Friday, June 12, 2015

The problem with Maternity care; Why don't I have a say?

This was not exactly the way I wanted to announce a new pregnancy but after what happened to me today I am so infuriated that I have to share.  Just some background in case you don't feel like reading my whole blog, I have had 6 full term pregnancies one of which was a stillbirth. My first two were c-sections, I had a stillbirth HBA2C, then 2 hospital VBA2Cs, and then a traumatic bullied third c-section birth. After my last birth I honestly planned to never see a doctor again. Unfortunately that ended up not being the case because I had an ectopic pregnancy and then a dramatic 12 week miscarriage that led to hemorrhaging.

That leads me to now. I found out I was pregnant  a few months ago. I was honestly torn on what to do prenatal and birth-wise. In some ways I felt like I should see a doctor so that if something is complicated I have a relationship with a provider. Transferring to the hospital in labor has not worked out well for me in the past. I have planned a homebirth with my last 4 pregnancies. CPMs cannot attend births in NC legally and CNMs no longer "allow" homebirth VBACs. So that leaves me stuck with a OB if I want to get any kind of prenatal care done..

I contacted several doulas in my area for recommendations on an OB practice that would be empathetic to my past experiences. There is a very small amount of offices here. I did not want to return to the office that did my primary and second c-section. I had a horrible experience with some of the doctors there. I refuse to be seen by the residents at the OB clinic after my last birth experience. So that left me with a limited amount of options. I called one of the offices where an OB practiced independently and was told he was not accepting new patients. The midwives associated with the hospital refused to see me as well, but recommended Glen Meade Ob Gyn and one other option. I looked into both of them and a read some reviews about Glen Meade in which a woman discussed how she felt they were very empathetic to her previous bad experience. I took that as a good sign that maybe they would be an ok fit for me.

I set up an appointment, which apparently was just a confirmation of pregnancy appointment. I was already 10 weeks along by the time I was seen. First let me say that I should have known better after that first visit. My appointment was at 10:15 am. I arrived 15 minutes ahead of time as requested and I was not seen by anyone until 11:15 am. At this point I saw the nurse practitioner of the practice. I explained to her that I have bad anxiety about seeing doctors and that I really need it to be understand and receive empathy for the fact that I have had really bad experiences. I mentioned that my last birth was especially traumatic and I really want to make sure that they would be sensitive to that. Of course she told me they don't do VBAC after more than one section but I knew that was coming. There are no places in my city that actually would even allow a VBA2C even though ACOG supports a trial of labor is appropriate in some cases. Anyway, I honestly in my heart have been on the fence on what my birth plan is for this baby. I told her that in the event of a repeat c-section I really wanted to make sure that my wishes were respected such as skin to skin contact in the OR and that I did not want a c-section scheduled before 40 weeks. I was threatened with being "fired" before I was even an established patient. She said if I didn't agree with their birth plan then they may have to transfer my care to another office. She added that I really had no other options either way because no where else was going to let me VBA3C ( which I never even said that I wanted during the whole conversation with her) and I replied that I knew that and that I honestly wanted to focus first on whether or not I even had a viable pregnancy since my last few were losses. I told her I was not set on anything at that time since I wasn't even sure this was a viable pregnancy yet. My ultrasound showed a baby with a nice heartrate and in the right place so all was well.

I had appointments set for me: nurse visit, first prenatal with the Ob that is listed as their high risk OB, and a maternal fetal medicine doctor appointment. All of these things are very significant to what transpired today when I went for my nurse appointment.  I show up for my appointment which is about 20 minutes away from where I live, they let me sign the papers and gave me my financial agreement. Told me I needed to pay a $300 deposit today which I paid. Then sent me across the street to see the nurse. I get there and she tells me to go back to the main building first because someone had to see me first.

Paula calls me back into a tiny office space and shuts the door. She then proceeds to tell me that she was sorry I drove all the way there but that they would not be able to see me. I was like um why? She said well we looked over your records and we just don't think we would be a good fit for you. So I was like so you are basically firing me and how are you coming to that conclusion when I haven't even talked to anyone. She said well it's because you refused a c-section. I was like what? I never refused anything. I realize now that what she was really referring to was my last three hospital births where I did in fact refuse a c-section. I refused consent for one completely, and refused the recommendations for the other two. After I told her that I never refused to have a c-section she switched it up to me saying I didn't want one done before 40 weeks. 

At this point I am now getting angry because I had not agreed or disagreed to anything yet. I had a conversation with the nurse practioner but made it clear that I was not even focusing on that at this time because I still didn't know if i had a viable pregnancy and wanted to wait until then. I explained this to this Paula lady that my conversation was really so that I could get some empathy over my traumatic experience during my last birth and that I never denied care for anything. I was never even given the chance. She kept trying to talk over me and repeating what she said. I got even more upset and I said that I get treated like crap at the hospital all the time because I choose to homebirth so I finally give in and make an appointment with an OB and you are refusing to give me care. Then she said my favorite part and I quote, "You are considered VERY high risk, and well... we have met our high risk quota." At that point I had to chuckle, and I looked at her and said " So you are telling me that I am extremely high risk but you are refusing to provide me with prenatal care is that correct?" I was about to really act up so I just said forget it I am outta here and walked out.

Here is the problem. I am a paying client that is hiring them to do a job. Because I am paying for the service I should be afforded the right to have some kind of say so over what does or does not happen to my body without fear that the provider will just drop me and leave me without care. If I hire someone to come clean my house I have the right to tell them how I want things cleaned. Why do doctors seem to feel that a patient should have no say so whatsoever in their treatment? Not to mention I was never even allowed to speak with the doctors in the office. And this type of stuff is the EXACT reason I stopped seeing an OB for pregnancy to begin with.

For me I am okay with it. I was prepared for the possibility of staying home anyway. I really just wanted to see them to make sure there were no complications. I am taking this as a sign I don't need them for anything. But this begs the question though, when do women have a right to their own births when using doctors?  No one should have to fight for the right to be actively involved in their own healthcare. And then what happens when you are labelled? I have no doubts I have a big fat red sticker on my medical records that says in big letters NON-COMPLIANT. Does this not lead me into a slippery slope where I will be mistreated by any and every provider based solely on my records? Where are my rights?