Robyn.Bowles.es

We had another OB visit today with our third doctor. About two months ago I contacted our insurance company to ask if there was a private hospital with a neonatal intensive care unit, just in case a problem would arise that might require hospitalization for Isabela (as happened with Josiah).

I was told that yes, there is one hospital in a suburb of Sevilla, but in order to go there I would have to be attended by the doctors in a specific office. So we had our first visit there with Dr. Rodriguez five weeks ago and again today. She is young and was nice and assured us that the NICU at the private hospital is much better than that at the public hospital. At our first visit we accepted another ultrasound and didn’t question anything she ordered or said.

Today, however, was different. Although at one time I touted the importance of every pregnant woman in our office doing the routine one-hour glucose tolerance test, I decided to follow the advice of my midwives and instead of downing 50gm of pure sugar in 5 minutes, then having my blood tested an hour later, I did what is called a 2-hr post-prandial (after eating) glucose test at the pharmacy.

I agreed with the midwives we have been seeing on the side that 1) I was not at risk for gestational diabetes, 2) I had no signs of gestational diabetes, and 3) downing that much sugar in one setting was not natural, would make me feel sick and we don’t know what affect it could have on the baby. I did a little more research on the accuracy of the 2hr PP test and found that in several trials, the results of the two tests were similar enough (within 5 – 10 points, I believe) to be considered accurate. My result was well within normal so I wasn’t concerned about the accuracy.

Of course, the doctor was none-too-thrilled to hear that I had made this decision. She was shocked that I chose to do it this way and argued with me about the inaccuracy of it.

Then it came to the ultrasound. As she stood from her desk and motioned me to the exam table, we paused and I told her that I prefer to avoid any more ultrasounds unless they are medically necessary. Shocked again, she sat down, looked at me and said “Why would you want to avoid ultrasounds?” I told her I wasn’t comfortable with the risk (which she quickly dismissed stating emphatically that it is only sound, there is no risk); and then tried to say that repeated ultrasounds, as are done in Spain, are not recommended in the U.S. (I think I got that out, not sure; and if I did she dismissed it).

She argued that of any time, today was most important to make sure baby had grown well. Samuel asked her if she could measure my uterus using her hands to which she gafawed and said, “You’re asking me to practice medicine from ages ago.” (as the doctors and midwives in the U.S. do!) She went on to say that she would not be responsible if something bad happened if we made this decision, and a few other things I didn’t catch because she spoke so fast. I hated the tension this created and was ready to give in to avoid fighting any longer. I also thought maybe she was saying if I refused this then she wouldn’t see me again; and I didn’t want to deal with the stress of finding yet another doctor to argue with.

She then told me about the labs she wanted to order next: a 24-hr urine collection to check for protein (a sign of preeclampsia), and other blood tests (again for signs of preeclampsia). I was still so flustered that I didn’t really hear what she was saying as I was trying to settle my mind and decide what to do. At one point she asked, “Do you agree?” and I said yes. I figured she was asking about doing the labs, but may have been asking about the ultrasound – either way, I just didn’t want to fight anymore, or be labeled “the crazy patient.”

She stood up again, and said she was ready to do the test, Samuel asked which test she was referring to and she responded, “An ultrasound”. He firmly, yet respectfully, said, “No.” She accepted this; quickly wrote something in my chart, looked at my belly across the desk and said I looked to be growing fine, and told the nurse to give me an appointment in another 5 weeks and we said our farewell.

It was so uncomfortable and I hated that feeling; but I am glad Samuel was there and he stood up for what we had decided ahead of time. When I got home I did more reading about current recommendations, accuracy and the usefulness of routine ultrasound and was validated in what I already knew to be true.

It is unsettling to be told one thing when I know and believe another. And I imagine that is how it was for her, too. I can remember a handful of our patients who would challenge the norm and I was puzzled by them: those who declined the one routine ultrasound offered or preferred the use of a fetoscope over a doppler to listen to the baby’s heart, and one woman whom we saw up to almost 40 weeks, and had no record of delivering we later found out she had chosen a home birth!

But at that time I was part of the system of the “norm,” and didn’t question why we did what we did. My own personal experiences – especially in a culture where the “norm” is way more medicalized than how we practiced in our office – has challenged and encouraged me to question “why?,” to consider alternatives, and to investigate and research more for myself. I now deeply respect those women by whom I was once puzzled, and I hope that just maybe, our “contra-corriente” (against the current) decisions will encourage our care providers to question “why?” they do what they do.

It may be only a drop in the ocean, but I am proud that we were able to add at least that one drop today.

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