Following Your Gut and Challenging Your Doctors

This post is going to veer way off the usual adventure theme. As discussed in my last post, we had some adventures of a different kind – threatened preterm labor and two separate trips to labor and delivery at 33 and 35 weeks which resulted in 5 weeks of bed rest and medication to stop contractions.

This post is about that kind of adventure.

Since that first episode at 33 weeks we’ve been seen at the OB weekly. Some things you should know. There’s one OB practice in this town. When we moved here, there were three doctors there full time and another who works on-call only – I was told never to expect to see her. In the past month or so, two new doctors have joined the practice. Expectant mothers are “required” to see each doctor in the practice, because any of them could be on call when delivery day comes around.

Our first round of threatened preterm labor, the female doctor I’d been told I wouldn’t see was actually the doctor on call. She was amazing – much better bedside manner than the other doctors I’d seen (all men, but I don’t think they have poor bedside manner because they are men). While we were in the hospital they ran a fetal fibronectin (fFN) test, which is supposed to indicate the likelihood of actually going into active labor within two weeks. Apparently, the fFN test has a high false positive rate, which means that a positive test could indicate that labor is likely to happen within two weeks, but may not actually mean anything at all. On the other hand, if the fFN is negative chances are good that labor will not occur within two weeks. My first fFN was negative, and the same was true when the test was repeated at 35 weeks the second time we found ourselves in L&D.

At 33 weeks they also gave me steroid shots to help develop the baby’s lungs and put me on Procardia to stop the contractions. I continued that Procardia until the 37 week mark. That came with some really fun side effects – wonky blood pressure, swelling in my hands and feet, flushing, dizziness and horrible headaches for at least an hour after taking each dose…it was no picnic. I also spent 5 weeks sitting around, going to campus only to teach my class and really doing nothing else.

Today I went to the doctor for my 38 week appointment. It’s spring break in our little town, for both the university and the local schools, and most of the doctors are out of town. I saw the newest member to the practice – he’s been practicing for >20 years but in another city until he joined this practice last week. And he had some very interesting things to say about preterm labor…

First, he said that if I had truly been having preterm labor they never would have been able to stop it for more than a few days (now, to be fair, they did call it threatened). Second, in light of the negative fFN test, he wouldn’t have put me on Procardia OR bed rest.

That’s right. Neither.

I haven’t taken the time to research any of this since I left the office, though I do intend to. When I was first placed on bed rest at 33 weeks, Adventure Guy went online to research that part himself. He found that as of 2011, the position of the American College of Obstetricians and Gynecologists (ACOG) is “bed rest, hydration and pelvic rest does not appear to improve the rate of preterm birth and should not be routinely recommended.”

Did I question the doctor at that time? Me, with the PhD?

No. No I did not. Why not? Because she’s the expert. When I’m talking to someone about [my field of study] and making recommendations based on what I know to be current in the literature, I expect that to be respected. Note: respected is not the same as taken at face value. It is possible to ask someone’s expert opinion and still question them, still challenge them, in a respectful way. But I didn’t do that. I knew that the ACOG recommendation was against bed rest, but I didn’t question it when the doctor told me that was what I needed to do.

I’ve obsessed over this all afternoon. And do you know why I think I didn’t question the doctor? Because of what happened at my very first OB appointment.

We had just moved to altitude. I’m very familiar with the benefits of exercise during pregnancy and I know what the recommendations are, I could spout them off to you in my sleep. I also know what the old recommendations are and could spout of several iterations of those, too. So when I asked the doctor what kind of exercise I could/should be doing – in light of our recent move to altitude – I knew that the recommendations he gave me were from 1975. After a short pause during which I’m sure smoke was coming out of my ears, I questioned him and I quoted the 2002 ACOG recommendations for exercise during pregnancy.

And he actually responded with “you wouldn’t want to hurt your baby, would you?”

Of course I wouldn’t want to hurt my baby. Who would? And I really think that one statement made me, an educated, confident woman, hesitant to question my doctors anymore. No, I don’t want to hurt my baby, so I’ll take what the doctors say at face value. I’ll do what they tell me because they think it’s best for my baby.

So today I asked this new doctor about bed rest. He told me that ACOG no longer recommends it and that there are negative effects to the mother that seem to outweigh any remote benefit. I bucked up and told him that I had read that, but had deferred to the expert, and he started talking about the benefits of all of the information that is available to us on the internet. However, he said, if he were to go online to research internal combustion engines he could find a lot of information but it wouldn’t mean much to him, and he would ask his mechanic. That was what I had done. However, my PhD is in the, uh…biomedical sciences…and I can read medical research and understand what it says. I told him this, and do you know what he said to me?

“Challenge your doctors.”

I should have. When my husband pulled up that article about the ACOG recommendations I should have asked the doctor about it. We could have at least discussed it, entertained the possibility that bed rest wasn’t really necessary.

On the other hand, if I’m going to make a mistake I’d still rather err on the side of caution. My baby didn’t come early. She’s still growing as she should and appears to be perfectly healthy. If I hadn’t gone on bed rest, hadn’t taken the Procardia and she came early and needed time in the NICU I probably would have always doubted my decisions. There’s no way to know for sure what would have happened if we hadn’t followed this course.

That is to say, if I could take it all back I don’t know that I would. But I did learn something from this – I learned to follow my gut, have faith in my ability and my husband’s ability to critically analyze the information available to us and to respectfully challenge our doctors. And that, in the end, might be what benefits Adventure Baby the most.

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3 Responses to Following Your Gut and Challenging Your Doctors

  1. As an OB/GYN to be, I really enjoyed this post and will definitely keep it in mind throughout my training! Thank you.

    • Allez says:

      Thanks for reading 🙂 Overall I’m happy with the care I received, but this served as a good lesson for the future. It sounds like you have a lot of concern for your future patients, and I’m glad this post could help!

  2. Pingback: Bed rest survival guide from the UK perspective | Honey, I'm lost with the kids!

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