Working together for families? WHY NOT?

I have a lot of respect for physicians – all physicians. Why is that respect not returned, I wonder?

My clients have had a few experiences recently that really leave me thumping my head against the wall in frustration – and yeah, I’ll admit it, a little anger. The level of disrespect that is shown towards my profession (not me, personally, as these events were reported to me – I wasn’t even there!) is exceedingly disheartening and downright insulting.

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I couple of months ago I had a client – first time mother in the middle of her healthy pregnancy – vacationing with family in Nevada. She let me know that she was having a lot of abdominal pain really low by her pubic bone. She said her belly was getting really tight, too. I told her that if she was having 8 or more contractions in an hour that it was NOT okay as she was way too early in her pregnancy to birth her baby. She informed me that they were about 4 minutes apart – and I told her to go immediately to the nearest ER. She was admitted to the hospital that evening, no cervical change, diagnosis was a bladder infection. That was great news!

Except they found out that she was planning a homebirth in Arizona with a midwife.

They wanted to keep her indefinitely in the hospital because they were concerned about her blood pressure since it was high when she arrived at the hospital (first time mom being sent to an out of state hospital by her very serious midwife for preterm labor?? Wouldn’t YOUR blood pressure be high?) The day AFTER they admitted her and started her on antibiotics, she showed some protein in a 24-hr urine catch…expected when you’ve had a bladder infection, yet they said they thought she had pre-eclampsia and wanted to keep her. They told her that since she had no prenatal care they wanted to do all sorts of tests. She reminded them that she’d been receiving full prenatal care with a midwife – they said exactly, you’ve had no prenatal care. They berated her for her desire to have a homebirth, ran a full drug tox screen on her, and looked everywhere they could to find some problem in the pregnancy. After 4 days they had to admit that she was totally 100% healthy and discharge her with the strong recommendation to follow up with a physician in Arizona and not a midwife.

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About a week ago I had a different client – 3rd time mom 14 weeks into her pregnancy – who had complained to me of this severe constant pain in her abdomen. She let me know that she had been to the ER and they didn’t find anything. (this was the first time she’d seen me in pregnancy and wasn’t really sure “how this all works with a midwife”.) She called again and said that it wasn’t getting better but worse and was going to go to Urgent Care. Her husband asked, “what do I tell them when they ask who her doctor is?” I said, “Uhhh…you tell them that I am your care provider..?” So they went to urgent care – who found nothing wrong.

She told me that she just felt like something was wrong, this didn’t seem right. She felt bloated, in pain, and knew something was ‘off’. I said that especially as this was her third baby, I definitely believed her and sent her for a general OB ultrasound as well as a renal/bladder ultrasound. The ultrasound found that she had over 4 cups of urine in her bladder AFTER she had tried to pee twice!! The muscles had spasmed and prevented her from being able to urinate – no wonder she was in pain! A quick trip to the ER and a catheter pretty much solved the problem.

The problem was that while she was getting the ultrasound, the tech was saying things to my client like, “At 14 weeks we can’t even see much with the baby – if you’d had a REAL care provider she would have KNOWN that!” “I don’t even understand these orders….*heavy sigh*” She treated my client like she was stupid for planning (another) homebirth and was generally disrespectful towards me (whom she’s never met).

My client was so insulted she said she is considering writing a letter to this very large radiology lab that performed her ultrasound.

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This week I had a first time mother at 20 weeks in her pregnancy call and tell me that she had a horrible pain on her left back that radiated around to her belly towards her groin. It was so bad it was making her nauseous and she had thrown up. She had tried shower, heat, position changes….no improvement.

I sent her to the hospital saying that I was concerned about her kidneys and didn’t want to miss something NOT related to the pregnancy just because she’s pregnant. I didn’t believe it was pregnancy related so I wanted her to go in to the hospital and get her kidneys and gall bladder and everything checked out. She did…and was diagnosed with a probable kidney infection and placed on antibiotics. She told me that the nurses she dealt with were saying things like, “A homebirth? Is that even legal??” “Licensed midwife? Doesn’t she have a doctor that she answers to?” “You are such a good patient…you really should have your baby in a hospital.” “Why would you want to have you baby at home? So dangerous…”

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These are all real situations…and very upsetting to me. I am so grateful for doctors and hospitals, the expertise they offer when we are having medical problems. Why is it, then, that there is no respect for those of us who don’t deal with sick but instead deal with healthy? It truly baffles me….I don’t understand it. I see a family doctor when I’m healthy, and sometimes when I’m not…but if I have a big problem he will refer me onto a specialist who can fix the big problem. If the problem is with my heart, he will send me to a cardiologist. Does the cardiologist really look negatively towards the family doctor and say, “WHY would you see a family doctor? What if something goes wrong? Why don’t you always see a cardiologist ‘just in case’?” Of course not…so why does an OB (or even a nurse!) say things like that about midwives?

It just makes sense that a midwife – who specializes in healthy pregnancies – see the healthy expectant mothers…and refer to a specialist when problems come up! This, to me, is a win/win situation for everyone! Doctors, clients, midwives.

One of my beautiful homebirth babies just an hour after she was born!

It is becoming clear to me why so many midwives are reluctant to refer for complications and end up trying too hard to deal with things themselves…..because the treatment the client will get is upsetting and the disrespect she will be shown is ridiculous. Rather than encouraging a good relationship, continuity of care, collaborative care, all working together to make things as good for that expectant family as they can be…instead it’s finger-pointing, looking down their noses at the midwife and her client, and a general attitude that makes the client and midwife want to stay away!!!

I don’t see how anyone wins in that situation….certainly not our clients. Do we not share a common goal? Healthy pregnancies, happy families? Tell me, doctor/nurses, how what you want is in conflict with what I as a midwife want?? And do you have any suggestions for a solution to this problem?

9 Comments

  1. Julie Westover wrote:

    I hear you Stephanie. I’ve also found disrespectful treatment between doctors and specialists as well. A Pediatric Neurologist looked down her nose at an Allergist and a Gastroenterologist was stuffy about all other specialists because he was the best. Each doctor wants to be “treated” as if he/she really has all the answers and wants a compliant patient. Thank heaven there are care providers like you!!!

    Tuesday, September 21, 2010 at 6:34 pm | Permalink
  2. Amy Lynn Drorbaugh wrote:

    It all comes down to a lack of education. Before my homebirth a good friend of mine (who happened to be a NICU nurse) kept insisting that I call her when I went into labor…”just in case”. When I asked her what she was planning to do that my midwife couldn’t do she had no answer…but continued to insist! When I told her my birth story (baby born before Stephanie could get to me) she was angry that I hadn’t called her. When she asked me why I hadn’t I said very succinctly, “I didn’t need you.”

    It insults me that medical professionals assume I’m an idiot who did no research before choosing homebirth when in reality our roles are completely reversed.

    Tuesday, September 21, 2010 at 6:49 pm | Permalink
  3. Kelli wrote:

    I had all these problems with my employer and insurance companies, both the one for my medical leave and for health coverage. By the way, they just reimbursed me for the “surgery” you provided on June 29th….our homebirth. I almost don’t even want to ask how they got that idea, makes no sense. Even the people in the CA disability office were offensive to me. Things like “Ok we know you’re midwife’s name, that doesn’t matter, we need to know who is delivering your baby.” (um, I am, my midwife will provide my medical care if thats what youre asking)and “Your due date was this past Friday, so what day did your doctor decide your baby will be born on now.” “We can’t accept a form filled out by your LICENSED Midwife, it needs to be filled out by a medical provider, someone who can actually provided prenatal and birth care.” and the worst “Your midwife can’t clear you to return to work it has to be a real doctor.” UM HELLO!!! She was the provider at my birth, and she was actually there, no one gave the OB who missed my first birth any grief about paperwork and the nurse was the only one who even knew me.

    I would love to hear a nurse or OB respond to this, I really hope they do. (and real OBs, not “dr.”amy)It really seems as though that side of the birth profession feeels incredibly threatened by midwifery care and their misinformation leads to the kind of ignorance I’ve had to encounter. I was insulted by these things as a mother, a woman, an aspiring midwife, and as an intelligent being capable of logical thought…my goodness the people I encountered were ridiculous. Luckily I had full support from family, friends, coworkers, and even some strangers which helped ease the frustration from the stupidity I encountered.

    Tuesday, September 21, 2010 at 7:41 pm | Permalink
  4. Tatiana Indrisek wrote:

    I have encountered many of these same situations and it can really drive a person crazy–especially a hormonal pregnant woman! I once went to a new dentist while visibly pregnant and they refused to see me until I could furnish a letter from my “Dr.” stating that I was “allowed” to have a routine exam and cleaning.

    I don’t know what the answer is, but I know the truth of what you speak–and as you so eloquently pointed out, the hostility oftentimes directed towards midwives is incredibly short-sighted and illogical.

    Tuesday, September 21, 2010 at 7:58 pm | Permalink
  5. sara wrote:

    I totally see the similarities between family docs and midwives- really family docs are only there now to make sure their patients are healthy and refer to other specialists if needed, which is what women need in midwifery care. There is really no reason for thousands of women every day sitting around in waiting rooms to see a surgeon to talk to them for 5 minutes in preparation for their vaginal (maybe) births. If I didn’t have any symptoms of a thyroid condition why would I go to an endrocronologist every month? I’m sure after a while he’d find some reason to give me meds for a perceived condition…

    It would be really great if obs could get over themselves and let the midwives take care of the healthy women!

    Tuesday, September 21, 2010 at 10:02 pm | Permalink
  6. Sarah Atondo wrote:

    I am ashamed to say that this sounds like where I work. Our docs and staff have no respect for women wanting something out of the hospital. It’s so hard to see people so hateful towards something they know nothing about. Ignorance. Stay strong.

    Tuesday, September 21, 2010 at 10:48 pm | Permalink
  7. Trena wrote:

    Speaking from my own ignorance as a first-time mom, I also had no idea recently where the lines are drawn between a midwife and OB care when I needed a minor problem checked out – which you, Stephanie, so easily helped me with. I was very reluctant to go back to my OB’s office bcz I anticipated some sort of pushback for leaving and choosing a midwife instead. I think it really boils down to ignorance for the most part, people don’t KNOW they have a choice. Besides, one way to control people is to make them fearful – which is exactly what teh docs and nurses comments perpetuate – I’m not a conspiracy theorist but the “system” is working just as expected! 99% of women just expect that they will be with a doc and a hospital! For paperwork I too suspect I will have some problems, like Kelli did, when I fill out FMLA and Short Term Disability paperwork, becuase the only box to check is “doctor”…but it’s ok. I know my rights, and it gives me the opportunity to educate the ignorant, and to buck the “expected” flow of system, and voice my choice for midwife care! Someday, greater society will get the message!! Keep the faith Steph!

    Friday, September 24, 2010 at 3:37 pm | Permalink
  8. Wouldn’t it be great if we could just find some way to turn around those MD egos and get them to think, “Oh good grief, why would I want to see this low-risk woman, her pregnancy and birth are going to be so normal and boring. Maybe I can get her to go see a midwife and come back if things get interesting.” 😉

    Tuesday, November 2, 2010 at 11:44 am | Permalink
  9. Monica wrote:

    I’m almost 20 weeks and while my midwife doesn’t require and ultrasound my husband and I would like to have one done. Not difficult you would think. Wrong, I’ve been denied an ultrasound from two places, (one being a clinic!) because I’m not seeing an OB-GYN for prenatal care. I was in shock that someone with health insurance could be denied care.

    Thursday, November 4, 2010 at 5:22 pm | Permalink

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