Betty Duffy

Wednesday, December 10, 2008

The More They Test … The More They Test

First of all, the baby and I are doing great. We've had a quiet week of getting to know each other, and I am settling into life with five kids.

I have been meditating, however, on the state of modern medicine these days, having recently brushed elbows with it, and here are my thoughts:

I may have mentioned that I contradict myself frequently. A couple weeks ago, I enjoyed sitting for an hour on a monitor having my baby in utero tested to be sure he was not in distress, but after a week in the hospital wanting only to be home in my own bed, I felt a little bit yanked around by tests.

Beginning during the pregnancy, there is a test for every abnormality. And rest assured, if any of those tests come back abnormal, the therapy will require another test and possibly a series of tests. Sugar in my urine means I need a four hour glucose test, a positive outcome of which, means I have diabetes. Now I’m testing my blood sugar four times a day. For what? So they can say they now need to perpetually test my baby in utero: Non-stress tests, Biophysical profiles, for what? So they can say he’s going to be big, and when I get around to delivering him, he’s going to require regular glucose tests starting the first minute of his life. What more, I shall deliver him early, if the tests say it’s favorable to do so, which will cause him to develop jaundice, which will require constant monitoring with blood tests and therapy under bili-lights.

The great thing about bili-lights is that they are guaranteed to work, because the bilirubin nearly always peaks around the fourth day and then goes down when Mom’s milk comes in. What is the control factor for these tests? All my kids have had jaundice. All of them peaked and contracted without lights. But it makes doctors (and mothers) feel good to prescribe something, especially if that something keeps you close enough to the hospital for regular testing. But who is testing the usefulness of all these tests? Apparently, I am, and I find them expensive. I find them inconvenient and anxiety inducing. Soon they will be testing me for mood disorders, for post-partum depression, for my suitability to motherhood because these tests are testing my sanity and I am going to flunk.

I chose a medically managed pregnancy and delivery, because I do believe that medicine, when it serves people, rather than the outcome of tests, has a valuable, life-saving function. It is good that my diabetes was detected, and that I was able to control my sugars for the good health of my unborn child. My mother worked in the labor and delivery rooms for 30 years, and saw enough sad, unnecessary outcomes to convince me that having access to medical intervention during childbirth is a good thing. But there is a line that has been crossed, perhaps even in the time that has elapsed between the birth of my first child and my fifth.

My good old boy pediatrician whom I chose precisely because he had been around long enough to have seen nearly everything and know when to say, just go home and spend some time nursing your newborn, now says, “I would have to have some pretty big cojones to ignore the outcome of that test.” I think I can safely translate those “big cojones” to “deep pockets” with the litigation climate in medicine. When I googled jaundice and dangerously high bilirubin levels, the first three listings were for attorneys conducting malpractice suits for the treatment of jaundice.

I do not blame the physicians for the attitudes I saw. I am glad firstly, that my child only had jaundice, with a known treatment and cure, rather than some congenital disease that required experimental therapies, etc. I have heard lately, several stories about mothers who have lost children due to Doctor error and have opted not to sue, in spite of the locusts that may have descended on them offering to file suit. But for every one of those cases, I’m sure there are thousands who do get rich off medical error, and turn the rest of us victims of protocol.

A highlight of my medical experience: NURSES.
Here’s a few good ones:
1. My cousin who is an OB nurse at the hospital where I delivered. We decided long ago that she would never be my nurse, as there are lines that need to be drawn when two people have grown up together. But she did arrange for me to have a very nice room, assigned me my favorite labor nurse, decorated my room with ribbons, and gave us a goody bag full of snacks, entertainment, and my husband’s favorite soft drinks.
2. My labor nurse, who has facilitated my two most memorable birth experiences. She is respectfully hands off and encouraging as I labor, letting me move around, and maybe even (God forbid) fall of the Toco monitor a little here and there. She advocated for me with the Doctor to let me hold on to my bag of waters for several hours so the baby could descend a little and avoid a prolapsed cord. Then, when her shift was over and she saw that things were going to happen quickly, she stuck around, because nothing is worse than transitioning to a new nurse when you’re in “transition.”
3. My baby nurse, who interpreted the protocols for babies of diabetics in such a way that our baby was able to stay in our room with us rather than in the nursery for his glucose tests. She also allowed me to pump and supplement with my own milk when the doc recommended supplementing with formula.
4. The lactation consultant, who encouraged me with breastfeeding my jaundiced child, because it doesn't make sense for the American Academy of Pediatrics to say that Breast is Best, and then prescribe formula for every problem a breastfeeding mother faces.

I know all of these nurses faced scrutiny for daring to live up to the motto of “patient centered care” that the hospital boasts of, so sadly, they will remain anonymous.


JenX67 said...

reading me this made me sad - it reminded me of the tremendous lack of support i faced when i tried to nurse all my kids. Man, that is a bitter post I don't think I can ever write. Brings home my own weaknesses. Breastfeeding is demanding. I needed more rest than I could get to make enough milk. So many regrets, but I have my babies and I don't work anymore. If I could be home now with a newborn and not return to work like I did with my three, maybe I could push through to success. As it is, I was lucky to sqeeze out three to six weeks. So disappointing, but, oh well. Sorry to vent. I pray you have lots of support during the coming newborn days.

John said...

Sounds like an excellent nurse. You should consider writing to the hospital/her boss to commend her and remind them what makes for a great nurse.

the sassy kathy said...

congratulations on your new baby! and, might i add, what a beautiful blond-headed family you have :) so sweet.

thank you so much for your comment - i was very interested to read your thoughts on a medically managed pregnancy etc. it's great to have a perspective from someone who has it so fresh in their mind!

and you know its funny because my mom was saying the EXACT same thing re. orgasmic birth. simply that it is such a fantastic relief/release, call it whatever you want, it's great!

thanks :)