Friday, October 10, 2008

Reassuring chat

I took the plunge and called a local midwife, I'd had this horrid fear that I'd somehow be ineligble for midwife care, there isn't so much a notion of shared care as there is in the UK and there are circumstances where a midwife pretty much has her hands tied over consulting a doctor and that can be troublesome.

In the UK a midwife has what is known as "duty of care", they have to care for whatever they are presented with, even if that person is completely non compliant, so someone could present with a situation that clearly needed more intervention than a midwife could give but refuse to transfer to the hospital, the midwife would probably inform someone to make sure her views were recorded independently and probably a few other things too, but ultimately regardless of when the situation presented, they'd still have to give care.

In the US a doctor can "drop" a patient - it's sadly not that uncommon to hear of a variation from normal, such as a prior c-section, being promised they could try for a VBAC with a particular doctor or group of doctors, only for them in late pregnancy to told the doctor was no longer willing to let them to that and in some states it would be illegal for a midwife to offer care, so it's possible to be left with no care.

There is a midwife in the UK, Mary Cronk, who is highly respected both by mothers and midwives (and hopefully doctors too!), she has several handy phrases to be used to point out to a doctor (she calls him Mr Hi-and-Mi-ti) that it's not his position to allow or not allow a woman to do anything - sadly that fundamental truth doesn't apply in the US, if the doctor says get induced and you say no, you could find yourself in a bit of a fix, there are some requirements in the law to care for a labouring woman as part of the requirement to provide emergency care, but it would be definitely suboptimal and you'd have to go to an emergency room and take pot luck.

All this was causing me some distress, the chances of me agreeing with a doctor are fairly slim, I don't respond at all well to orders, I want to know what each and every blood test is for (and if I remember rightly, last time I concluded that two blood draws with very basic tests was useful, but I'd do nothing more unless medically indicated) etc. and I need to be respected if I say no to things - especially anomoly screening type things, but there is other stuff that is routinely tested for that when you dig deeper the benefits of testing are unclear.

These things are all reasons that scream "find a midwife", but I'm not a trivial case, I'm not high risk, but not clear cut low risk either and there is stuff that will need management through pregnancy and getting to the end of pregnancy and deciding a c-section is the best option isn't an unlikely scenario and I didn't think it would be possible to go into midwifery care with that as a possible outcome. But I had a long conversation with a midwife today and it appears that it is, that at the end of a pregnancy the doctors they have relationships with will accept patients for elective section. Another thing that helps this particular midwife pairing is that one is also a natropath - which means they can fulfil some of the requirements to consult a doctor on certain issues without going outside.

It's such a weight off my mind, the only thing that does concern me is that having researched a bit into how to have the best c-section for both mum and baby there are a few things that I consider very important that aren't routine practice currently. Hopefully as the pregnancy goes on I'll have a better idea of the chances of me going that route and thus how much thought I need to put into it, or if it's a bridge I can cross when I get to it.

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