Monday, July 19, 2010

Finding a Doctor

As I mentioned in my last post, these are some thoughts I had based on my experience at a Level II ultrasound, the one they normally do between 18-20 weeks to check for fetal abnormalities such as heart and spine defects. Another thing the consulting doctor said after the ultrasound brought home the necessity of finding a supportive care provider to help you do things differently.

"Good luck getting your doctor to agree to let you go to 41 weeks."

The induction question was one of the first that I asked my new doctor and he's OK letting me go to 41 weeks.

I'm about to sound like every natural childbirth book that has ever been written, but this comment, and indeed, my whole experience at the high-risk clinic, demonstrates how important it is to find a supportive care provider! A provider that is willing to make different assumptions and use different methods, with fewer interventions, to help you. A provider that will treat you like an individual, not just a statistically-average diabetic. Even though diabetics, on average, may have elevated incidence of certain risks, you may not be average! It's OK to ask to be treated as an individual, which may allow you to avoid standard interventions such as early induction of labor and so on. Some tips on finding a doctor from someone who's had to do it in two different locales:

Ask around. You may see if you can find a homebirth midwife amenable to your situation. However, if you want to deliver in a hospital or can't find a homebirth midwife that feels comfortable assisting you at home, which is probably the case for many of us, ask homebirth midwives and doulas who they like to work with. Doctors that midwives and doulas like are generally open to low-intervention birth, and are willing to individualize care beyond standard protocol for diabetics. Maternal-fetal specialist groups often induce pre-existing diabetics at 39 weeks regardless of other circumstances (see Doing Things Differently), so I would avoid them unless complications require you to come under their care. Unfortunately, you probably won't be able to find a nurse midwife or a nurse midwife/OB practice to help you, either in a hospital or birthing center - they usually refer diabetics to maternal-fetal specialists.

Show them your numbers. A healthy pre-pregnancy weight, minimal diabetes-related health complications for you (retinopathy and kidney damage), well-managed blood sugars, low A1Cs, and any children with average birth weights that you have delivered before will help you make your case, particularly to an OB that doesn't normally work with pre-existing diabetics.

Be flexible. Whether you are working with a homebirth midwife or low-intervention OB, be willing to consult with maternal-fetal specialists if complications arise, or for routine ultrasound screening. It is important to be willing to compromise since your care provider may be taking professional risks or receiving criticism from their colleagues to help you with a low-intervention birth. In the end, the specialists will only be doing consultations and making recommendations, and you probably won't have to make any decisions until after you've had an opportunity to talk it over with your midwife or OB.

And just a note, you should be able to ask a doctor that you call for an initial consultation or interview. In my experience, if they are not in the habit of providing this service or resistant to doing so, this can indicate a practice or a doctor that is unwilling to discuss alternatives to standard interventions.

Have you had a great experience with a doctor? I'd love to hear about it. Let's make it civil, though, and keep our criticisms specific to behaviors and actions, rather than people.

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