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My Prenatal Care
Many birth stories focus on labor and don't share any of the anxieties
women have throughout pregnancy. I am 36 weeks. My impending birth and subsequent birth story would not be complete without
the details leading up to it. I became the client with needs unable to be met by birth teams, which I attribute to different
cultural customs and routines taken for granted. These differences have been a major stress point in my third pregnancy.
My Birth Plan was simple: To give birth surrounded
by my midwife and doula friends in the comfort of my house.
Considering my friends are in the birth field, my plan
is not that complicated. I thought about birthing this way before I was pregnant. As circumstances would have it, my family
moved out-of-state. It was tough to leave my friends. Even with phone and email the distance seemed enormous.
The the new community was vastly different
from Florida. The small town culture was not expected. After all I trained in this state; I lived in this
state longer than anywhere else, but this town was so different than the other ocations that I lived-- I would
have never believed it even if someone had tried to explain it.
Making friends in
the birth community was one of the first ways I attempted to make new contacts. A few weeks before the move, I searched
yahoogroups and found a birth community and introduced myself. I was welcomed before I even left Florida. This gave me something
to look forward to even as I grieved what I was leaving behind. Meeting on-line would eventually turn out to be different
to meeting in person.
This difficult move became even more challenging when
I became pregnant a few months later. I could continue the e-mail and telephone communication, but would not have the familiar
prenatal care or birth plan I hoped for. I was going to have to recreate a birth plan or find meaningful friendships quickly.
As soon as I knew I was pregnant, I sent email to my doula friends in Florida. Their initial replies were exciting. I felt
special. They made it so exciting for me that I wanted to tell everyone else I knew that same day. Since I had family all
over, and several Internet communities of friends, e-mail made it real easy to share the news.
I was taken back a bit by the cumulative responses in my new birth
community. First, "Congratulations. I am shocked. I don't know what to say." This
is from a midwife-hopeful who I knew socially and couldn't wait for me to be in her
locale; she previously claimed that she was deprived of a birth network living out in Mayberry. She had claimed before that
she could never tire of talking about birth and babies, yet she was speechless over my news. A few days later, I ask her for
the name and number of her midwife. She says that she'll look it up and try to get back with me. She had just given birth:
she had to try and look for this number? Her responses made me uncomfortable. I didn't
get it. Was this a communication gap that I misunderstood? Why was she shocked? Because I just moved,
because I was looking for a new practice situation, or just my overwhelming personal family issues. I felt judged and
realized she wouldn't be good prenatal or labor support with the tone set. I found the midwife's number without her help before she got back to me days later.
Next I had run into a doula at my boys Martial Arts Class.
I shared my great news. She didn't say much, again confusing me, but a few days later I found out she was dreading leaving
the area and wouldn't be around for my birth. I obviously knew how it felt to move and I thought I should be sensitive to
her needs rather than to brag about my pregnancy, birth, and desire to have a doula with me. This was frustrating. I really
wanted to share my excitement with someone in person.
My doulas in Florida are still sending me notes of enthusiasm
and encouragement while I made contact with the recommended midwife. I told her she came highly advocated by several local moms
and I'd look forward to my first prenatal in a few weeks. Being in the birth community, I was thinking ahead, being courteous
and letting the midwife know when I was due. Somehow this offended her. It was her policy to have a "consultation" first not
an "initial prenatal." She stated that just because I wanted her, did not mean she wanted me wanted me as a client. Whoa.
Low blow. Why would she not even want to meet me before coming out and saying something so humiliating? This made me really
second guess myself. Where was the support in this community? I had participated whole heartily in the natural childbirth
movement, supporting midwives, and she responded like I was unworthy. To keep from being depressed, I could only think that
it was cultural issue. What if I did say "consultation?" Did I come across too sure of myself? This was such a let down. I
thought I was a good home birth candidate. Now, I wasn't so sure. After thinking about it a few days I decided I should not
have to feel obligated to prove myself to her. I could find another midwife.
While I was searching for another, I also discovered
the midwifery "is not legal in this state, but not prohibited either." It is legal in Florida. More adjustments! What this
means is that there is no state licensure for midwives. A midwife could obtain a national license or credentials, but
this is a personal choice and not recognized by the state. The midwife takes the risk. Perhaps this is why the midwife was
cautious, but I did not realize her huge responsibility at the time I called. For the birthing family they can birth anywhere
they want without legal consequence. It also means that midwives could not order labs and medications. This part did have
an advantage. I was not contrived in to having unnecessary testing, especially amniocentesis, or coerced into taking medication
I did not want. I'd have to make the effort to go to a physician if I wanted these "extras."
This part of the state doesn't have an
abundance of midwives, but I did finally find one. She was a lay midwife, without formal training, credentials, or a state
or national licensure. My husband and I do value formal education and accepting this difference was also challenging. I value
the initials after my name. It is another one of those things I didn't understand. Even if the state didn't recognize it,
why wouldn't you want to show the world you could do it! And show the state this profession was worthy of being legal. Some
people think I am just proud because it is an "M.D." after my name. I am equally proud of the IBCLC initials. I feel like
it shows my patients I am committed to helping them breastfeed and differentiates me from other physicians who support breastfeeding
with lip service, but don't keep up with the information. I was so uncomfortable with the no-credentials thing; I hated to
ask her how she felt about it. I feared being alienated by another midwife. Not asking, however, did not help me resolve my issues.
I did eventually ask other midwives
in "legal, but not prohibited states." Jan Tritten, editor of Midwifery Today, explained to me how complicated this issue
is and deserves its own dissertation. I may not understand it all now, but can respect the difficult situation for midwives.
On the phone initially my midwife warned me that she
has a distributorship for vitamins and would highly recommend all sorts of vitamins from her company. I felt like my pregnancy
was a racket for her other business. She really meant it, too. I made it clear to her by the second visit that I will eat
well and I will take cheaper vitamins. I thought it was unnecessary for anyone to buy the most expensive vitamins and I wouldn't
be buying hers. "Look at me. Do I look deprived of food." I rarely have taken vitamins in the past and what I am taking already
is a big compromise on my side. I didn't take too many vitamins my previous two pregnancies. I had started them this time
because I had lost eight pounds initially and I questioned if I was eating enough. She told me she had a
big problem with my decision not to take her recommended vitamins. "Other clients of hers who felt poorly with previous pregnancies,
find that they feel much better with the current pregnancy when they take her all-natural megavitamins. If I didn't want to
take them, I could just continue to feel tired." If birth providers weren't limited, she would have been told to leave. She
did retract a little bit when I pulled out all the different teas and vitamins and shakes I had and was willing to take. I
must say it is hard to accept being talked to like this when I have been around so many empowering doulas and midwives. Words
can have a powerful effect. I read Gail Hart's timely article in Summer 2003 Midwifery Today summarizing this in reference
to why woman choose to birth unassisted, "Are we so untrusting of birth that we must carry and recommend a bags of herbs and
medications, put our client on special diets ... do we horrify them with our talk of risks, consequences, worries, fears..."
In my own article, Reflections of my Obstetrical Training, I referred to the family practice department I trained with
being more open minded compared to the obstetrics department. One of the points the family practice faculty made was not to
force horse pills down the throats of our nauseated first trimester patients: give it some time. A point was made that with
good nutrition many of our healthy patients could do fine without vitamins, whereas, for the high risk obstetric patients
it probably was better to get them on a compliant vitamin schedule. So hearing the midwife endorse a certain brand and tell
me that I needed those specific MVI, calcium, Vitamin C, B12 complex, and alfalfa really was imposing on my training that
was freeing me from rigid OB routines and also conveyed it to me that my body could not labor naturally if I didn't
follow her recommendations. If I didn't feel so scolded, perhaps, I could have fully explained this. Funny, she barely
mentioned raspberry tea. Her company must not sell it. This is what I did take: four gummies or Flinstones daily, raspberry
tea, which I really did enjoy drinking hot or cold, Ovaltine or Noni shake, and eventually Vitamin C. I have heard good things
about alfalfa reducing post partum bleeding, but my gag reflex was strong this pregnancy and I found it very unpleasant to
swallow the large tablet.
I had also given her copies of my stories that has been
previously published or soon-to-be published in Midwifery Today. I told her these topics I wrote about were more important
than what I could tell her clinically. To this day, I am not sure if she has read my birth story. After several months she
commented on the Reflections of my Obstetrical Training. These were not very long stories. You'd think she be curious
about what I would have to say and want to talk about my feelings. I did not feel very valued as a client. I did not bother
to pull out my artwork --pregnancy photography-- to share or my belly mask. I did not sense an interest.
I really want to be able to promote birth choices in
my new community, a role I am very comfortable with, but I didn't like how things were going, for myself, let alone to be
recommending these choices to other woman. I felt gypped of my chance to brag about my pregnancy and my well-thought out decision
to not birth in a hospital. I did not feel like I was making a well-thought out choice.
As far as labs go, I didnt have much of a problem if
she couldn't order them. It was my third pregnancy; some things just dont change. She did request a blood count. My husband
wanted a triple screen for reassurance, even though I knew I wouldnt pursue an amniocentesis no matter what the results. I
took it casually; Get the test and he'll be off my back. What a surprise to see that it was positive test for Down's and Spina
Bifida. I cant tell you how much anxiety this provoked in my husband, and myself and even the midwife. I finally came to terms
with how many times this particular test gives false results and could put it behind me. As I looked at the calculations and
values that went into getting the results, I saw plenty of room for error. I can't say I recommend this test routinely or
lightly.
To top off our communication problems, she talked about issues in a way that made me feel very
uncomfortable. It's hard to pinpoint exactly what bothered me, everybodys entitled to have their own opinion, but I think
it was that she made assumptions that I shared the same beliefs. There was no open end for
me to express my own thoughts. I couldn't be myself, and when I finally did tell her otherewise, it was awkward. I felt
like I was the first person ever that didn't share her agenda; Even if I did share the same views coming from an international diverse back ground (South Florida, Atlanta, New York
and medical school) you learn to not make assumption about people and respect their opinion. It was just one more communication barrier blocking me from fully
enjoying my prenatal care. Other woman from the area probably would have been excited to find a midwife with the
typical regional values and presentation and not have found this to be a difficulty at all.
I always envisioned prenatal care with a home birth midwife
to be laid back, enthusiastic, and encouraging. My appointments with her continued to be quick, uncomfortable, and somber.
I dreaded them. I kept holding on to the hope that towards the end our weekly appointments-- we would get to know and understand
each other better. It effected me physically, too. When she checked my blood pressure it was often on the high end. I checked
it on my own several times and it was always on the lower side.
I still had a problem of not having a local doula either.
When I was about 32 weeks another doula who is 45- minutes away posted to the yahoogroup that she desperately wanted
more birth experience. She seemed to beg for someone to take her under their wing. I thought she could be a good match for
my birth needs. I responded to her post. Without even calling me to get details, she determined that I lived too far. Frustrating.
The one good thing is that my friends in Florida continued
to provide the optimism I needed. I was actually enjoying this pregnancy despite all this. It was suggested several times
that I look into unassisted birth. Mistakenly it was assumed because my husband and I are physicians we could handle it. Going
back to my birth plan, I thought birth was a time to be shared, not go into isolation. Woman who had unassisted birth often
had above-average-supportive husbands. My husband and I mutually agreed that he did not fit this role. I wanted to know if
I was alone for a long labor who would help me change positions, take photos, watch my other children, explain to my children
what was going on, make phone calls, get snacks, help clean-up, do laundry, and comfort me. I certainly could not do all that.
A planned unassisted birth was not for me. I want a strong birth team.
Several of my doula friends expressed sincere interest all along in
coming to me for my due date. It was so hard to believe this could come true. I was a long ways away. At the 35-weeks,
I went down to Florida to visit. I was proud to flaunt my pregnancy around people who cared. A midwife and several doulas
were interested in caravanning to me got together for a meeting while I was visiting to work it out the plans.
I was with four women who made me feel on top of the world. I felt like my birth was the most important birth in the world.
I felt like my family and needs were important. What a high! All childbearing woman should feel this way. They were actually
excited to come to me and stay awhile with me around my due date. This was beginning to look like reality, not just a
dream. No one knows how much their enthusiasm meant to me. I could be happy about this and enjoy the last month of my pregnancy!
It wasn't too late to change providers.
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