How do you deal with pushy doctors?

granola_mom · 06-28-2007, 10:45 PM

It's one day after my client's EDD and she is meeting with her doctor tomorrow to talk about induction. He says he will do the induction at one week past her due date, and didn't even talk to her about any of the alternatives. She doesn't have any complications that would make it necessary. I'm meeting with her tomorrow night to talk it through, but I'm wondering what kind of advice I should give her? Over the phone I have informed her that it is her right not to get induced if she doesn't want to (which she doesn't), and that she should ask him about alternatives and what his procedure is if she goes overdue (ie will he let her do BPP's to keep an eye on things?)

What I am worried about is her saying to her doctor "my doula told me... bla bla bla" and then having a doctor thinking I'm getting in the way of his convenient little plan. Then when I meet him at the hospital maybe we won't be on the best of terms. How do you all deal with doctors like this tactfully?

brooke.friedberg · 06-28-2007, 11:51 PM

I'm looking for good techniques on that one.....

MyDreamDoula · 06-29-2007, 12:44 AM

I would just be sure she has all of the proper information so she can make her informed decision.
BTW, I am also curious as to what people will suggest.

aspenleaf · 06-29-2007, 01:06 AM

Although I am new to these boards, I am not new to this type of situation.

If your client does not want to to be induced then she needs to communicate this clearly to her ob. She does not need to in any way phrase it with "My doula says...." share with her that this approach will be counterproductive. She needs to tell her ob that unless there is fetal/manternal distress she wants to avoid induction unitl 42 weeks. Give her some good info. to arm herself with as in knowing that edds are essentially guestimates and that she is comfortable with allowing baby to go past the due date. Alot of times compromising will work, i.e. coming in every so many days to have her bloodpressure taken or an u.s. to ensure placenta's viablility etc. This can help put the caregivers mind at ease. With induction sometimes starting w/stripping membranes also can achieve a compromise (if mom's cervix is favorable), it does not commit her to anything and can be repeated. Also have her discuss her preferences on induction. The bottom line is that she does not have to agree to an induction, again unless there is distress. There are no induction police out there. Is her ob going to send someone out to bring her in for the induction? No.

Just encourage her and her partner, if present , to be united and to stick to their guns while not being confrontational. Firm not fighting is effective. If it makes her feel better offer to be present at the visit but make clear that you will not speak on her behalf but rather will be a silent support. Hope this helps....getting sleepy so my thoughts are bit disjointed..sorry!

UtahDoula · 06-29-2007, 01:41 AM

Don't you think the OB will "find" distress if she says that? I've wondered a time or two. Like when the person doing the BPP says "Everything looks perfect" - and the OB calls mom and says "Come in RIGHT NOW - your baby needs to be born immediately" but won't say exactly why, even though execting mom is a doctor herself and is asking good questions.
And hmmmm...... it's Thursday, doc leaving town on Saturday am. And hmmmmm...... 6 pm Friday cesarean. hmmmmm......
My point is that it is hard for parents to say "Unless there is distress" - because the only way they can know is by what the OB tells them. It's a catch 22

douladot · 06-29-2007, 05:45 AM

I would definitely tell her about the Bishop's score and have her ask her dr. for one.

earthgirl · 06-29-2007, 08:16 AM

Educate her, and empower her to ask questions. When the time comes, she should know her Bishop score, alternatives to medical induction, benefit, and more important- the risks involved. She should also ask if it is routine for him to simply induce post dates, or is there something about her case specifically, and if so she wants more information. If she does not want to be induced she needs to communicate to her OB, "I do not want to be induced because __________".
She doesn't need to hear it from you...she can read it from info you have presented to her, and she can make her own informed decision. She can say I read (lend her Henci Goer's book if you have it), and I have questions about 'whatever'. Maybe the simple fact that she is educated in the matter, will give the OB pause to reconsider. One can hope.

Goodluck to you and your client!

tlcdoula · 06-29-2007, 08:31 AM

Honestly I think most of the work needs to be done as early as possible in the pregnancy or when the doula is hired. Finding out if there is that good fit between mother and doctor and if not having the mother find a new doctor as early as possible is best. By this point in the pregnancy it gets harder to do anything about it. Yes the mother can tell the doctor that she does not want this unless there is a reason for it and trust me I have seen many doctors who have found a "reason." Unless mom has a medical background her could tell her just about anything and often times I see the doctor convince the mother. It is wrong, but they do it.

At this point unless the mother is very strong in her convictions it is almost a lost cause because he will start his speech and often times the mom's cave out of fear (again it is wrong and stinks, but that is what happens). That is why I believe it is so important to find these things out earlier in the pregnancy. In fact that is what I do at the first prenatal. I talk with parents about their healthcare provider and his/her beliefs and we talk a lot about it. If the family even gives me an inkling that they are not comfy I will suggest that they talk more with their doctor to find out if they are on the right page. A few times I have had mothers come back and say "well he says he will do this or that" and I will ask her how she feels about it and if her feelings are strong I will suggest changing doctors and will offer to help her find a good one. If she refuses (like my one client right now) then that is her choice and she has accepted this doctor as he/she is and the mom then accepts the doctor's practices as well.

I have one client like this right now. She moved to this area, met the doctor once and wasn't comfy with her. We talked about it at length and she said that she doesn't want to switch again, so she is accepting what this doctor stands for and has to offer and it is out of my hands. Other moms I have worked with have said they wanted to change and went on to have great birth experiences with great doctors.

tlcdoula · 06-29-2007, 08:32 AM

Quote:

Originally Posted by douladot

I would definitely tell her about the Bishop's score and have her ask her dr. for one.

Instead of asking her doctor what her Bishop's Score is I have found it is better if mom asks the questions that will tell her position of the cervix, dilation, etc and then she can go home and plot it out herself because if her doctor knows what she is doing he could give her a number that is higher and more favorable.

earthgirl · 06-29-2007, 08:40 AM

Quote:

Originally Posted by tlcdoula

Instead of asking her doctor what her Bishop's Score is I have found it is better if mom asks the questions that will tell her position of the cervix, dilation, etc and then she can go home and plot it out herself because if her doctor knows what she is doing he could give her a number that is higher and more favorable.

That's a good idea. I agree Michelle about women caving because of the fear factor. I find it very disheartening when healthy (non high risk) women go OB's they don't even like!

Worse when they can switch, but don't want to hurt their feelings. Like the OB's feelings are more important than their own!

doula Michele · 06-29-2007, 09:40 AM

I just tell women of benefits, risks and informed consent. I tell them about their cervix, and how it works and that they have the right to say yes or no.

Beyond that it is up to her, and I am there to support her.

aspenleaf · 06-29-2007, 11:04 AM

Just want to clarify my post since I am new to all of you and I was soooo sleepy when I wrote it. Literally the last thing I did before rolling into bed!

Distress....yes...many ways for an ob to use that to his/her benefit. But there can be ways to compromise and not look like a "difficult patient" was the point I was trying to convey.

Ultimately this is an aspect that needs to be shared with clients early on working with them. It is a huge part in my opinion and when it is caught last minute it becomes
difficult. I think it does boil down to informing the client on options and finding what they are comfortable/not comfortable with. How a client phrases their thoughts to the hcp is huge. Being a positive support for the client no matter how this plays out is huge, agenda pushing never gets anywhere.

Blessings to you and your client granola_mom!

AmandaB · 06-29-2007, 11:26 AM

I have handouts from the CIMS report about inductions and can get my hands on a variety of others. I share these along with the Bishop's Score with clients so that they can make an informed decision and have an open conversation with their hcp. I also provide them with my BRAIN handout on Prostaglandin Gel.

There is always alternatives. Especially with healthy mom and babes. I think people need to be informed about the options. They also don't have to show up the day of the induction, they will play the "dead baby" card which also sucks but it is up to your client to make the right choice for her.

granola_mom · 06-30-2007, 12:12 AM

I met with my client tonight and we talked for a good while. I assured her that it is her decision, not her doctors, whether or not she will get induced if there isn't any fetal/maternal distress. Basically, her doctor makes all her decisions for her and doesn't really tell her what is going on. He told her one of the reasons he wants to induce her is because her feet are swollen... I've never heard of this. I know face and hands are a sign of preeclampsia, but not feet. Anyone know more about that? I told her to ask him why he's worried about it, drink plenty of water and put her feet up to bring the swelling down.

I wish I had met her earlier in the pregnancy. I feel she is afraid to stand up for herself. He wants to do the prostaglandin gel on wednesday, and so we've talked about questions she can ask such as if she can try a stretch and sweep, if she can try natural induction methods, do the BPPs, the questions so we can determine her bishops score, and if everything looks okay if she can wait another week. He hasn't even mentioned BPPs to her! He also stripped her membranes today and didnt even ask her consent! He told her afterwards.

I told her I can come to her wednesday appointment with her if she wants. Unfortunately she cannot meet with her doctor until wednesday, which is the day he wants to start the process and if the gel doesnt work, do the IV on thursday. She asked me if it would be possible to get the gel and then refuse the IV... wasn't sure on this one, but told her I was pretty sure it would be easier to stall things as long as possible than try to stop him in the middle. Would she get the unnatural contractions from the gel?

I'm planning on calling her on tuesday night to go over things with her again, and hopefully she gains the confidence to stand up to him. This is the kind of things that really makes me want to become a midwife.

Babycatcher · 06-30-2007, 01:26 AM

Quote:

She asked me if it would be possible to get the gel and then refuse the IV... wasn't sure on this

YES, she has the absolute right to NOT consent to anything, and if she doesn't want to be induced, she can stay at home and not go in at all. They will not drag her to the hospy, and if she is worried about pissing the OB off it is ok because 9 times out of 10, he won't show up until it is time to push so she won't even have to face him. She CAN request an ultrasound and biophysical profile, and the suggestion to ask about the cervix so she can come home and look up her bishop's score is awesome.
ALSO if there is NO WAY out of pitocin, she CAN insist on them ONLY turning it up once an hour, and at tiny incriments, AND she has the right to demand they turn it off once she is in a good pattern. In fact, if she doesn't get in a good pattern, she can request it be turned off, stoppped altogether, and she can be sent home as long as they haven't snuck in and "accidently" ruptured her membranes during a vaginal exam.
As far as swelling in the feet and hands, about 80% of women have some swelling in those areas. When it becomes an issue is when there is a dramatic amout, often in the face, and there is a high BP AND Protien in the urine (BOTH signs have to be present with the swelling) for it to indicate a problem like pre-eclampsia.
I think just giving her some good information so she isn't unnecessarily concerned or mislead by the Dr is the best thing you can do for her.