Now that is what I call prenatal care! Photo from lululemon athletica on Flickr.

You Call that Prenatal “Care”?

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.

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Now that is what I call prenatal care! Photo from lululemon athletica on Flickr.

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! 

  1. 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!”
  2. This time we’re aiming for none. If only I had known more then!
  3. That is until we get moved to someplace with good midwives!

26 thoughts on “You Call that Prenatal “Care”?

  1. Amy @ You Shall Go Out with Joy

    How awful! I have often thought that a big shortcoming among a lot of maternity care providers is the difficulty some have in realising that while they see pregnancy and birth dozens of times a day, this is a very unique and special occasion for each of their patients. Hope you can find a bit more of what you are looking for at your new clinic!

    Reply
    1. melissa Post author

      I really do think that’s a challenge for some! Others, I’m sure are amazing at it, and the doctor I had last time around really did seem to be genuinely kind and caring, would ask about my husband when he wasn’t at appointments, smiled, congratulated us, etc. It does exist – but it’s sure not the case with every care provider.

      Thanks for your well wishes! I’m scheduled with a doctor I don’t know next time around, but following that I should be able to see the wonderful woman who attended Annabelle’s birth for the rest of our time here :) Looking forward to that!

      Reply
  2. Amy

    I’m so sorry for your frustrations! I also felt like a number at times. I know that the PA did not recognize me from one time to the next. But, I did feel like I was getting great care, as strange as that sounds. One funny thing is that when I took an at-home test, my husband was so shocked (we were a little surprised by how quickly we conceived..Q-ball was actually created in my final days in Iraq) that he didn’t want to believe until we had a blood test. But, at our hospital, when I told them about the positive at-home test barely wanted to bother with the blood word because the at-home tests are so successful now! Everywhere is different. At least you are moving before the actual day! Good luck!

    Reply
    1. melissa Post author

      Thanks, Amy! My husband felt the same way this time around. He was sort of in disbelief that we had been successful right away and was really eager for the blood test to come back. I guess it just feels unreal when you’re not the one who’s nauseated ;) I’m glad to hear you were mostly happy with your care with Q-ball, and hope you have an even better experience if you decide to have another child!

      Reply
  3. Anna

    With all of my three I was cared for by a team of midwives and I had them for the births as well.

    In fact, Abi was planned to arrive in a birth centre but I was transfered to hospital, with my midwife, at 3 cm dialated because I had protien in my urine and my blood pressure was worrying. The midwife stayed with me for 6 hours beyond her shift time ending and left only to go and pick her children up from school. She came in the next day to see me in hospital. She was AMAZING.

    I hope your new clinic is a more positive experience.

    Reply
    1. melissa Post author

      That is wonderful, Anna! Europe seems to be far ahead of North America when it comes to matters of pregnancy and childbirth.

      Reply
  4. Rach

    Crikey!
    Talk about overkill! I am sorry your experience wasn’t more positive.
    Just to show you the contrast across the pond in the standard care I’ll tell you about the UK. Not to make you feel worse I hope, my intention is to show you that your instincts are correct – it doesn’t have to be that way.
    Here in the UK in general you just see a midwife generally throughout the pregnancy (there is one attached to my doctor’s surgery). You don’t see an OB unless there is something wrong. 2 ultrasounds only as standard throughout the whole pregnancy. Homebirths available with two midwives (no doctor). 1 midwife from the start of “proper” labour, another one comes out for the second stage.
    Not saying it’s perfect here, not at all, and yes most births are in hospitals. And medicalised.
    But there are birthing centres in some hospitals which are more homely and low-tech. Birthing pools etc in all hospitals I think.
    Midwives do most of the care.
    There was no hassle with me going 18 days past the due date.
    And it’s all free.
    If you did have to move to Suffolk and used the state health system then your birth would be midwife led in any case, although you could hire a private midwife too.

    Reply
    1. melissa Post author

      Thanks, Rach! That definitely does not make me feel worse. I *know* it can be better, and I sure wouldn’t mind if we ended up in England for this baby’s birth! I love that homebirth is treated as a perfectly reasonable and normal way to have a baby. It’s crazy to me the way most of the medical profession treats the idea here – and that it’s even illegal in some states!

      Reply
  5. Jessica

    You poor girl. That was super yucky and to think that it only happened in my third world country..hah!

    Hopefully your new clinic would be better…hugs…

    Reply
  6. Hail

    That is so annoying, it really angers me.

    Its like the other day I wanted to make an appointment to see the dental hygenist so I called up and was told that I needed to see the dentist 1st who would then see if I qualified for an appointment with the hygenist. People sticking to rules that are put in place for rules sake and annoying – yours is a little worst but I wanted to let you know this kind of thing happens to all of us!

    Reply
    1. melissa Post author

      I understand the value of rules, I really do – but there are times when they just don’t apply! Critical thinking should trump rules any day!

      Reply
    1. melissa Post author

      Thank you, Charise! That’s sweet of you to say. I know your prenatal care experience wasn’t ideal at the outset of your pregnancy this time around either. I hope it has all been positive from there!

      Reply
  7. Kelly

    Melissa I am so frustrated for you! :( I was cringing through this whole thing – and gagging at the What to Expect conversation! And one of the biggest bummers about your situation is how across the board ‘normal’ it is for most people…exactly the opposite of what it should be.

    I totally get the wanting to share your excitement thing and how awful it feels when it is squashed by someone you feel should be on your side (won’t go into negativity here, but I KNOW exactly what you mean from personal experience).

    An unexpected fear I have about becoming pregnant again that I never imagined I would have is that my prenatal experience will once again be not the one I want – it is something (among other reasons, to be fair) that is actually prohibiting me from wanting another child, when I always assumed I would want more. And they say it doesn’t matter!

    I am very sorry that this has been your experience so far…really, really hoping that it gets better and you find some awesome people to care for you and support you during this time. Blessings mama!

    Reply
    1. melissa Post author

      Thanks, Kelly! I’m so sorry to hear you had a negative experience with the Bean, too. It’s amazing what a difference that makes – it definitely *does* matter. I hope that as you continue your doula training, you meet some amazing birth professionals who restore your faith in the possibility of a good prenatal experience. It makes me so happy to see people like you going into the business of supporting pregnant women and new mothers. You’re just the type of person we need :)

      Reply
    1. melissa Post author

      See, I did not know that! Actually I do it almost daily because it’s part of the session on my prenatal yoga dvd. Thanks for the info – will have to look into that more – what’s the reason behind avoiding it? Your supported backbend looks glorious, in any case!

      Reply
    2. melissa Post author

      I looked it up, since I do it regularly and don’t want to continue if it’s ill advised. Everything I’m finding says it’s a great pose for pregnancy. If you have information on why it would be a bad idea, I’d be grateful for it! Certainly want to be mindful in my own practice.

      Reply
      1. Vicki

        I study and practice Iyengar Yoga, and we are taught that Vrksasana puts too much of a strain on the lower abdomen, which of course you don’t want to do while pregnant!
        This is the book I used while I was pregnant, Iyengar Yoga for Motherhood: http://www.amazon.com/Iyengar-Yoga-Motherhood-Practice-Expectant/dp/1402726899
        If there is an Iyengar teacher near you, you should go to class if you can. You should practice in different ways throughout your pregnancy, because your body changes so much (as you know!). A teacher can help you make sure your practice is safe and helpful to you and the baby.
        If you prefer videos, this one looks good, though I’ve never done yoga from a DVD. http://www.amazon.com/Prenatal-Yoga-Complete-Mary-Pappas-Sandonas/dp/B000980GXE

        You can email me if you have other questions. I feel like prenatal yoga really got me through being pregnant, and I love reflecting on my own practice and using it to help other mamas! Best of luck to you (and glad you are still nursing your toddler!!!)

        Reply
        1. melissa Post author

          Thanks for the information and suggestions! I took a live class during my first pregnancy, but this time around the only classes available are during dinner or bedtime for my toddler, and aren’t specifically prenatal anyway, so it’s not worth adjusting our schedule. Options here are pretty limited, so while video is not my favorite, it’s the only reasonable way for me to get a practice in right now! I am currently using this DVD, which is not amazing, but I have enjoyed it: http://www.amazon.com/gp/product/B000297NJA/ref=oh_o05_s00_i00_details

          Reply
  8. Janine @ Alternative Housewife

    I went in to ‘confirm’ my pregnancy and get my prenatal visits started the day I got a positive test. I totally feel you about wanting to share the excitement! That sucks that you had such a negative experience. I was actually congratulated and commended for making my appointment so early and being on top of vitamins… Maybe because I was 23 and they expected less of me? My doctor was not an OB but a family care doctor. She is a pretty good mix of crunchy and mainstream, just really laidback and trusts my judgment. Still, I’m not sure that she will deliver my next baby (although we will probably keep her as Sebastian’s pedi) because I feel like a midwife might give me better emotional care along with the standard visits. I hope you find someone who is a good fit for you!

    Reply
    1. melissa Post author

      I’m glad someone understands the sharing thing – I felt a bit silly reflecting on that as I typed it out, but I suppose it’s natural to want to share something so exciting!

      It’s so cool to hear about your positive experience. I love that there are caregivers out there who truly do care and I’m glad you found one!

      Reply
  9. Zoie @ TouchstoneZ

    Thank you for writing about your experience. I waited to read this because I knew it would make me angry. The only way that things will get better is if enough women question their care and respectfully demand better.

    I had a similar experience through more than half of my first pregnancy. Until I was so fed up with the level of care, I ended up homebirthing. The quality of care can’t even be shown on the same chart. My OB experience was impersonal and, frankly, insulting. My midwifery care was empowering, enriching and loving. I’m not knocking all OBs or admiring all midwifes. There are great and horrible of both.

    The point is that, everyone woman deserves to be treated better than you described. Everyone woman deserves the right to choose the care providers that best fit her. Some women might enjoy the experience you had and they should be allowed to choose them. You should be allowed to choose a care provider that will support you in the way you need.

    Reply
  10. Melissa Vose

    Argh! I’m so angry for you. I’m glad you got a referral to the doc who delivered Annabelle, she was pretty skoukum! This type of treatment is inhumane. I was also thinking yesterday after I read Annabelle’s birth story that telling a labouring woman that giving birth is one of the most dangerous things you can do, and reading her a list of what can go wrong, is abject cruelty. It’s also stupid. If birth is a parasympathic nervous system function, why purposely introduce fight or flight? WHY? Good intentions, cruel actions.
    This type of treatment should be outlawed. I hear you on the unassisted thing… I’m sure you will find a great midwife once you move, and she will be a great blessing as you navigate your birth. xxoo

    Reply

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