Question Everyone and Everything
May 28 '00
Being pregnant is both a wondrous and frightening time in a woman’s life. Carrying a life inside of you is a tremendous responsiblity and like most women I know, I took the responsibility for building my baby seriously. Before I even conceived I began a healthy regimen that included a more balanced diet and began taking supplements containing just the right amount of vitamins and folic acid. I did not smoke or consume alcohol. I avoided caffeine and second-hand smoke. Prenatal care began early with a highly qualified, licensed nurse-midwife. I devoured books on pregnancy and prenatal care.
I believe in taking a more natural, holistic approach to childbirth and do not believe that a normal pregnancy should be treated as a disease or high risk medical condition. I do, however, support proper prenatal care through qualified midwives and/or physicians and in seeking appropriate medical guidance when necessary. In other words, I had educated myself enough to be an active participant in my pregnancy and to question the validity of routine and often unnecessary procedures, but also knew when I was in over my head and needed to seek counsel from those more qualified than me.
I read countless books and studies on risks and benefits and felt confident in my decisions. I was informed. Being able to advocate for myself and my unborn child was never in doubt. Yet, I never imagined that only 9 weeks into my pregnancy that I would find myself in a position where I was unable to properly question a physician and as a result, I unwittingly put the health of my unborn baby in jeopardy.
I have been a chronic headache and migraine sufferer since I was a child. When I mean chronic, I mean chronic. As many as 3 to 4 migraines a week if I am not on preventive medication. Due to the hormonal changes that occur with pregnancy, migraines can occur frequently. Many woman experience their first migraines while pregnant and I knew that with my migraine history, my risk was high. For obvious reasons, I was no longer taking any preventive medication.
The first two months of my pregnancy were nearly unbearable. Several moderate to severe migraines per week. I was functioning at half my normal level and in a great deal of pain. Since hormone levels tend to stabilize after the first trimester, I looked forward to reaching that second trimester and finally enjoying the process of being pregnant. Shortly before I reached that milestone, I developed a severe migraine. The worst that I ever experienced. For three full days, I was in such pain that I could not lift my head off of the pillow. Lights and sounds would cause excruciating pain. I could not eat food or drink liquids. Those all important prenatal vitamins didn’t stay down long enough to be absorbed into my system and the simple act of swallowing saliva was enough to send me into another fit of projectile vomiting.
The fourth day into this horrendous migraine, I become dehydrated. No food or liquids had managed to stay down for three days. I was in pain so severe that I contemplated suicide (alas it was true). My husband contacted my midwife and I was instructed to go to the nearest ER. That was my first mistake. (I did not yet have a back-up Obstetrician as I was having difficulty in finding one in my area that was willing to provide prenatal support to a qualified and fully licensed nurse-midwife for a homebirth. My midwife’s normal back-up OB did not practice in my area).
When I arrived at the ER, I was attended to by a physician who refused to treat me. Instead, I was referred to an OB with hospital privileges. He determined that I was seriously dehydrated and I was given intravenous fluids. The OB also suggested that I be given medication to abort the migraine. Risks versus benefits. Obviously not retaining fluids or nourishment during pregnancy is not beneficial and I was in such severe pain at that point that I barely protested. I did have enough presence to ask if the medication was safe for my developing baby and was told, “I wouldn’t be giving it to you if it wasn’t. Don’t worry your pretty little head about it”. While I found his remark condescending, I was in no position to question him further and simply trusted him. That was my second mistake.
Within a few hours my migraine was gone, I was re-hydrated and I could once again function. I immediately set about finding both a back up OB and treatment for the uncontrollable migraines through a more qualified physician (someone who had extensive experience both with the condition of chronic migraines and in treating pregnant patients effectively, yet conservatively). To reassure myself I also looked up the particular medication that I had been given in the drug reference book and was shocked to discover that the drug was contraindicated for use in the first trimester of pregnancy. It had a strong potential to cause heart valve damage in the developing fetus.
Needless to say, I was both angry and frightened. I blamed myself for allowing myself to receive treatment without being fully informed. Both my headache specialist and my new back up-OB confirmed that while my migraine needed to be aborted, there were safer and more effective alternatives to the medication that I had been given. 21 weeks into the pregnancy I reluctantly submitted to an ultrasound to check for heart valve damage. This was a routine procedure that I wished to avoid, yet ended up having as a direct result of the medication. Fortunately, the ultrasound confirmed that my daughter’s heart was developing normally and my frightening ordeal was over.
This story is not as an indictment of physicians. On the contrary. I have nothing but respect for my personal physicians and the medical community in general. However, medical care must be a collaborative effort. Take responsibility for your healthcare and pregnancy. You must educate yourself. Know the risks before you consent. Get a second and even third opinion if you must and more importantly, conduct independent research. Do not rely strictly on the information given to you by your physician, midwife or your anesthesiologist. Be as informed as possible and never completely trust someone simply because they have a degree or fancy initials following their name. You, and only you, have your best interests at heart. Doctors and midwives are human. They are not infallible and like everyone else, sometimes they make mistakes.
If I were granted the opportunity to relive that day in my pregnancy again, I would have resisted more and made it clear to my husband that it was his responsibility to question the doctor and the medication he prescribed thoroughly. I would have requested a second and possibly third opinion and if possible, had my husband look up the drug in the drug reference himself. Knowing my migraine history, I would have also made certain that I was under the care of a qualified physician who understood my special circumstances and determined a preventive cause of action and treatment before I conceived. I accept equal blame for what happened to me and have learned from the experience.
Work with your physician, but do not follow their advice blindly. Know what the full risks and benefits are and render your decisions accordingly. If you know your facts and can discuss it intelligently with your doctor, they will respect you. I concurred with my back up-OB on many issues and disagreed with him wholeheartedly on others. We had a mutual respect.
One of the biggest challenges I faced with my back up-OB occurred during the final weeks of my pregnancy. Although I knew my exact date of conception (trust me...it wasn’t difficult to figure out), the doctor insisted that I was now over due. 3 days past his “due date” he pushed for an induction and I respectfully refused. Armed with facts that supported my position and that disagreed with his more conservative approach, he reluctantly agreed that we would allow the pregnancy to progress normally. To reassure him and to show him that we were not willing to risk the health of our baby in order to achieve a longed for homebirth, I happily agreed to come into his office for regularly scheduled non-stress tests during the final week of my pregnancy. This gave him the comfort level he needed to know that he was practicing within his medical guidelines, yet also granted me the added time I needed to continue to grow my baby and allow her to be born on her schedule...not mine or the physicians.
Two weeks later, my daughter was born safely at home as planned and at full gestation...40 weeks. Because she was born at home, my back up-OB was not present at my daughter’s actual birth (my midwives were there for that), but I consider him a very necessary part of the equation. Our experience was so successful and satisfying that shortly after my daughter’s birth, he agreed to become the back up obstetrician for my
midwives in my immediate area. I am proud that through our collaborative efforts other local woman can now explore the benefits of homebirth while still receiving proper prenatal care and follow through with an excellent physician.
Whether you are seeking medical care or purchasing nursery furniture, be an informed consumer. Read everything you can get your hands on and when you’re done, read some more. Conduct as much independent research as possible. Know your rights and inform yourself of the risks versus benefits. Do not have an epidural or an ultrasound simply because your friend had one and experienced no side effects, or because someone on a message board told you they were safe. The time to question your doctor about the risks of an epidural or other procedures, is not when they are ready to insert the needle. Do it early in your pregnancy, when you are calm and after you have concluded your independent research. Furthermore, do not have a homebirth simply because women have been squatting and birthing in the fields for thousands of years, or because my experience was positive. Everything has an element of risk. Only when you are fully informed can you make appropriate decisions throughout your pregnancy and be fully prepared to accept the consequences.
Question everyone and everything during your pregnancy and birth. If you cannot advocate for yourself, have someone that you trust advocate for you. Your health and your baby’s depends on it.
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