Conflicted after talking with OB..

luvmygoofyguy · April 2012

Sorry this is long, not good at explaining sometimes. I kinda need to get this all out... had a routine OB visit last week (I'm in 3rd tri, OB visits every 2 wks), having second thoughts about her & hospital where I'm delivering. Initially chose her & the hosp because I love my primary (who referred me to this OB), have had good prior experiences with this OB group in past for non-pregn issues, and was comfortable with statistics I could find for C-sections, episiotomies, etc at this hospital. I'll mention up front that my insurance doesn't allow for birth centers or midwife care for a home birth, so that does limit my options.

I'm mentally committed to a natural birth, which by my understanding can be more challenging with a hospital environment vs home birth or birth center, but still doable. I know I've put off this discussion with my OB later than I should have, but I only recently arrived at the decision that I truly wanted a natural birth. Perhaps I was a little naive as well - the hospital has a shiny new maternity ward and promotes itself as being being labor friendly. It's only recently (at this OB visit last week) that I realized that being labor friendly doesn't necessarily mean they are open to the labor process taking place through more than one avenue of approach/protocols.

So last week's visit I discussed that my hosp tour wasn't till next month, but was hoping to get some answers earlier than that about policies and choices/options. OB said she'd try to answer any questions I had. Started with the IV question (and whether hep lock alternative would be an available compromise), and she flat out stated that "you're going to get an IV"- or at least that's what I thought I heard. I got confused a bit after that, because right after that she started listing the things for which it was needed (it felt like information overload- I dont' know if she was trying to list all the reasons why they have this as standard protocol, or if she was listing them as reasons they might be needed). So by the end of the conversation I wasn't really clear whether she meant it would be required regardless? She did mention that they also require fetal monitoring every 30 minutes (so at least they don't require constant monitoring...), and that I wouldn't be allowed to eat once admitted.

I was so flustered I forgot to ask about whether I'd be able to use a shower or drink fluids on my own vs ice chips (I think it might be the latter, if they're going to require me to be on IV would they still let me drink fluids?). I have other medical issues that make lying still the worst possible thing in the world for me when I'm even a little uncomfortable. With my fibromyalgia, when I'm in pain or even a little uncomfortable, it literally feels like my skin is crawling and/or burning and I want to rip it off if I'm not able to get up and move around- IV's, epidurals, and monitors (oh my!) make moving around much more difficult, I'm thinking. I don't think I explained this part of my concern very well to her.

On the other hand, she was very supportive of laboring at home for as long as possible (she raised the topic before I did - as I said, I was a little overwhelmed), and mentioned that this was a good way to nd avoid some interventions. She also talked about how every labor is different. She did bring up the whole "you won't know for sure what you'll want or what will happen until you're actually in labor" (I am a FTM, so I get this...), but not in a condescending "I know better than you" way, more of a "I want you to think this out" kind of way (does that make sense?...not like the "natural birth fantasy" way that another poster was talking about earlier today).

Her biggest concern seemed to be that she's had more complications (she specifically mentioned that some led to c-sections) in patients that were adamant about refusing everything than those patients that took the "lets see what happens" approach and being open on things. So I can see that she is viewing these protocols as ways to avoid c-section. I can also see that blindly refusing to consider anything but a set plan can be problematic, and I understand that babies don't follow rigid schedules/plans/etc. So I'm not arguing that she had some valid points.

I started the whole conversation because I wanted an open dialog between my OB and myself, to work together toward a common goal (at the end of the day, we bioth want a healthy baby, right?) - even if we both might have slightly different views on how to reach that goal. I feel like she was trying to hear my thoughts/wants. I just keep getting hung up on the impression I have that she flatly stated the IV would be needed, that there was no option. I'm not adamantly anti-IV, but OTOH, everything I've read/researched indicates there are some cons, and I wanted to know what my options were when the decision needs to be made... now I'm not sure the decision is available to me. If I lose that decision already, it makes me wonder what other decisions are going to be unavailable regarding other inventions?

DH heard me out in venting on this last week, and he is going with me for the next visit for support (work makes it difficult for him to go to every OB visit). He doesn't completely get my reasons (he's much slower at reading/researching than me, so he's still learning about all the pros/cons), but believes its my body, and has faith that I'd never do anything to put our baby at unnecessary risk, he also knows that I am stubborn and tend to really dig in on things that I feel strongly about. We don't want to be combative, or agumentive- we just want to feel things out as to whether a workable relationship is possible, and whether I can feel comfortable enough that I'm not making things worse by being stressed and feeling helpless (the whole negative mental thing will just makes things worse). I really don't want to switch OB's or hospital at this point... any thoughts or suggestions on how I can approach the next visit in an assertive but non-confrontational manner? Am I being too sensitive on the IV thing, and need to "choose my battles"?

FyreFlyeRush · April 2012

I'd ask for clarification on the IV and ask why a heplock isn't an option. Mostly, tho, I'd labor at home as long as possible. I think that's why I was able to do it.

ncjulia12 · April 2012

First of all, I'm going to admit that I skimmed a little bit reading your post, so hopefully I won't say anything that doesn't make sense. : p

I would make a list of specific questions for your next visit and also see if you can go to your hospital tour sooner than next month to go ahead and get some questions answered there too. It sounds like your ob just got on a roll and started overwhelming you, but maybe if you have a list and try to get some information from the hospital too, it will all make more sense.

I'm kind of tweaking (both officially and unofficially) some of my hospital policies.

For example:

My hospital's official policy is that everyone has to have an IV, but my ob and the childbirth teacher who works at the hospital said I could just have a heplock. (I plan on getting that in writing at my next visit.) They also have a no food/water policy (only ice chips and hard candy- which seems kind of weird to me) but I plan on laboring at home as long as possible where I can eat and drink and then I dare someone to fuss at me if I want a drink of water when I get to the hospital.

Hope you get your questions answered and feel better about your ob/hospital!

tngrl3 · April 2012

On the IV issue she may just mean that you have to have one in place, not actually hooked up to fluids the whole time. A hep lock is simply an IV with a special little cap or tube on the end that keeps it sterile and blood from running out through the tube that is in your vein. Medical professionals will often use the terms interchangeably as they are basically the same thing! (not sure why so many people think they are so different. yes i work in a hospital)

I think the idea of having a list of questions to go over with her is good. You may able to clarify some of this with a phone call to her. I know my OB is great about talking things over with me via phone.

tokenhoser · April 2012

If you're still not clear on a question you asked, ask it again next time. Say something like "I know we talked about this last time, but I've been thinking about it a lot since then. Do you think we could try just setting up the hep lock and reserving it for an emergency? I've read what the ACOG says about allowing fluids during labour, and it looks very low risk to me." (Then hand over the print out)

https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Oral_Intake_During_Labor

That says no food, but clear liquids are allowed. I laboured at home for a long time, so by the time I got to the hospital I was done eating. I drank about 4 liters between 11 pm and 1 am, though,while pushing.

luvmygoofyguy · April 2012

Oy. I just re-read my post. I think I just did the same thing my OB did, overloading my comments. Sorry about that.

I like the idea if trying to list out questions before I go. I usually have to do this with my other Dr visits, don't know why I thought this would be different. I think approaching it that way will help us both.

WildcatPrincess · April 2012

I think you've gotten some good advice, I just wanted to say I was able to drink all I wanted with DD and I had a heplock with an antibiotic and fluid running. It just made me have to pee double. I thought maybe it was because of the MW I got to eat and drink, but with DS when I was in the middle of pushing I said I was so thirsty and the nurse actually went and got me a jug of water (this was before the OB got to the room) so it may be hospital policy? Who knows, I was just glad I got my water! GL at your next appoint, I hope it goes well.

Kitttkattt · April 2012

It means that sometimes interventions on a body that isn't ready to labor fail and that leads to a c section. But on a body that is a little bit ready, the interventions give the body a little extra boost to do what it needs to do to have a vaginal birth. I am a labor&delivery nurse for 15 years and I've seen it go both ways. I used to work with a doctor that induced everybody at 37 weeks and he had a 50% c section rate at least. I have on the other hand seen patients refuse intervention after intervention and their options narrow and narrow until the only option left is csection or high chance of dead/damaged baby. The problem lies it's hard to know which category your OB falls in.I actually signed AMA at the hospital I was supposed to deliver at because they were pushing me hard for a csection based on lies. But at that hospital and the one I went to, nobody cared if I was in bed or what position I was in. I had to move around a lot because I had bad bad rib pain. I knew how to adjust the monitor to keep the baby's heart rate on, as long as they can see the heart rate, nobody cares if u sit,stand,bend over, walk as far as the cords permit.My doctor didn't want me to eat or drink anything. I kept ginger ale in my purse and had little sips. Or sent my husband for ice. I could only have little sips since I vomitted everything anyways. I didn't stay at the first hospital because while I could think and advocate for myself, I knew I would lose that ability as labor progressed. And I did, the pain was all consuming since I had a failed epidural and I was just taking it one contraction at a time. At that point my doctor could have told me any lie and I would have agreed to a csection. Luckily I knew this doctor for many years, liked how he practiced, knew from years of watching him that he was very vbac friendly, so I trusted him. Never questioned anything he said. I as a nurse loved doing deliveries with him, because from a nurse point of view, more interventions=more work for me. But on the other hand not doing a needed intervention,as a nurse,=more mental stress for me. He practiced safely with as few interventions as possible. Going into labor and having to stand up for yourself is most likely not going to work because you will be vulnerable overwhelmed and in pain. If it does work, it will be a tense situation with you having to fight every step of the way. Oh and doctors have been playing the "game" for years. If they tell your baby is in trouble and might die or be brain damaged, how will you know if it's true or if they just want to hurry up and section you to get it over with for them. Would you take that chance? Cuz that's what the doctors at the first hospital told me, but I looked at the monitor and it took me all of one second to know y baby's heartbeat was perfect, no issues at all. In that moment, I felt lied to, betrayed,unsafe, and knew I had to leave AMA since the trust was gone. Cuz I've been reading monitors for 15 years. What if I had no prior knowledge? That's what he was counting on. Nobody wants to hurt their baby. That's what he actually said to me, you don't want to hurt your baby. In my mind I'm thinking my baby couldn't be healthier, I'm outta here. But again, if I didnt know, I would have consented to a c section. You gotta be on the same page with your provider. I thought I was from my prenatal appointments. If you push too much at your appointments, there is the danger that the doctor will tell you what you want to hear, knowing that he or she will manipulate the situation when your in labor.

emberlee3 · April 2012

You still have plenty of time to clarify things with your OB. She sounds reasonable. Ask if she means continuous IV fluids or just a saline-lock (heplocks are not used any more, but the term is still common). Intermittent monitoring will allow you freedom to move around.

I had a med-free delivery in a hospital with DS. Saline-lock was mandatory; as it turned out, the nurse did not even have a chance to insert one until I was pushing. So, yeah, laboring at home as long as possible is key.

The saline-lock came in handy when my blood pressure dropped to 60/30 after delivery, and I needed IV fluids and vasopressors

Conflicted after talking with OB..

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