sore fingers, feelings

A few weeks ago I had a disagreement with my midwives. They wanted me to take a glucose tolerance test, which screens for gestational diabetes. I wanted them to feel assured that I knew my body and the way unhealthy blood sugar levels would make me feel and I would alert them the second I had any symptoms. I was told they would drop me as a client unless I agreed to the testing. I felt very hurt and angry that they would mandate a screen with an 85% false positive rate rather than trust me to know my body. All of my research this year was about this very issue and I was shocked to find myself on the victim end of it. I showed them literature from studies that demonstrated screening for gestational diabetes doesn't reduce GD-related complications, but rather increases c-sections, as compared with the control group. In short, it gives a care provider reason to doubt a woman's health, which leads to unnecessary interventions. I didn't want my health doubted.

In the case that I tested to have high blood sugar, they would recommend a diabetic diet with little sweets and simple carbs, which my family already eats. I don't think they actually believed me when I said this, and it was definitely never written on the charts. The other intervention would be to initiate fetal non-stress tests at 36 weeks, and if my little baby failed just one (they're pretty easy to fail), I'd be fast tracked to induction and induction is always the biggest predictor of c-section. In short, John and I saw ourselves in a flow chart. We knew all the turns and we didn't want to begin the path on the intervention side of the chart.

At one level, the midwives want this test because they've experienced births with horrible complications and want to prevent that from occurring. This response is common in the field of maternal and child health, and is most commonly blamed for the patterns in which obstetrics adopts new medical findings into practice slower than other fields. For example, the studies released last month on HRT are already being introduced into medical practice, but studies first conducted in 1990 and repeated since that indicated O2 stats were not predictors of infant distress have not been integrated into hospital birth practices, meaning falling or variable O2 stats are still a common cause for c-sections. OBs aren't just stubborn, but rather very human. Seeing a newborn suffer complications or even die causes an OB to carry around anecdotal precautions that outweigh their observations of population-level analysis. In a sense, they become superstitious. And very over-protective. It's a well-intentioned health crisis, considering that on a population level, c-sections increase maternal mortality, damage to bodily structures such as the pelvic floor, and childhood illnesses like asthma. And we haven't begun to research the mental effects.

Beyond their fear of diabetes itself, my problem was also caused by another commonly known and poorly researched phenomenon: the diluting of care when midwives become mainstreamed. The midwives share a practice with obstetricians and they explained that if they lower their testing standards the OBs will begin to lose faith in them, and may eventually stop practicing with them. They hinted this had happened in other practices and was why theirs is the only remaining midwife/OB practice in Houston. So we were caught in a loop where I didn't want to lose my credentials (position of health) and they didn't want to lose theirs (adhering to tests and procedures rather than trusting the mom's health).

We were at a stand-off, except that I've had difficulties getting my insurance to consider covering home midwifery care (apparently, I'm the first one who has asked HMO Blue to do this) and if I'm trying to transfer my care to a NYC midwife, I can't exactly have this big giant unresolved issue on the first page of my medical charts. I told the midwives this and that they were forcing a woman to have a medical procedure against her will, something they theoretically stand firmly against. Everyone felt bad, but only I gave.

At one point, when the crazy error margins of the GTT were being raised, they offered me the option of testing myself with a home blood sugar monitor so at least I could choose this path and feel like at least the error whiskers were not out of my control. On Friday, when I went to get the prescription for the testing kit, one of the midwives gave a last ditch effort to discredit even this decision, saying the technology was too complicated for me to learn and the kit would be too expensive. I assured her that this procedure developed for daily home use for the 3rd most common disease in the country would surely depend on being easy to use.

Three days into poking my fingers four times a day, I can happily report that my blood sugar is perfect. Even after a cup of hot chocolate--my Green and Blacks is among the only indulgences I have. If only my grudge could drop so easily. I actually don't trust them anymore and even if I weren't moving, I don't think I could open myself up to the vulnerability of birth with individuals that forced me to make decisions I didn't feel was best for my body. But the womb is the last frontier of human rights, and I have to choose which hill to fight on very carefully these days.