Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Must Read Blog: “It’s Your Birth Right!!” April 26, 2009

Stemming from a comment left on my blog, I was directed to check out a relatively new blog entitled It’s Your Birth Right!! and I have to report that this is quickly becoming one of my new favorite blogs J! 

 

Blog creator Nicole Deggins, CNM, MSN, MPH is an author, educator, childbirth enthusiast, and woman’s advocate.  She writes that the goal of her blog is “to help women and their families make INFORMED decisions about their birth experience based on HONEST/ UNBIASED information.”

 

I am most excited about two of Nicole’s posts entitled: Choose Wisely Part I & Part II.  These posts are great because they are better than any other article I have ever read about how and why families should be picky about choosing their best birth attendant.  In my opinion these posts not only give great, unbiased advice and reference variety of helpful resources, but they are also honest about the Top 4 TERRIBLE reasons for picking a birth attendant.

 

Nicole writes,

 

“I get questions, all the time from friends, friends of friends and even strangers.  They want my thoughts about pregnancy, labor and childbirth. I have spent HOURS talking with women providing answers and information they should be able to get from their prenatal provider/birth attendant.  I think to myself at the end of those conversations, “Why isn’t she able to get this information from her?  If  he doesn’t make her feel special, does not answer her questions, and doesn’t agree with her philosophy on childbirth and labor, why on earth is she allowing him to be her birth attendant?!”

 

When I pose this question to the women themselves, the answers unfortunately never include “Because I did my research and I found him to be the best match for me and my desired childbirth experience.”  Most of the answers I receive fall into the four categories below, none of which are good enough reasons alone to choose a prenatal care provider/birth attendant.”

 

The four categories that Nicole is referring to are:

 

1)     “She delivered my sister/girlfriend.”  

2)     “She is my gynecologist.” 

3)     “He is the best/most popular person in area.” 

4)     “Her office is so close and convenient to my office/house.”

 

I have to “second that” to every thing that Nicole writes about in her two posts.  I too am flabbergasted at how many women spend more time researching a new car, camera, computer, appliance, or handbag purchase than they do researching their care provider or birth options.  I am also floored by many of the women I take care of that seem to have NO IDEA how their doctor or midwife actually thinks, feel, and behaves in a labor & delivery setting.  One time, and I am not exaggerating, a woman I was assigned to care for looked up at me after a particularly upsetting encounter with her attending obstetrician (he was very rough with her vaginal exam, was down right pissed off that she refused an amniotomy and an epidural, and stormed out of the room) and said, “Wow, I didn’t realize he was so pushy!  He was really rude!  I don’t know if I want him to deliver my baby!”  I was thinking to myself, “HOW in God’s name are you just figuring out now that he is an asshole?!”  (Excuse my language but this particular doctor is a high intervention, low patience physician with the stats to prove it, on top of the fact that he treats nurses like his personal empty-headed gophers…ARG!)  Turns out the only research she did to find this doctor was that her cousin went to him and was happy with his services since he agreed to induce her early because she was “sick of being pregnant” (her words, not mine).

 

Of course there is also the lying phenomenon as well and this is one area where I feel the most sympathy for my patients.  That’s right ladies…people LIE and I hope that I am not the first person to tell you that doctors and midwives are people too!!  That’s why, as Nicole writes, interviewing potential birth attendants and ASKING FOR THEIR STATISTICS is so important.  Someone I know ended up switching her birth attendant at 36 weeks along because it had turned out that he flat out lied about his experience and philosophy regarding VBACs (vaginal birth after cesarean).  For example, if you have a question about a particular intervention, say episiotomy rate, and the birth attendant you are interviewing either skirts the question or says something vague like, “I only do them when I deem necessary,” I encourage you to ask him for his STATS.  You might be surprised at how often he “deems it necessary.”  It is also important to note that you cannot make sweeping generalizations about a care provider just by their credentials, that is, not all midwives follow a midwifery model of care and not all obstetricians follow a medical model of care (although by the very nature of their education many of them do).  So it is still important to research your birth attendant even if you are planning on choosing a midwife!

 

Also, I wonder if many women do not research their care providers/birth attendants because they come from generations of women who nodded their heads, smiled, and did exactly everything their doctor told them too regarding their reproductive health.  I mean, if a woman’s mother, aunts, and grandmothers didn’t question their doctors, what influence does she have to act any differently?  The good news however is that in today’s day in age, unlike our mothers and grandmothers, we have a most wonderful thing called THE INTERNET J.  So you have no excuse!

 

But really, I am preaching to the choir here aren’t I seeing as if you are reading this blog you obviously are seeking out more information J.  Rock on!  But to all the ladies out there who might be thinking about getting pregnant or are currently pregnant who haven’t yet started to do their research, I hope at some point someone tunes you in to all of the fantastic, helpful information that’s out there J!! In my dream world, no women ever feels the need to say “If I had only known…”

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33 Responses to “Must Read Blog: “It’s Your Birth Right!!””

  1. atyourcervix Says:

    Just one outside the ballpark question: why do you sometimes end your statements or questions with a J?

    Just curious……

    • nursingbirth Says:

      atyourcervix, I do not end any of my posts with “J” haha so I think Jessica might be right…I think my smiley faces are looking like “J” to you….weird!! okay here’s a test….does this look like a “J”———-> :) ?

  2. Jessica Says:

    atyourcervix…I didn’t see any phantom “J’s”…could it be that her smiley faces are coming up as a “J” for you?

    Now, off for another good blog read…

  3. Amy Romano Says:

    Great original post and analysis. The timing is right for women to claim their “birth right” to information about their providers and planned birth settings. The Birth Survey is now available for women to read up on the providers and facilities in their communities. It’s a wonderful resource, and as a nurse, you are in the perfect position to encourage the women you care for to complete it – whether they are pleased with or disappointed in their experiences. http://www.thebirthsurvey.com. Also check out my blog for a post about how to build the case fir increased transparency using the medical literature. http://www.scienceandsensibility.org.

    • nursingbirth Says:

      Amy Romano, since the first time you posted I put your blog on my google reader so I am def keeping up on your writing!! haha! I need to start telling more women about the birth survey for sure! I signed up for a “webinar” about it recently but technical difficulties on the moderator’s end caused it to be canceled. So we’ll see about next time :)

  4. They look like “J” when I read your blog too! I thought is was some sort of colloquialism that I am not familiar with.

  5. atyourcervix Says:

    The smiley in the comment was definitely a smiley! But yeah, there are definite J’s. Just wondering what the J’s were.

    (Here’s an example: the first paragraph of your post……”Stemming from a comment left on my blog, I was directed to check out a relatively new blog entitled It’s Your Birth Right!! and I have to report that this is quickly becoming one of my new favorite blogs J!”

    I’m glad I’m not the only one who sees J’s! Thought I might have been a little off my rocker there…..just for a second…

  6. aisha Says:

    From my experience going to an OB/GYN or a Midwife, women don’t ask questions and blinldy follow doctors orders, otherwise, when I ask a question, I wouldn’t be looked at like “shut up and trust me”. I like to ask why, I like to know my risks and consequences before agreeing to things and I generally like to be informed so I can make an educated decision.
    I switched to a midwife during my pregnancy (I’m 26 weeks with my first) because I thought that she would be more respectful of my wishes of minimal intervention. She works at a large OB/GYN practice and delivers only at the hospital. But at 24 weeks when I asked her what I could “expect” from the midwives during labor and delivery, if they advocated towards minimal intervention labor and breastfeeding, she only replied “Well, we do whatever it is you feel comfortable doing and if you want to know more, I suggest that you take the childbirth classes” I guess that’s the correct answer but it left me the same, I still don’t know where she stands, or what she would do to avoid interventions and was incredibly non-commital. So I guess that I will keep researching on my own and attend the hospital classes. The “maternity coordinator” is a joke, she only gave me a bunch of brochures and no orientation whatsoever.
    Needless to say, on my first appointment (mind you, no orientation whatsoever) I said that I wanted to breastfeed, well on my last appointment at 26 weeks, they gave me a new “hospital bag” with a huge bottle of ready to use formula. I guess I wasn’t heard… everytime I look at it, it makes me mad.

    • nursingbirth Says:

      Aisha, GIRL I feel your pain!! How FRUSTRATING to be handed a bag with formula in it! And I hear you on “hospital childbirth classes” and “maternity coordinators”. I am sorry you are feeling a bit disillusioned with your midwife choice so far and from what you have told me, it sounds like you have good reason to be frustrated! Unfortunately not all midwives follow a midwifery model of care, and this might be especially true if they work for a “big OBGYN practice.” You write, “I like to ask why, I like to know my risks and consequences before agreeing to things and I generally like to be informed so I can make an educated decision” and I have to say it is a BREATH OF FRESH AIR to hear that coming from a gestating woman :) Please dont ever stop asking questions! I hope you continue to research birth attendants even though you are seeing this one for now. That way you are keeping your options open. Oh yeah and CONGRATS on your pregnancy!!!!

  7. Joy Says:

    AtYourCervix- do you use Internet Explorer or Firefox? Sometimes the browsers do that. The “J”s are the smileys.

    NursingBirth- so I have a question. What do you do when you find yourself giving birth with the on-call doctor instead of your regular OB? My particular doctor uses a practice of OBGYNs. I’ll get to meet each of them. But what if I end up with the one guy out of the whole practice that I didn’t want to deliver my baby?

    I also have a major MAJOR fear of my former doctor (who also delivers at the same hospital) ending up in my room because everyone from my doctor’s staff is in a c-sec or busy, etc. Tough questions! I hope you have some insight on that to share sometime.

    • nursingbirth Says:

      Joy, this very predicament you are describing is a really good point. Unfortunately my answer is unhelpful because I have no idea what is the right thing to do!? This very thing happens to my patients all the time. Or even worse, they meet all the docs in the practice they go to but ANOTHER practice is covering for thier practice that day and a completely NEW doctor whom they have NEVER met is delivering them. Ahh! I can understand the uneasyness of the situation. Here are some suggestions I can think of:

      *One thing you can do is ask your main doctor if you can have their home/cell/beeper number (instead of their answering service) and if they would be willing to come in for you even if they are not on call. Believe it or not there are some docs and midwives that will do this for some of their patients (Some of the attendants I work with do this for some of their patients).
      *Another thing you could do is consider hiring a doula so that you know that there will be someone besides your family or friends there that knows you and your birth plan and can advocate for you with a doctor that is not familiar with you. (Check out DONA to learn more about doulas: http://www.dona.org/)
      *If you really get a bad feeling about the doctor that is on call for your doctor, you could request to talk to the charge nurse about having the In house attending be your birth attendant. (Note not all hosptials have a 24 hour in house attending) However this is, of course, another stranger. But if you really really get a bad feeling about the on call doctor it could be an option.
      *It is probably unlikely that your former doctor would happen to be the only one there to attend your delivery but of course, crazier things have happened. I would certainly let your nurse know that under NO circumstances should that OB be allowed ANYWHERE near your room. Most nurses understand that kinda stuff!
      *Finally, another option could be to look into hiring a homebirth midwife and planning a home birth. You would pretty much be guaranteed that only one of two midwives (or so) would be attending your home delivery as typically home birth midwives only take on as many patients as they can personally handle attending. If you havent yet watched the “Business of Being Born” I highly suggest it! For more info on homebirth check out: http://www.midwiferytoday.com/articles/homebirthchoice.asp Homebirth might not be for you but here’s the info :)

      That was a really great question Joy. Does anyone else have any suggestions for Joy?? Thanks for reading!!

  8. Joy Says:

    P.S. My former doctor is with a different practice. Both practices deliver at the same hospital. That’s where the fear stems from!

  9. Krista Says:

    Joy, I have two thoughts for you. 1) Be sure to write a birth plan. You may already be doing this, but its a great way to make sure that whooever is on call will know your wishes. Be sure to discuss your birth plan with your partner and whoever else will be with you during your labor/birth. That way, if questions arise or Drs. start doing things that are contrary to your birth plan, someone can question it, even if you are not at a place where you can. 2) (and this is something I don’t think many, if any, women think about…I know I didn’t!) We (meaning gestating women) tend to think a lot about who their provider will be (i.e. doctor, midwife) but in reality the doctor is not really going to be taking care of you. Its the nurses (can I get an “AMEN” nursing birth?)! I’ve found that a good or bad nurse (meaning one who is supportive or unsupportive of my childbirth choices) can really make or break the experience for me. I tend to have long labors and I’ve had nurses come and go, on and off their shifts. I definitely remember very positive times with great nurses and times when the nurses weren’t quite as supportive as I would have liked them to be. I think this is another great reason for a birth plan and maybe even put in the birth plan that you’d like to be placed with nurses who will be supportive of the decisions you’ve made for your birth.

    Just wanted to add my two pennies. Best wishes to you and your baby!

  10. Marissa Says:

    I hadn’t thought about asking for a nurse who is supportive of my decisions on my birth plan. I think I will have to do that.

    Random question, I haven’t been tested for strep B yet, but if I test positive should I include the fact that I can’t be given Penicillin in my birth plan? I know it should be recorded by my OB, but just to make sure that it gets put in the nurses hands an extra time?

    • nursingbirth Says:

      Marissa, it certainly can’t hurt! Penicillin allergy is pretty serious so I would tell your OB, put it in your birth plan, remind every nurse that comes one, make sure they put an allergy bracelet on you (a hospital requirement), and maybe even tell the the cafeteria people too. Haha, just kidding :) But seriously, good point!

    • nursingbirth Says:

      Marissa, one more thing, I know treatement of GBS with IV antibiotics is controversial for women at low risk for thier babies to become infected and I too am learning more about it as I read and read and read. But going off the policy in my hospital as of right now, if a mom is PCN allergic her prenatal care provider is responsible for doing a CULTURE AND SENSITIVITY when they swab her for GBS, that means, if she is positive, they actually test the bacteria to see what antibiotic it is suseptable too. This is VERY IMPORTANT to make sure they do. Because if they dont have a C&S, at my hospital, they use VANCOMYCIN, a nasty nasty really BIG GUN when it comes to antibiotics that has a lot fo side effects. Just wanted to make sure you knew!! Oh and the CDC has a website about GBS for the general public if you were curious: http://www.cdc.gov/GroupBstrep/general/gen_public_start.htm

  11. atyourcervix Says:

    Re: treatment for GBS with a PCN allergy. I would make sure, when you get tested for GBS, that they (the doctor’s office staff) makes sure they mark the GBS culture for sensitivities. Doctor’s offices are *supposed* to do this on PCN allergic women, but I have seen far too many times where it’s NOT done. Our 2nd line treatment fr GBS in labor is Clindamycin. Unfortunately, there are many strains of GBS that are resistant to Clindamycin. So, if sensitivities have not been done, and you get Clinda, then guess what? Your baby gets stuck for blood cultures and labs. It’s so WRONG.

    Make sure your doctor’s office has C&S written all over the GBS culture lab slip!!

  12. atyourcervix Says:

    Oh, and Joy: I use Mozilla. Still seeing the J’s. But at least I know what they are supposed to be now!

  13. Marissa Says:

    glad I asked. I will definitely make sure they do a C&S. My OB isn’t aware of the fact that I can’t be given penicillin yet because *I’m* not allergic. but the baby’s dad has a really severe penicillin allergy that’s genetic (which I didn’t find out it was genetic until after filling out all my initial paperwork with the doctor). so I basically need to be treated as though I am.

  14. Nicole Says:

    WOW!! … so many good questions, comments, and suggestions here!! Melissa thank you sooooo much for your “shout out” and endorsement for my blog and posts. I LOVE reading your posts. I relate so much to what you share. It is amazing how OB care is the same across the country. Thank goodness for the little pockets of hope.

    Joy….keep asking the questions, not only in this forum but to your prenatal providers. Remember the squeaky wheel gets the oil and you have a RIGHT to know the answers. The grass roots movement is the only thing that is going to change how OB providers are practicing and you my sister are a part of it.

    Suggestion re: your provider situation. After you have met everyone, figure out which one you bond with the best and try to get most of your appointments with that person. Many midwives and physicians will “special” a patient, meaning even if they are NOT on call they will come in for your delivery. Not only do you have to feel bonded with them, they have to feel bonded with you and if you have more time to establish a stronger relationship they will be more likely to “Special” you. This goes along with the Melissa’s previous comment suggesting that you ask for the providers private number/pager. It can work. I’ve watched it happen. Good luck.

    In Birth and Love
    Nicole

    • nursingbirth Says:

      Nicole, thanks for the great post and comment!! I too relate so much to what you share :) It’s great to know that even if you are not getting the support you need at your job, that there are still people out there that dont think you are crazy! :)

  15. atyourcervix Says:

    Marissa – if you’re not allergic to PCN, there is no need to act as if you are, based solely on the father of the baby being allergic to PCN. I can’t tell you how many times people think that they are “allergic” to PCN, due to a family member having an allergy to it. Just because someone else has the allergy, doesn’t mean you will do, or that your baby will have the allergy.

  16. Marissa Says:

    atyourcervix

    it’s not just the father of the baby who has the allergy, his father and half-sister also have it, so yes, it is familial. and I do know that doesn’t make the baby automatically allergic, but it does mean that she has a much higher chance of developing the allergy than the average child. also, he is allergic enough that he could have a reaction to penicillin given to me excreted on my skin or into my saliva. the last thing I want to have happen during my giving birth is have him have a reaction. and we will have the baby tested for penicillin allergy to be sure, but that can’t be done yet, so I would rather play it safe.

  17. Lynz Says:

    I am so happy I found your blog. I’ve always wondered how L&D nurses think, and am SO HAPPY to have more insight my fourth time around at delivering (any day now)!

    I love studying, but never thought to ask to see stats on the doctor I choose! I guess I didn’t even think they would allow it. But I do love my doctor… he is so kind and, even if he doesn’t agree, will nicely let you do what you want to do and will encourage you.

    • nursingbirth Says:

      Lynz, CONGRATS on your pregnancy and “any day now” BIRTHday! :) I am so happy to hear that you have found a supportive birth attendant!! I mean, it’s your fourth time after all!! I am so happy you are enjoying my blog and I hope you keep in touch :)

  18. Lil Says:

    Hi,
    Just wanted to say that I love your blog!!! I found your website the other day, through another blog (sorry I can’t remember which one now). I’m a newly registered midwife in Australia and am finding your blog so interesting and informative! Thanks!
    Lil

  19. Nicole Says:

    I have been called “crazy” since my first labor and delivery job!! I have learned to embrace it and realize that there are lots of crazies out there!! Thank God!! LOL. Can’t wait for you to join the ranks of us crazy midwives. We need more like you!! Keep up the good work!!

    Nicole

  20. Jill Says:

    This post reminds me of a quote I heard recently: “If a woman loves her doctor, she should ask herself if her doctor loves her just as much.”

    Chances are the answer is NO. I am right there tearing my hair out along with you, girl. Sometimes I think women act like abuse victims when it comes to their doctors…they keep coming back for more because they have no idea that it doesn’t have to be that way!

  21. LeAnn Says:

    Hi! I found your blog today and can’t seem to stop reading. It’s great and I thank you for it.
    However, this post struck a nerve with me. My first child was born in a hospital in Florida. I chose the OB I had based on her proximity to our home and because she gave us more than one option as to the hospital I could birth at. I would love to have known more about her actual philosophies before the birth, but this information is difficult to obtain. The real reason I chose her is more complicated than that, but if I were asked, that’s how I would answer.
    I chose a different OB first, and tried to obtain information about him via phone before setting up an appointment. The receptionist was very vague and avoided giving me any real answers, only insisting that I make an appointment ASAP, as I was so far along in my pregnancy already. I did, expecting that I could just see the OB at the appointment and ask my questions then, however I did not see the doctor on the first visit. I questioned the receptionist about this and she advised me that the doctor was only in his office for two hours, TWO DAYS A WEEK! I requested that my next appointment be scheduled on one of those days so that I could speak with him. A couple of weeks pass, I go to the next appointment, again, no doctor. I ask about it again. I am handed off to one of his nurses or someone, she doesn’t even introduce herself. She takes us to an office where I begin my questions, including asking why I haven’t met the doctor yet. She pretty well blows me off, acting as though I’m getting uppity and have no right to see the doctor, how dare I ask! Due to my husbands aversion to conflict and his unwillingness to switch at such a late date, we returned for the third appointment. I still did not meet the doctor and we left the office without completing our appointment after finding someone elses’ urine in the cup in the bathroom.
    After some pleading with my husband to allow me to switch, I began searching for another doctor. I called several places and was told I could not be taken because I was so far along, they also were reluctant to give me any information concerning the doctor in question. I was probably 32-36 weeks. I looked at the only listing for “midwife” I could find and called. The receptionist told me only that the doctor would “probably be willing to work with me on my wishes for the birth.” I pleaded with them to take me, even though I was so far along. This office was better than the last, but I still didn’t actually meet the doctor until the second to last appointment before my due-date. I wasn’t entirely satisfied with her answers, but how on earth can a woman switch doctors at 38 weeks?! Especially with it taking three or more appointments to actually get to talk to the doctor in question? INSANE! I could go into so much detail about the (IMO horrible) things I experienced with my first birth, but the point of my comment is to point out to you how HARD it is to obtain any information prior to an appointment. Obviously, were I asked, the short answer would be “She was close”, but I’ll tell you, that isn’t the half of it, really…
    On another note, we elected for a home birth for my second child, (and most likely, for any future children as well) and I am SO GLAD I did!
    Anyway, thank you again! I love your blog!

    • nursingbirth Says:

      LeAnn, unfortunately your story is not unique…I hear stories like yours from women all too often. You are right….it is almost impossible sometimes to get your questions answered, especially if it is your first baby and you haven’t even had to “navagate” that type of screwed up “doctor is never in the office” system before! Clearly even though your first experience with the doctor and getting your questions answered was less than ideal, you still learned a whole lot (especially since you elected for a home birth for baby #2!). Thanks for sharing. Your story will hopefully inspire women who read it to start looking for a birth attendant very early, perhaps even preconception, before the clock starts ticking down the weeks, and not take any of that crap you had to put up with!! Thanks for sharing!


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