Wednesday, June 03, 2009

Thoughts on Prenatal Care

Almost not able to squeeze between the stakes I hammered in:
I haven’t written much about the impending birth or the whole pregnancy this time around. For one thing, I’ve been busy with the garden and life, and for two, I have a damn-cute near two-year-old who I focus a lot of attention (and photography) on. But I thought since we are in the home stretch and I happen to have a half hour with nothing to do today while I am substituting for Raph that I might as well get around to writing about our hopes for this birth and my experiences this far around. I’ve been meaning to do that anyway.

With Makili’s birth, I read a lot of books, and though that I knew what I was getting myself into. I hired a doula to help with my anxiety about the hospital part of the birth, since I was very nervous about all the interventions and what not that are commonplace in that environment. Doctors are hard to come by on the Big Island and the OB who ended up being my doctor throughout the pregnancy was the last name on the list alphabetically.

The first time I went to his office I waited in the waiting room which was covered with posters and brochures for laser hair, acne and vein removal – a secondary speciality of my doctor. There was a video playing of people have hair zapped off of their faces by lasers. Really welcoming. When I did go in, there was a huge board of babies and cards from patients. There was not one white baby on the board, which really shouldn’t have mattered at all, except that I guess it made me feel more unsure. The nurse gave me the urine test, came into my room and asked if I had taken a pregnancy test. I told her no, since I was fairly certain I was pregnant. She said, “You’re pregnant. Are you going to keep it?” Maybe this is common place – asking a question like that in that way. But it totally freaked me out. What kind of world is this that such a question can be thrown out there so nonchalantly. Like a piece of clothing or a gift – to keep it not? It still bugs me, though I guess they probably ask other people questions like that.

The vast majority of appointments lasted less than 5 minutes each, rarely allowed time for questions, and were generally somewhat cold. Most appointments involved a 60-second or less “listening to the baby” with the Doppler, after which time the doctor would quickly leave the room, I would get dressed or wipe the goop off of my belly, and go and sit in his office to speak with him. He would sit behind this HUGE wooden desk and Raph and I would sit attentively on the other side while he told us everything looked fine and then dismissed us. I don’t know what kind of message he was trying to send, but it almost made me feel dirty – like he couldn’t talk to me until I was dressed and sitting at his desk. He probably thought he was maintaining some sort of dignity for his patients, but I felt like it was pretty condescending.

Every single time I went to the doctor’s office there was an issue. Once I showed up and they asked me if I was sure that I had an appointment, since they had shipped my file to Maui since they thought I had moved there? I tested positive for just about everything except gestational diabetes – toxoplasmosis, down’s syndrome, anemia, etc. All of these “positive” tests turned out to be meaningless, but each one was devastating and scary when the information was shared inappropriately. Even going into the birth, I thought there could be a chance that Makili would have down’s syndrome, despite that being a very unlikely possibility. In short the whole prenatal experience was psychologically challenging and overwhelmingly negative. Mostly I came to feel this retrospectively. At the time, I’d be upset here or there, but like most things in my life, I was happy with my experience – after all the munchkin inside me seemed to be growing and healthy (except for the scary test results.)

When the time of the birth actually came, it was the weekend, and lucky for me my doctor wasn’t on call. Instead I got this REALLY wonderful female doctor who was incredibly kind and willing to help me to do as much as I could to avoid the C-section. Most of the nurses were pretty great, though there were a few duds, like Kate, the nurse who happened to be on when the C-section was called. She seemed excited about it as she fluttered about the room in her black scrubs (seriously? Black scrubs for a labor and delivery nurse?) preparing the room. While the C-section was about as far from the birth that I wanted, I had somewhat come to terms with it by the time it was called. I stil mourn the vaginal birth I wanted in a way, but mostly I was happy for a healthy baby and a quick and easy recovery.

I had to see my doctor a few more times before we left Hawaii and it was then that I REALLY started to hate him. The straw that broke the camel’s back happened the day of our departure from Hawaii, when Makili was four weeks old. I had already gotten over the “soreness hump” that comes when you start breastfeeding, and then a few days before we left I started to get sore again. The day we were scheduled to leave (at night), I noticed some white spots on Makili’s lips, which I recognized immediately to be thrush, basically a yeast infection in the mouth, that is obviously transmitted back and forth between mother and child when breastfeeding is happening. I called his pediatrician, and they were super-nice about it, called in a prescription, but reminded me that I needed one as well, or it would be useless to treat Makili. So I called my doctor. He would categorically not call in a prescription, but said I could come and wait in his office to be seen between appointments. So we sat for six hours in his office waiting for a chance to be seen, on our last day on the Big Island when we could have been relaxing at the beach or whatever. When I finally was seen, I had to stand there topless while he looked at my nipples only to tell me I didn’t have thrush and that I ought to take Makili to the pediatrician before I gave him medication. I was sure he had thrush, but now doubting, I went over and begged the receptionist at the pediatrician’s office to have the doctor check on Makili. The pediatrician was super-nice and immediately confirmed that in fact Makili did have thrush and that I needed to be medicated as well. My doctor’s office continued to refuse to call in a prescription for me, so I had to put drops of Makili’s medicine on my nipples and hope for the best. Awesome, huh? So we went back and struggled with getting rid of the thrush for over six weeks. It was pretty damn frustrating.

So onto the present day. This time around our options for the baby’s birth were different. We could have seen the doctors at our local hospital and signed up for a C-section, driven over an hour to another hospital to attempt a vaginal birth knowing that we would have a lot of interventions and monitoring, or we could go a new route. Neither the scheduled C-section or the hospital birth were particularly inviting for me. While the C-section wasn’t as terrible as I feared, I don’t want to sign up for one. As Nadine once said “there’s a lot that goes on physiologically at birth that we don’t really understand.” It just didn’t feel right for me to give up the chance for a vaginal birth. The intervention prone hospital birth wasn’t my first choice either, since the period of constant monitoring and pitocin during Makili’s birth weren’t really all that pleasant. And then I heard about a birth center in New Hampshire that did VBACs (Vaginal Birth After Cesarean), closer than the hospital. So I went and checked it out. I quickly decided that this was my best option, though of course there are some risks with having a baby outside a hospital. They are slim though.

Regardless of how this birth ends up the prenatal experience so far has been TERRIFIC! When I go to the birth center for an appointment, it is like a home. In fact it actually is a home, with a living room and birthing rooms that are really just bedrooms with birth tubs in them. There is tea if you want it and each appointment takes about an hour. An hour that flies by really. There are toys for Makili to play with. And mostly the midwives are interesting and ask good questions and they talk to you about so much stuff. We laugh a lot. Each time they feel your belly and tell you how the baby is positioned, which psychologically makes a big difference. It helps me too visualize the baby in my belly and connect to him. They are really into homeopathic stuff and always offering suggestions for how to help me move along. Why didn’t I heard of Evening Primose Oil before? That stuff is amazing. My cervix is super-soft apparently. All we need now are some contractions to push the baby against the cervix and get things going. And they have lots of suggestions for that too. I just feel so much better connected to and cared for, regardless of the outcome. I am hopeful that my body cooperates better this time around for a different outcome, but if it doesn’t my experience this far has been SO much better all around that it doesn’t really matter. Whatever route leads to the healthy baby is the best one, but boy my prenatal care has been so much better that I can’t really believe I put up with such bullshit the first time around. It has made much more particular about health care providers in general. We don’t have to settle for crappy care, because there are other options out there. I believe finding a doctor that you can connect to is so important. So here goes nothing. Let’s hope this positive psychological state has a positive outcome. Let’s go baby!


Anna said...

wow, that's AWFUL about the H.I. doctor. i thought my midwife was uncaring (when she told me i'd probably be sick for the rest of the pregnancy, at 5 months or so)but yours takes the cake. i'm so incredibly happy for you in this experience!

camille said...

You're such a beautiful pregnant woman! You look so happy and healthy. I want to see more pics of you on this blog!!