Key West Birth Saga Continues…

by countingdowntildaddy

You may have read a recent post about limited options for having a baby in Key West, Florida. If not, you can catch-up here. Long story short, the hospital is big on technology and pretty silent about labor that doesn’t involve constant monitoring. I had hoped that my fears that this hospital was less than accomodating to women aiming for a natural birth were unwarranted, and contacted a couple of doulas to see if they could tell me I was wrong and they just forgot to mention their midwives and birthing tubs. Or maybe there is a birth center there that doesn’t show up on an internet search. Or maybe there is at least one midwife doing home births. Here’s what I learned from them:

  • There is no birth center. The closest one is in Miami (three hours away). There is no midwife for a home birth because none of the doctors there will back one up.
  • There is a birthing tub. There is one midwife in Key West and she has “rights” to the tub. If you want to use it, you have to be seeing her and the OB she works with and pay $1000 for a liner for the tub. The doctor she currently works with has the highest c-section rate.
  • You can labor in the tub but cannot have the baby in it. They will make you get out when you reach transition.
  • The midwife practices like a doctor and actually wants women on their back and in stirrups for delivery.
  • The only doctor that really worked with women to have their babies without pain medication and in any position is currently not practicing because she had an aneurysm.
  • One of the doctors has great bedside manner and patients seem to like him. However, he is notorious for using every reason under the sun to start pushing a c-section around 38 weeks (the baby is too big, you’re too small, fluid looks low, etc.). He promises to be at all of his patients’ births and does not use the on-call doctor on weekends like the other OBs. That sounded good at first until I was told of a story where a mom arrived at the hospital about 7 cm dilated. She was admitted and the doctor was called. He was about 45 minutes away, so he told the nurse to give the mom something in her IV to slow things down. Had mom not asked, the nurse would have injected the drug without consent. Apparently this doctor is better if you have a doula, but still wants you to have the baby in the lithotomy position.

Lithotomy Position - maybe the worst position for avoiding a tear. After having a 4th degree tear with Madeline, avoiding another one and the possible incontinence issues is of the utmost importance to me. Since a water birth is out, position is all I've got.

  • There is a doctor considered the “next best thing” now that the one is out with the aneurysm. However, he has been described as “crotchety” and reeks of cigarette smoke. I’ve heard good things from some  women I’ve communicated with, but they’ve all had c-sections.
  • Two different women that I have talked to were threatened by their doctor and hospital staff with calls to Child Protective Services because they refused to consent to certain interventions.  Here is one story I got after asking on a military wife forum if anyone had a baby naturally in Key West:

Well, I hate to be discouraging, but prepare yourself for a fight.

Unless things have drastically improved from six years ago, they will argue with you about every little thing that doesn’t fit their “plan to be bothered as little as possible and get you out of our hair as soon as we can.” I was forced to stay on a monitor and submit to regular checks, which meant that I couldn’t get up and walk normally. I was “required” to have a full IV, even though they acknowledged that I was drinking enough fluids. After a few hours (of normal progression), I was bullied into taking pitocin and it was just downhill from there.

They used threats (such as me killing my baby if I didn’t do what they said and how they would call CPS on me for ignoring medical advice.) If I hadn’t been in so much pain from the pitocin, I probably would have been able to stand up for myself. I knew I would have no trouble giving birth (DS1 was born naturally and he was almost 10lbs…this baby was only 7lbs), but the constant pushing and scare tactics made me give in. We won’t even go into the breastfeeding nightmare.

Like I said, I don’t like telling horror stories, but I do think people should know what happens there. They have pregnant women at a disadvantage because there is no where else to go to have a baby. And I am, by far, not the only one this has happened to…there are some here on CC that have been through even worse there.

  • Another doctor was described as “the worst of the bunch.” He has the highest c-section rate and usually works with high-risk patients. The impression is that he treats all patients as high-risk. He was the doctor involved in the other CPS story I heard.

We had been thinking about going to Miami to have the baby at a birth center there. Not wanting a three hour drive while in labor (on the one road going in and out, so you’re shit out of luck if there’s an accident or traffic or something) we decided to go there the week of my due date and bank on the baby being born right at 40 weeks like the other two. I was liking this idea because it meant no monitors, no checks, no IV, no epidural being offered, and best of all, a tub for delivery. I wasn’t fully committed because I don’t like the idea of trusting that the baby will be “on-time” and I would really rather be at home the last few days of my pregnancy.

So this morning, after reading about the CPS threat I shared above, I decided that maybe I would rather beat them at their own game. I will do more research that I did during either of my other pregnancies. I will read up on patient rights and seek legal counsel regarding what happens when a patient’s (particularly a pregnant patient) desires are in direct conflict with hospital or doctor policy. I will speak to CPS myself when I arrive to find out if they had ever been called and what their take on this kind of situation would be. I will let them see me in a professional setting rather than risk meeting them for the first time at the hospital and pissed off. I will arrive at the hospital as far into labor as possible, preferably holding the head in as I waddle into the ER. I will arrive with a detailed birth plan and binder full of my research that will include documentation on patient rights, copies of business cards from my lawyer and whoever I speak to at CPS, and a copy of the Hippocratic Oath in case someone forgets it. Just for fun I might write up a legal memorandum summarizing the law as it pertains to informed consent and the right to refuse consent during childbirth. I will be super nice to my doctor at all prenatal appointments so that he has no idea what a true pain in the ass I will be if they don’t work with me to have the birth I want.

I’m also going to make sure Jay is wearing something Special Forces related…maybe one of his t-shirts with a picture of a skull with a knife going through it.

I’m not sure what showing up for a war will do for my psychological preparedness for childbirth, but I’m hoping that being over-prepared for the worst will make me confident that I can win a battle of wills with the hospital should it become necessary.

And it goes without saying (at least it should) that I have no problem consenting to interventions that are medically indicated. I don’t want constant monitoring, but if I need it, fine. I don’t want a c-section, but if there is a real emergency, I’ll sign the paper. I’m not an idiot. I’m an advocate for natural childbirth, not a crazy fanatic about it.

For anyone who thinks that I’m being crazy and no one can force me to do anything, let me leave you with a story I first read about in the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care and read again while researching forced interventions this morning:

When a pregnant woman refuses an intervention that doctors judge provides a substantial benefit to her fetus, is overriding her refusal ever ethically justified? It is typically a sacrosanct principle in medical ethics that patients have an absolute right to refuse medical interventions, including life-saving interventions, if they make an autonomous, informed, competent choice to do so. However, in the case of pregnant women, this principle has been questioned and sometimes violated by force in the name of protecting the fetus. Examples have included forced cesarean deliveries, mandatory HIV testing, and life-saving blood transfusions performed despite religious objections.
The 1987 case of Angela Carder, a 27-year-old woman who had cancer that had gone into remission but recurred during her pregnancy, brought these issues to a head. Fully competent, Carder made clear that she wanted everything possible done to save her life. However, during the 25th week of gestation, it became clear that Carder was dying. George Washington University Medical Center, where she was a patient, tried to insist upon an early cesarean section delivery in order to save her fetus. She refused the intervention, which was nearly certain to kill her, with the support of her family, husband, and doctors, but the hospital obtained a court order and forced the delivery. Both Carder and her extremely premature baby survived the operation only very briefly. In 1990, the D.C. Court of Appeals posthumously vacated the court-ordered cesarean section, holding that Carder had the right to make health care decisions for herself and her fetus, and that only in the most exceptional circumstances should a pregnant woman’s right to refuse interventions be called into question 
Stay tuned…