Monday, February 11, 2008

Our new baby, installment #21

Continuing the story of my plan for a home VBAC, I was mulling what to do about Strep B testing, the enormous birthing tub was finally set up, and I was meeting with the midwife for a weekly appointment. It was then that she took my blood pressure and found that in the space of a week, it had jumped from about 115/70ish to 139/80ish, with 140/80 being the benchmark for preeclampsia, a mysterious and potentially fatal afflication for which the only cure is delivery of the baby. Yikes. For the first time, I was worried, even though she did not appear to be. She said she did not think I was preeclamptic; that elevated blood pressure was just one symptom and I had no others. I was swollen but not more than most pregnant women in the last weeks. Still, we agreed to monitor this closely.

The next day, I felt a bit more swollen, so instead of trekking a few miles to my midwife's office, I thought I'd go to the medical practice right next door to my office. In my naivete I thought I could simply call up and ask to have my BP taken. Which I did. And they all but laughed. Who is your primary care doctor, they asked. My primary care doctor had left the state some time ago and I never bothered to find a new one. (There is a shortage in Massachusetts, by the way, and long waiting lists.) Anyway, I was outraged that no doctor or nurse would take my BP, even though I had insurance and saw doctors in that practice.

I quit working that day and followed the midwife's advice to consume as close to 120 grams of protein per day as possible. Not easy to do. I tried to pack in the protein by drinking Kashi protein shakes, eating lots of eggs. It was gross.

A couple days later I felt a bit more swollen and wanted to check my blood pressure again. Although my midwife's office was not far away -- just a few miles -- it was more convenient to go to the medical practice office where my kids go for their pediatrician visits and where I had been seeing a certified nurse midwife for my primary screens and GYN appointments long before I was pregnant. I had not seen an OB in about 4 years, since my first son was born. So, I waddled into the office and asked if I could have my blood pressure checked.

"Do you have an appointment?"

"No," I said, giving her the name of provider I last saw there.

"Why do you want your blood pressure checked?"

I told her it was elevated.

She told me to take seat.

Then someone whom I think was a nurse called me in and asked with big huge eyes and hushed tones what was wrong. I repeated the situation again. She looked very concerned. She asked me what hospital I was delivering at. I stuttered. I said I just wanted my blood pressure checked. She asked me who my OB was. I felt like I was about to be grounded. For some reason I panicked and gave her the name of my last OB. I thought I would get kicked to the curb if I told her straight. Anyway, it was no surprise that when she took my blood pressure it was 140/80. The. Stress. Of. Going. To. That. Office. Was. Awful. She told me to get to the OB immediately.

I left really upset and called my midwife. She told me to go home and rest and offered to come to me to take my BP. It seemed like a silly thing for her to have to do, given that I had closer options.

I demurred, went home and had a protein shake. The next day, I was feeling stubborn. I figured I would go to the local health clinic around the corner from my house, a clinic where people without health insurance go. I knew they would gladly take my health insurance and co-payment and take my blood pressure. They did. It was a few points lower. I skipped the blood tests, went home, and had more protein. I talked my midwife, who reassured me that all was well.

Again she said she would come to me. But I figured I could wait until my next appoinment with her a few days out. At least I hoped I could. In the meantime, I fumed about the health care system.


Amy Tuteur, MD said...

I'm confused. Why were you fuming about the healthcare system? Can you go to a lawyer without an appointment, just to ask a quick question? Can you go to a psychologist without an appointment, just to get a little bit of help because you are feeling down? Why, exactly, should a healthcare professional see you without an appointment, simply because his or her office is more convenient for you than seeing the provider that you hired?

What about the legal liability for the provider? Suppose your blood pressure had been 140/95. Do you think the doctor could just let you walk out on your merry way? Obviously not. He or she would have to interrupt office hours, inconveniencing patients who have do have appointments, while he counsels you, examines you, arranges for your transfer to the hospital, etc.

I'd be the first to agree that the healthcare system could be far more responsive, but is it reasonable to expect that every doctor's office is like McDonalds. you just step up to the counter and order what you'd like?

Sheridan said...

Well, I am nervous now. It is interesting you didn't just have your midwife come over and check you out. How were you feeling at this point? Were you nervous or did you feel like everything was really ok. It seems like you were concerned, hence the desire to find a place as close as possible to get checked out.
I hope with all the protein you are eating and relaxing you are able to get it under control!

Howdie said...

Shouldn't this be installment #21 Tina?

I am also confused as to why you didn't just call your midwife?

Tina Cassidy said...

Howdie, thanks for the edit. Duly fixed.

Tina Cassidy said...

I did call my midwife. She even offered to come to me. I was feeling fine. Just wanted to get it checked. For my own convenience, the local clinic worked and I did not need an appointment. As for stopping at my other provider's office, I did not go in and demand I be seen, as if placing an order at McDonald's. I went in because it was on my way to someplace else, and I merely inquired if it would be possible to have my blood pressure checked, as this was the office our family had been going to for nearly a decade. Didn't seem unreasonable to me since drug stores have blood pressure machines near the front doors. But Dr. Amy hit the nail on the head. Everyone is worried about malpractice. The was clearly what I had run up against. No doctor wants to see for the first time a woman who is 9 months pregnant.

mom said...

Dr. Amy - Are you kidding me when you say "Why, exactly, should a healthcare professional see you without an appointment, simply because his or her office is more blah, blah, blah"? Because, these are human beings responding to a 9 month pregnant woman who is concerned that her blood pressure is dangerously elevated. She didn't just stroll in to get some medical advice. It is inconceivable and inexcusable for any health care provider to turn someone away - especially under these conditions. That a mother and baby could die is reason enough to say to patients waiting, "if you could just give us a minute or two to help this woman" would do more for their practice than to turn someone away and risk a catastrophic outcome. The more I went through this process with my daughter, the more understanding I became of her need for compassion and support. Would you have helped her? Or would the practice that you worked for make you turn her away because of liability? You don't think there's liability in turning someone away that could be seriously ill? I will reserve my final opinion of the HBAC until Tina has written her last installment. But insurance is driving the direction of healthcare. Who really is in charge? You seem so passionate about womens healthcare - and you're smart too. For the sake of humanity, why don't you work toward reform so that the medical profession can do their job the way they were trained instead of weeding out high risk patients who don't have an appointment because of liability. I would hardly liken this visit to the medical practice to ordering a cheeseburger at McDonalds, but I bet McDonalds could give them some tips on treating people like people.

Amy Tuteur, MD said...

Tina's mom:

"It is inconceivable and inexcusable for any health care provider to turn someone away - especially under these conditions."

It was my understanding that this was about convenience, not a medical emergency. A medical emergency would be an entirely different circumstance. I don't think there is a doctor alive who hasn't, on more than one occasion, rushed to the emergency aid of a complete stranger in a restaurant, on an airplane or by the side of a road after an auto accident.

mom said...

Dr. Amy - I just think it's common sense. If I saw someone that pregnant come in for any kind of evaluation at that point - I'd drop whatever it was that I was doing to attend to her needs. What would you have done?

Amy Tuteur, MD said...

Tina's mom:

"What would you have done?"

I would not have seen her and would not have allowed my staff to take her blood pressure. You simply can't walk in off the stree and ask for a medical evaluation, which taking her blood pressure would entail. I would have advised her in the strongest possible terms to see her own midwife since medical history is critical to evaluating pregnancy complications. Blood pressure can only be interpreted in light of the history of blood pressure throughout the pregnancy.

Had she asked me I would have told her that all the existing scientific evidence to date shows that homebirth has an increased risk of neonatal death compared to hospital birth for low risk women, that a home VBAC substantially further increases that risk and that eating extra protein to control high blood pressure is a scam fabricated by a charlatan.

On the other hand, if a pregnant woman walked in complaining of an emergency, I would have seen her immediately.

mom said...

Dr. Amy - That's a very strong response. And, actually, dispite your answer I think you're borderline compassionate! But if I was a patient in your practice and I heard a 9 month pregnant woman being turned away because her concerns were being dismissed I would leave your practice immediately. You don't think women have the intelligence to know what their blood pressure history is? And furthermore, how would you know if it was a medical emergency if you didn't take her blood pressure? By any human account, you cannot convince me that your reasoning is correct. Lack of human decency is one of many reasons why people in general are looking for alternative healthcare options. I'm going to bed. Good night.

emjaybee said...

Oh man, I'm loving this so much. Tina's Mom, Dr. Amy is notorious on every midwifery blog/birth blog I've ever visited...and now she's found you. Be prepared for constant trolling.

Tina, if you don't know what I mean, just visit a few midwife blogs and ask..ha.

I get white coat syndrome with BP myself, which is funny since even when pregnant, my pressure was usually low. I had one kind doc who finally told me to visit 3 different drugstore machnes on three different days and write down the measurements, then see what the median was...and whaddya know, my pressure was considerably lower than in her office.

Sort of the medical version of quantum physics, where to observe a particle is to affect it..patient stress levels (and what they tell docs) are always going to be affected by the dr./patient relationship.

mom said...

Emjaybee - I am very aware of Dr. Amy's participation in this and other blogs. In fact I have visited her site from time to time. Dr. Amy has a lot of good important information to offer but the problem is that she cannot communicate it the way most women would listen to it. Instead of conversational, she makes it adversarial which is too bad. It's kind of a waste, really of her expertise. But some people who are as passionate as she is needs a voice and she has found it here and on other blogs. Her comments are imoprtant - kind of balances things out. Keep up the good work Dr. Amy.

chris said...

I am confused about the protein thing. What does eating protein do for your blood pressure?

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