Where's the trust gone?

A friend just called to discuss her ultrasound today. She’s 36 weeks pregnant, first baby, in extremely good health, relatively normal pregnancy. Her doctor told her the ultrasound showed amniotic fluid levels on the low side of normal (7 on a scale that goes from 5 to 20). Doctor suggests a non-stress test twice a week every week until the baby is born and “We’ll induce at 38 weeks.”

My friend’s response, “Why?”

Doctor’s reply, “Well, it’s one option. We’ll discuss it at your appointment on Thursday.”

So, what do you do? What does she do? How would I handle it?

This post is not about the specifics of the limits of an ultrasound or what a non-stress will show and how accurate are these pieces of information. My friend will be searching for those answers as she prepares for her appointment on Thursday. This post is about the trust that needs to be present between the two or three people who will be sharing one of life’s most amazing, wonderful, and difficult events: labor and birth.

Medicine in the obstetrics world seems to be becoming more and more complacent about changing the way women give birth. "http://www.slate.com/id/2142622/?nav=navoa" (See “Pregnancy is shrinking" at the end of the article.”) I believe this is a mistake for many reasons. But that is the subject of many posts and the many months I have ahead as this blog matures.

One of the reasons for these changes is due to “defensive medicine.” As my husband puts it, the sooner the doctor can say, “I have concerns,” the better it would look in court. This is not to say that the doctor doesn’t have valid concerns, but is she able to screen out self-protection from baby and Mom’s best interests? Doctors are human, too. They want to do well, have people like them, be successful. But in obstetrics, I think a line has been crossed. I no longer believe it is consistently about the health and safety of the mother and baby.

And that means the mother and her partner have to decide who they will trust. Do you trust the doctor who doesn’t give you options or tell you the downside of a procedure, but only tells you what “we’ll be doing.” But then you go home and check out the information on the internet and you learn the research isn’t cut and dried. There are risks to being induced or having extra ultrasounds or taking the gestational diabetes test. And everything you read confirms your feeling that everything is fine with this baby, that having this extra information isn’t going to change your mind.

You decide to discuss this with your doctor, who then also has a choice. Does your doctor trust you to not sue if something goes wrong? Of should she push you to do what she wants, in the best interest of everyone involved, including herself?

Why is having a baby so complicated? When did it turn into a politically charged environment? Is it because doctors are trained to think they are the only ones who know best? Has medicine embraced the internet and its creation of an easily educated, or seemingly educated population, or has it rejected the notion that someone reading medical studies could have anything valid to say about the field of medicine?

What I know is this: the c-section rate is more than 30% in many areas of the country. This is not because nearly 1/3 of women are incapable of growing healthy babies and delivery them. I also know that with any intervention, even something seemingly innocuous like an ultrasound, there are risks. Women have to know that they cannot just take their doctor’s word for things anymore. That is no longer the safest option, maybe it never was.

So, back to the original question, what do you do? What does my friend do? What do I do?

1) You choose a health care partner you like and trust, throughout the pregnancy.
2) You ask your doctor, “Why?”
3) You ask your doctor, “What are my options?”
4) You listen to your gut and what it tells you about what your doctor is saying.
5) You do the research.
6) Once you’ve made the decision, be open to more information, but trust you have made a good choice. Our midwife wouldn’t have chosen to go with a c-section when we did with our footling breach first baby, but we were totally at peace with the decision and had a great time because of that.
7) If something negative happens, but you’ve had a trusting, respectful, open relationship with your health care provider, please think not just once, not just twice, but 15 times before you decide to pursue a malpractice lawsuit when the malpractice attorney calls you on the phone. Just as I believe women will have to be the ones to change the medical model of obstetrical care, they will also have to be the ones to give doctors reasons to stop practicing defensive medicine.

This is a partnership. Partnerships must be based on trust if they are to be healthy and successful.

What’s my friend going to do? She’s going for the first non-stress test to see what sort of information can be gathered.

What would I do? I wouldn’t have gone for the ultrasound today based on the weak reason the doctor gave for performing it.

Now, what about you? What’s your relationship like with your health care partner?