Let's talk abut trust. Is it possible to be well informed but still have trust in your provider? Every now and then I get a patient who is so adamant on doing things their way to the point of unsafety. I certainly believe that women should be well-informed and an active participant in their healthcare. I love it when women come in and ask good questions and express their thoughts and concerns openly. It warms my heart and I try to foster this relationship with every woman I see in the office or on L&D.
However, occasionally, I get a woman who is so deadset on a vision in her head of what her childbirth experience will be that I wonder just what they have been looking at on the internet. For example, I remember a couple I worked with who would not let the nurses on L&D even auscultate the baby. I went in to talk to them and explained that even if they were having a home birth or at a birth center, that the fetal heart tones would be auscultated periodically. They finally consented to this. I've had other patients come in either prenatally or to L&D with very set ideas on how things will go.
Now, I am certainly not unreasonable. If a couple has planned natural childbirth then they don't need an IV, they can be up and about, in the tub, eating, etc. These things are not a problem. But for example, a woman showed up for IOL at 41.5 weeks. Now, we typically offer induction of labor at 41 weeks. If a patient wants to go longer, we inform them of the risks and let it be their decision. This woman was already dilated 5cm (was told this in the office) but the baby was ballotable (head still floating). She wanted an AROM (artificial rupture of membranes) induction (break the water in order to create stronger and more frequent contractions). This was her second baby. She was insistent with the nurse that she call me and would not allow the nurse to check her prior. I was not in the hospital, and I live 45-60 minutes away. I was off call in one hour when she called me. She tells me what the patient wants...AROM, no pit (synthetic hormone used to induce labor), no IV. She didn't want anything from us other than for her water to be broke. Ok, that's fine. I grumble about having to head to the hospital and being off call by the time I got there but told the nurse to check her and I would head in that direction (we have a WHNP who doesn't always do the most accurate vag exams and I wanted to know the station). She calls me back 15 minutes later (what the hell took so long???) and the patient was indeed 5-6cm...but baby's head was far to high to break water. If the head is still floating, then you worry about a prolapsed cord which is a ticket, non-stop, to cesarean section. So I tell the nurse that there is no way I will break her water. The patient ended up going back home and was supposed to come back the next day (I agreed to this).
So what's my point? It comes down to a trusting relationship between the provider and the woman. It's teamwork. It's not a dictatorship, where one party calls the shots and the other should just meekly follow along. The worst is when a woman comes in and says "my massage therapist/bradley instructor/bank teller says I should...". This has happened. I know this will sound uppity and all, but I am pretty damn sure I went to school longer than a massage therapist and likely have caught more babies than her. A woman should have a provider that she trusts to answer her questions honestly and accurately. In return, a provider should be able to trust the woman to be forthcoming and honest about her plans and intentions. I had a woman come in around 20 weeks, we hadn't seen her since her initial visit at 8 weeks. I asked where she had been, she informed me that she was planning a homebirth but did want an ultrasound. Ok, fine, not a problem. I ordered her ultrasound, wished her well, and told her to let us know if she needed anything. This I can deal with.
Anyway enough! Words of wisdom for anyone seeking care during pregnancy. Trust. If you can't trust the midwife/doctor/massage therapist that is providing care...find someone else!!!!