Posts Tagged ‘care providers’

Passenger or Driver: The Importance of Informed Consent.

Monday, June 15th, 2015

PASSENGERYes, it almost sounds like a Dr. Seuss-ism – “Would you rather be a passenger or a driver?” Most of us would rather be the driver, I would venture.

In every other aspect of our lives, we exercise informed consent. We want to be involved, in control, and overseeing every detail. Take for example the research we do in buying our next car, cell phone, or home. Think about how much we invest in knowing our stuff, so we can avoid the sales pitch and just get exactly what we want because we desire to make a responsible informed decision.

Yet, when it comes to our health care–prenatal care in particular–we often content ourselves with being a passenger. We readily abdicate responsibility for our health by laying down our questions and concerns to take the word of a stranger. We leave our right to informed consent in the waiting room.

Why is that?

“But, they’ve gone to medical school for a million years! What do I know?” Of course, their expertise is invaluable. Their advice is often sound. While they have an intimate knowledge of the human body and its various pathologies, they do not have an intimate knowledge of your body in particular. Its quirks and signals that are all too familiar to you.

What many fail to realize is that, no matter which role we choose to play in our health care, the consequences of any and all decisions are carried by the patient. By you and me. For the physician, it is out of sight, out of mind, not because they are inhumane, but because they are human.

When it comes to prenatal care in particular, we see a unique dilemma, because the health care we receive has more to do with a physiologic process, rather than pathology or disease. This isn’t a broken femur, a tumor, or a chronic illness. It is not even a parasite, in spite of the tongue-in-cheek proclamations of many. It is something our bodies do naturally, without a lot of help. It is a process more in need of general oversight, rather than active management.

Pregnant or not, it is imperative to understand that the practitioner is hired for his or her advice. It is up to the patient to decide what to do with it. We have many options.

1. Follow the advice without question.
2. Question the advice, decide what to do.

  • What are the benefits?
  • What are the risks?
  • What are my alternatives?
  • How does this advice apply to my personal case?
  • What happens next if it doesn’t work?

3. Get a second opinion.
4. Discard the advice in favor of an alternative outside traditional medicine.
5. And more…

Medical decisions are rarely black and white.

The key is to remember who it is that carries the weight of the risks. It is ultimately the patient. There are many factors that play into the reasoning behind your doctor’s recommendations–not all of which are health-related. (That’s another post for another day, however.)

In the end, all you have to do is decide which set of risks you are most willing to live with. That is true informed consent.

Only the driver can decide that. Not the passenger.

In which seat will you choose to sit?

Thanks for reading.

Our best to you,
Desirre & Tiffany

A Message About Preeclampsia to Every Mother

Wednesday, June 4th, 2014

If your care provider is seeing a slight increase in your BP, a bit of protein in your urine, and asks you questions about headaches, swelling in your hands and face, pain under your ribs on the right, and if you’ve been seeing spots, they may tell you that you are turning preeclamptic. The Preeclampsia Foundation website can help clarify a lot of what they are telling you, and give you some tools to partner with your care provider in making sure of your diagnosis. Before you can proceed, having a good understanding of what you are facing is important for you and your baby’s health. A preeclampsia diagnosis is nothing to sneeze at, and therefore, it behooves you to learn what you can in order to participate fully in your care, and to make decisions based on information and instincts, rather than fear.

However, it is important to note that, if you do have preeclampsia, you are in a situation where the benefits of certain interventions (such as induction or occasionally cesarean section) very likely outweigh the risks of waiting it out. Preeclampsia doesn’t play fair. It is imperative that you speak clearly with your provider, and make sure you understand why they are suggesting certain procedures. Even if they are necessary, they can be hard to take in if you were planning an unmedicated vaginal birth. Knowing really is half the battle in this case. Do not be afraid to learn about preeclampsia, learn about the way your care provider treats it, and walk forward in confident awareness of the power you still have to choose rightly for you and your baby.

Some things to consider if your blood pressure slightly elevated during only one prenatal visit, and in the absence of other symptoms:

  • What is your stress level like?
  • Have you been sick lately?
  • Are you dehydrated?

Some questions to ask if you have more indicators and/or symptoms:

  • “Am I being diagnosed with preeclampsia, or are these numbers borderline?”
  • “Could this be pregnancy-induced hypertension? If so, how do you normally treat it? Can it lead to preeclampsia?”
  • “What other symptoms might come to light if it is preeclampsia?”
  • “Do I have the option of monitoring BP at home, and being checked every couple of days, or does this need to be taken care of now?”
  • “Is the protein in my urine shown via a reagent strip, and if so, can we double-check it with a 24 hour catch?”
  • “What are my options for induction if it becomes necessary? What are the benefits/risks/alternatives of each method? Which do you prefer, and why?”
  • “How soon do you typically decide to move on to a cesarean section if the induction does not work?”

Preeclampsia is not the end of the world, though it is serious. It is just one of several curve balls that get thrown at some women. It is not something that we currently know how to prevent with any degree of scientific certainty. We have a lot of ideas of what seems to help, but nothing we can hang our hats on just yet. One thing that I think is so important to understand is that we can do everything “right,” have a textbook healthy pregnancy, and still end up with preeclampsia or other problems. We are never guaranteed a “good” outcome when it comes to anything in life, and we should not expect our births to be any different.

What matters most is to do the best we can with what we have, and to be flexible when we are handed something unpleasant, difficult, or even downright terrifying. We face our fears and challenges head-on, and make the best decisions we can within our circumstances. We do not lose our power just because of a medical diagnosis. We just lose a few options we otherwise would have had. Never be afraid to ask your care provider, “Why?” The more you understand, the less scary it will be for you, and the better you will be able to process your birth after the fact.

Preeclampsia or no, your birth is still your birth. You are already a good mother. You can do this.

What do you know about preeclampsia? Where did you get your information? Have you had preeclampsia before? What was your experience with it? What did you learn from it? What advice would you give to someone facing a similar situation? Share your story in the comments…

Grace & Peace,
Tiffany