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?

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