My OB: Hello Dr. Jeckyll? Or Is It Mr. Hyde?

I decided to blog about my OB, Dr. Jeckyll & Mr. Hyde, over at My Best Birth.  Here’s an excerpt:

So, I arrive this morning with my husband.  After the nurse weighs me and takes my blood pressure, she tells me to unclothe waist-down.  I then notice the ultrasound machine right by the bed.  “Uh oh,” I think.  Compliant-patient side of me agrees to undress (though I know my cervix is still high and posterior).  Not-gonna-comply-patient will not agree to an ultrasound!

This week, instead of having a big baby, I have “not a very big baby” (based on external palpation) . . . “maybe 6 6.5 pounds right now.”  I’m measuring “right on” (which he didn’t say last week).  Everything looks good.  No worries.  Who is this guy!?  So, a very straight-forward appointment with Dr. Hyde this week.  At this point, I am planning on keeping my 39 week appointment, just so he doesn’t get suspicious of anything.  Suspicious of what, you might wonder?

To read the entire post, click here.

Blog it out: 38 week OB appointment

As I get ready for my 38 week OB appointment tomorrow, I feel the need to just ‘blog it out.’  Ya know . . . as a way to relieve some tension and stress from last week’s appointment.  I’m maintaining ‘shadow care’ with the only OB I know in town who would ‘tolerate’ babysitting an ill-advised VBA2C in the hospital.  Only thing – I’m not planning on going to the hospital.  However, I’ve been encouraged to keep up this disingenuous relationship just in case I do need to transfer during or following the birth.

I blogged last week about his ridiculous statement that “short, Mexican women” have the best births.  Here are some of his other de-motivating tactics:

Sketch by American artist, Ben Murphy

  • “So . . . we still doing this?”  He likes to begin my appointments with this rhetorical question.  He knows the answer, but yet, he continues to ask.
  • “You’re not gaining weight but you have a BIG BABY.”  Such bullshit.  He doesn’t share my fundal measurements with me, but I know I have been and continue to measure ‘right on’ each week.
  • “When you have a bad outcome, ________.”  He’s filled in the blank with a variety of scary things.
  • “When you need a cesarean, you can’t freak out on me.”  I told him that was way too much for him to expect.
  • I have to have a perfect Friedman’s labor.
  • CEFM, IV, yada yada.  Ok, whatever.  I’ll agree to the monitoring assuming they have telemetry.  I’ll consent to heplock but not an active IV.
  • As soon as I’m in labor, I’m to go directly to L&D.  (Yeah, right, doc.  I’ll do that.)
  • I asked him why my rupture risk is increased since they went through the old cesarean scar.  His response: “Because it just is.”  My response: “Come on, you know that’s not a good enough answer for me!”
  • When I told him that I gestate longer than 40 weeks, he said “that’s bad!”
  • Doesn’t believe vaginal delivery is best for healthy babies (?!?!?!?!!!!!)
  • Places VBAC in the “want” not need category, though he seems to understand that I have my reasons
  • Doesn’t seem to believe that the pelvis expands during pregnancy and birth?  The only way to get more room would be to break my pelvis (not that he was suggesting that route).  Does he not ‘get’ the physiology of birth?  Does he not understand the role of hormones in preparing the body to birth??
  • Seems to consider 37 weeks as term . . . not early term as I suggested.  (A newly released NIH study asserts that babies born in the 37th and 38th weeks are more likely to die before age 1 than babies born in the 39th and 40th weeks.)
  • “You know I’d prefer not to do this.”  In response to my objections over having him and an anesthesiologist breathing down my neck during my entire labor and birth.  Which is a mis-representation anyway of what would actually happen.  If I’m in labor during the day, he can continue seeing his patients.  If I’m in labor at night, he’s welcome to go sleep somewhere in the hospital or at his office.  And our hospital has 24-hr anesthesia immediately available, so he shouldn’t be guilting me about an anesthesiologist having to be there for my labor.  If a hospital isn’t safe for a VBAC . . . . it’s not safe for any birth.

Wow, when I write all of that down, I just get angry.  I’m going to crawl under the covers with my Hypnobabies tracks, strengthen my bubble of peace, work on fear cleansing, listen to my pregnancy affirmations, and call it a day.  My husband will go with me tomorrow to my appointment, so I imagine it will be uneventful.  I have a mind to bring in my “birth preferences” just to see how the doc would react, but really . . . is it worth it?  Probably not.  At this point, I’m no longer interested in his opinion because he continues to skew the ‘truth.’  I don’t want to argue about laboring in water or delayed cord clamping or any of it.

Point is – I’m not going to the hospital to have this baby unless the need arises before, during, or after the birth.  I fully recognize that at any point between now and my birthing time, that I may need hospital services.  My husband and I will decide if we agree with recommendations to abort our homebirth plans.  Otherwise, I’m not planning on needing the hospital or an obstetrician.  So the last thing I want to do tomorrow morning is have an off-putting, destabilizing, stress-inducing discussion with someone who begrudgingly is putting up with my wingnut idea to have a natural birth but very vocal about what all “will” go wrong.

You can read my last pregnancy update (34 weeks) here.

Hispanic Female Pelvises are Better?

My OB said the most bizarre thing today.  At first it didn’t really strike me as bizarre, but the more I’ve thought about it, the more I’ve realized it’s a crock of shit.

I’m not exactly sure how we got onto this topic this morning, but he stated that the Hispanic female pelvis is bigger than the average white woman’s pelvis.  The best birthers are short hispanic women according to the doc.  And then said something about a study in Southern California that I didn’t really pay any attention to.

Let’s just break this down a bit.  According to this post over at The Unnecessarean (July 2010), the cesarean rate in Mexico’s private hospitals is 70% and 40% in public hospitals.  If Mexican women are so much more physically capable of using their pelvises, then why does their cesarean rate exceed ours?  Perhaps pelvimetry is not as much a factor as OBs would like us to think?

The Unnecessarean post, an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010, further points out:

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

None of these cesarean rates support my doctor’s assertion that a woman’s genetic structure has anything to do with achieving a vaginal birth.  According to Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal, other factors are at work here.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

Aha!  I knew it.  I wonder if some jackass OB in Mexico is currently telling his patient that you need to be tall with a Nordic bone structure (my genes) to have a baby fit through the pelvis?  What do you think?

For more information on CPD (cephalo-pelvic disproportion) diagnoses (and what it probably doesn’t mean for you) and pelvises, I recommend: