I have considered many titles for this post, from “How to Ruin a Perfectly Good Pregnancy” to “Thanks for the Buzzkill, Doc!” and “Please Don’t Ask Me What the Doctor Says.” Can you tell I’m a bit frustrated? I’ll go ahead and add a disclaimer here, to get it out of the way: I respect the medical profession and I’m grateful for it. I’m also grateful that we have access to doctors when we need them. I am not of the mind that all doctors are the same, and I believe wholeheartedly that most operate from a genuine desire to help their patients as much as they possibly can.
Now, on to my ranty post.
When I first confirmed my pregnancy, I was overjoyed, but also struck by the contrast between this one and my pregnancy with Annabelle. Both children are equally loved and wanted, but there’s a big difference between finding out you’re pregnant in the bathroom of an auto shop after picking up a test on a strange hunch; and charting, counting, waiting, and having a test on the ready for the very first day it could possibly return a positive result. It’s no matter that Annabelle wasn’t planned – she is the most pleasant surprise I have ever received and I’ll forever be grateful that she came along when she did. I may not have known it, but the timing was perfect.
This time, I was fairly certain I was pregnant, but when the positive test confirmed it, a cloud instantly appeared beneath my feet. I smiled to myself all day long and waited eagerly for my husband to call so that I could share the news. I felt no rush to call a doctor, as it was so early and I expected no complications, but the more the day went on, the more I wanted to share my joy. I wanted to wait until I was a bit farther along to share the news with our extended families, but I could certainly tell the anonymous voice on the telephone! And so I decided I’d go ahead and call and schedule my first appointment. It sounds a bit pathetic now, that I was seeking congratulations from some stranger at the clinic, but when you’re that excited, you just want anyone to join you in celebrating. At least I did.
Much to my disappointment, the conversation went something like this:
Appointment Line: “How can I help you?”
Me: “Hi, I’ve just found out that I’m pregnant, and I’d like to schedule my first prenatal appointment.” [Patiently awaits congratulatory response.]
AL: Requests identifying information and types away. Pauses. “Have you come in for a blood test?”
Me: “A blood test? No, I took a test at home.”
AL: “Oh, well you’ll need to come in for a blood test before we can schedule you. Once we get the results, you’ll need to go to an OB Orientation, and your first appointment won’t be until 12 weeks.”
Me: “I see. Well, I was there in my first pregnancy, so I don’t think I really need to attend an orientation.”
AL: “You’ll still need to go. You can come in for your blood test any weekday between 8 and 12.”
Me: “I see. Thanks.”
I felt deflated. My cloud disappeared. Not only was there no sharing of joy, but I was going to have to go in and have blood drawn to prove I was pregnant? Seriously? I don’t know anyone who has received a false positive on a pregnancy test, and I didn’t even need that darn stick anyway – I already knew. I am woman! Have they no faith in woman?
A few days later, I went to the clinic and let them run their stinkin’ blood test. I was annoyed when they told me a nurse would call with the results. Outwardly, I smiled, but inwardly I thought, “I don’t need your stinkin’ nurse to give me the results. I already told you jerks I’m pregnant!” It seems I was already nice and hormonal.
That afternoon, as promised, a nurse1 called and methodically let me know they now believed my claims. No congratulations from her either. She then went through a twenty minute survey in which she inquired into my complete medical history, including information on my first pregnancy. Having been seen for my first pregnancy at this very same clinic, I was irritated that they didn’t simply have this information on file. It seemed I was a mere number. She then let me know when I was to attend my (3 hour long) OB orientation, and I tried again to make my case, “I was seen there throughout my entire first pregnancy just two years ago. I’m pretty confident that I know what to expect.” She explained that I, “still need to go because that’s when you’ll make your chart and find out when your prenatal appointments will be, and we’ll also give you some really great books. There’s one called What to Expect When You’re Expecting. In fact, if you want it even sooner, you can come by to pick up a copy.” Interesting.
Of course I knew they couldn’t make me go to their orientation, so my plan was to skip it. As the date grew closer, however, my curiosity grew. I wanted to see what exactly they were telling women that they felt was so important, and so I went. The first thirty minutes or so were spent in silence, at tables, while each woman filled out her chart as nurses looked on. The questions covered on the chart were the exact same ones I had spent 20 minutes answering over the phone, and had answered at least once during my first pregnancy at the exact same clinic. What followed were three simple briefings, given using PowerPoint presentations, and then they scheduled everyone’s first appointment, though I had already made mine since I hadn’t planned to attend. Everyone was given the same stack of materials, which included brochures on everything from quitting smoking to asthma during pregnancy. Nothing was the least bit relevant to me personally, but the clinic’s job was accomplished, and the group of us was sent on our way.
No one could tell me who my first appointment was scheduled with, though I knew it wasn’t my usual doctor, since he was on extended leave. I went in for my first appointment, accompanied by Annabelle and the Daddy and waited in an empty waiting room twenty minutes past my appointment time. I was then ushered back to the exam room where my vitals were taken, I was told to strip down and cover myself with the blanket provided, and the nurse, with hand on ultrasound machine as she walked out the door smiled and informed me that, “We’ll get to see baby today!” I stripped down and then noticed the blanket was not, in fact, a blanket, and was not large enough to cover me properly so I got dressed again. I was glad I had done so, because I was shivering in my jeans during the extended wait as it was. Annabelle’s patience reached its end while we waited, and the husband had to take her out. The one thing I had wanted was for her to hear the heartbeat. We had talked about it all morning, but that was not to be.
Finally, the provider came in and introduced herself as a midwife (score!). She sat down and told me my “due date.” I explained that my due date should actually be a week later than one would expect, since my cycles are regularly 35 days long, not 28, and because I was charting I was positively certain that I didn’t ovulate until right around day 21, the day I conceived. She smiled and said, “Well, the ultrasound will tell us that.” Because you know, a dating ultrasound weeks later than the optimal range for dating accuracy, will be much more definitive than the confidence of the owner of the uterus in question. I then explained that I didn’t actually want an ultrasound, as there was no medical need for one at that point. She looked stunned and asked, “Well then how will we hear the heartbeat!?” My reply, “With a doppler?” “Oh, it’s way too early [11w5days according to her, 10w5d according to me] to hear the heartbeat with a doppler.” “Hm. Well, it was no problem at this stage with my previous pregnancy.” Silence.
We discussed the issue of my “due date” further, and I expressed my worry that when I neared the end of my pregnancy, I would have a doctor pressuring me for an induction because my chart would tell them I was “overdue” when I was really only 39 weeks. She launched into a lecture about the stance of the ACOG and explained the “dangers” of going too far past dates, closing with, “You’re my patient, but the baby is my patient, too.” As though I was certain to put my unborn child at risk and she would need to stop me. Of course none of that was relevant to my concern over inaccurate dating. Frustrated, I told her that we could just go ahead and change the date of my LMP, then. She was not a fan of this suggestion. At this point, I no longer cared.
She looked at my chart, then looked at me, apparently at a loss as to what to do next if there was not to be an ultrasound. “So what exactly would you like to do today?” I wasn’t sure how to answer her question and, annoyed, I simply said, “Check a box, I guess?” She stopped, then asked cheerfully, “Shall we check the heartbeat now?!” I expressed my concern that, if she really didn’t think we would hear one, checking would only lead to worry. She then insisted, “Oh, you’re thin, so it shouldn’t be a problem!” Hm, because that’s not what you said a minute ago. She added that it was really important to monitor the heart rate because, for one, that would tell us that the pregnancy was inside the uterus and a pregnancy outside the uterus could be life-threatening. I’m pretty sure that if I were dealing with an ectopic pregnancy, I would have figured that out before I hit 11 weeks, but what do I know?
No matter, she checked the heartbeat and it was strong and steady. We said our goodbyes on that positive note, and off I went.
So the result of my prenatal “care” so far?
I have felt like a number, not a patient. I have sensed a complete lack of trust for my own self-knowledge. So you think you’re pregnant? Take this test and prove it, then we’ll talk. You think you know how your body works, think again. The ACOG says you’re wrong, but I’ll give you an ultrasound, just to humor you. I went into this thing excited, and now I’m just mad.
I have been given a “due date” that I know to be incorrect. I have been told I’m anemic, when the numbers say I’m actually in the normal range for a pregnant woman and my past experience tells me my numbers will likely go up by the time I reach term. And finally, it has been confirmed that my pregnancy is, indeed, inside my uterus, though I was pretty well certain of that fact already. So far, I have wasted hours on “prenatal care” that has only served to undermine me. I certainly don’t feel the least bit cared for.
When you’re pregnant, all anyone wants to know is when your last appointment was and when you see your doctor again. I know these questions are meant in genuine love and curiosity, and I don’t take issue with the people who ask them. I do appreciate their care and concern, but each time I’m asked a question like that, I feel still more disappointment. It’s as though everyone around me is of the mind that I couldn’t possibly know anything about this pregnancy unless the doctor enlightens me.
I’m beginning to question the value of prenatal care in a normal, healthy pregnancy, and wishing for a real midwife, with patience, kindness, trust, and understanding – and clinical skills that don’t necessarily involve a machine. When I was pregnant with Annabelle, a few causes for concern arose and turned out to be absolutely nothing. I had way too many ultrasounds2, and a few extra tests to look into things that turned out to be non issues. All my prenatal appointments did was give me reasons to worry, and worry is no friend to the pregnant woman.
I’ll continue through the system (though I have managed a referral to a different provider in a different clinic – one I know I like!) because I know that having a record of prenatal care when we move will help me to find a good midwife to attend my birth. I also know that mommy guilt would eat me alive if anything happened that could possibly have been detected in a routine appointment, and so I check the boxes so that I can say I’ve done my duty. I won’t, however, look forward to my appointments3, and I certainly won’t blindly follow the recommendations of any provider. I’m beginning to see why some women choose completely unassisted childbirth, and opt out of prenatal care. Those choices are not for me, but I can see where the women who make them are coming from!
What is your experience with prenatal care? I would love to hear positives, as it’s not in my nature to be such a negative nelly!
- This happened to be the same nurse who I had spoken with about Annabelle a week or two earlier, and who had apparently been horrified by the idea that I was still nursing, prompting this post. She again expressed shock over my continued nursing and was quite curious to know when I was going to stop, since she knew that “some crazy people nurse them till they’re 3!” ↩
- This time we’re aiming for none. If only I had known more then! ↩
- That is until we get moved to someplace with good midwives! ↩