Well, today's doctor visit was a bit of a shocker.
First, I waited for about an hour and a half. I felt bad for the nurse who kept coming out to apologize that the doctor was running behind. It wasn't the nurse's fault and yet I bet she'd been dealing with grumpy patients of that doctor's for a while.
Once I got my turn with the doc, I took my sweet time and she spent almost a full hour with me, answering questions and explaining things. That's an eternity in doctor time, so I felt vindicated at least.
The news? The residents and the attendings and the other important medical people talked about my case in their latest meeting and came to some conclusions. Basically, there has been a little bit of a debate amongst the three residents (Dr. Nervous, Dr. Laid-Back, and Dr. Inthemiddle who is the main one I saw until the last month or so when I started to rotate to meet the others). Two of them said that I didn't have chronic hypertension, because in-between pregnancies my blood pressure was at acceptable levels without any medication. One of them, Dr. Nervous, said I did have chronic hypertension because he noticed in my chart that indeed I was hypertensive and my blood pressure was managed with medication before and during my pregnancy with Evelyn.
The question is... once chronic hypertension, always chronic hypertension? It's a bit of a gray area. It's the reason I got the boot from the Birth Center - my favorite nurse ever was advocating for me to stay since my chronic hypertension seemed to have gone away after my pregnancy with Evelyn and with the addition of a good exercise and eating regimen in my life (hello, boot camp). But when all the staff met on me there to determine whether I'd risk out of their care for this pregnancy, the answer was yes. Because - once chronic hypertension, always chronic hypertension. The docs at the family medicine discussion came to the same conclusion.
The net result of this conclusion is that if you have a patient with chronic hypertension, there is a certain protocol to follow to lead to the best possible outcomes for mom and baby. There is a different protocol for gestational hypertension, and another for pre-eclampsia (actually, several depending on the severity of the pre-eclampsia or eclampsia). Two of my docs (guess which!) were treating me as though I had gestational hypertension and taking a watch and wait approach. One of them was treating me as though I had chronic hypertension and suggesting that I be induced between 39 and 40 weeks, which is the general rule for people with chronic hypertension.
According to the docs, I have gestational hypertension superimposed on chronic hypertension (because apparently I will always have chronic hypertension even if I need no medication and my blood pressure is good... once you have it, you have it - which by the way I think is ridiculous). As a result, the rule is that I need to be induced as close to 39 weeks as possible. And 39 weeks is tomorrow.
I asked lots of questions.
Me: "Can we schedule the induction for 39 weeks and 6 days?"
Doc: "Um, we'd really like to do it as close to 39 weeks as possible. Will tomorrow work?"
Me: "Tomorrow is my husband's birthday, so no."
Doc: "Let's look at Wednesday then."
Me: "Who is on call on Wednesday?" (Fingers crossed it's not Dr. Nervous)
Doc: "Dr. Inthemiddle."
Me: "So this means I'll have Pitocin. Do I also have to have Magnesium Sulfate?"
Doc: "No. Just Pitocin. Your cervix is ready so no balloon or prostogladins or anything either."
Me: "Excellent. But I don't like Pitocin. Can we increase it slowly and see if it sort of triggers my body into its own labor?"
Doc: "We usually up it every 15 to 30 minutes but we can talk to the nurses* about a plan."
Me: "With Pitocin, you'll require continuous fetal monitoring, right?"
Doc: "Yes."
Me: "So I will be tethered to the bed. You are basically setting me up for an epidural and cascade of interventions." (I actually said this, which is a bit out of character for sweet lil' me, but Honey Badger don't care**.)
Doc: "Well... There are telemetry units so you can move around. But there are only two so you could use it if it's not in use already. And for some women they just don't pick up the baby or the contractions so you'd have to use the wired units."
Me: "Um... Okay. But I will sign an AMA if it comes to it because I WILL be moving around in labor."
Me: "Also, will I still be allowed to eat and drink as I please in labor?"
Doc: "Well, with Pitocin we're more cautious about that."
Me: "I will be eating and drinking."
Doc: "Sometimes it depends on the nurse."
Me: "Can nurses really make that decision?"
Doc: "Well, they kinda can*."
That was about the gist of it. She called Labor and Delivery and scheduled me for 8 AM Wednesday. It makes the logistics of arranging things with our animal sitters, Evelyn sitter, doula, and photographer easier this way at least. But I'll tell ya - Honey Badger has been showing some claws and collecting pens to sign AMAs. I managed induced labor, pitocin, and mag sulfate with Evelyn but I also had the joys of a catheter and a nurse pushing Ambien and telling me I wasn't having contractions. I figure this time if I'm going to be induced, I'll make it the best experience it can be.
The bottom line is always healthy baby and healthy mom. However, I think it's right and okay for the means to matter too. Birth can be an incredible, empowering experience.
*I'm waiting to hear back from the director of the maternity program at my practice, who I called after my appointment and after talking with my doula, to ask about all this "nurse power" I didn't know about. Do nurses really get the final say on these decisions? I like nurses and I think they're knowledgeable and great and everything but it's frustrating to have things that I consider important be left to a toss-up of whether I get a nurse who is interested in low-intervention, supportive birth or the typical assembly line process.
** "Honey Badger don't care" is my labor motto this time around. Jonathan makes fun of me because I'm so late to the game in appreciating this meme (not safe for the faint of ears... but hilarious all the same). But you know what? Honey Badger don't care!
First, I waited for about an hour and a half. I felt bad for the nurse who kept coming out to apologize that the doctor was running behind. It wasn't the nurse's fault and yet I bet she'd been dealing with grumpy patients of that doctor's for a while.
Once I got my turn with the doc, I took my sweet time and she spent almost a full hour with me, answering questions and explaining things. That's an eternity in doctor time, so I felt vindicated at least.
The news? The residents and the attendings and the other important medical people talked about my case in their latest meeting and came to some conclusions. Basically, there has been a little bit of a debate amongst the three residents (Dr. Nervous, Dr. Laid-Back, and Dr. Inthemiddle who is the main one I saw until the last month or so when I started to rotate to meet the others). Two of them said that I didn't have chronic hypertension, because in-between pregnancies my blood pressure was at acceptable levels without any medication. One of them, Dr. Nervous, said I did have chronic hypertension because he noticed in my chart that indeed I was hypertensive and my blood pressure was managed with medication before and during my pregnancy with Evelyn.
The question is... once chronic hypertension, always chronic hypertension? It's a bit of a gray area. It's the reason I got the boot from the Birth Center - my favorite nurse ever was advocating for me to stay since my chronic hypertension seemed to have gone away after my pregnancy with Evelyn and with the addition of a good exercise and eating regimen in my life (hello, boot camp). But when all the staff met on me there to determine whether I'd risk out of their care for this pregnancy, the answer was yes. Because - once chronic hypertension, always chronic hypertension. The docs at the family medicine discussion came to the same conclusion.
The net result of this conclusion is that if you have a patient with chronic hypertension, there is a certain protocol to follow to lead to the best possible outcomes for mom and baby. There is a different protocol for gestational hypertension, and another for pre-eclampsia (actually, several depending on the severity of the pre-eclampsia or eclampsia). Two of my docs (guess which!) were treating me as though I had gestational hypertension and taking a watch and wait approach. One of them was treating me as though I had chronic hypertension and suggesting that I be induced between 39 and 40 weeks, which is the general rule for people with chronic hypertension.
According to the docs, I have gestational hypertension superimposed on chronic hypertension (because apparently I will always have chronic hypertension even if I need no medication and my blood pressure is good... once you have it, you have it - which by the way I think is ridiculous). As a result, the rule is that I need to be induced as close to 39 weeks as possible. And 39 weeks is tomorrow.
I asked lots of questions.
Me: "Can we schedule the induction for 39 weeks and 6 days?"
Doc: "Um, we'd really like to do it as close to 39 weeks as possible. Will tomorrow work?"
Me: "Tomorrow is my husband's birthday, so no."
Doc: "Let's look at Wednesday then."
Me: "Who is on call on Wednesday?" (Fingers crossed it's not Dr. Nervous)
Doc: "Dr. Inthemiddle."
Me: "So this means I'll have Pitocin. Do I also have to have Magnesium Sulfate?"
Doc: "No. Just Pitocin. Your cervix is ready so no balloon or prostogladins or anything either."
Me: "Excellent. But I don't like Pitocin. Can we increase it slowly and see if it sort of triggers my body into its own labor?"
Doc: "We usually up it every 15 to 30 minutes but we can talk to the nurses* about a plan."
Me: "With Pitocin, you'll require continuous fetal monitoring, right?"
Doc: "Yes."
Me: "So I will be tethered to the bed. You are basically setting me up for an epidural and cascade of interventions." (I actually said this, which is a bit out of character for sweet lil' me, but Honey Badger don't care**.)
Doc: "Well... There are telemetry units so you can move around. But there are only two so you could use it if it's not in use already. And for some women they just don't pick up the baby or the contractions so you'd have to use the wired units."
Me: "Um... Okay. But I will sign an AMA if it comes to it because I WILL be moving around in labor."
Me: "Also, will I still be allowed to eat and drink as I please in labor?"
Doc: "Well, with Pitocin we're more cautious about that."
Me: "I will be eating and drinking."
Doc: "Sometimes it depends on the nurse."
Me: "Can nurses really make that decision?"
Doc: "Well, they kinda can*."
That was about the gist of it. She called Labor and Delivery and scheduled me for 8 AM Wednesday. It makes the logistics of arranging things with our animal sitters, Evelyn sitter, doula, and photographer easier this way at least. But I'll tell ya - Honey Badger has been showing some claws and collecting pens to sign AMAs. I managed induced labor, pitocin, and mag sulfate with Evelyn but I also had the joys of a catheter and a nurse pushing Ambien and telling me I wasn't having contractions. I figure this time if I'm going to be induced, I'll make it the best experience it can be.
The bottom line is always healthy baby and healthy mom. However, I think it's right and okay for the means to matter too. Birth can be an incredible, empowering experience.
*I'm waiting to hear back from the director of the maternity program at my practice, who I called after my appointment and after talking with my doula, to ask about all this "nurse power" I didn't know about. Do nurses really get the final say on these decisions? I like nurses and I think they're knowledgeable and great and everything but it's frustrating to have things that I consider important be left to a toss-up of whether I get a nurse who is interested in low-intervention, supportive birth or the typical assembly line process.
** "Honey Badger don't care" is my labor motto this time around. Jonathan makes fun of me because I'm so late to the game in appreciating this meme (not safe for the faint of ears... but hilarious all the same). But you know what? Honey Badger don't care!
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-Abby