What am I so afraid of, lately? Why so nervous and defensive? Look at my sleepless, 2am face. I have three months to get everything in place and ready for a new life, for Baby and Husband and me. It’s finally that time where thinking and planning aren’t enough. I actually have to make sure this is going to happen. I have to be a mom, too. Oh, dear, that’s a lot to think about. Can I unload a little?
I mentioned that I’ve been considering a change in care providers. Today’s visit was going to be the last chance, and now I’m pretty certain.
At the previous visit, we finally got down to the first of many common procedures to come. Glucose screening time had arrived. I thought it was a good opportunity to begin the discussion on how she views and manages different complications. This one in particular for me, was a concern. Being insulin resistant before, I do have a higher risk of developing gestational diabetes. But it’s also a concern for me because of the mode of care that accompanies that GDM label… Dire predictions. Extra tests. Induction—shiver. It goes on from there.
Despite the fact that I knew any sense of tact had been drowned in the hormonal tide, I made the bravest start I could. “I’m not sure how I feel about this test, and gestational diabetes as a condition. I’ve read some things that…” The truth is, I’d read everything from ‘This is not a disease; you just need some extra time to birth gently’ to WebMDoom-and-Gloom’s list of 20+ potentially fatal complications. That’s a wide range of opinion. The midwife’s response was definitely more in line with the latter. “I have NEVER delivered a baby over nine pounds, and I don’t intend to…perineal trauma…brachial plexus injury…STILLBIRTH.”
On the bright side, it was heartening that I already knew the terms and what she was talking about. I finally just negotiated for a food
source of 50 grams of sugar instead of the drink, and made my next appointment. She was probably right. But I continued to wonder. HOW BIG A PROBLEM COULD THIS BE? No, seriously. I wanted to do the right and healthy thing, but couldn’t I do that with a little home testing, care in eating and exercise, somewhat more frequent monitoring in the last weeks, no procedures that might contribute to malpositioning or possibly slow my labor, and by staying off my back during delivery? I could accept a ‘no’ answer, I just needed to really talk it through.
The next scheduled day started out okay. I couldn’t recall all of the specific directions for the test, and the office wasn’t due to open
until about the time we arrived. How long was I supposed to fast, again? I looked it up and apparently EVERYONE does it differently,
from one to twelve hours, with or without a breakfast which might be specifically prescribed. I couldn’t recall any mention of eggs and
cheese, so just maintained the fast I’d begun through the night before choking down a Snickers and some fudge brownie ice cream. We commenced our early morning hour’s drive, with the sugar making me sicker every minute. Of course, halfway there, the car overheated. Grr! We arrived 10 minutes late, and they didn’t take us back for another 10-15. Too late. I was SO mad—well, as mad as I ever am. I got quiet and pouty and hid behind my hair while Preston tried to poke and make me look him in the eye. Not the best way to begin.
I thought it worth another attempt to clear things up with the midwife and explain how I simply wanted to understand her approach to this and other conditions, how she assessed risks and dealt with them. What I wanted to say is: I know my behavior seems odd and inconsistent, and logically speaking, I’m being a little bit silly. Not to mention that I had NO time to understand the PCOS thing before having to add the pregnancy changes, too. I don’t entirely know what it means for me, how serious it is. But doesn’t that indicate another side to the care that I need? I’m confused. I just need to talk. I especially need to know that you understand why I’m concerned, and that you actually care enough to let us work together to find a solution. Maybe you hear “I choose to remain lazy and ignorant regarding this diabetes thing,” but what I’m really saying is, “I don’t understand how big a risk this is for me. Is it a big jump from pre-pregnancy insulin resistance to full-blown GDM? Is the real problem just a big baby? HOW MANY stillbirths happen, and how serious were the cases that caused it? Do you think I’m that bad? I hear the glucose test is not that accurate. Why do you use this option? Can it really be that beneficial when it makes me feel so sick and doesn’t reflect my natural habits? What about…A1C, is it? Or home testing, as others have done? What are they and how do they compare?”
We never made it that far into the conversation. This time the immediate and stern response was, “Well, yes, we induce—again, dead or
injured baby—but WHY are you worried about this? You think because you had a little PCOS one time that you’re guaranteed to have full-blown diabetes? Given the baby’s measurements, your small weight gain, etc., I don’t think it’s going to be a problem. Calm yourself.” Somewhere in there was a lecture about evidence-based care vs. whatever anecdotal reasoning I’d heard from whoever was certainly not qualified. These things come from the top. They’re in the big journals. End of story.
(One note in my defense: a 2011 study—in one of those big journals, no less!—determined a mere 1/3 of ACOG recommendations to be based on consistent scientific evidence as opposed to limited evidence or consensus of opinion. I think that leaves some room for questions.)
On one hand, she is in the right. She has settled on what method of patient management she feels is her responsibility to follow through
with as a care provider, with the backing of general medical opinion and practice. I don’t question that at all. On the other hand, there
was a level of care I found completely lacking. Never did I feel like there was any considerable effort to understand what I was asking for, to address my concerns other than outright dismissing them.
Doulas often talk about the importance of providing support, physical, emotional, and INFORMATIONAL. Childbirth educators obviously understand the necessity of a thorough understanding of common occurrences and procedures in preparing mothers and birth partners for the journey, emotionally and otherwise. Why is this somehow occasionally missing in the people ultimately responsible for supervising this process? Lack of available time and other resources? Limited interest among the typical patient set? Simple differences in personality? Probably some level of each.
So I’m leaving with some bruised but not deeply resentful feelings. I knew in the beginning that employing a midwife was no guarantee of the treatment I was hoping to receive, particularly one so closely connected with a hospital. Every provider has a different personal and professional attitude. My lasting fear is the question of whether or not I’ll find someone who’s matches mine. There are other midwives available in that town, but I’m finding it hard to muster the fortitude to weed through them. The despairing side of me says that if I’m going to have to endure this type of stress and treatment, I’m at least not driving an hour each way for it. I mentioned earlier that we have a nice hospital, with staff members dear and familiar to various family members. There is a local family physician I have visited before who provides obstetrical care. My grandparents are fond of him; my doula also speaks well of her experiences with him. His wife apparently teaches yoga and does essential oils, so I figure he’ll be fairly open-minded. I hear he’s good at giving options. It seems like the next best thing to try. We have an appointment next week.
My final gripes are these: all of the differing ‘experts’ have left me in a very difficult position discerning between them, and I fear I have no safe place to go for answers and care. If you want me to feel safe, please talk to me openly. Please listen to me. Please give me some control and don’t belittle my confusion in this fragile state. This is WHY if I could afford it, I’d be at a birth center or at home. Because I know how much more likely I am to find someone who cares about ME just as much as my health, who knows when to act, when to
refer, when to let be, but keeps at the center of her practice a love for the spirit and whole being of a mother, child, and family. I hear
them talking. I read the things they write. And THAT’S what I want to accept as the truth. Why? In that place, it’s about hope, and
confidence, not fear, not efficiency, not covering your back. You can Tuteur-bash me all you want, but I’m going where the positivity is. The downside comes when I have to manage all these voices in my head, compare them with what’s in front of me and available to me, and figure out which is the best way to go.
It’s getting considerably more tempting to abandon my own responsibility in this. I could so easily just go with the flow and ‘leave it to the experts’. But what do I do about the other things I’ve learned and seen? What about the choices I’m told I should have or press for? Sigh. I suppose this means I’ll have to summon some humility, as well. I wonder if anyone will connect my name with the rather…passionate note left on the hospital’s facebook page a few months ago in my displeasure with there being no nurse midwives available (or possibly allowed) to deliver there. What will this doctor think of my having gone elsewhere for prenatal care when he was the one to diagnose me and prescribe the medication that probably enabled me to conceive? And after all this, who knows, I may finally get around to taking that stupid glucose test.