdiagnosed with cellulitis when he was really bitten by a spider and being in the hospital for over a month. A sister almost dying from a mixup with her medication at the pharmacy. My mother's gallbladder disease being misdiagnosed as panic attacks for 3 years until she had to have emergency surgery to save her life. But I think the psychiatrist thing left the most indelible mark on me. Learning that, after being told your whole life that your doctor knows better than you, he doesn't is very eye-opening. I mean, think about it. Are you sick? Gee, I don't know, I better go see my doctor. Am I overweight? Is this mole normal? What is with this strange rash? Why do I want to sleep so much? I don't know, I'll go see my doctor. They will tell me how I feel, then they will give me something to make me feel different. It isn't exactly a great leap in logic that so many women turn over their whole pregnancy to their doctor. And it is very scary to realize that doctors can be wrong. It wasn't until after my first baby that I really started paying attention to what my body told me. Luckily I was raised by a woman who bf'd and hb'd, who believed in Lamaze, so I read up on childbirth and I had a hb (I think I still would have birthed in the hospital if the nurses at the dr's office hadn't been so horribly rude to dh). But it didn't carry over to my whole life until after that experience. When I was ashamed that I had no idea when my last period was b/c I never paid attention and wasn't trying to get pregnant. When I couldn't take a pill if I felt bad b/c I was bfing. I started seeking the cause instead of trying to ignore the symptom. So I started researching.

But I think that until American society stops acting like your doctor is the end all in knowledge of YOUR body, women are going to keep trusting that their doctor knows better than them. And think about it, from the time we are 2 wks old, we are already going to the doctor, having the doctor tell our parents if we are sick or healthy, signing our self-knowledge over. We take our children to the doctor when they aren't even sick, just so the doctor can tell us they aren't sick. It weakens our confidence in our ability to know our children, it teaches us and our children that it isn't necessary to know our bodies b/c that is what our doctor is for.

This sounds militant and really, when my dc is sick or I am, I gladly go to the doctor. I just don't think our society needs to be so obsessed with western medicine.


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## katja (Apr 13, 2004)

It's so nice to see a doctor asking these questions.

For me it is pretty simple--I *hate* being told what to do. I hate time limits, I don't perform so well under pressure. When I was about 18 someone loaned me Our Bodies, Ourselves and I thought that what they had to say about childbirth made a lot of sense. I've done lots of reading since then, and always knew I didn't want my births messed with, which is why dd was born at home. Plus I am a big reader and I like to know everything I can about everything.


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## SamuraiEarthMama (Dec 3, 2002)

great questions, and wonderful responses.

i believe if more of our children were taught to question and research their decisions (and to be responsible for the outcomes), we'd have a happier world. but, especially in the US, we are taught from a very early age to hand over our autonomy to teachers, doctors, bosses, etc. if you read some of john taylor gatto's writings, you'll understand that we indoctrinate our citizenry at a very early age to abandon responsibility... in return, the nation gets a docile workforce and military. it's a widespread cultural phenomenon, not limited to childbirth. here at MDC, you are seeing the freaks and wierdos, those of us who choose to break away from that mainstream. we pay the price... often we feel isolated and unsupported, even though we KNOW we are doing the right things for ourselves and our families. but we are NOT doing the "right" things for society, and so we have to pay the price.

all this is rewarded by the lawsuit mentality... turn over your decision-making power, and get a perfect outcome, and if you don't, you'll get a big fat settlement instead. so really, there's no positive reinforcement for the free thinkers, other than what they gain from their knowledge and from hanging out with the other freaks.

sometimes, i don't think it's a question of why aren't there more folks who take responsiblity for themselves... it's more a question of why are there any folks who take responsibility at all?

katje


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## oceanbaby (Nov 19, 2001)

Quote:

I try to build that trust so that if I really feel something must be done, they can trust that I am doing what I'm paid to do, give good advice, and not just in a hurry to get somewhere.
That is exactly what made me choose the OB that I did. I switched to him towards the end of my pregnancy. It wasn't having a c-section that I was afraid of. It was being told I needed one and having to decide if I agreed while I was in the middle of labor. I wanted a doctor whose advice I could trust.

That's actually why I chose the ped that I did. She doesn't accept private insurance, so it's all out of pocket for us. She and I don't see eye to eye on parenting issues, so we don't discuss them. Her office is on the other side of the city. But she takes a natural, holistic approach to medicine, and I know that if she tells me that ds needs antibiotics (which she never has), I can trust her. And that's what I want to pay for. I don't want to pay for someone to just hand over a prescription.


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## Mamid (Nov 7, 2002)

When you've had a nasty scare of a medical mixup in the middle of hard labour (the nurse about to hook in an antibiotic you are allergic to into your iv) you begin to not trust medical establishment.

Hell, I didn't trust them back when I was 16 and had my appendectomy, but that was my mother making the decisions then. The amount of antibiotics my family doctor _loved_ to pour into me - especially the liquids because I as still a "child" just pissed me off. Especially when the last liquid he scripted was done up in a flavour I react too - Banana!

And of course, the one thing that pissed me off the most was when I went for a prenatal visit I had scheduled 3 months earlier and had traveled 2000 klicks to see my family doctor's partner cause he was on vacation. Not only did I wait in 40C heat in the waiting room for over an hour then another half hour on the exam bed under a pitiful little paper blanket because she was backed up due to an "emergency" that really should have been taken care of in the emergency room, but she told me I had to come back in a month in order to do the exam she was supposed to do that day that I had scheduled because she was backed up! Then, when she heard my plans for birth, she called me irresponsible and worse! I had suffered a 19 week miscarriage about 3 years earlier and I was looking at plans A, B, C and D and had listed them to her!

That was the last time I ever saw that office. EVER. Saw the family doc once or twice in the mall and I still hadn't confronted him about his partner. I should have.


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## Jennifer H (Jan 19, 2003)

Add me to the list of "that's just how I approach life." I'm methodical about everything. My dh had hernia surgery last week and I read everything I could get my hands on, insisted upon going to the doctor with him for his consult and then asking some very pointed questions about why he felt one technique (laprascopic) was right in dh's case. Dh was laughing that I could probably perform the surgery by the time I was done.

The other thing that happened to me is I worked in a hospital as a social worker and one of my areas was the NICU/L&D/Postpartum areas. A social worker only gets called into L&D when something is going very, very wrong. I got to see a few epidurals go very, very wrong. I also heard a few doctors on the phone to wives/girlfriends/friends saying they'd be home in an hour so as not to miss out on their tickets to the opera or Lakers game and then head off to do a "failure to progress" c-section. I know I had a skewed view, but it was enough to make me feel like I really wanted to go a more natural route and to be able to advocate for myself. Only way to advocate is to be educated about options.

I do sometimes wish I could just "play dumb" on some things. I have researched the heck out of GBS protocols and think the "screen all and treat all positives" is based on some LOUSY research (and as a public health measure is only done because many, many hospitals and doctors were not appropriately treating for symptoms). On something like that that is sooooo iffy I sort of wish I could just go with the flow and let them do what "the protocol", but I know that "the protocol" could put my baby at risk of other things so I won't escape the guilt either way!


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## pinky (Nov 21, 2001)

Doctorjen, are you familiar with this program?

Centering Pregnancy Program

It's specifically geared at getting women more involved in their own care. It's a group-based prental care where you check your own weight, bp, etc. and then meet individually with a practitioner and then as a group. The website explains it better than me!

I just started this with the clinic (family practice) where I am getting my prenatal care, and it seems promising--though particularly suited to moms who are less educated and empowered (which, honestly, is not me--I think that's why my midwife wanted me in the group, LOL).


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## saintmom (Aug 19, 2003)

I could write alot of flip answers like,doctors always make me sick(they do!)or I didn't need help getting this baby in why should I need help getting herout?But it's alot deeper than that.I'm blown away that a doc would ask why.Yeah!
I have a brother who has fragile x retardation.i always thought something had happened to mom so I've always been really wary of hospitalized birth.I read spiritual midwifery at 18 and that pretty much set the stage for how I would give birth.We didn't find out until he was an adult that his retardation is caused by a genetic mutation.
My first two were hb.the first was great,the second was a shoulder dystocia and big baby so more difficult.The next four were hospital with midwives.The 3rd i had a creep of a doc as the mw wasn't on call







.I still resent being told to either have the baby or a c-sec.She was 10lbs.I still think that's why the subsequent hospital births were so fast-sheer terror!
Our last baby was a long 36 hour labor at home in the water.I wish I'd been brave enough to just do it on my own with all the others.It was tough it was long ,at times it was painful.I birthed her when I had no more strength like a runner hitting the wall,shaking uncontrollably before each contraction,and I not the doc not the mw reached down to take her in my arms and hold her,find she was a girl and look into each others eyes.
I'd been told at the beginning of that last pregnancy I was to old(46) I'd had too many mc's.I had to have an amnio etc,etc etc....So I walked away from allopathic care.My Mw were awesome.The're brave ladies who operate under the radar with an inate belief in womens ability to give birth.Not something that's learned in medical school.I was so very blessed to have found them.
The cnm came out to visit when dd was 3mo.She had taken care of me after my many mc's and done my first prenatal with dd.She was totally blown away by the birth pictures at how awake and alert dd was.She said you never see that in the hospital!


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## Peppamint (Oct 19, 2002)

I took charge long after I should have, but there was a decided lack of support from my dh re: birthing anywhere but the hospital with anyone but an OB. After all, his mother gave birth six times knocked out on ether. Each time she had an episiotomy and greeted her child the next day when she finally woke. I assume they did forceps or some other form of torture. <shudder>

So needless to say, when I said homebirth during my first pregnancy he blanched and I backpedaled.







I ended up being induced at 38 weeks because my BP was a whopping 130/80 (no protein in my urine BTW and my bp was less when I was at rest).







Then dd's heartrate would drop (internal monitor







) when I tried to squat to push so I had to push in the lithomy position. So of course I ended up with an episiotomy that I think my female OB must have sewn up for my dh's benefit. Thankfully it isn't as bad since I gave birth again, perhaps the scar tissue stretched or something.

Anyway, when I got preggers with my ds I knew I didn't want the same experience but I was uninsured so I went and signed up for Hoosier Healthwise (medicaid for children and preg. women) and of course there is a limited choice of OBs and no midwives at all. So I signed up for care at an OB office that had something like 8 obs.







At 19 weeks, I had decided to seriuosly pursue a homebirth no matter what, so we ended up paying the midwife's fee with our tax refund. I went in for my u/s and after the u/s was over I waited and waited for the doc and finally went to the receptionist. She told me that the doc was running over 2 hours late. I had family holding a huge table at Olive Garden so that we could celebrate. I left the OB office and never went back. They never called to see where I went either. I called my friend's midwife and she came to my house the next week.

I was empowered to take resposibility for my births after I handed everything over with my first birth only to be very disappointed. I decided that if it's that important to me, then I need to be informed and in charge.

It is me who bears the scars on my perineum and it is me who has to deal with the emotional baggage.

And yes, my second birth was fantastic. Still more intervention than I plan for next birth (internals only tell me that I can walk around for 3 weeks at 4cm, 90% and bulging waters) but it was the birth of my dreams. Even my dh is convinced and I hope and pray I never had to be admitted to the hospital again. For birth or anything else.


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## cottonwood (Nov 20, 2001)

What motivated me to take responsibility for my own pregnancy and birth was largely the experience with my first. I hired a care provider I liked and who was well-respected in the community, and I didn't take it any further than that. I didn't ask any questions except the most basic ones in What To Expect When You're Expecting -- it didn't even occur to me that there were other questions to ask. It ended up being a terrible experience, which woke me up to the fact that no matter how educated and experienced and nice someone is, they will _never_ know enough that I can fully trust them to know what is best for me.

Hearing other women's testimonies might have helped. Michel Odent, when he had his clinic in France, had a weekly get-together for all interested women (TTC, current clients, and past clients) to talk with each other. You could recruit women who took responsibility for their own care, maybe have them give little talks in certain topics. This could be a powerful thing.

I'm sure it would have helped to hear my care provider say, "listen, doctors and midwives don't always know what's best for the individual, sometimes they even practice with wrong or outdated information, sometimes they make mistakes or have lapses of judgement, and sometimes they practice according to malpractice fears rather than evidence-based information, and I am human and therefore not immune to any of that, so it is in your best interest to research these things yourself and make your own choices, and look, I'll help you find ways to do that. Here's where you can start:..."


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## Mamid (Nov 7, 2002)

Quote:

I'm sure it would have helped to hear my care provider say, "listen, doctors and midwives don't always know what's best for the individual, sometimes they even practice with wrong or outdated information, sometimes they make mistakes or have lapses of judgement, and sometimes they practice according to malpractice fears rather than evidence-based information, and I am human and therefore not immune to any of that, so it is in your best interest to research these things yourself and make your own choices, and look, I'll help you find ways to do that. Here's where you can start:..."
But if doctors and other medicos started to say that then they'd loose all power and worse, patients would question their decisions. Heavens, we can't have that now can we! Where would patriarchy be if we had that?


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## cottonwood (Nov 20, 2001)

Exactly. You can't have have it both ways, i.e., patients who trust you implicitly, and who also take responsibility for their own care. People simply are not going to see the _need_ for taking responsibility for their own care until they begin to face up to the fact that medical professionals are not infallible, perfectly wise, and all-knowing.


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## grnbn76 (Mar 3, 2004)

Quote:


Originally Posted by *doctorjen*
One lady was so defensive at our first interview visit, that it was great fun to see how shocked she got every time I agreed with her about things that every other doc in town had told her were crazy (you know, really radical things like no episiotomy for a primip, or laboring upright, sarcasm intended.)
?

I haven't read past this post, but I have to say this....
This is me!!!!!!!
Everytime I go within 100 yards of our base hospital, it makes my bp rise! I am so prepared for a fight about everything. I'll never forget meeting the MW there and showing her my birth plan. I was prepared (I actually had a binder of studies, research, etc. to back up my choices) for a fight. She looked at me and said "This looks like a normal birth plan. It's all doable." I burst into tears.
And when I said to her that I have every reason to believe that I "won't get to the hospital in enough time", she said "Good for you." All she asked is that I would continue to come in for prenatals and come in with the baby within 48 hours.

Yep. I cried.


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## momto l&a (Jul 31, 2002)

Quote:

What makes you want to take responsibility for your own pregnancy and birth?

The way I was raised. I was taught that we are responsible for ourselves.

I was also taught not to have herd mentality, just because people do it one way or the other doesn't make it right.

In other words for me I was taught to think and that is what caused me to take responsibility for pregnancy and birth.


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## luvmylittleman (Jun 4, 2004)

Doctorjen,
I took responsibility for my decisions because as a labor and delivery nurse I saw what happened as I worked. Between a doctor that humiliated a patient because she had a small yeast infection and other doctors in which informed consent was far from informed, I decided to do things more my own way. I think many women hear that labor is not progressing or the baby may be "too big" and give up hope. I've seen CPD diagnosed so many times without trying other options (besides going right for the c-section). Prime examples are turning off or turning down an epidural for more effective pushing and changing pushing positions. So what could change this? More informed patients. How do you get more informed patients? Perhaps an office nurse (educated on childbirth options) can take more time to discuss a birth plan during an office visit. Perhaps, your patients will feel more comfortable discussing things in this manner. Perhaps, running a video in the waiting room about birthing options or making choices during childbirth, etc. would help. Maybe, setting up a networking system where former patients can contact current patients (of course within privacy guidelines).
Hope you get the answers you seek from someone out there.


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## Changed (Mar 14, 2004)

There are women like us in every city looking for a Doctor Jen.


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## nuggetsmom (Aug 7, 2002)

NAK so gorgive me. What motnivated me to accept responsibily this tiem is that my last irth was such a nightmare. I got the standard "what to expect", and took the class from the hospital and that was taht. What more did I need? Well, I didn't realize how much of an experience birth was and had I realized, I would have done things differently.
This time I was still with an OB and i a hospital, but it was a wonderful experience. And I was much more involvrd in the decision making process. At first i wasn't because i do tend to act like a deer in the headlights, but when i realix=zed what i really wanted the dr and i worked with that and what he, with responsibilkity, was also comfortable with. i got lucky with the dr in the end i think, because with insurance i did not have much choice.


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## MelMel (Nov 9, 2002)

Quote:


Originally Posted by *doctorjen*
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?


mine's easy, and a bit irrational....I just distrust 'authority' (as if a doc is an authority







) see there i go again.....anyway, and dont like being told what to do. I cant help it.

also, I think the world is getting outta wack because of all the control we try to take of it. I like leaving stuff to nature and instinct.

you sound like a nice doctor, though


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## supervee (Nov 21, 2001)

Comparing myself to friends who don't take responsibility for such things, I think I am older, more feminist, more self-reliant and less inclined to trust authority or experts, more of a researcher than just listening to what my friends say/do, and less willing to go with the mainstream flow. HTH!

Meant to add... so I think it's personality. I don't think you can directly motivate people to do anything. They have to decide for themselves. I think you can educate people, but they have to make the decision. Maybe get people involved in writing a birth plan so they see all the choices they can/need to make. My birth center had this as an upfront requirement, the taking responsibility.


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## IntoTheRoseGarden (Aug 5, 2003)

I just wanted to add that before dd's birth, I was educating myself, but I'm sure my OB was not aware. I felt so intimidated that I couldn't speak up even when I disagreed. Part of the problem was that he did not seem to have much respect for me as I was (gasp!) 21 and single







. I ended up with a c/s after going along with all his suggestions, even when I knew better. I was just raised not to "talk back," to be a good little girl and do as I was told. I know better now, and I'm actually in training to become a doula so that I can help to empower other mamas.


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## yeah yeah yeah (Aug 8, 2003)

I'd say all it takes is witnessing a single hospital birth (my sisters) where the nurses only care about:
1.) When Sis wants the drugs. Won't you talk some sense into her? Won't you tell us when whe wants something? Is she ready for it? Etc.
-and-
2.) What the fetal monitor says, regardless of the fact that it changed output every time the woman moved in the slightest, prevented any sort of walking or position changding, and seemed utterly useless for anything except reccommending drugs, drugs, drugs... did i mention drugs?

To decide that maybe I should actually read up what the whole bit should be about. *Shrugs*

I'm still TTC#1, but, I still can't believe what I witnessed at that hospital. They didn't care about the patient. They cared about machines. About getting her out of the "birthing room" in a timely fashion. About "fetal distress" based on a machine that seemed entirely unreliable. It was just... awful.


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## Aura_Kitten (Aug 13, 2002)

Quote:

About "fetal distress" based on a machine that seemed entirely unreliable.








this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped.







yet they still rely on that more than anything else.


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## yeah yeah yeah (Aug 8, 2003)

Quote:


Originally Posted by *klothos*







this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped.







yet they still rely on that more than anything else.


Well, _when they are in the room_, that's all they care about. The thing slipped off at one point, and the kid could have been vaporized, but I guess no one was watching at the nursing station, 'cause they still only showed up on schedule, once an hour to two hours, to offer pitocin and pain-relievers. It was like she wasn't important enough to warrant any attention until she let them dose her up, and then they were in there all the time messing with IV bags, and playing with equipment.

I could rant for hours. Grr.


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *klothos*







this stood out to me because that is so totally what they do. they don't even take into consideration that if the mama leans forward and sneezes the machine will say the baby's heartbeat stopped.







yet they still rely on that more than anything else.

ITA, klothos. However, this is the "evidence" that stands up in court of law in a malpractice case.

A mother's feelings are too subjective and therefore not reliable and do not stand up as 'evidence" in a court of law in a malpractice suit.

You and your feelings do not count.

Sad, but true.

Our culture is so screwed!


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## doctorjen (May 29, 2003)

"ITA, klothos. However, this is the "evidence" that stands up in court of law in a malpractice case. A mother's feelings are too subjective and therefore not reliable and do not stand up as 'evidence" in a court of law in a malpractice suit. You and your feelings do not count. Sad, but true."

Unfortunately, this is very true. As much intervention as possible has become the standard of care, and in a malpractice case, having done "everything you could" definitely helps you defend yourself. This is a lot of the reason I tend to practice more interventively with moms who expect to come to doctor, leave all decisions up to them, and be handed a perfect baby at the end. Courts are reluctant to hold patients accountable for their own health, just as much as many people are reluctant to take responsibility for their own health.


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## CairaJade (Jul 12, 2004)

I think this is an excellent question, and I hope nobody minds that I'm dragging this month-old thread back up.

For me, it is four distinct things that I can identify.

1. My overall personal philosophy and personality. I'm a researcher, an anthropologist, and have always been a tree-hugger. My family use to make fun of me for digging out their recyclables out of the trash for years, and still make fun of my homemade bathing and cleaning stuff, soymilk (not that I even drink it regularly, sheesh), and organic stuff.









2. Growing up in a military environment with seriously deficient health care. My mom used to tell us our birth stories, and how I was a scheduled c/s because at that time in that particular Army hospital, _all first deliveries were automatically c/s_.







: Add to that I was footling breech. Well my mom went into labor and called the L&D nurses station to see when she should come in. They told her she wasn't in labor and hung up on her. And did it again a few hours later. Finally, when my mom and grandma (who was a RN and obviously knew her daughter was in hard labor) knew they couldn't hold out much longer, they got to the hospital and my mom had me right away vaginally without any complications, feet first. Fast forward throughout my teen years, and it's just story after story of poorly run hospitals and inept doctors. The various post and base hospitals lost my medical records four seperate times, never found. I have no documented medical history before the age of 20 except for the copies of vaccination records that my mom saved. There's more about my mom and her hip replacement, but I grew up with a huge mistrust, for good reason, of both doctors with their own agendas and schedules, and terrible hospitals. Most of my opinions formed about the medical establishment during this period was subconsious.

3. Incidents with my best friend who had an eating disorder and was also in a devastating car crash, in which she broke her back and required reconstructive face surgery. These incidents were small but numerous, but the worst was after the car accident and I was with my friend plus two other friends in the accident day and night for a week. No account at all was given to their personal comfort, even when they were moaning and crying out in pain. They were ignored. At least they never kicked me out of the rooms, that's the only good thing I can say. Unnecessary procedures were performed without informed consent, that set my friend's back recovery back by months. It was horrible, and the doctors and nurses made it worse than it had to be.

4. This is the moment when it all clicked - watching birth shows in TLC and Discovery Health. When I saw labors being managed and treated like a trauma, I knew it was wrong. Every single thing about those shows ran contrary to what I've learned and what I felt was a normal human process. We are the only species on Earth that "require" assistance during birth. There is a reason for it, bipedalism being the largest culprit, but we are not so different from our fellow animals that we are _unable_ to birth naturally, which is a growing misconception we must keep fighting.


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## MommytoTwo (Jun 20, 2004)

I did the 'whatever you think is best' and for it I got just about every intervention in the book. Cytotec, Pitocin, AROM, Stadol, Epidural, Cesarean.
Which led to the NICU and breastfeeding failure.
Like someone else said- no one cares as much as I do. Just curious - the women you speak of in your practice who want you to make the decisions- are they first time moms? I would think moms who have had a baby before would have very definitive ideas on what they want.


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## Peppamint (Oct 19, 2002)

Hi Tina! Wanted to say welcome... and I noticed your baby's name is Elaina!







My dd's name is Elana (ee-lay-na), but we call her Ellie most of the time.


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## MommytoTwo (Jun 20, 2004)

Quote:

I also heard a few doctors on the phone to wives/girlfriends/friends saying they'd be home in an hour so as not to miss out on their tickets to the opera or Lakers game and then head off to do a "failure to progress" c-section.
uke

My son was born at 4:58 pm via c/s for failure to progress. DH & I joke that at least my OB got it done just in time to get home for dinner. Not that I find it funny at all.


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## Mamid (Nov 7, 2002)

That's pretty much the same time >I< was born in 72. 4 minutes to 5, just in time for the doc to go to dinner.

My mother never made it clear if I was a section or a vag. She did say that I pissed pretty soon after birth and that I was born "so blue you were black" and was a child who was "watched" by the doctors closely while growing up.

I should check with my dad about that. He might know although he wasn't told that I was born for several days. My mother had left my father well before I was born.


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## AmandasMom (Nov 19, 2001)

For me it was finding this site! When dd was born, I had the "typical" birth.. you know, C-section, etc. I didn't think twice about it till I by accident found MDC. DD was due for her first round of shots, and I don't know what it was, but something in my stomach told me to read more about it. I did a search, found MDC, and well, here I am with an unvaxed 4 year old







This site has been the basis of all my parenting. Before here, I didn't even know there was anything different then what I had been doing. It opened a whole new world for me. That was 4 years ago, back when there wasn't really a board here, just 1 long thread. Now I'm 21 weeks pregnant with #2, have a new OB who so far I really like and I really feel like I can trust her. I'm taking responsibility for ME this time around. I've refused all testing and all internal exams (cept the pap the month before i got pregnant). She is perfectly fine with all that. My blood pressure is unfortunately high again, so if its still high next week I have to go on meds. I've been researching PIH and I do feel meds are the best thing. What's most important is that I've been researching it, not just taking a doctor's word for it.


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## *~*SewHappyNow*~* (Sep 25, 2002)

I do think it takes a certain personality type to want to learn about things.

For me, I've always jumped into anything that has taken my interest and researched and explored. I always have to know EVERYTHING possible until I am satisfied with my level of understanding. That's just the way I am. I love investigating and gathering knowledge. Perhaps being a control freak has a little to do with it









When I was expecting my first daughter I knew from my mom and I talking that she was a strong believer in BFing and natural childbirth and also had agreed that children could be born at home.

Finding this community was what really got me motivated and helped empower me to take responsibility for my own birth expirience and mine and my baby's well being.

I think that is probably key to motivating women.. _empowering women_ They need to know that they are the real _experts_ when it comes to their body and their birthing of their baby.

I agree, there will be women out there who have no desire to learn or explore or take responsibility. Their whole life is probably a reflection of this attitude, either stemming from laziness or ignorence or a little of both. Perhaps handling these women in a more interventive manner is wise, based on the belief that they will probably be the first ones to sue when something goes wrong. Sad, but true.


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## aquarianangela (Apr 25, 2003)

this is an interesting thread!
i wish my patients were more like the people here. unfortunately the practice i was able to find a job with is very much like this - the hospital has a 95% epidural rate and cs rate is about 30%. my practice has recently stopped accepting bradley method patients or clients of a certain doula. "they are just too difficult to work with". most of the patients want an epidural before they hit the door practically.
i am actually glad we don't take bradley pts because they would be extremely disappointed.
and even though i am pretty noninterventionist when i go off call the next person on usually is interventionist.it is pretty upsetting. i have always been pretty "alternative" minded and in mississippi where i used to practice a lot of people were afraid of epis and didn't get them so i saw a lot of normal labors without the epi and i wish people here wouldn't get them.but i am a small voice. i don't even want to attract my kind of patient because i can't guarantee them i will be there. i think that is problem - a lot of women want o work parttime or not be on call 24-7 because they have kids and so it's hard to find a solo practioner who does ob anymore like you drjen.
my dream once my dd is older and my dh has a stable job situation is to have a solo ob only practice, see pts in my home or theirs, labor with them at home and have privileges at the hosptital and deliver them there. i am trying to figure out a way to do this and still have malpractice insurance and still be able to charge a reasonable amount and actually make a living at it. i can't imagine what my malpractice would be if i did homebirths! in miss it was approaching 100000 a yr for obs who hadn't been sued. here in sc it is around 35000 but is going up by 300% a year or something. so where we end up could determine if i can ever practice like this or not.
in order to keep my home life reasonable i would have to limit it to about 8-10 people due a month i think. do you have a limit dr jen?


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## CJ 5 (May 30, 2004)

This is exactly the practice my midwife has 8-10 patients a month. Maybe to spread out the malpractice insurance you could get another OB and two midwives and the four of you could pay malpractace togeher since theirs is so much lower you might make it but if the rates keep climbing I don't see it happening.

I am a first time mom with too many friends who had C-sections. I have never had a surgery and was very concerned about getting a "failure to progress" C-section.

I like most first time moms was naive and started at a hospital. Two condencending visits later I started shopping around. I contacted a Bradley instructor and before you know it I was interviewing 6 different practitioner until I found one I liked. I wanted someone who was not going to rotate and who was going to show up for more than the catch. I was naive to say the least because the health care system sucks but I have become educated and If feel a great empowerment in being the advocate for my body and my baby


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## biberin (Jun 25, 2003)

Drjenn,

What if you did what some websites do with birthplans: have a list of options for each point, and have them check off what they want. Like, for pain control I want
a. epidural
b. narcotics
c. a jacuzzi
d. a doula

It would give you a ton of talking points, anyway, and make them aware of options.


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *doctorjen*
How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?

Dr. Jenn,
Its great to know a DR is out there encouraging patients to educate themselves. In my early 20s I felt like I had planned and educated myself and took responsibility for my pregnancy and birth, but then so many eventful things took place that were out of my control: like getting chicken pox at 12 weeks, getting the flu and having to be hospitalized for high fever, and having a transverse baby due to a uterine anomaly. I had a really green doctor because she was willing to give me my all natural Bradley Birth, free of intervention -- I ended up with a torturing, painful, emergency csection after a failed ECV.
With my last pregnancy, I definitely took a more responsiblity and talked a lot more with my doctor about my risks, my uterine anomaly, and what I wanted in a planned csection. In those five years I had done a lot of research about the anomaly, about cesareans and my OB was so impressed she thought I had a medical degree. She freely shared literature with me and sat me in her office several times to pull out her medical books to show me things. I let her know right up front that I was looking for a cooperative effort in having a safe pregnancy, safe birth, and healthy baby. She was also candid with me about my risks and her own risks (malpractice).
In my experience, women unfortunately are easily led -- whether is be the all natural granola route or the all medical intervention and let my dr make the decision route because they went to med school after all. There really doesnt seem to be a balance and there really doesnt seem to be enough education and the way statistics and studies are used to back one or the other up are often misused and abused. Just looking at the internet for information is confusing because there seems to be no middle ground. The closest I think there is, is the Dr. Sears series and I like Sheila Kitzinger (sp) for a more balanced approach.
I could say so much more, good question.


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## Marlet (Sep 9, 2004)

Quote:


Originally Posted by *doctorjen*
How's that for a long, vague title?
Anyway I'm discouraged lately with my IRL practice. Online, I see so many mamas who educate themselves, choose birth attendants who will respect their decisions, and actively plan to be in charge of their own care and childbirth experience.
IRL, the majority of the women I care for don't have half a clue. I give moms a list of my favorite books at their first prenatal, have those books available in my waiting room, encourage them to make every decision throughout, and yet the majority of women I care for spend 9 mos saying "whatever you think is best." And I definitely practice more interventively when I know that I am having to accept all the responsibility for decision making.
So, what motivates you mdc mamas to assume responsibility? What do you think I could do to encourage mamas IRL to do the same?


My main reason is I watched what my sister went through in regards to not getting what she wanted. She had a birth plan but they didn't care and that pissed me off. Who knows my body better than I do? I would like to honestly know how a doctor can look at me and say, "Oh this needs to be done" JUST by looking and poking!! They have no idea what's going on inside that is not acessible to them, kwim? I am also VERY controlling. Obsessivly so, not like I have to have control but when I do it HAS to be done a certain way.......I wash dishes in the same pattern EVERYTIME I do them my obsessiveness. I don't like the idea of having someone else take control of my body during a time when it knows what to do. Very scary to me.


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## eilonwy (Apr 3, 2003)

I'm a geek.









I've never been someone to take a doctor's word for it just because they were a doctor (though I was more trusting with my first than I should have been). I've never been one to take *anyone's* word for *anything*. I will question even though it makes me unpopular and makes other people uncomfortable or unhappy; I've always been this way.

I've been lucky, I suppose, to have doctors who, for the most part, were totally on board with that. My last pregnancy, I talked to a nurse and she said "I'm not worried about you at all, I know you'll make an appointment if you need one." And so I did! I went to get weighed and have my belly measured because it was fun (and I don't have a scale at home), and then my dr. and I would talk about what I was reading that week. :LOL I had a great experience, and I am seriously considering not only planning an "accidental" UC but telling my dr about it in advance (my only concern is liability issues... but I've got several years before it's more than theoretical).

If you want to encourage people to take a more active role in their health care, my suggestion is that you ask them why they don't. In my experience, most people just haven't thought about it, they've simply assumed that the doctor/nurse/midwife/teacher/whatever is in charge because "they know more than I do" and they feel unequal to the task. Ask them about it: why are they willing to let someone else heavily manage so intimate a moment of their lives?


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *blueviolet*
Exactly. You can't have have it both ways, i.e., patients who trust you implicitly, and who also take responsibility for their own care. People simply are not going to see the _need_ for taking responsibility for their own care until they begin to face up to the fact that medical professionals are not infallible, perfectly wise, and all-knowing.

I do have people who trust and question both. They are a blend and are probably the best clients. I can work and do work with extremely questioning untrusting clients but they are a lot of work and I usually worry how they will handle labor which is not controllable at all. And I have people who have done their own research and know what the want or don't want to a degree and then they say ok I will trust you to either inform us or let you take this part because we don't know. Stitching and resuscitation , heart tone assessment are a few things that come to mind.
On the other hand clients saying to me you decide is not something I let pass, I want to be sure that they understand what is going on and why something is offered and the advantages/disadvantages are. Some things say eye salve, we talk over and they can read over why it is used, and I go with what they decide most don't have eye salve but I don't question it if this is what they want after delivery.
I also agree that consumers need to understand that care providers are people, they may know many things you don't but they do not know everything.
the centering birth program is great, the birth center in town has taken this on as the way they practice. The only complaints I have heard is that some people feel that things are not presented as choices but rather this is what we do and why.


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## Felicitymom (Jul 28, 2004)

Hi Dr. Jen...

I think a good way to have women become more involved in their own birth is to present them with simple, clear information. (I am assuming you already do some of this, but thought I would put my two cents in)

Give them a questionaire to find out what kind of life they live outside of pregnancy... are they passive and impassioned or are they a go getter. (I think most women follow the trend they see and hear about in the mainstream medical society, ie: birth is a medical proceedure. If they are told differently (and made to believe it) then they will actually get it that they have an option.

YOu could present them very simply and clearly that if they choose a passive/epidural birth... the birth process is in the hands of the medical team. If they choose an active/natural birth (maybe even with an epidural) they will be in charge. Find out if they are interested in 'having a baby only' or are they at all interested in the 'birth experience' ? When posed that question some of them might actually think... and want a birth experience









Have them watch videos of natural births... women who take the chance and deliver without anestesia. I know the more women see other women doing it the more they believe they can do it.

Once they 'sign on' to be an active participant there are a ton more things to do... at our BC we had group prenatal visits for the last 3 months of pregnancy. 6 couples who were all due within a month or so of everyone else. This made huge differences in our attitude. We all wanted natural births to begin with (all but 1 gal), but asking questions, hearing birth stories, seeing videos, and approaching birth in a more casual (as opposed to medical) way was very supportive and informative. By the way, the one gal who said she would not want a BC birth and wanted to deliver at the neighboring hospital with an epidural... had her baby naturally with NO intervention









You need to approach these women in a completely new way... get off the beaten path and forge a new one. Women will listen... most of them probably would want an awesome birth experience... they just simply don't know they have the option.

Hope this helps.
Nancy

3.


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