When I found out that I was pregnant, I scoured the list of approved obstetricians and nurse midwives from my insurance company. I had a wonderful experience with a certified nurse midwife when I delivered my son. She was always attentive and caring, and I never second guessed her medical decision making. Sadly, I discovered that she wasn’t an option for this pregnancy; since my experience with her was so pleasant, I was convinced that I wanted to use a nurse midwife this time around. I’ve slowly discovered why people use the phrase, “assumptions will make an ass out of you.” I regret my assumption that my experience with one specific nurse midwife would equate to a positive experience with another group of nurse midwives. I’m sharing my personal experience with selecting the wrong midwives and I’m trying to help you answer the question, “When should you find a new healthcare provider?”
My pregnancy with my son was relatively uneventful. I had hyperemesis (a severe form of morning sickness) that required medication and a few trips to the hospital for IV fluids. I had very few non-routine office visits during that pregnancy, but I still developed a good relationship with my nurse midwife. She came into the hospital on her day off to deliver my son. When I had a hemorrhage following his delivery, she helped to keep me calm and my faith in her never wavered. I can even laugh that she managed to lose a suture needle post delivery and they had to x-ray me to look for it; the needle disappeared in the process of trying to stop my hemorrhage.
I never anticipated the complications that would arise with my second pregnancy, so I put little forethought into how a nurse midwife would handle them. One of the most important questions that anyone considering using a nurse midwife should consider is: who will handle your care in the event that complications arise? Depending on where you live and the hospital that the nurse midwife is affiliated with, the vast majority of important healthcare decisions may be made by a physician that you have no familiarity with and vice versa.
I ultimately chose a certified nurse midwife clinic to handle my care and we drove nearly 1.5 hours each way to their practice. I appreciated that they were a small stand-alone nurse midwife practice with only two CNM’s (Certified Nurse Midwife) and a nurse practitioner. Since CNM’s can’t perform procedures such as caesarean sections should the emergent need arise, they require having some affiliation with an obstetrician or obstetric practice. When I became a patient there, the clinic maintained affiliation was with a small OB group who also delivered at the birthing center across the street from their office.
I ended up with hyperemesis again during my second pregnancy. Shortly after entering my second trimester, for nearly two weeks I suffered with erythema multiforme (an inexplicable and painful body-covering rash) that required intravenous and oral steroids, along with 5 or 6 emergency room visits due to swelling around my eyes and mouth. In the middle of the treatment for rash, my primary care provider suggested that I switch from a nurse midwife to an obstetrician, and I didn’t heed her advice (hindsight is always 20/20). Unfortunately the pregnancy complications didn’t stop there. I ended up with an abnormal result on my thyroid panel that required me being referred out to endocrinology; then I was referred out to rheumatology because they were concerned that the erythema was caused by undiagnosed lupus. I received an inconclusive diagnosis (lupus can be hard to diagnose during pregnancy because hormones can elevate certain inflammatory markers which are also elevated in lupus patients) and I’m scheduled to follow-up with them a few months after my daughter’s arrival.
The biggest complication of my pregnancy would be discovered during my first anatomical ultrasound. My daughter looked great and was developing normally, but I had a complete placenta previa (the placenta was covering my cervix). Placenta previa can cause several major complications and would make a vaginal delivery dangerous. The midwife sent me over to Maternal Fetal Medicine for an evaluation on that same day. I was given restrictions until the previa resolved and they planned to monitor my condition. During my next ultrasound appointment, the nurse midwife said the previa was resolved, but she felt my ultrasound showed evidence of another complication. I had to be referred back over to Maternal Fetal Medicine for a second time. They didn’t see evidence of the second complication but the placenta previa hadn’t resolved. I guess that was the first time that I had serious doubts about my decision to use the midwife practice, and I began to lose faith in them.
During subsequent ultrasounds we discovered that my daughter was breech, but they kept reassuring me that she would probably turn on her own. The placenta previa resolved enough for a vaginal delivery to be permissible around 33-34 weeks, but alas my daughter remained breech. They repeatedly reassured me she had plenty of time to turn, and ignored questions from my husband and I regarding how the situation would be handled if she remained breech.
In the middle of all the complications, the practice decided to become affiliated with the university hospital and a much larger obstetric practice. I was told that nothing would change about my care other than my delivery location, but everything changed–everything. They added another nurse midwife to the group and all major medical decisions regarding my care were essentially handed over to an obstetrician whom I have never met before.
When I was scheduled at the hospital for an external cephalic version (a procedure used to turn a breech baby; you can read about that experience here), I was surprised to learn that not only would it be done by several physicians who were strangers to me, but that none of my the midwives would be in attendance. In fact, not one of the midwives or the practice called to see how the procedure went or to see if any complications arose. I had to call back to make my own follow-up appointment at the clinic and it took several transfers before the staff could determine what an appropriate follow-up date would be or when they could “squeeze” me in.
I had been their patient for 9 months and I realized that I was nothing more than number; I was a statistic on a board and money in their pocket. If I passed one of them on the street, I wasn’t entirely sure that they would even recognize me. Now I laugh when I read this quote from their website: “Our role is to support you in your choices and help facilitate safe passage for you and your baby during your pregnancy and birth.” I had been given no choices regarding my care and I certainly didn’t feel supported by the clinic or their providers. They hadn’t asked about my preferences. They didn’t provide me with options. They just kept scheduling appointments with no long-term plan or strategy. It gets worse, and it took one last straw to break this camel’s back.
At my appointment yesterday, I was put into an exam room and completely forgotten. I sat there for over an hour; I was trying to be patient because after years working in medicine, I know that emergencies sometimes arise. When my husband, who had been in the waiting room with my son, watched the waiting room fill and then empty with other patients, he finally became agitated. He inquired about my status with the receptionist, who lied and told him that the CNM was with me. He told her that he had been texting me the entire time, that nobody had seen her, and that her lies weren’t going to fly with him. A flood of the most insincere apologies ensued–not for forgetting me, but for being “standoffish” to my husband. The only laugh I got the entire day was hearing the girl who referred to herself as a “nurse” ask me if I, “had that procedure where… you know… they um… turn the baby?” I laughingly replied, “You mean an ECV? If so, yes.” It took everything in me not to tell her to stop referring to herself as a nurse when she hadn’t earned the title and she was just clinic staff. (My husband likes to remind me that in a clinic where they refer to the nurses as doctors, it probably doesn’t take much to be called a nurse.) The midwife came in and she was willing to say whatever she thought she needed to in an attempt to appease my husband and I while we were in the office. Not once did anyone actually apologize for forgetting about me, it was just a line of excuses. My appointment, which should have been for measurements, a cervical check, and fetal heart tones took over 2.5 hours.
When I was walking out of the office I realized that I didn’t have a single happy memory leaving the clinic. The first time we ever got to see our daughter was clouded by the placenta previa diagnosis and being rushed out the door to a maternal fetal medicine appointment. Subsequent appointments were discussing the previa or her breech status. Today should have been my appointment to finally relax in anticipation of her arrival following a successful ECV, and I was made to feel like just another number on a conveyor belt of patients.
The first day that I visited the clinic I noticed a sign that seemed like reassurance, but in retrospect it should have been a big red flag. I’ve seen it shared multiple times on their clinic Facebook page and it wasn’t until yesterday that I realized how truly dangerous that sign might be. They keep track of the year-to-date birth statistics for the office. It reads something like this:
- Vaginal Deliveries: %
- Cesarean Deliveries: %
- Inductions: %
- Epidural: %
- Non-medicated: %
- V-BAC: %
- Intact or 1st degree tear: %
At first glance, you might think that their statistics aren’t bad; but why do they deserve “bragging rights” over any woman’s delivery. Vaginal delivery statistics floated as low as 76% on their page, which means nearly 2.5 out of every 10 women ultimately had their birth attended by a complete stranger. If you make the conscious decision to visit a nurse midwife over an obstetrician, do you really want your delivery to come down to those odds? My biggest concern over the “published” statistics is that women may have been forced or coerced into birth plans or medical decisions just so the clinic and the providers could “brag” about success rates. If a baby arrives safely and a mother is happy with their mode of delivery, then why do statistics matter? I certainly don’t want the delivery of my daughter to be a “notch on their belt.” I am not just a number.
Here’s my piece of advice for you if you’re pondering the question, “When should you find a new healthcare provider?” If you need to ask yourself that question, then you already know the answer. Whether a medical provider is delivering your baby or attending to your primary care needs, if you’ve lost faith in them, find a new one. Trust your intuition; if you have doubts, they’re probably founded. Everyone has bad days, but professionals rise to the occasion and perform their job to the highest level. I could give birth any day and I’ve spent half the morning researching my delivery options elsewhere. I decided that if another clinic was going to be making important healthcare decisions for my daughter and I, that it would be a clinic and a set of healthcare professionals that I chose. When I became at patient at what is now the UK Midwife Clinic, I was never informed that another doctor (whom I have never met nor do I have any familiarity with) would be making my healthcare decisions. I was made to believe that my delivery would be attended by one of the two midwives who were in the clinic, and now I was playing the obstetric lottery and suddenly there were 10+ providers who I could potentially see that day.
I cried last night and I NEVER cry. I learned following the murder of my brother, that tears really don’t help anything. I consider myself pretty stoic, and in fact, I could almost count the times on one hand that I’ve cried since he died. But last night I sat in my pool and I bawled. I kept thinking to myself, “Why are you crying over someone else and their crappy behavior?” The situation wasn’t my fault. Then I was realized that I was mourning; the trust that I had in my healthcare providers had slowly died and I had to face that reality. The lovely picture I had in my head of bringing my daughter into this world with the help of someone I had grown to view as a friend was gone. Instead of me being patient number 12,345 on their conveyor belt, the midwives had just become another set of medical providers on mine.
Don’t ever take selecting a healthcare professional lightly. I hope my experience can help you make better decisions regarding not only choosing a healthcare provider, but also making an informed decision on when to seek out a new provider. Who will deliver my daughter? Check back soon, and hopefully, I’ll have an update to share or maybe even her birth story.