Wednesday, August 18, 2010

A Change Is Gonna Come - We Think

I saw my doc on Monday for my 30-week (yikes!) appointment.  Everything looks good, and I even managed to lose 4 lbs.  The weight loss is likely due to a slight return of nausea over the past two-week period.  My doc had warned me previously that this could occur in women who've had hyperemesis and that I should take the Zofran pills on an as-needed basis.  Most of my nausea was eased by a cup of tea and longer naps; there was really only one day where I needed the Zofran to get me out of the cycle.

I also went over our preferences for the birth with my doc.  JD and I are both hoping to have as "natural" a birth as possible, i.e., one that is as unmedicated as possible.  Our doc was mostly willing to work within our preferences, but absolutely balked on the question of external electronic fetal monitoring (EFM).  Apparently, the policy of our hospital and of our doctor (who only works out of this one hospital) is to have the mother on continuous EFM from the time she walks in.  At our hospital, this means that mom cannot get out of bed while she's in labor.  (Other hospitals have the capability to do wireless EFM, so that moms can move around, change positions, and even take a bath while remaining monitored; it's just that our hospital does not have this capability).

In our research and through our Bradley Method classes, JD and I have learned techniques to cope with labor and almost all involve being able to move freely and change positions as needed to encourage an easier labor and easier delivery.  It seems like we're at a deal breaker with our doctor, which just stinks.  If our doc delivered at any other hospital in the area, we could go on the wireless EFM and that would be fine with me.  But we can't, so it's time to investigate other options, even at this late stage in the game.

I contacted a local midwifery practice that delivers at a hospital only 30 or so minutes from us.  The nurse was pretty sure that they'd be able to take me on; I just have to go through a phone consult with one of the midwives to make sure that I'm not high-risk for their practice (I'm not).

Once that's done, they'll want me to meet all of the midwives in the practice, and I need to make sure that I get my records transferred over at least 3 business days before they meet with me.  The nurse highly recommended that I call my doc's office to inquire about their policy for transferring my records and the doc's office manager said, "Well, you have to give us at least 30 days, although we usually get it done before that."  WHAT?!  3 days vs. 30 days.  After looking at my records though, the office manager said it shouldn't take really long to get them together, since I only started with the practice during this pregnancy.

Still, before they start copying the records, they need a letter from me releasing me from their care.  I'm not ready to do that yet, because I don't know if the midwives will take me on.

I also didn't want my doc to know that I was thinking about changing practices until after the decision was made and I could write a letter explaining that I loved her, but that the EFM issue was a deal breaker for me (maybe this would give her leverage with the hospital).  This stinks.

I think I may have to get a little lawyer-y with the office manager and tell her I want a copy of my medical records for my personal records.  It's called HIPPAA, dude, I'm pretty sure I'm allowed to get my files cause they're MY files.

Anybody have any other ideas or experience in dealing with this?


Anonymous said...

Ugh, sorry you even have to deal with this, at this stage in the game. As far as the monitoring itself... (this is all fairly hazy, as life with a 17 month old has sucked my brain cells away) but I believe our doctor/nurses only "needed" 10 minutes of fetal monitoring per hour until I reached a certain point - which I believe was like 7 or 8 cm or something? So that meant I was able to get up and walk the halls with my little IV cart, sans monitor. Now, they were clear that if the baby was under stress, then my hall pass would be revoked and I'd need strict monitoring. Once I got the epidural I was obviously in bed anyway, and the monitor was fine. He was moving quite a bit and they were unable to get a feel for his heart rate, so they ended up using a fetal scalp monitor (which was even more invasive, but I didn't have a choice, his heart was decelerating too much). Anyway, all that to say, I loved being able to have some freedom to move about, and would have been pissed to stay in bed the entire time. Maybe your doctor is willing to compromise so you have some freedom but they still get the monitoring they need, a few minutes per hour?

Carrie said...

Yes, they are YOUR files. Get bitchy with them if you have to. (I swear no one who works in the offices actually understands HIPPA rights.) I once stood in line blocking everyone and demanding MY files. They can charge you to copy them, but I think there's even a limit on how much.

Melissa G said...

I think it's great that you are being so proactive with your birthplan. I don't blame you at all for looking elsewhere. I think your doctor will understand, and hopefully even be able to work something out for you.

My BFF used the Bradley method for the birth both of her kids- one of which I was in the room for. She did great. Yes, it's hard. Yes it's painful, but she made it through great, and so did both of the babies. said...

I switched doctors at 34 weeks because my first ob was a jerk bag :)

I agree about demanding your records. There's some limit of time they need to do it in and 30 days seems excessive.

In the hospital with my DD they wouldn't really allow me to walk around. it was awful. I don't blame you for wanting your birth experience to be more natural at all.

~Jess said...

I think you should go all lawyer on them :-)

Our hospital had me hooked up when I got there, but disconnected me before I got in the tub, but I never made it to the tub, so I don't believe I had the EFM. I don't know if that's standard or that things just transitioned so fast they forgot. I also labored the entire time (almost) on my knees leaning against the bed.

Hopefully things work out, either with the doctor or the midwives.

Quiet Dreams said...

The whole thing sounds like a huge PITA. 30 days to transfer your records? That's just crazy.

Lorin said...

Its a PITA, but just tell your doctor's office you want copies of all your records - no need to tell them why and, yes, by law, they have to give them to you - and send a copy to the midwife yourself. Don't ever trust a doctor's office to forward records.

Amanda said...

It SUCKS having to get your records from a doctors office. I had to switch OB's when I was in my first trimester (twice). They were snotty when I tried to get my records because they thought I was leaving just to was insurance related only! Maybe if you contact the midwife practice again they can request your records. Often times one practice will show more courtesy to other practices.

I'm sorry your doctor doesn't have privileges at the hospital with the wireless monitoring. :(

Courtney said...

Could you contact the midwives and see if they have a release paper you can sign for them that THEY can fax to your ob for the files? I had to do that with my RE from my gyn for tx.

I agree with uncomplicate there a way to compromise with the ob? Like, use the EFM for a certain amount of time during an hour and/or if the baby is in distress?

Either way, I hope it all works out for you to have the birth experience you want:-)

Michelle said...

I always ask for my records even when I don't need them. I like to have them for my records and then I can freely copy them for any new doctors. Plus, I love to see whats the doctors write about me :)

Sam said...

I think that being able to move freely is very important during labor. Do whatever you need to have the birth that you want.