Have you ever had this happen to you? A provider is pushing an intervention or test on to you when you're pregnant, and brings up the "you don't want your baby to die?" or "your baby could die if we don't do ___."
I have had that happen to me. As a 29 year old L&D RN, pregnant with my 3rd baby, I was refusing the GBS screen at my 37 week prenatal visit with one of the CNMs in the practice I was going to. I had my own reasons for refusing the screen, and I informed the midwife of this, and pointed out the futility of even doing the test. (I'm allergic to several antibiotics, including the ones used to treat GBS in labor. The remaining antibiotics that could be used I would refuse, due to my own personal and genetic history concerns related to the side effects of the antibiotic.)
There I was - an L&D RN of all people - and the CNM played the dead baby card with me for refusing to do the GBS test. I point blank said to her: "do NOT play the dead baby card. I know my rights to refusing testing, and I know the signs and symptoms to be on the lookout for with a potentially GBS-septic neonate."
I was planning a hospital birth, with no interventions (didn't need any of them), no IV, and an early discharge to home. I honestly would have had a homebirth if my health insurance would have at least paid for part of a homebirth. Unfortunately, the insurance would only pay for a hospital birth. Financially, it was just not going to happen about a homebirth.
Looking back on my birth, I was able to give birth precipitously, with no interventions other than minimal fetal monitoring. I had absolutely no complications with her birth, and no complications in the postpartum period. I went home in 24 hours (would have gone home sooner if the darn pediatrician had actually rounded early in the morning!).
I'd like to also note, that before anyone jumps on me about refusing GBS testing, I ended up allowing it to be done at my 38 week prenatal visit, with another midwife, who actually understood my rationale for not testing. She knew I was going to refuse any antibiotic coverage due to my severe drug allergies, and the last drugs left (vanco or gent) I would have refused. It would have not been in my system long enough anyway, due to my history of rapid birthing. (I gave birth maybe an hour after arriving at the L&D unit.)
Oh, and all of that fuss and dead baby card talk? I was GBS negative at the 38 week visit. So it was all a moot argument. (See the screaming Mimi in the above picture - healthy 6 lb 9 oz baby girl, just minutes after her birth.)
(On the topic of refusing testing, I also refused the 3 hr glucose tolerance test after my 1 hr test was slightly elevated. I checked my own random blood glucose levels, and was very strictly following a diabetic diet throughout the pregnancy. I also refused the erythromycin ointment in the baby's eyes after the birth. I'm also the "annoying" woman who refused to let her baby go to the nursery and insisted on non-separation of mother and baby after the birth.)
31 comments:
I like to have non-seperation of baby but they had the stupid hearing test in the nursery. My hubby went, but they wouldn't let him in. They insisted it had to be done at 1 am because it was quieter, but then there were several noisy babies in line and two or three talky nurses. He was dead tired, couldn't even see the baby...what in the world? They used to do it in the room...
Blessings!
Dawn
When my water broke prematurely with breech twins, I wasn't just told one or both of the babies *could* die, I was told that any attempt at a vaginal birth and all three of us WOULD die. I was also told they were going to do a c-section with or without my consent. I walked out, a couple of days later I walked into a different hospital and had them vaginally with no complications (other than prematurity). They left the NICU healthy and thriving six weeks later.
As someone who has had a stillbirth the dead baby card gives me the rage. It's a fear tactic that has nothing to do with science and everything to do with legal coverage.
My son just died - there was no reason, try as the coroner might to find one. Sometimes babies die, but most of the time everything is fine.
FFS, I wish they'd drop the dead baby card; it's bad enough when it does happen. No one needs to be guilted into something, and if the terrible does happen, live with those words echoing in their head.
Anyway - a topic close to my heart obviously. Keep up the great work.
Thank you for this. I argued with a nurse practitioner at my OB's office about the glucose intolerance test, and she played the dead baby card. I had the same thought you did ("you did NOT just say that to me!") She had no idea of the research I'd done and wasn't interested in my reasons for refusing the screening. She told me my baby could be seriously sick or die if I didn't get it done. She even insisted on putting the lab order on my chart just in case I changed my mind, and kept trying to convince me to go downstairs to the lab and get it done right then and there. I was so angry. I did have the GBS screen done, which I might not do the next time around. It just really bothers me when medical professionals assume we don't know what we're talking about and use scare tactics to try to change our minds. It's ridiculous.
Good for you! I hate the dead baby card. Of course no mother wants her baby to die, but how horrible they use it as a tool to manipulate moms into what they want to do.
I love that you threw it back in her face! "Do NOT play the Dead baby card with me."
Ditto Sarah H. My second baby died, not because I refused a test or used a midwife, or because a black cat crossed my path. He just died and no amount of testing can tell me why. I am so grateful for midwife care that has helped me get appropriate testing for my current pregnancy (mostly pre-conception genetic testing to make sure my last loss wasn't caused by something likely to recur) but who would also never ever play the dead baby card with me, even when I refuse a suggestion.
"Next time" I would do the GBS, treating with hibicleanse and/or garlic before hand, so I could have a negative result to show the hospital in case of transfer.
I'd much rather save the antibiotics to use in the rare case the baby did pick it up. Otherwise, I would just treat myself with hibicleanse during labor.
i am right there with you! i could have written this entire post, almost word for word (right down to the home birth dilemma - damn insurance struggles...!). because i didn't have any allergies to the antibx - and didn't have the cajones at the time to just say "no" - i just took them, and rushed in to the hospital as soon as my forebag ruptured (even though i would have soooo rather stayed home and been comfortable).
prior to having that stupid GBS test come back +, the plan i had with my doc (no CNM's to be found in my area, and again, no home birth for the insurance issues, sigh...) was that i would wander in when i started feeling ready to push, deliver, and then head home shortly thereafter.
of course, that darn + changed everything. suddenly, if i didn't get the golden loading dose of ampicillin and 4 hrs of coverage in --- she wouldn't let me (let me - ha!) take my baby home before baby's 48 hr culture came back clear. never mind that i was a l/d RN, that i knew the s/sx of a GBS newborn, and that i lived less than a block from the hospital... i couldn't be trusted to watch my own child.
anyway, long story short --- this was before i became 'educated' (i thought i was pretty educated and empowered, but oh, how much more so i have become in the past 2.5 years!), and i just shrugged it off... and held my labor just long enough to clear the amp.
what a load of BS. as maria said, *next time* i'm doing garlic, etc, to avoid that + in the first place. and if it does come back? i'll know my stand.
I love you.... just sayin'..... sounds like lots of my last birth...... your blog here is wonderful, and more people need to hear things like this.... I REALLY like, calling it like it is.... the dead baby card....
Wonderful wonderful.....
When I went to see a doctor to find out about treating my PCOS with clomid, the midwife and dr both told me I would have to have a c-section (previous cs due to breech) and then they BOTH played the dead baby card. DUDE! I wasn't even pg yet and they played the dead baby card. At that point I knew I wouldn't be using their OB services... I'm still not pg, but I have a new dr at least.
**ETA previous c-section.
The dead baby card is obviously wrong...but....maybe because I see the problem from a physician's point of view, I don't understand why be "against" some interventions for a matter of principle. If you don't trust me (and you don't if you refuse all interventions except the ones you like) you are totally free to find another doc/midwife/nurse etc. I believe this is true also if you are an healthcare professional. I would never discuss on anhestetics before surgery...
i wish my cnm would have been more open about risks. maybe if she had played the dbc with me at 42 weeks, my baby wouldn't have died from her placenta giving out. sometimes the dbc is a good thing, after all, some dr.s are coming from experience and would rather tick off their patients with extra testing rather than possibly hold their hand while their dead baby is brought to the morgue. just another perspective.
Back in '93 I had what was assumed to be a GBS baby, septic pneumonia at birth after a 23 hour labor more than 12 hours with ruptured membranes, she lived but it was awful and require recusitation x3 and 14 days in the NICU & Gent drips for us both! 15 months later I gave birth to my second child in less than 1 hour, the kicker is that I was not even tested for GBS during my second pregnancy and it was the same doctor who delivered the first.
OMG...I HATE when our docs play the "DBC"! One of them even tells the pts that their baby will die if they don't get an epidural! Of course, as soon as he leaves the room I advocate for my patient and tell them the truth.
SOOOO ridiculous!
I think without saying the words "dead baby" it can be implied with "your baby is having a decel" and then you try to get out of bed after the decel is over and you get, "but you have to think of the baby." I got that with my horrible experience with the nurse not allowing me to drink, leave the bed to go to the bathroom, or get off the monitor after one decel event. It scared her, but when I was upright I didn't have a decel. I had them when I was on my back flat, or at the end when baby was nearing being born (and not bad at that time as the nurse stated). She did all sorts of annoying things, and when I complained later to my OB she said, "well, but you had that ONE decel." One decel? That's all that caused her to keep me in bed for hours, and all that confinement, excessive ve's (every 20 minutes for 5 hours), stretching me, and rude comments like, "your baby's heart rate looks great NOW that you are on your side" (complying while in transition). All this because I needed to think of my baby first. But I was thinking of my baby first, her heart rate went back up from the decel when I bucked the system and sat up. It was fine when I was out of bed (though the monitor kept slipping or she moved away from it hiding behind the anterior placenta making the nurse want to put me back in bed). The monitor IS the dead baby card most days. I think it's got it's place, I mean, I'm sure there are babies saved because of the monitor. But it's not always necessary to confine a mother.
Blessings!
Dawn
Antibiotics are overused. What is happening: we can no longer use ampicillin for GBS because the bugs are now resistant, therefore we now use Penicillin. How much longer until we can no longer use Penicillin?
The GBS are killed off, but now we have created superbugs which in turn will make a baby ill.
Perhaps keeping VEs to a minimum and stop using FSEs so much especially with epidurals....FSE's are not necessary with an epidural, most hospitals I worked in here in Canada rarely use FSE's.
CDC estimates that only 0.5% of all babies born to untreated GBS+ women will develop a GBS infection and only 6% of those will die. Those are small percentages....and it is estimated that due to the creation of other risk factors by TREATING with abx - such as resistant bacterias that are allowed to flourish that may otherwise have not affected the baby - and this nullifies the babies "saved" by treating with abx.
I have seen a death by GBS - the mother had ruptured membranes and was waiting for a c/s...and yes it was devastating....but that, in all the 5K births or so that I have been in on, is the only one I have seen.
It is a difficult and controversial question, but I happen to be on the side of no treatment with abx - MOST of the time.
I want to clarify about my declining antibiotic tx for GBS (if I was positive): I have a history of severe allergies (even anaphylaxis), including PCN, cephalosporins, and erythromycin. There goes first line tx for GBS. Vanco or Gent - I would refuse during pregnancy due to the increased risk of ototoxicity to the fetus. My daughter's father has a genetic hearing loss, and she is already at a higher risk of following in his footsteps, genetically. I prefer to keep the risk of hearing loss from drug use down to zero. (To date, she is of normal hearing status. Thank goodness!)
Also - if Vanco or Gent were used, it would never be in my system long enough to be considered effective treatment (8 hours between doses, usually). I am a rapid active labor person. Less than 6 hrs from onset of active labor to birth. Each baby comes faster. My last child was no exception.
E-mycin eye ointment - I refused because there was a zero chance of me having chlamydia. It's unneeded.
IV in labor - didn't need it. I labor quickly.
Pitocin after birth - didn't need it. Expectant management and breastfeeding helps keep my bleeding to a minimum.
To say that I shouldn't see a MD/CNM because I don't comply with their suggestions for testing or treatment, doesn't mean that I am non-compliant and should seek prenatal care elsewhere. It simply means that I know my rights, I know my options, and I choose not to have unneeded interventions or testing.
On the other hand, if an intervention was medically necessary, you betcha I would agree to it!
Decels - yep, get that IV and fluid bolus in!
Fetal distress that doesn't resolve with intrauterine resuscitation - yeppers! Take me back for a c-section! WHEN MEDICALLY NECESSARY!!
Yes, I've had that done to me. It was around my 20 week mark with my son (1st pregnancy). It was with an OB I didn't normally see (I was only seeing the one who specialized in pregnancy-related diabetes). He had stepped out for a birth. She wanted to schedule a c-section for me at the visit, and said that if I didn't, the baby would be macrosomic and would DIE. I was so upset, and thankfully my husband was there. When my doc was out again toward the end of my pregnancy and she was the only one there, I intially refused to see her. The nurse pushed us to tell her why, and then the OB confronted us about it (thankfully, my husband was with me again) and said that she would never say anything like that. She shut up really fast when my quiet husband piped up and countradicted her. What an awful woman. She was young, too, so she has a lot more OB years in her left, which such a shame.
My family doc recommended that practice, and I told him of the horrible experiences I had with them. Hopefully he will recommend the second practice of my second pregnancy, who were no-nonsense but they worked with you.
The dead baby card is no fun. They tried that with me too when they suggested that I neeeded fetal monitoring because of HG. I needed help in the first months of my pregnancy not the last months. Likewise, I refused the glucose test. I kept an eye on my blood sugars. They were always WNL.
Thank you for this. Could you do an info post on refusing stuff? I'm all for testing (heck I even did the quad screen despite being in my 20s and no familial ONTD history). But I want to refuse the eye meds (no risk, married, etc) and room in COMPLETELY. The nurses with my other children were REALLY pushy. I'd also like all stuff done in room or my husband to accompany baby. What are the rights or info and how do you get around bossy, pushy nurses. I don't want to be rude to them so I'm trying to research and get my ducks in a row so to speak. But I want to be clear and not "bullied".
Congrats to you on your beautiful baby and standing up for yourself. I wonder when all hospitals will get on the band wagon and let newborns room in with their mothers. My hospital doesn't allow it....only if the woman insists. I will be one of those 'annoying' women who will want it. Thanks for sharing your story :-)
Sarah RN
I just recently found your blog and LOVE it. My husband and I are expecting our first baby. I've done a fair share of researching and know there's a few things I want to do differently. I second Sierra's comment above... would love a post about how to get around pushy nurses. (I've read older posts of yours and thought, if only she could be my nurse when I deliver) I'm very excited about the delivery but nervous about how I will handle situations I might not agree with. I feel like I'm going in with my fists up ready for a fight... but of course I want to be relaxed and feel secure. Any thoughts would be great!
There are certain important things to be followed in the hospital. These are really important steps especially for newborn care. I would like to add that the first hour life of the newborn must be in the nursery to monitor any fetal distress. I would like to emphasize that mothers should follow the rules regulated by the hospital to be able to avoid certain problems.
Um no. "First hour MUST be in the nursery"??!! Someone lied to you coin. It isn't necessary or mandatory for the first hour or hours to be spent in the nursery. Skin to skin contact and bonding should always come first. What about home births. There is no "nursery" there. As long as baby is healthy and delivery went smooth there is absolutely NO reason baby can't stay with mom. Monitor fetal distress? 1st, after the baby is born, its a baby, not a fetus. Where on earth did you get your misinformation from? Not everything routine is necessary. I really hope you dont work in obstetrics. Ugh.
And I too really wish AtYourCervix was my nurse. Or at very least someone like her.
Thank you for this post. Well written. Well said (now, and then!)
Good for you for being the "annoying" woman. There's nothing wrong with knowing your body or what's best for it.
I just found your blog and I literally laughed at loud at your title! Love it.
I had a Dr. use this line with me during my delivery with my 4th child. However, it was "played" with an opposite reason to what you are suggesting. A "mother's instinct" reason. I was 37 weeks with a large baby due to serious problems with gestational diabetes, total compliance on my part but medication that did not help (Glyb.uride). My daughter was breech and I had an amnio to determine lung maturity which sent me into active labor. I had 3 courses of Terb. but continued to dilate to 5. I was to have a c-section however it was 2 am and the Dr. did not want to come in. The nurse advised me to insist on the section because I had a "bad feeling" and the interventions weren't working. I got on the phone with the doctor and he said "Your baby will be premature and end up in the NICU with serious complications she may even die if you insist on this." I still insisted. During my c-section they found her head was so severely wedged under my ribcage they had to fracture 2 ribs to remove her. She was 9lbs 6oz. and DID require 3 days in the NICU. I was CRUSHED, I thought I had caused her to be ill, until the pediatrician seeing my guilt explained to me that she would have died if they had continued to allow my labor to progress with her in that position. She's a healthy 4 year old now.
Don't understand why even come to the hospital if you're going to have a list of refusals. The interventions are there because it is a hospital! You say you would get an IV if a decel happened or you needed an emergency section but why wait until your in the middle of a serious emergency situation to have people searching for an IV when you could already have one there! Why wait or refuse pitocin after delivery? It's not harmful and why would you wait until you're hemorraghing to ask for it and then you're playing the catch up game of trying to control your bleeding. That's valuable time wasted on much more important interventions to get a heart rate back or to fix whatever problem is causing maternal/fetal distress.
I had preeclampsia with my first, with both protein in urea and borderline high blood pressure and as a precaution I was placed on bed rest for the last 6 weeks. I never had the rapid swelling of face or hand but I had edema from toes to mid thigh and "there was nothing wrong, it is normal". When I went into labor and my contractions were about 5 minutes apart, L and D told me "oh thats too early to come in" I replied that I had preeclampsia and a severe headache they told me to stop being dramatic. When I got to the ER since LD would not admit me the ER staff put me in a wheelchair wheeled me up and got me checked in, my VE showed me 5-6 and 80% effaced. My blood pressure? 160/100. Pitocin and Mag sulfate and a healthy baby followed.
I showed minimal signs with my second of PE. A week or so before my due date with this pregnancy I had normal BP but insanely high protein levels. The doctor wanted to admit me and induce with the possibility of a section, or my baby would likely die. I said I had planned on having my daughter with us during delivery but I needed to have someone there to help with her, so I needed to wait until the weekend, I chose to sign out of the hospital against medical advice. I ended up vaginally delivering a healthy 9lb 13oz baby who got stuck at the shoulders, I was then folded in half and the doc climbed up on the end of the bed and pulled him out I barely tore. I refused mag sulfate and pitocin this time all I had was an overnight cervadil.
My goal next time is a home water birth.
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