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I want to understand what constitutes a positive pregnancy experience... and how the health system can help.
July 13, 2011 3:04 PM   Subscribe

I'd love your experience and advice on how to be a good practitioner of women's health in pregnancy.

I'm looking for anecdata to help me contextualize the literature on patient-provider communication as it relates to women's health - and to eventually put it into practice in my own work as an advocate.



* Were there things your doctor/midwife/nurse practitioner did during your prenatal visits that made your experience better - were there things they told you that helped? Were there things you wish your providers had done, or wish they'd left out?

* How did your provider explain issues like induction and augmentation of labor, pain control, or cesarean section? Did you find these explanations helpful?

* When you got to the labor floor (assuming you had a hospital delivery, as most women in the USA do), were there interactions that worked, or didn't?

* What general advice would you give to health professionals who work with pregnant women about how to make the experience of pregnancy and labor/delivery a positive one?
posted by noonday to Health & Fitness (34 answers total) 12 users marked this as a favorite
 
At just shy of 33 weeks I was admitted to labor and delivery with leaking membranes. It was touch and go at first, but I stuck out two weeks of bed rest and had a perfectly healthy baby at 35 weeks. For the most part I had a wonderful experience through to being discharged from the NICU - this was at a large Kaiser hospital in California. The single best thing that happened to me was the first night - my baby's heartrate was decelerating and then coming back up, and it was very unclear if I'd be headed for an emergency c-section right then. After the heartrate issues stabilized, the doctor took a moment to connect with me and he asked "What's your sense? Do you feel like you're having a baby tonight?" I really appreciated his perspective that I had some insight into my own situation (not that it was my choice if I did or didn't, but that I might have some perspective that wasn't part of the monitoring they were doing).
posted by handful of rain at 3:29 PM on July 13, 2011 [1 favorite]


Man, where to start? I just returned from a road trip so my wife could be with her sister for a birth. Our birth experience and her birth experience are worlds apart.

Things we liked about our experience:
Our midwife was constantly telling us that what we were experiencing was normal, or withing a normal range, or that she'd seen this exact situation before, or that while this particular aspect of our situation was a new one, it's nothing she can't handle, and here's x, y, and z things that we're going to be doing.

Every procedure/intervention, while minimal, was described fully, was explained why it was being offered, and the side effects were also laid out for us to consider.

They were extremely patient with us. We never felt like we were being rushed. They were 100% on mama-time. Their world revolved around us, not the other way around. They focused on us and nothing else for the entire experience.

Follow-up care felt the same. Options were given, with clear explanations of everything, with side effects.
How this was different from my sister's-in-law birth:
From the moment she checked into the hospital, she felt as if she was being steered to have a c-section. These are of course necessary in some situations, but it really felt like they wanted her in and out as quickly as possible. "Well, you can try to do this on your own and it can take God knows how long, or if you want a c-section, you can be holding your baby in your arms in less than an hour, sweetie. You just say the word."

Nurses didn't explain the side effects of medication, or even give the name of the medication. One nurse came in, and seeing my SIL's discomfort, said "I can make you feel all better with a margarita in a needle. SIL consented, and then proceeded to pass the fuck out for four hours. After she woke up, she was groggy for another solid two hours. She had no idea that the "margarita in a needle" would be that strong.

After her c-section yesterday, she had a very difficult time holding her baby because she was shaking (I think from the anesthesia). Nobody told her this might be an issue. Nobody told her that it's basically major abdominal surgery, and you're not going to be able to get out of bed for a little while.
(I'm not trying to come off as anti c-section, but what I'm trying to impart here is that she felt more like things were being done to her rather than that she was participating in her birth experience.

Empathize with your patients. Ask them what they want. Explain what you're going to do. Explain possible side effects. My SIL definitely could have been more of an advocate for herself and asked these questions, but she was never fully in her right mind after the first major sedative they gave her. We feel that her doctor and the nurses should have been more.....gentle?......or at least should have explained procedures/medications more thoroughly.
posted by spikeleemajortomdickandharryconnickjrmints at 3:49 PM on July 13, 2011 [4 favorites]


The thing that made my experience stand out was the amount of information I was given. I had complete and total access to my chart and test results and was encouraged to read through and ask questions. For example: While trying to deliver Toddler theBRKP's (3+ hours of pushing - yikes!) I needed to an episiotomy. The midwife attending asked my permission to do the procedure and gave a complete explanation as to why she wanted to perform it. Little things like that add up over 9 months of pregnancy.
posted by theBigRedKittyPurrs at 3:51 PM on July 13, 2011


The most important thing I can tell you is that a woman's birth may be one of only four, or six, or eight that you see that day for you -- but it might be one of only one or two times SHE gives birth in her entire life. It's hard to maintain an atmosphere of specialness and anticipation for your entire working life, but if you can manage it, it will be really helpful.

I had a hospital delivery with an OB with my first child, and it was awesome. I had a home birth with midwives for my second child, and it was also awesome. One thing the midwives did that my OB didn't was that they would always ask me before they touched me. My OB would say "OK, you'll feel my touch here" rather than just leaping into an exam, but my midwives would say "Can I do a vaginal exam?" and it was really nice and respectful. (I ended up with almost no exams in labor itself, as I had a very, very fast labor.)

Don't threaten women; don't pull the dead-baby card unless you really are dealing with true blue-light emergency like a uterine rupture or a shoulder dystocia. And if you are dealing with something awful like an IUFD or a fetal anomaly incompatible with life, remember again that for you this is a shitty day at work but for the parents it's a monstrous tragedy.

With my hospital delivery, there were several things that stand out in my mind as being really great. My water broke at home and sent me instantly into hard, hard labor; I arrived on the floor with contractions 2-3 minutes apart that were really rocking me. Everyone moved very fast to get me into a room, which was great, particularly as I was still leaking amniotic fluid. When I said I wanted to wait on an epidural, I didn't hear the word boo about it until I requested it about forty minutes later, and then even though that was a pretty quick reversal, nobody said "I told you so" or anything like that.

My nurse set me up on my left side with pillows between my knees to open my hips up, which also allowed VEs to be done from behind, without having to roll or move me. When my OB came into the room, looked at the fetal trace, and went flying out again (to check the status of the OR, I found out later, as I'd been having some troublesome late decels), the nurse broke down the bed SUPER FAST and had me do a test push. The results of that test push were great, and probably kept me from a C-section. And finally, when my baby was crowning and we discovered that the late decels were caused by an occult cord prolapse, my OB absolutely kept her calm and said "Well, Dad, I'm going to have to be the one to cut the cord, I'm sorry. You can cut it down after she's out. OK, Kathryn, let me just deal with this. . . OK, one big hard last push and she'll be born." I had absolutely no idea that there was an obstetric emergency going on, and my daughter was born with 9/9 Apgars.

Some things that were really awful, and which contributed to my choice to have a home birth the second time: I could not get any sleep that night because people kept coming in at all hours to poke and prod me. My daughter would not be happy in the bassinet by herself, and there was one nurse in particular who yelled at me every time she came in and I was holding her. She lost a lot of weight in her first 12 hours of life -- 9 ounces -- almost certainly because she was born waterlogged from the saline bolus they had to give me from the epidural, but one of the well-baby nurses still freaked out, blamed her weight loss on the fact that we were co-sleeping (?!), and tried to get me to supplement with formula after every feeding (?!?) despite the fact that she was gaining an ounce and a half a day on demand nursing. She tried everything to get me to go to a bottle, including muttering darkly about Involving Authorities if we didn't do "what's best for baby." Typing this out, I can feel tears starting again; I was so scared and so vulnerable, and I had a really neurotic relationship to my daughter's feeding until she was about 18 months old that I am dead certain started with that nurse.

Hm, let's see, what else. If someone asks you for numbers (hCG, progesterone, CRL measurement, NT measurement, or really anything), don't just say "Oh they're fine"; give them the numbers. Adding context is great: "Baby's heart rate is 146, which is perfect!" "Your progesterone is 14, which is a little on the low side, but we'll talk about that more with the doctor." "Your beta hCG was 812, which is typical for this stage of pregnancy, but that number varies a LOT. The more useful figure is how fast it's going up, which we'll be able to tell you after your next blood draw two days from now." But don't ever just handwave. You don't know what someone's previous story is, or why they might want so badly to get whatever reassurance they can get from numbers. (I'm G6P2, so. . . yeah.)
posted by KathrynT at 3:53 PM on July 13, 2011 [5 favorites]


Having recently had my first baby after a very fast labour, the thing that stuck with me through it was the nurse telling me before things were in motion that pushing out the baby would be like pushing a BM and that I needed to push three times during each contraction. After my waters broke labour came hard but very fast. There was no way I would have been able to process new information and when I suddenly felt the need to go to the bathroom I knew what that meant, so I was able to tell the nurse that the baby was *coming* and 11 min later my son was born.

So my suggestion, go over the important labour details in as early labour as possible.
posted by saradarlin at 4:08 PM on July 13, 2011


When my daughter was born I had been in labor for a while and finally went in to the hospital at about midnight and told the nurse I felt as if I was close, she didn't even examine me but told me to go home and see how I felt the next morning. She told me ' you wouldn't be able to talk to me like this if you were close'. I went home and then insisted on returning about an hour later. My daughter was born at about 2 am. I felt ignored because how I deal with discomfort. Because it was my first child I assumed the nurse was right and that the labor was going to increase for another 8 hours and that didn't make things easier for me.
When my son was born there was a scary few minutes when the cord was around his neck. He was a big baby and the last few minutes of delivery were hard. As soon as he came out the doctor left the room, the nurse commented that his color was off and set him on a table and rubbed him a bit and then she left the room and left him on a table behind me where I could neither see him or reach him. I finally yelled 'would someone give me my baby' and a different nurse came in and gave him to me. This was a major Boston Hospital. I assume the staff was needed to be with another delivery but never leave a baby out of reach of his mother.
posted by InkaLomax at 4:10 PM on July 13, 2011


Not in the US, but to answer the questions: I liked that my ob was upfront when he didn't know something and would research it before our next appointment; whenever touched me without permission and warning; he encouraged research but not in the 'birth stories' sense; he wanted to know my family history of labors and pregnancies; and when shit started going wrong he never ever once blamed me and tore shreds off the midwife who did, while reassuring me about what I could doto mitigate the issues. He was also very open about his experiences and risk levels. I wish his receptionist hadn't grilled me about refusing the 12 week scan and hadn't asked me how I know the baby is still alive. That sucked.

Induction was off the table until my blood pressure skyrocketed. Then we talked about how likely it waas to fail at 33 weeks and how our goal was 37. We got to 37 and used gel to ripen my cervix which is all I needed. He explained the gel and we talked about the options for syntocin and pain relief. We discussed c-section parameters and worked out what I wanted with that (I wanted to avoid and emergency section if possible, but would request one under certain circumstances).

Interactions that didn't work during labour - telling me I wasn't. In spite of the ob leaving copious notes and my own presentation, the midwives insisted I wasn't really in labour, right up to the first cervical check that revealed a baby's head. Also the midwife being unable to operate the gas machine properly and insisting I was doing it wrong. That sucked a fair bit. As did their decision to give me sleeping pills four hours before my daughter was born (see the 'not in labour' commentary). My ob and my partner were amazing though. The other stupid interaction was a midwife asking me if I was just going to sit there'd looking at my baby all day. I just pushed her out! Of course I am! Due to the sleeping pills and a few other issues we didn't get the amount of skin on skin I would have liked.

Afterwards my ob came and congratulated me on working really hard and getting through all of the shitty things that happened with the pregnancy and labour. That made me feel good, which surprised me.
posted by geek anachronism at 4:14 PM on July 13, 2011


What I liked:
Before labor:
- Listening to my concerns without brushing them off
- Not being too "AVOID EVERYTHING" and telling me not to be too worried
- Being honest about what was worrisome and telling me what the guidelines are once we got close to them ("Lose two more pounds with morning sickness, and we're going to hospitalize you.")
During labor:
- Making me walk around to make more labor happen in a way that made me feel stupid for coming in when my contractions were whenever apart like the doctor told me
- Private room
- My baby was the most important focus on everyone in the room
- They clearly told me everything they were going to do, showing me the equipment before they went to town with it
- They made everything my choice with their recommendations
- They looked calm when things went really wrong
- They made it seem like every baby gets a huge pediatrics team and an ICU stay right away, even though logically I knew they didn't

What I didn't like:
Beforehand:
- If I get kidney stones from the calcium/iron supplements, tell me this is normal for some women. Don't make me feel like a freak until I look it up later.
- Just because I'm going to have a baby doesn't mean the receptionist should talk to me like I am a baby
- I'm about to take a whole lot of time off work and worried about my career. Do I really need to come in CONSTANTLY with little flexibility in the schedule?
During:
- Spend as much time introducing the huge cast of characters standing around my nether regions as you did with the drugs and the equipment
- Don't tell me "If we had known she was in that position, we would have c-sectioned"
- Keep that damn Jesus-freak nurse away from me before I threaten to punch her in the face and way before she tells me I'm not pushing hard enough because I don't want this baby

I went to Lucille Packard on the Stanford campus and didn't appreciate how amazing it was to deliver there until I was much older and a doctor friend was all excited by it. I'm incredibly glad that no one was arrogant or treated me like I was anything but the second most important person in the room (my daughter being first).
posted by Gucky at 4:24 PM on July 13, 2011


Goddamn auto correct - the ob NEVER touched me without permission and warning. Not whenever.
posted by geek anachronism at 4:25 PM on July 13, 2011


What InkaLomax said about respecting the different ways patients deal with discomfort really struck a chord with me. In the days after my c-section (I had pre-e and my doctor and I decided that was the safest route, although at no point did I feel forced to go that way), I had a violent and miserable headache. I have been a migraineur all my life, and I thought I was just having a reaction to the meds I was on or being a bit dehydrated or whatever, but nevertheless it was so awful I kept mentioning it to the nurses. One nurse in particular said, "Oh honey, I've seen people with bad headaches, and you don't have one. You wouldn't be talking to me like this if you were in real pain." Finally, when I was still in agony on the day they were going to discharge me, I decided to advocate for myself much more strongly. I demanded to talk to my doctor about my headache before signing my discharge papers - and it turned out that when she asked me a few specific questions about the nature of the pain, she easily surmised that I had a spinal headache. I was given one pill and the pain was gone within the hour. It was so frustrating to know that I spent the first four days of my baby's life in needless agony (beyond the pain from the c-section) because I am too stoic about headaches. If a patient says she is hurting, or something isn't right with her body, slow down and listen.
posted by katie at 4:42 PM on July 13, 2011


Things I liked:

My midwives were very communicative and made it clear that I could choose to bypass certain tests (glucose screening, genetic screening) if I so wished.

When my midwifery team was shuffled close to my due date, and I had a real problem with the style of one new team member, I felt totally comfortable talking to my midwives about it and my concerns were taken seriously.

When I developed Pregnancy Induced Hypertension and found I was going to have to be induced, one of my midwives called to see how I was doing emotionally.

One of the nurses who was helping me during my induction was incredible. Very kind, very patient, not in the least condescending, and didn't make a murmur about having to reposition the fetal monitor frequently when I moved around.

Things I disliked:

Upon hearing that I hoped to give birth at home, my GP gave me a long lecture about how "we're not in Africa, we have choices here".

The other nurse who was helping during my induction was rude and condescending while I was in Pitocin-induced-contraction hell.

While I was having the Foley catheter inserted the night previous, the residents who did the procedure not only didn't introduce themselves, they didn't make eye contact. They spoke about me in the third person and made jokes to each other about the size of the catheter, while I was in stirrups and openly weeping on the table.

We were woken frequently for entirely non-essential things the night after the baby was born.

My midwife, while not technically in charge of my care at that point, was present for the birth... and had to ask several times for the baby to be brought to me.
posted by lizifer at 4:57 PM on July 13, 2011


Please ohgodplease be aware of Symphysis Pubis Dysfunction and Sacroiliac Joint Dysfunction. Know how to recognize it, and be able to give your patient options during and after pregnancy. Mine was and sometimes still is crippling, and the only "help" I was given during my pregnancy - after I discovered for myself what was wrong with me - was a physical therapist who looked it up online, handed me a pair of crutches, and wished me luck. Years later I tried again, and this doctor knew exactly what the problem was and got me to people who had extensive experience with it. Treatment had a powerful impact on my pain levels and functionality.

I also had hyperemesis for four months that went unrecognized and unaddressed. I could barely get to the bathroom. I lost weight. I said I was dizzy and blacking out. I said I couldn't keep much of anything down. I was told to drink a little more water.

In contrast, my providers were right on top of, and supportive about, the gestational diabetes, which was really helpful. (Yes, this all happened during the same pregnancy.)

I was another stoic. Nthing that if your patient says she's in pain, listen and further evaluate, even if she's not being very expressive about it.
posted by moira at 7:40 PM on July 13, 2011


Oh, also, it probably seems obvious what "pushing" involves, and I thought I knew, but I got nowhere for a long time until, at the end of a push and in desperation, I pulled in my lower abdomen. I immediately got loud cheers, it was that much more effective than what I had been doing. I gave birth quickly after that.
posted by moira at 7:59 PM on July 13, 2011


With my first pregnancy, I was so freaked out by the newness of it and felt really lost in the mechanics of the medical practice itself. Like, I could look up stuff about the PREGNANCY, but I was confused about appointments, tests, ultrasounds, etc., and I didn't want to be a bother about it since these weren't medical questions or particularly pressing. (My doctors were actually really good about those questions, but the front-desk nurses who dealt with scheduling and minor questions would always say, "Oh, they'll tell you all about that at 18 weeks," and kind-of blow it off, which made me more frantic.) I would have seriously appreciated the option for an orientation session to "Nuts and Bolts of How We Manage Your Pregnancy Care." Not that it all wasn't explained to me at the proper times, just that I'm a planner and I wanted all that information RIGHT AWAY to banish as much uncertainty as possible. With the second pregnancy it was like, Okay, I know all this, let's get this show on the road. :)

I wish I had realized that because I had my second baby over a holiday weekend, it was like a carousel of rotating nurses at the hospital. Unlike the first where it was basically the same three or four nurses. There was a real difference in continuity of care. Not that I would or could have particularly changed anything, just that I would have been prepared for the difference if someone had mentioned it in passing.

My husband and I have different preferences in bedside manner and different communication styles with doctors/midwives. Some of the doctors/midwives in our practice did really well at accommodating both of us; others would accommodate MY needs but not pay much attention to his, which would leave him feeling unhappy and unsure about things. (It took like three visits for him to feel comfortable with the information we were getting about C-section risks, because the first two the midwives talked to ME and not him and he didn't really get his questions answered or his concerns addressed. I felt like I had what I needed after the first visit.) If you're dealing with a couple, obviously the pregnant person is the primary person to communicate with, but try to make sure you're connecting with the partner as well.

My surgeon dropped by a couple days after my C-section not on rounds but just because he was in the hospital for a different surgery, just to see how I was doing and admire the baby. That was awesomesauce. He even wanted to see my pictures.
posted by Eyebrows McGee at 8:10 PM on July 13, 2011 [2 favorites]


A woman I'm close to had a bad experience with her OB. This was at one of the prenatal ultrasounds - I forget how far along but probably early in the 3rd trimester. She had gone to the appointment solo (no husband, no friend along for the visit). This was at a practice where there are several doctors and who you see depends on who is in that day.

They do the ultrasound and then the doctor has a consultation with her. He says, brusquely and without eye contact: It looks like there may be a problem. It looks like the brain is not forming correctly, which is probably not survivable. It's too late for an abortion in this state so you'll need to carry the pregnancy to term anyway. We won't be able to get another ultrasound for another three weeks (?).

She remembers him dropping this bomb, and she dissolved into tears and couldn't follow anything else, and then he left the room to let her cry and never came back. She eventually slunk out to cry in her car.

It turned out later, on her next visit (when she brought a friend), she spoke to a different doctor. Who said "oh yes, I remember your ultrasounds. They were blurry and we couldn't read them well, they went around the office and we all looked to see if we could figure it out. It's possible there is a problem with the brain, but there are a lot of brain problems that end up having no external symptoms, and it's possible it's not a brain problem at all but something else. That other doctor is very focused on worst-case outcomes." And she explained at length what all the possibilities were, and explained what they would do about all the contingencies, etc.

I'm not sure what the lesson is here, since it sounds like the original guy was (a) cold and didn't seem to have any human connection to the idea that he was delivering an absolute bombshell, sounds like he was discussing it like he would discuss a faulty spark plug; and (b) focused on worst-case outcomes without giving a sense of how likely they were. This meant my friend spent 3 weeks (or whatever) crying, not sleeping, unable to concentrate at work, etc. until the meeting with the good OB. (Eventually the baby was born and seems to be healthy.) But I suppose the lesson is, remember that those consultations are a huge deal to patients even if they're routine to doctors. Every word said drips with meaning. Giving perspective is very important. And if your patient is alone and you're going to give her bad news, take extra time with her.
posted by LobsterMitten at 8:11 PM on July 13, 2011


Albert Einstein once said “If you can't explain it simply, you don't understand it well enough.” Make sure you keep this in the back of your mind when answering questions.
posted by bkeene12 at 8:17 PM on July 13, 2011 [1 favorite]


Accompanying other people to the hospital, a couple of good things-

At a late ultrasound/check-up (38 wks?) they had a hard time getting the test results they needed. (This was not ultrasound but another test) An experienced tech stuck with her and tried a bunch of different things until it worked. Had her drink a little water, eat some crackers, etc to stimulate the baby to move. Calm, sense of humor, but not overbearing. (We had another tech who talked about her personal problems as a way to defuse tension, and that was just weird, a very off note.)

Another person was having an emergency c-section. While we were waiting for her husband to arrive from work, nurses and other staff dropped in regularly, though not obtrusively, to check if she needed anything. The anesthesiologist came in to explain what would happen, and was very clear and good in his explanations. He explained they were going to start her off with [whatever, which numbs only the lower body], but if something happened where they needed to move to a general anesthetic, that he wanted to clear it with her ahead of time - in case she was unable to give consent later, he wanted to walk her through what a general anesthetic would mean, that there was a slim chance she might wake up in a different room than she remembered etc. (And presumably this would normally be for the benefit of the partner too - what will happen when she's waking up etc)
posted by LobsterMitten at 8:32 PM on July 13, 2011


from KathrynT's comment: "fetal anomaly incompatible with life"

Yes! This was the other phrase the cold OB used to deliver bad news to my friend. Terrible phrase! Oh my lord, never use this phrase with a patient! Trying to soften news like that by making it sound impersonal or dry is just an awful strategy. It's going to be personal, period.
posted by LobsterMitten at 8:37 PM on July 13, 2011 [1 favorite]


I feel I focused too much on negatives, so here were some things I really appreciated about my pregnancy and delivery:

They were very good at keeping me informed. I was given plenty of info on pregnancy, labor & delivery, breast feeding, and PPD. They offered childbirth classes, and there was an integrated birthing center that had real beds, exercise balls, a shower (I LOVED that shower), birthing pools, etc. for women who preferred to go sans drugs. They even provided a free on-call doula. Everybody was super friendly and supportive.

When the gestational diabetes was discovered, I got sent to a class, was given supplies, and was carefully monitored, while my personal choices for childbirth were still respected (though if my baby girl had gotten any bigger, I'd no longer have had as much choice in how things happened).

I appreciated the followup visit from a nurse, and the careful questions she asked me about how breast feeding was going and particularly about PPD.
posted by moira at 8:38 PM on July 13, 2011


Another good thing was after the birth (c-section after long failed induction, so the mom hadn't eaten anything in nearly 24h), the nurse who made a point of showing the husband where they kept the popsicles and whatever other food she was allowed to have right away.
posted by LobsterMitten at 9:08 PM on July 13, 2011


Another thing (sorry, I keep thinking of them):
After the delivery, in one hospital, there was a whiteboard on the wall facing the mom's bed. On this, nurses write notes and whatnot (mainly seemed to be times), but at the top they wrote stuff for the mom in big enough letters for her to see - her name, baby's name, a goal for the day ("goal: good sleep!" or "goal: try breastfeeding" sometimes more specific things she had agreed on with her doctor) that the mom could focus on and the rotating cast of characters all know that that's a thing to ask about or whatever.

One trivial thing that got lost in some of the shuffle was, what are the rules about her stuff (eg her purse, her phone, her street clothes) if she comes in for an emergency c-section? Where does the stuff go, does anyone keep an eye on it, that sort of thing. This was something where there seemed to be no formal process for telling her what to do with it.
posted by LobsterMitten at 9:17 PM on July 13, 2011


My doctor liked to fuss at me about things I couldn't do anything about. For example, I had Gestational Diabetes with all three of my pregnancies. At every appointment (Even when I was there twice a week) she told me, "You know, you really need to lose weight after you have this baby since you have a higher risk of getting Type 2!" Yes. I know. I'm fat. Still pregnant, still can't do anything about it just yet.

Also, no one was on the same page with this: The dietician my doctor sent me to said I could have ice cream and ketchup and eat a lot of carbs because you have to eat carbs to be healthy and if your sugar gets high you need more insulin!! My doctor wanted me to eat practically no carbohydrate and take barely any insulin. The nurse I had to fax my results each week didn't believe that if I ate one piece of whole wheat bread with eggs my sugar was high. She insisted I was eating junk. Then, the nurse would freak out that I had ketones in my urine test and my doctor would say, "Of course she does, she's diabetic." Try to make all of your people at least be on the same page. Getting told at least three conflicting things in the same day (none of which match the information I'm reading on the internet or in books) was very hysteria causing. (I only gained 14 pounds, including none during the 3rd trimester and had a 6 pound baby, for the record. Which seemed to freak out the doctor who wouldn't let me gain any weight despite my assurances that I have small babies. Told you so.)

I also have had trouble with doctors telling me things and then denying ever saying that later. First: "You should get your sugar checked a month after you stop breastfeeding." A year later, when I ask her to get my blood sugar checked, "Of course you don't need to get your sugar checked. Breastfeeding doesn't affect that. If anything, it's better now." Also, my first OB said I'd likely always need a C-section given the size of my first baby and the trouble we had. (Small baby, stuck anyway.) When I was pregnant the 2nd time she said she would never say such a thing and tried to talk me into a VBAC the entire pregnancy. After the 2nd c-section, she said, "Wow! I'm glad you didn't listen to me!" If you are going to make a pronouncement, at least write it down and don't call me crazy when I remember what you said. I often notice doctors acting very concerned about something at one visit and then at the next visit saying, "Oh no, you're doing fine" with the same symptoms in front of them.

Sorry for the length and randomness!
posted by artychoke at 9:25 PM on July 13, 2011


Inspired by a few of the other comments: I was not only encouraged to have a nice big lunch before I was induced, I finished my dinner after the gel was applied AND was encouraged to have a bag of labour snacks with me (fruit salad). That was awesome. I didn't eat any of it since labour happened sneaky and fast, but it was great for post-labour breastfeeding hunger.

Oh, my ob never once mentioned my weight. That was a relief, since there was jack all I could actually do about it (I didn't gain any weight until I started ballooning with water retention the last three weeks) and I didn't want to deal with that while dealing with pregnancy.

And different women want different things. I shudder at the idea of my medical provider being all friendly and intimate with me. My partner once asked why I persisted in calling my ob 'Dr' regardless of the 'call me whatever' - if someone is going to be all up in my genitals, either they are a doctor or my partner. Calling my doctor by his first name (or the nurse, midwife, GP) just feels way too intimate for me. I know I am a minority in this, but that's how it is.
posted by geek anachronism at 11:12 PM on July 13, 2011


Whatever happens in labor, don't laugh unless the person in labor is laughing, as well. I will never, ever forget being young and scared and in labor and having my mother and the nurse start laughing at...I don't even know. Some bodily function, I assume. Maybe one of them had said something amusing and they weren't even laughing at me, but right then--and, in honesty, right now, nine years later--all I could process was that I was in pain and stressed out and they were laughing at me.

If you're telling a story about "Oh, yeah, we saw someone with this exact same symptom..." make sure before you start talking that the story doesn't end with "...oh, I guess that baby died, actually."

Don't tell a new mother that her choices are weird. Even if you think that they are, if they're not harmful, you shouldn't be commenting in a negative way. (I got this for wanting my daughter in my room, for keeping her in a sling, for being determined to breastfeed...)

More positive: The nurse asked in advance what sort of popsicles and Jello I liked, and then made sure that I had them through my whole labor. That was fantastic.
posted by MeghanC at 11:27 PM on July 13, 2011


I don't know if this really applies to your question but I hope it does as it seems to be an area that most care providers, advocates, and generally everyone wants to ignore. Learn how to handle the worst possible outcome of labor and delivery; a stillborn or dying baby. When this happened to me I found that while some of the people who were around knew how to handle the situation others were completely clueless and some unnecessarily hurtful experiences came out of it as a result.
posted by teamnap at 6:06 AM on July 14, 2011


Along those lines, please also treat a miscarriage with compassion, and don't leave the woman in the dark about what is happening and what she can expect.
posted by moira at 9:07 AM on July 14, 2011


I had an abnormal pregnancy. I developed high BP and then pre-eclampsia. I don't think there's one thing that could have been done better or differently during my pregnancy. I felt well cared for. I was admitted to the hospital and the worst part was waiting on bedrest. But I was a very compliant patient and did everything I was told. And I communicated with my doctors. I didn't hesitate to report if my headache didn't go away or whatnot.

I gave birth in a hospital, which was fine. I had to pump since my baby was born at 32 weeks. The NICU nurses were wonderful advocates for pumping--the one whom I connected with most was actually the mom of a preemie too, so she'd lived it. She was far more helpful than the lactation consultant at the hospital who barely knew how to operate the pump. When I was moved from L&D to postpartum recovery, I was instructed to pump every 4 hours, which I did, and give whatever I got to the nurse on duty to take to the NICU. So I'm like 72 hours postpartum and finally able to walk around and take a shower, and I pump maybe 3 mL of milk. I gave it to the nurse and she didn't take it. MADE ME SO MAD. I know it's barely anything, but the neonatologist and nurses have just told me it's LIQUID GOLD and like medicine for my PREEMIE so of course I am upset that she didn't take it. But that was the only bad thing that happened in the hospital.

After the pregnancy is another matter. There are recommendations in the US for women to get a pertussis booster shot after delivery. Hardly any practice serving adults carries this because there is such a low demand for it. I ended up paying cash at my baby's pediatrician's office to get the shot, since both my PCP and my OB didn't carry it. Same goes for the flu shot during or after pregnancy--OB-GYNs have a captive audience, and for many women, their yearly visit to the OB-GYN is the only contact with a physcian or healthcare provider. Why not offer a flu shot, if it's within the correct timeframe? Better screening for thyroid issues after pregnancy would be good, too.
posted by FergieBelle at 9:14 AM on July 14, 2011


The reason I'm going with a midwife and birthing center this time around is because my hospital experience was so bad. (not nearly as bad as many of these scenarios, but still!)

Because my OB practice was so big, I saw a different doctor at every visit so that I would "know" them all... because who knew which one would be present at labor. Of course that didn't work - how can you possibly remember someone from a 15 minute visit months ago? If you have a choice, go with a smaller practice.

My doctor, when I got to the hospital, was unbearably dismissive. I was only 1 cm and 10 days early for a 1st pregnancy, so he sent me home despite crippling contractions. (Even the nurse commented that generally when she sees patients with contractions that strong it means the baby's coming, no matter what the dilation. Wish the doctor'd listened to her.) The Dr. gave me a sleeping pill with side effects of hallucinations (!) which he said wouldn't matter because the effects would have worn off by the time I gave birth late the next day.

We drove the 15 minutes home. My water broke. We turned around and went back to the hospital. I gave birth 45 minutes later. The doctor wasn't even THERE. I was delivered by a resident. (Which my husband tells me was awesome because she was so enthusiastic and elated.) My husband had to hold my legs because there was no one else around.

I don't remember any of this because I was hallucinating a rabid raccoon perched on my belly and clawing me and hissing at me. It was absolutely terrifying. So I couldn't concentrate, I had no control over my body or over the process of labor, and I tore really, really badly.

All this, and the original Dr. never even visited the hospital afterwards to see how I was doing or apologize for having sent me home. I never saw him again, and I don't remember the first day of my daughter's life. I bitterly resent that doctor to this day.

Moral of the story is, I guess, listen to your patients. Really listen. Their bodies know what's up. If you make a mistake, apologize.
posted by GardenGal at 10:31 AM on July 14, 2011


Oh yeah, I forgot to add that I also told the Dr. that all the women on both sides of my family have really fast labors, and he completely dismissed it. Told ya so, doc!
posted by GardenGal at 10:32 AM on July 14, 2011


Stuff I liked:

Having every process explained to me--not only the why, but how it might feel. Examples: "The glucose drink tastes like flat soda--I think it's kind of gross, but some people don't mind it." "It's early to hear the heartbeat but I'm going to try, but if we don't, it's still okay."

Dealing with my quirks. I had a missed miscarriage in my first pregnancy and found out because of an ultrasound, but didn't find out until after the ultrasound. I had bad dreams about ultrasounds after that, and asked if someone with the ability to diagnose could actually be in the room during the ultrasound, so if there was a problem at least I wouldn't be there making googoo noises at a dead fetus. I got the impression that no one had ever asked for this before, but they were flexible enough to do it and that was wonderful.

In labor, waiting until a contraction is over before giving information. I had a non-emergency c-section after a lot of pushing that did nothing, with no pain meds, and the staff was AWESOME at not messing with me during the contractions themselves when prepping for surgery. Obviously would be different if it was an emergency, but it helped me feel in control and respected when people would stop their explanation when it was clear I could not pay attention.

Telling someone that they're doing everything right as long as they're doing nothing wrong. This happened throughout my pregnancy and I felt validated every time. Actually, the baby's pediatrician does it too. But a lot of docs have the "but it could always be better" mentality that makes me feel crummy about any health-related progress I've made.

Stuff I didn't like:

I just wrote a lot of paragraphs about my labor and erased them because they boiled down to: don't assume that a person in labor has any ability to form coherent sentences, but don't assume that since they're not talking that they can't understand what you're saying, or are agreeing to what you're saying. I did a lot of stuff that didn't work because it was easier to, say, follow someone down a hallway into a tub and stay there until they said to get out than it was to say "this is lonely and cold and gross". It was easier to spend four hours hoping that someone would stop doing (I think?) perineal massage than it was to say "dude, cut that crap out or at least tell me why you're doing it." Being told what I might feel was more useful than being asked what I DID feel. (I know a lot of that is stuff that I could have been proactive about, but my brain just wasn't making words at ALL because I was really far into laborland. On the plus side, labor didn't hurt much!)

Oh, and don't hand dense legal text to someone that's been pushing for 5 hours. My eyes were puffed into slits and I couldn't focus properly for about 12 hours afterwards. If they'd had my husband or doula read it to me (fulfilling the legal requirement) and let me know if they saw some problem in it, that would've been much better.
posted by tchemgrrl at 11:16 AM on July 14, 2011


Nthing the thing about listening to your patients. I had a difficult labor -- tried a homebirth, transferred to the hospital where I had Pit and an epidural. I had an unusually long, painful second stage, and a baby who was trying to present chin-first. (Which, forehead-into-pubic bone? OW.) While everyone involved was amazing (on which more later), I rarely felt like my comments on pain were being acknowledged. I was a very quiet laboring woman, and I felt more than I could express. So when I said, "This really hurts," I actually meant, "On a scale of 1-10, this is an 8 or higher." While I think my midwife got it, because she tactfully suggested the epidural later, before that point, no one ever acknowledged what I was saying when I said it.

Otherwise, the practice I worked with and the hospital I transferred to did a wonderful job of taking care of me in a potentially scary situation. They reassured me regularly that my baby had a beautiful heartbeat. They told me how strong I was. Since nothing was an actual emergency, I felt like all the choices my partner and I made were ours to make -- when to transfer, when to start Pitocin, whether to have an epidural. The consulting OBs at the hospital were a bit wary, because I hadn't had a gestational diabetes test. (I'd declined.) Given the length of my labor, they were concerned that the baby was too big. They very clearly outlined their criteria for allowing me to continue pushing, defining what would constitute grounds for a vacuum delivery or a Cesarean. They gave me space to ask questions, and answered kindly when I asked questions that, in retrospect, were completely absurd.

Prenatally, the midwife practice I went with was amazing. We sometimes had hour-long prenatal sessions. I was encouraged to ask all the questions I wanted to. When my partner came and he wanted statistics, they had that information at the ready. I was encouraged to bring in the other people who'd be at the birth, so that the midwives could meet them.

Postnatally, they were also great. I tore badly, and in the first two weeks postpartum, I got completely freaked out about how I was healing. When I called to see whether they'd let me get checked on, they were amazing about it. The midwife available came to my house to check on me and then asked a lot of questions about my emotional state. Just knowing that I could call them when I needed it, and no one would say anything negative, was huge.

I think the other big thing I'd want to encourage from my experience at the hospital is more explanation. No one told me until well after I needed it what the peri bottle was for. The rude CNA on shift while I was in recovery just sprayed it at me when I was urinating, without saying a word. It is supremely uncomfortable to have a strange person start squirting liquids at your genitals without asking permission or explaining their actions. (This is the same woman who, while teaching my partner how to swaddle and change a diaper [because I could not do those things], kept telling him how bad men were at those things.)

Also, it'd be awesome if I could hold my baby while he has his newborn screening. It is gut-wrenching to lie in bed, unable to do anything, while two strangers hold your newborn down as he screams in pain and terror. When we had the two-week newborn screen, the midwife said, "Why don't you nurse him while I do this?" and it went MUCH better.
posted by linettasky at 11:27 AM on July 14, 2011


I am an anomaly that had a home birth with a midwife (LM) for my first baby. I also saw a hospital midwife (CNM) in a practice overseen by OBs for a portion of my pregnancy. Worlds of difference between the two.

Things I liked about the LM:
- she took the time to get to know me. Not just my medical history, but my hobbies, things I like to do, my personality, etc.
-I was never treated or felt like things were recommended to me "just in case something goes wrong." Everything she recommended to me was for a reason that she could back up with both science and experience.
-I got to choose what I wanted done. If I didn't want something, I didn't have it. If my midwife felt it was important, we discussed it in a way that didn't make me feel threatened or bullied, and my wishes were always respected.
-I was never, not once, touched before I gave permission. I had two vaginal exams my entire pregnancy and birth, one at my request, the other was optional.
-I was never rushed or made to feel as though my body was anything but fully capable of performing properly. I was encouraged and uplifted at every opportunity. It anything seemed weird or out of the ordinary, it wasnt that i was doing it wrong or broken, but a variation of normal. Often, she mentioned a possible cause and gave me non- medicine options to fix it.
-I was allowed and encouraged to labor and push in whatever position felt good to me. I never had to lay in bed, and I pushed in a squatting position.
-my baby was treated with respect. He was never taken from me, ever, for any reason. He was treated gently, and allowed to enter the world with dimmed lights and quiet. I was allowed to choose what was done to him and when.

Things I liked about the CNM
- this is difficult to say. We were limited by the confines of the insurance mandated 15 minute appointment. She was fine, but I definitely felt like a patient. it was just like seeing any other doctor.

Things I disliked about the LM:
- occasionally, I had to follow up on blood tests. This frustrated me the most in the beginning of my pregnancy, being used to the standard model of care, it didn't occur to me to just ask or start a dialogue about my concerns. Once I did, problem solved.

Things I disliked about the CNM:
- at one appointment, my BP was high. It hadn't been high anywhere else (LM's office, chiropractor, etc) or at any previous appointment, but she didn't believe me. She DIDN'T BELIEVE ME. I consented to doing a full pre-ecclampsia workup, which came back fine. At my next appointment, she had a prescription for BP medication already written out, would not accept the chart copies from my LM, and told me that she didn't think my home birth was a good idea. Though I was under stress at this appointment, my BP was normal and it was determined that the cuff used at the prior visit was broken. She told me that I should still take the prescription and ditch the home birth idea. I discontinued care with the CNM at this point and did not take the medication. Obviously, I had the home birth, and my blood pressure has been totally fine since. I should mention at this point that I am fat, and I believe with every fiber of my being that I was treated like a potential liability because of it, even though there was no basis for it. Fat does not automatically equal unhealthy. The biggest turnoff was that I was not treated like an individual. I was never once asked about my eating and exercise habits. It was assumed that I would have problems simply because of the number on the scale.
posted by LyndsayMW at 1:56 PM on July 14, 2011


Wow. I really appreciate that y'all have been so open about sharing your experiences - really informative, and absolutely helpful. If anyone else has thoughts - feel free to continue sharing!
posted by noonday at 7:38 PM on July 14, 2011


Another thought, back from visiting a hospital today -
The whiteboard in the room has the day of the week, the date, and the names of the on-duty nurses on it, where the patient can see it. That is GREAT. It's so easy to lose track of the constant stream of changing faces, and it's especially nice if the nurses have unusual names etc to see them spelled out.

It's great when nurses, docs etc stand or sit in a position that makes it easy for the patient to face them without turning the neck etc. Being in a hospital bed can be such a restrictive thing, hard to think, hard to re-position yourself, etc.
posted by LobsterMitten at 10:19 PM on July 14, 2011


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