I don't have a Gyno

posted 3 years ago in TTC
Post # 3
Member
3677 posts
Sugar bee

You might just be able to continue to see your primary during your pregnancy. You might also look into working with a midwife.

OB/GYNs are the default for maternity care in the US, but that’s actually kind of a weird and really inefficient way to do it. We also have the worst outcomes in the industrialized world for maternity-related morbidity and mortality, and that is not an accident. OB/GYNs are surgeons by training, and they specialize in pathology (i.e. problems and high-risk cases). They’re not really trained in normal, uncomplicated, low-risk pregnancy and birth, believe it or not!

In other countries with better maternity statistics (notably the Netherlands, Denmark, Sweden, the UK … much of Western Europe, really) the majority of pregnant women receive their care from midwives as long as they remain low-risk. When/if a risk factor materializes or a complication develops, only then are they referred to obstetricians. It leads to lower intervention rates and more successful outcomes overall, as well as lower costs.

Your chances of achieving an intervention-free or low-intervention birth are significantly improved if you seek your maternity care from a midwife or a family physician. I would say, if you like the doctor you have, just see if that person is willing to continue caring for you during pregnancy.

 

Post # 4
Member
9137 posts
Buzzing Beekeeper
  • Wedding: November 2013 - St. Augustine Beach, FL

@MsTargaryen:  I have seen an obgyn since I was 16 for paps and well woman visits. Some women wait until a positive pregnancy test before seeing an obgyn for the first time. It’s usually better if you are an established patient before getting pregnant. In my area obgyns sometimes refuse new patients if they have too many established patients due around the same time as the new patient.

Post # 5
Member
3010 posts
Sugar bee

@MsTargaryen:  I would ask your pc for a recommendation. Research your options and consider what type if birth you want. Some people here seem to think think that ob/gyns are just looking to ruin your birth experience. Most are great and willing to work with what you want. Some people prefer a birthing center/midwife route. Just do some of your own research and talk to your doctor!

Post # 6
Member
8821 posts
Buzzing Beekeeper

I’ve only ever seen an OB when I had a D&C for a pregnancy loss.  I’m 15w2d pregnant now and the doctor says I won’t see the OB until 20 weeks.  It’s not that uncommon for a woman to not have an OB.

Post # 7
Member
2243 posts
Buzzing bee
  • Wedding: January 2012

I have never had an appointment with a gyno either and won’t be needing one unless my pregnancy has complications. My GP has always handled my gynecological needs (paps, exams, pre-conception bloodwork). Once I hit 12 weeks my pregnancy care was transfered to my midwife who will be monitoring me from now until post-partum. Hopefully this is an option for you. 🙂

Post # 9
Member
174 posts
Blushing bee
  • Wedding: April 2013

@KCKnd2:  They’re not really trained in normal, uncomplicated, low-risk pregnancy and birth, believe it or not!


Is this a joke? Please show me some evidence of this. 

Post # 10
Member
3677 posts
Sugar bee

@cstarkwe:  No, unfortunately. I wish it were a joke, but obstetrical training focuses on pathology and complication and not on normal physiology. Additionally, the routines and policies that are standard for most hospital births in the US may be “normal” in the sense that they are numerically commonplace, but they are not normal in any real, physiologic sense of supporting optimal birth. OB/GYNs practice exclusively in hospitals and so virtually every birth they see (except for women who arrive already in advanced labor) is either surgical or, for the vaginal births, affected by these unnatural conditions. A few examples:

– nearly all women who give birth in a hospital do so in a recumbent position, either flat on their backs or semi-sitting. This might be because of hospital policy, and/or it might be because they are hooked up to IVs and monitors that de facto immobilize them in bed. In a normal birth, women instinctively move around and change positions to make themselves more comfortable, and in doing so they advance their labors and assist their babies’ passage down the birth canal. A reclining position narrows the birth canal, risks compressing the mother’s blood vessels and the baby’s umbilical cord, and forces the mother to work against gravity and push her baby upwards out of her vagina. When not confined to bed, many women naturally assume other positions for labor and birth that do a better job of opening up the birth canal and taking advantage of gravity: squatting, kneeling, sitting, standing with support, all fours.

– Most hospitals time labor against the Friedman curve, which prescribes an average length of time for each stage of labor. They typically use Pitocin to artificially accelerate labors that don’t adhere to the Friedman curve, and women know that they are up against a deadline: if they don’t give birth within the time frame, they are facing a C-section. This produces stress that works against the natural progress of labor. Interventions such as epidurals also slow labor. Furthermore, there is evidence that the Friedman curve is artificially short, especially for first-time moms. Besides which, it’s an average, which means that, by definition, half of all births will run longer. In any case, OB/GYNs are trained to push birth to conform to the hospital’s timeline, rather than nature’s. They also only spend a relatively brief amount of time with any given laboring woman – hardly any OB/GYNs simply sit with a woman in labor and witness the full natural process unfold, neither during their careers nor during their training. Incidentally, like the Friedman curve, due dates also represent an average length of gestation, the peak of a bell curve that extends for nearly two weeks on either side. According to the law of averages, about half of all pregnancies are supposed to go some length of time past their official due date (again, it is especially common for first-time moms to be on the long side). But most OB/GYNs are trained to induce before natural labor can start in pregnancies that go past the EDD. Induction and augmentation are, by definition, unnatural conditions for labor.

– Labor progresses best and most normally when women feel safe and secure, and are attended by people they know and trust, in familiar, peaceful surroundings, ideally quiet and with dim lighting. Many hospital birth settings are the antithesis of this: frequent intrusions, beeping equipment, the woman might be attended by the on-call physician rather than her own doctor, she will be attended by nurses she probably doesn’t know and doesn’t get to choose, and they may change shifts in the middle of her labor, there might be residents and medical students involved in her birth, and she has no control over it. All of this conspires to make labor slower and more difficult, which in turn increases the likelihood that she may end up with a C-section. This is known as the “harsh environment theory,” and Rebecca Dekker mentions it on her Evidence Based Birth posting that talks about why doulas are so effective at helping lower rates of intervention.

– Most births that OB/GYNs see involve at least one of the following: IV drips, Pitocin (synthetic oxytocin), narcotics, epidural anesthesia, continuous electronic fetal monitoring. None of these are part of normal birth, and all of them have been shown to increase morbidity. Obviously there are cases where their use is necessary and justified, and women who want anesthesia during childbirth should have access to it, but their use should not be dictated by policy or routine, but rather by medical necessity. Pitocin interferes with the interplay of maternal and fetal hormones that controls natural labor. Maternal oxytocin originates in the mother’s brain and causes contractions as well as emotional bonding. It also self-regulates, keeping the contractions far enough apart to protect fetal circulation and allow the mother a breather in between. Pitocin cannot cross the blood-brain barrier, so it cannot promote emotional bonding. It can only accelerate contractions, which it does much more intensely than the mother’s own oxytocin. This, in turn, can suppress fetal heartbeat and circulation and cause hypoxia. Pitocin also disturbs the mother’s endogenous oxytocin, which in turn can dampen bonding and delay milk production, complicating breastfeeding. IV drips can cause edema when mothers receive too much fluid. This can also artificially increase the newborn’s weight at birth and then later cause it to (appear to) lose too much of its birth weight too quickly afterward, as it sheds the extra fluid. Anesthesia is passed from the mother’s bloodstream to the infant’s and can make him/her sluggish, lowering Apgar scores and interfering with breastfeeding. Continuous fetal monitoring, in addition to immobilizing the mother during labor, has been shown to significantly increase the risk of C-sections and other morbidity without conferring benefits, as Rebecca Dekker’s Evidence Based Birth posts demonstrate.

– Most hospitals have policies of forbidding women in labor from eating and drinking, which runs contrary to nature. Labor is physically challenging, and a woman deprived of calories and fluids will become exhausted and may be unable to successfully complete the birth on her own. OB/GYNs don’t generally see women who have had the option of eating and drinking of their own free will, they usually attend women who have been fasting for hours, and they assume that such artificially depleted reserves of energy are “normal.”

Some of this evidence is outlined in the Millbank Report on Evidence-Based Maternity Care (2008). See in particular the sections beginning on p. 62 and p. 64. The Milbank Memorial Fund is an independent health policy research foundation.

If you’re interested in learning more, here are a few of the books I’ve been reading over the past few months:

Birth Matters (Ina May Gaskin, 2011)

Ina May’s Guide to Childbirth (Ina May Gaskin, 2003)

Safer Childbirth? A Critical History of Maternity Care (Marjorie Tew, 1995)

Pushed: The Painful Truth about Childbirth and Modern Maternity Care (Jennifer Block, 2007)

Obstetric Myths vs. Research Realities (Henci Goer, 1995)

The Thinking Woman’s Guide to a Better Birth (Henci Goer and Rhonda Wheeler, 1999)

Optimal Care in Childbirth: The Case for a Physiologic Approach (Henci Goer and Amy Romano, 2012)

Birth as an American Rite of Passage (Robbie Davis-Floyd, 2004)

Birth Models that Work (Robbie Davis-Floyd et al., 2009)

There is also a lot of excellent research-based information on the Evidence Based Birth site I referenced above, as well as at ChildbirthConnection.org

Post # 11
Member
174 posts
Blushing bee
  • Wedding: April 2013

The evidence you posted has nothing to do with my question. 

 

You said that obgyns are not trained in low risk uncomplicated pregnancy and birth. This is a 100% fabricated. Have you been to med school? Do you know what is taught in the medical model? 

All obgyns know how and can manage a low risk birth. Augmenting the birth plan does not mean they don’t know how to manage a natural birth.

 

in addition, all the research you posted is extremely controversial. I could sit here and argue about why IV fluids are used and why the patient can’t eat, why pitocin is used.. Etc etc. But I don’I want to waste my time.

 

i for one, will not participate in a non-hospital birth. Home births gone wrong, are not a fun patient to stabilize in the emergency department.

Post # 12
Member
3010 posts
Sugar bee

@cstarkwe:  this is her crusade. Best not to debate or even ask questions. All “evidence” will be slanted and presented from midwife centric sources. Look at past posts to see. 

Post # 14
Member
407 posts
Helper bee
  • Wedding: April 2013

@KCKnd2:  “They’re not really trained in normal, uncomplicated, low-risk pregnancy and birth, believe it or not!”

This is 100% inaccurate. You have to LEARN and know the NORMAL uncomplicated things inorder to spot and diagnosis the abnormal. The number one phrase in the medical profession that i have heard from every instructor, teacher, and doctor is “You have to know the Normal to know the abnormal”.

Post # 15
Member
3677 posts
Sugar bee

@ashleyr0512:  Unfortunately, there has been a “normalization of deviance” in medicine with respect to the management of labor and childbirth. Active management of childbirth is, by its very definition, not normal intervention-free birth. The administration of interventions has become “normal” in hospital settings, but that doesn’t mean that it reflects true physiologic normalcy. Most medical students nowadays never see, start to finish, what birth looks like when a woman is not confined to bed and hooked up to and IV and/or a monitor, is not dosed with Pitocin to either start or augment her labor, is given privacy and not interrupted during labor by intrusions from hospital staff, etc. This is simply not how hospitals work, and medical education trains students to work within the institutional framework of the hospital, not to sit and accompany laboring mothers for as long as it takes them to give birth normally and naturally. Even the Active Management of Childbirth protocols, as developed at the Dublin Maternity Hospital starting in the 1960s (O’Driscoll, Meagher, & Boylan, 1993), have changed in how they are used in the US. In Dublin, women were not admitted (and thus the labor clock was not started) until they were in active labor, but in the US women are often admitted in early labor or before labor starts if their water has broken, which drastically accelerates the timeline of labor and results in many more C-sections. Also, the Dublin protocols required that women be constantly accompanied by a trained labor companion (in Dublin, a midwife) throughout the actively-managed labor. The US does not do this, in spite of evidence that continuous support from a trained labor companion is one of the most important aspects of optimal care for laboring women.

@MsTargaryen:  OP, this thread has gotten jacked from your original question, and I apologize for my part in that. I stand by the points I have made, however, and I invite you to compare the sources I cited with those offered by other posters. If you look at the website cstarkwe linked, you can see that it consists mainly of anecdotes, links to articles in the popular media, and propaganda. Frankly, anyone who knows how to google can find a website with anecdotes and propaganda about anything – besides which, home birth wasn’t even our topic of conversation anyway. (Although, if you’re curious, the Netherlands has the best statistical outcomes on maternity and childbirth in the world, and home birth makes up a high percentage of births there. Clearly, when done right and when the system supports it, home birth can be a safe and appropriate choice for many women.) The books I referenced are based on published, peer-reviewed research and have extensive bibliographies you can use to follow up on the original studies for yourself, should you wish to do so. Obviously some of the authors have strong opinions and biases on their topics (after all, few people bother to write books about topics they don’t care about): Ina May Gaskin is a highly-respected midwife, Henci Goer is a childbirth activist, Robbie Davis-Floyd is an anthropologist who studies pregnancy, birth, and motherhood. However, they are transparent about their biases, write well and clearly about the research, and document their sources so that you can decide for yourself whether you agree with their claims.

I especially encourage you to check out Marjorie Tew’s book, Safer Childbirth? A Critical History of Maternity Care for two reasons: She specifically compares outcomes of women who were attended by OB/GYNs, GPs/primary care providers, and midwives, and she has the most unbiased background of all of the authors I mentioned. She is a statistician who came across this topic when she was preparing to teach a course on medical statistics, and wanted some examples to use for classroom exercises. She started off assuming, like everyone else generally does, that developments in obstetrics accounted for the increased safety of childbirth over the last century, and she went looking for examples to use in class. However, when she crunched the numbers to develop the exercises, she was surprised to find that things didn’t add up and, in fact, childbirth got safer in spite of many of the trends in obstetrics, and outcomes were consistently better among women who were attended by GPs or midwives. She wrote the book because she was so surprised at her own findings. Not being a midwife or obstetrician herself, and not having her employment connected to a hospital or medical school, allowed her the freedom to report her findings without worrying about her job.

Please understand, too, that I am not wholesale anti-obstetrics. OB/GYNs provide vital, necessary care for women with high-risk cases, and some of the advances they have made (for example, RhoGAM to treat Rh-incompatibility disease and recognizing the importance of preventing rubella during pregnancy) are sound, evidence-based practices that have demonstrably saved lives and improved outcomes. But many of their routine practices are not backed up by evidence, and, since you asked about switching from your GP to an OB/GYN, I encourage you to investigate whether or not you need to at all. You might be able to simply continue working with the doctor you already know and like, and set yourself up for a better outcome in the long run. Best of luck to you!

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