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Hard Truths: Women Need to Stop Being "Good Patients"
- Aug 10, 2009 at 6:18 PM
- By
- Comments (67) Total Views (1976) Everyone can see this journal post.
Good patients get taken advantage of.
Good patients perpetuate the bad "routines."
Good patients don't get what they deserve.
Good patients don't offer a bad doctor incentive to improve.
Good patients keep poor practitioners in business.
Good patients have been trained to be "yesmen"
Good patients are placed, or see themselves as "below" a person in authority.
Be a "difficult patient" instead!!
In medical code, that means you see yourself as an equal who has hired someone for their expertise, but knows how to say no, is willing to seek out a second opinion, asks questions, expects answers, listens to advice, but ultimately makes the final decision because YOU are in charge. It is NOT your responsibility to make it easier for the people you hire by stuffing yourself into some narrow box of acceptability based on arbitrary rules.
If you hired someone to paint your house and you discussed the color and they dismissed your choice of a lovely shade of blue gray and insisted on white, you'd fire them. If they made no fuss about the color, but you came home and found your house painted brick red, you'd take serious action. If they painted your house the color you chose, but did a crappy job, you'd be livid to say the least. Doctors are just people. Some are extremely good at their jobs and other's aren't worth the nail holding up their fancy diploma.
STOP asking permission!
Don't lie on your back to give birth just because it makes it easier for whomever is on call. They should accomodate YOU even if you want to give birth standing on your head. YOU are doing the work. They are supposed to be YOUR backup in case you need them.
Don't "purple push" just because a bunch of people tell you to hold your breath for a count of ten. That's stupid. Ever try to run holding your breath? Not very effective is it?
Don't let people put their fingers in your vagina. Know why they have that "rule" about water breaking and infections? Because multiple strange people keep sticking their non-sterile hands into your vagina. Those gloves? Those aren't sterile. Unless you see someone scrub their hands and arms up to the elbow and open a FRESH single use sterile package in front of you they aren't as clean as you think they are. Those open boxes of gloves are NOT germ free being exposed to the air and multiple touches to retrieve gloves.
Another reason not to let people stick their fingers up your vagina. Let's be frank here. The same muscles you use to give birth are the same ones you use to poop. Mother Nature likes to multitask. So think about having to take a nice poo but suddenly someone bursts into the bathroom, flips you over ass up, and sticks their finger up you rectum to "check your progress." How would you feel? Would you want to poop then even if you really needed to? So, you calm down and start your business again and...someone else comes in to check your progress and then tells you you haven't progressed much. How good are you feeling now?
Dilation and effacement. Those are numbers in a book used as a teaching tool based on an average model to demonstrate progression. They mean little else. Why? Well, you aren't a number. When you take an average that means some people are below that average, some are higher and there are even a few "tail ends". Take your period for example. The text book says you ovulate on day 14 and have your period on day 28. And we all know that doesn't happen and it is perfectly NORMAL. Human menstruation has a pattern, but it doesn't care about the numbers in the book. Some women walk around "dialated and effaced' for weeks. Other women stay closed and tight until the very last moment in labor and then are ready all within a few minutes. All the constant checking does is to stress the poor woman and give other people something to write down on a chart.
Constant Fetal Monitoring. If you aren't bed ridden by an epidural you don't need it. It restricts movement and studies have shown that it is no more effective than intermittant monitoring and even can show something wrong even if there is absolutely nothing wrong. The machine doesn't have a brain.
Epidurals. It's a drug. Drugs have side effects (even aspirin has side effects, so ease of use, availability, and it is used a lot isn't an excuse to not know). Epidurals have even more because they are placed with a needle in the spine. Be aware of what the side effects are so that you are prepared. And note that they don't always work for everyone and that they can have long lasting effects such as numbness and spinal headaches. They do slow down labor and so you will not be given one before a certain time. So always have another coping mechanism at your disposal.
Episotomies. There is NO reason to cut a woman's genitals to prevent a tear. How about if someone suggested breaking your leg before your skiing trip, just to be sure you got a clean break and not a shattered leg if you happend to wipe out into a tree? Would you agree that that was a sane thing to do? A lot of problems are caused by the episotomy including prolonged pain at the site, painful sex from deep scar tissue or being stitched too tightly, numbness, and even incontinance. An episotomy does NOT make a surface cut, it cuts deep into the pelvic floor muscles. There are instances where an episotomy is needed in a real emergency -- but those are extremely rare. Natural tears heal stronger, are generally less deep and relatively minor, don't always require stitches, and MAY NOT OCCUR AT ALL if a woman is given time, patience, support, and isn't forced to push without rest to give the tissues a chance to expand. If you already had an episotomy without your permission and you are mad about it, don't hesitate to complain! Do you think a man would hesitate to raise a big stink if a doctor cut his genitals without his permission for whatever reason?
Once a C-Section alwasy a C-section. That's bull. There are countless studies that show that a VBAC is not only safe, but the better option. Tearing of the uterine scar is a rare event. And it has been shown that subsequent c-sections cause exponentially more problems the more a woman has them. Major abdominal surgery is nothing to sneeze at. http://www.ican-online.org/ Don't be bullied. You aren't a piece of meat and you aren't alive to be put at a doctor's convenience. Do your research! There is no reason why you can't labor and IF somethign goes amiss you can STILL have a c-section if necessary. You have the right to refuse surgery. You have the right to be able to compare objectively the risks of c-sections and of VBACs and assess them yourself for your situation. Don't take one person's word for it. Just because one doctor says they won't do it, doesn't mean another won't. And no hospital by law can refuse you treatment if you go in and need to use a doctor on call (which usually happens anyway). You don't really have a choice unless you know what your choices ARE. And if you do have a c-section, be sure that the people around you know that you have just had major surgery and you can't "just get over it" and "bounce back fast". It may take you some time to recover and heal. If you are emotionally distressed over it, don't let people tell you that all that matters is a healthy baby. YOU matter!
Inductions before or at 40 weeks. Look. You can refuse any an all treatments including inductions. Inductions often fail because the baby simply isn't ready. Not all babies gestate at the same length. Gestation isn't set on an egg timer. You aren't a carton of milk, you don't expire! You should NOT be considered post date until AT LEAST 42 weeks. Human gestation is a RANGE. The number they use is an average. That means some go before 40 weeks and some after and that is perfectly normal! Human gestation generally falls between 38 and 42 weeks with tail ends of 36-37 and 43-44. It all depends on how long your menstrual cycles are (short cycles will calculate differently than long cycles), and your family's history of gestation (if your family has a history of longer gestation you are likely to go long too. If the history is short, you are likely to have shorter gestation). Induction carries real risks, including a cascade of interventions that can lead straight to a c-section. A lot of pre-term babies are born because of early inductions! If you MUST be induced for some reason, be sure that they use the "bishop score" to assess your favorability for induction. Oh, and your "doctor going on vacation" or your "doctor not liking to deliver on weekends" or your "doctor wanting to leave in time for dinner" and any other reason of scheduleing including your own are not acceptable reasons to induce labor. The problem is that women are left with a fale impression that inductions are "no big deal". They are a VERY big deal and come with consequences, and thus need to be considered with contientious care.
But they said the baby is big! Don't believe it. How many stories have you read on cafemom alone where a woman was induced for "big baby" that turned out to be a mere six pounds? Did you know that ultrasounds predictions about weight are notoriously WRONG? Did you know that predictions about gestational age using ultrasound are notoriously off after week 12 and get progressively worse as time goes on especially when you hit the third trimester? Well, THEY should know that and should tell you that. Even fundal height can be off because it all depends on the length of your torso, the shape of your body, the lay of your uterus, and the position of the baby. What they are looking for is macrosomia, but there are OTHER clear physical indicators of abnormal growth. The WHO and even the ACOG do NOT reccommend inductions for suspected "big baby" for these reasons and more . They reccommend to allow labor to proceed as normal (this goes for "small pelvis" too. The female pelvis MOVES and unless you've had a serous accident affecting the pelvis or have a genetic pelvic deformity...yours spreads to accomodate a baby's molding head too. They know nothing until you labor OFF YOUR BACK). And no matter what anyone tells you 8 and 9 pounds is NOT big. Pounds is more than size--it is also muscle mass and bone density etc and must be taken into consideration. You can look at two babies and assess that the "fatter" one weighs more than the "compact: looking one, but you can be wrong. Just like you can be wrong about assessing toddler weight until you pick up the one that looks little and feel like you are picking up a stone and the one you thought was so heavy looking is rather light. Six pounds is a SMALL baby. Some women make small babies and that's fine, and sometimes that size is a direct result of early induction and means that the baby hasn't had time to put on the necessary weight to regulate body heat and lay down reserves. If you were induced for "big baby" and ended up with a small or normal sized baby... COMPLAIN!
No Eating or Drinking. Please. Don't let them do that to you. Let's all try exercising for 12 hours straight without taking a drop of water by mouth or stopping for some food fuel (another reason to labor at home as long as possible if you intend to birth in a hospital). If you did vigorous exercise for that stretch of time or longer with fluid and food restriction you would be called insane. Yet some hospitals still go by this stupid policy. And their reason of aspiration? They have tubes they put down people's throats for surgical emergencies to prevent that. Ask them what they do for accident victims who are rushed into surgery but who forgot to fast before their accident!
Pulling out the placenta forcefully. The placenta is attached to you and it will detatch once the uterus has begun clamping down on the blood vessels. If they pull it out it will hurt AND can cause a serious hemmorage. Tell them to back off and be patient. You aren't going anywhere anyway! The room is paid for, they will get paid whether the placenta comes out now or a couple of hours later.
Cytotec (aka Misoprostol). Bad news. Look up the FDA sheet on it. It is NOT recommended for use on pregnant woman, it can't be dosaged properly, and can't be removed once in place. It has been known to cause hyperstimulation of the uterus, uterine rupture, and hemmorage. Why do they use it? Because it is cheap. Don't be a guinea pig. If it was used on you, and especially if you were not fully disclosed of its off-label use and serious, dangerous side effects...report it! Complain so its use can stop.
There is SO much more to know! Breech for example...why should a woman suffer because of lack of skill and willingness to learn how to manage a variation of birth or lack of knowledge of non-invasive techniques to ecourage baby to shift position? It may seem like a lot to know, but every woman is responsible for her own health and well being. Ignorance is not bliss. Strive to be empowered, never strive to be a "good patient." Any doctor worth anything wants partners in health care, not people to pat on the head. They are less concerned with money and control and what they want, and more concerned with patient health and what works best for the individual.
Tags: empowered, women, choices, facts, truths, labor, delivery, doctors, hospitals
Comments:
Wonderful post!!!
Awesome. Love it! Women do need to stop giving all their power away to their doctor.
I heart you! I swear, if it weren't for you and your information I'd not be sitting here at home laboring joyfully. Instead I'd have had another section or I'd be in the hospital being PUSHED into another section. THANKS!
awesome!!! if i had known what i know now, i would not have stepped foot in a hospital, and you can be sure i won't make that mistake again. wonderful information.
Awesome journal! Doesn't it make you feel powerful just reading it. It makes so much sense! Just because someone's a doctor doesn't mean they aced their courses!
Very awesome..... its soo true. SO powerful
WONDERFUL POST!!!! Im printing for my mom who told me I was paranoid and needed to trust doctors....
good post! so true.
Love it, love it , love it.
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