Monday, July 22, 2013

A Letter to My Former OB

I have a great story. It's about a couple who educated themselves and broke free of their OB at over 39 weeks.  It was the difference between a vaginal birth and a c-section.  She was planning to give birth at the hospital where we did our rally last year - the worst in the area, as far as I'm concerned.  I wish I could tell you our rally made all these great changes in our community, but all it did was cause more animosity and bitterness - on both sides.  

I was so proud of this woman, not only for hiring a new care provider so late in her pregnancy, but also for writing this letter afterwards:
*This letter is shared with permission by the author.

As you may already be aware, I discontinued my prenatal care with your practice at 39 weeks on September 16, 2010. I am writing this letter to give brief explanation as to why, in the hopes that a better understanding of the situation will positively affect the care of current and future patients.

Until September 16th, I had been a patient with Dr. Udell for 10 years, I trusted her and respected her opinion. So when I found out that I was pregnant on January 10, 2010, it only made sense for me to continue my care with her. However, I was deeply interested in keeping my prenatal care as natural as possible. I am of the belief that my body was designed to create, carry, and deliver a baby with limited outsider involvement. This is not to say that I am completely against medical advancements and screenings, but I do not subscribe to inductions and cesarean sections when one or both lives are not potentially in jeopardy.  I do not agree that there is a sound medical reason for the cesarean rate in America being well over 30%. Being that I had done significant research on pregnancy and birth, I was well aware of possible complications that could happen and the implications carried with each of them. This being said, I made my wishes very clear to Dr. Udell early on in my pregnancy. Dr. Udell was agreeable and said she would do whatever I wanted as long as I kept in mind she was going to do whatever it took to keep both mother and baby safe.
When my husband and I took the tour of the hospital on June 13, 2010, we were unsettled by the policies surrounding labor and delivery at Medical Center of Arlington. The fact that the hospital did not seem to have any “pro-baby” policies, but instead had very rigid policies that were very counter intuitive made us very nervous about our impending delivery. The requirements for continuous fetal monitoring, and baby being taken from the room for 3 – 4 hours following birth, are the two that stand out in my mind at this time. However, the most unsettling issue was the statement, “Most of our births are scheduled inductions or cesareans.” The fact that Monica, our nurse tour guide, gave Dr. Udell a glowing review, was about the only saving grace for the entire tour. 
I felt secure in the fact that Dr. Udell was going to do exactly what she said. It wasn’t until my 30 week ultrasound on July 15, 2010, when my suspicions were confirmed that my son was going to be large, that my confidence began to waver.  I explained to Dr. Udell that both my sister and I had above average birth weights and my husband at the higher end of the average as well. She seemed to accept this response at the time, however getting a baby that was too big seemed to remain a recurring theme for the rest of my visits. It was not until my 37 week appointment, August 30, 2010, that I started to truly doubt Dr. Udell’s word.  I remember the comment that planted the seeds of doubt specifically, “I find that it’s best when somebody goes into labor naturally at 38 weeks, otherwise you run the risk of baby that can be too big.” At the time, I wrote it off and prepared for my 38 week exam.
At my 38 week exam, I expected a vaginal exam that was similar to the two I had already had on April 12, 2010 and August 24, 2010.  Instead, what I got was a very painful experience that resulted in spotting. I fully understand that vaginal exams are painful and can often result in spotting, the statement that Dr. Udell made, “You’re thinning, but not dilated. I tried to push through, but couldn’t,” was what worried me the most.  In hindsight, I should have asked her what she meant immediately. However, I was too shaken up by the whole experience to think about it at the time. When I called and spoke to Amy, her initial response was something along the lines of, “Dr. Udell was just trying to get things started.” Then when I mentioned that I did not want anything like that it became the standard of care.  Several times during the phone call I felt as though I was being made to feel like I wouldn’t know the difference because I was a first time mother. This, combined with my 39 week visit, where I was called out in the waiting room by Dr. Udell, told that she was feeling for the baby’s head, reassured that she woulddo whatever I wanted,  then told me whether I liked it or not to expect the next visit to be rough.  After that visit, I was very confused.  I got the answer that I ultimately wanted – I will do whatever you want- but it was followed by another comment that conflicted with the last.
In the end, the combination of the poor policies at Medical Center of Arlington and thecontradicting statements I got late in my prenatal care with Dr. Udell led me to believe thatthe likelihood that my birth would turn into a Cesarean section very quickly and easily. After my 39 week visit on September 13, 2010, an opportunity presented itself to switch to the Certified Nurse Midwives at Harris Methodist Fort Worth.  After several days of conversations with my husband and the midwives office, I made the decision that their philosophy of limited medical interventions, limited vaginal exams, intermittent monitoring,  clear fluids, and the option of hydrotherapy during labor were exactly what I was wanting. That combined with the fact that Harris Methodist Hospital was a “pro-baby” hospital, and had a wide array of policies that supported the birth that I wanted, including the fact that all testing immediately following birth are performed in room with the parents present.
I am happy to report, that on September 27, 2010 at 0130, I spontaneously went into labor, during which I was allowed to and instructed to freely walk the halls after my water broke,  I was able to have clear liquids, and use the tub for pain management. After being allowed to labor down for an hour and pushing for almost 3.5 hours, at 1552 on September 28, 2010 I vaginally delivered a 10lb 3.9oz baby boy.  While he was posterior until the last hour of second stage labor; we did not experience shoulder dystocia despite his above average birth weight.
While the prenatal care I received at your office was great, medically, I believe that it was the lack of confidence in the natural process and in my intuition in my body’s abilities that finally ended my care with your practice. I do continue to believe that if I had stayed with your practice this delivery would have definitely turned into a c-section and I would be fighting for my VBAC on the next one.

Thank you ,

Tiffany C.

If you were dissatisfied - or satisfied! - with your care provider, I encourage you also to write a note explaining why. Take it a step further and take a few minutes to fill out The Birth Survey.  In my humble opinion, this is how change takes place.  


Janie said...

YES! A well worded letter has power, please also put this on YELP. New moms might see it there!

Karis said...

I don't understand what natural childbirth has to do with Baby Showers. The showers are a time to celebrate the baby and allow friends help us "prepare" for babies once they get here. Why does that interfere with natural childbirth?

Tristan said...

Karis, I'm not sure I understand what you mean. Is this because of her blog name? Or did I miss a reference to baby showers in this blog post?

JoyBelle said...

I have written letters in my mind over and over again. I should just sit down and DO IT. I switched from an OB to midwives at 37 weeks pregnant with my third daughter after the OB said my baby would be too big and we should just do a cesarean. My daughter was my first epidural-free birth with no tearing and she was a perfect 8lbs 4oz; hardly big at all!!!

ob said...

I can completely understand this lady's choice. I wish every woman would do the same questioning of their provider. It is only by consumer choice that the market will change.

OrganicBabyU said...

I fired mine at 36 weeks with my first after I reviewed my birth plan and she literally rolled her eyes and went line by line telling me why each point may not work out. I never went back. I did however, have a conversation with her after they called wondering why I was missing my appointment. I told her that I knew that I would not get the birth that I wanted with her and went into detail why I believed that.It was important that she know that there are people who would fire her for that...I had preeclampsia so I found an OB who was the midwives backup and while I was induced because my blood pressure was VERY high...I delivered vaginally after being stalled at 3 cm for 8 hours. Best choice I made. I encourage others to do the same....we will only get better care when we demand it.

Yve said...

I had my membranes stripped without warning or permission on my last visit to my ob. It resulted in quite a lot of blood and my water broke a couple of hours later. I had a very long and painful 30-hour labor and didn't get to hold my daughter for an entire hour after she was born. This was a vaginal delivery. To this day I feel incredibly violated and angry.
I wish I could do anything to make these feelings go away.

Rachel said...

That sounds a lot like my care with my son. I ended up firing my OB at 35 weeks when she told me we do things her way in delivery because it is easiest for her. I too ended up with the UNT midwives at Harris Methodist of Fort Worth and had a great experience delivering my 9 lb, 4 oz baby after my water had broke 23 hrs and 45 minutes before. I am positive my OB would have taken me in for a C-sec long before then. Seeing the midwives again for this pregnancy.

Sabrina Craig said...

This is quite a great move. Many mothers have already suffered traumatic childbirths, due to various reasons. And to all the mothers out there, it’s essential for you to listen to your body. If you think you can make it through with natural delivery, you really can. Never doubt your instinct, for it is what tells you if your life would be in great peril or otherwise.

Sabrina Craig @ Medical Attorney