Advocating for Myself in Pregnancy

I want to start out by first saying that by writing this blog I am not in any way encouraging you to disregard any of your providers suggestions. This is simply my experience in advocating for myself and choosing what was best for myself and my baby.

When my husband and I started planning for our second child, I knew I wanted to give birth at home. I had an overall positive hospital birth experience with my Daughter, but for many reasons I felt home birth was the right decision for myself and my future baby. Before I was even pregnant I went to visit a midwife and discuss my plans for the future. During this meeting we went over my medical history and talked about my previous birth.

For my first birth I was induced at just shy of 39 weeks due to what was explained to me as gestational hypertension. We'll talk about this more later. After the birth of my daughter I developed a headache and called my providers office. They had me come in for a BP check, prescribed me meds and said I should try to sleep more. So easy with a newborn at home, right?

At my 6 week follow up visit, I spoke with my OB about going off of the BP meds. She explained that since I wanted to have more children, it may be in my best interest to stay on them through my next pregnancy to keep my BP under control and stay on top of it. This seemed to make sense to me. Little did I know that that would come back to haunt me with the diagnosis of “Chronic Hypertension.”

Again I want to state that gestational hypertension and pre-eclampsia can be very dangerous. Its not something to mess around with and you should discuss all options with your healthcare provider.

Anyway, a few days after my meeting with the midwife I got a call that they were not comfortable with me giving birth at home. Having a history of gestational hypertension and then chronic hypertension was a risk. I respected their opinion and although I was crushed, I quickly moved on to develop a new plan.

I decided to see a midwife who could help me deliver in the hospital. I started care with her and explained my situation about wanting a home birth. She was understanding and assured me that we would do everything possible to make this birth a positive one. Due to my diagnosis of chronic hypertension however, I would need to be seen by Maternal Fetal Medicine.

I went to see the MFM doctor and left that appointment with my head spinning and feeling extremely overwhelmed. The doctor I saw explained that due to my diagnosis of Chronic Hypertension, they would plan on inducing at 39 weeks. Due to the fact that we conceived with IVF, they would want to perform a fetal EKG. Due to the fact I had 2 seizures as a child, they would want to look into taking me off of an SSRI I had been on for nearly 8 years. I would need to be seen monthly and towards the end of my pregnancy I would have weekly appointments for non-stress tests. It felt like I was moving further and further away from the birth I had envisioned. MFM physicians are incredible doctors and can be literal life savers for those with complicated pregnancies. I however felt that in my case it was a bit overkill.

A week or so later I went to see my midwife to discuss what the MFM doctor had said. I was upset and hoping that she could ease my mind a bit. Turns out I was about to get some more bad news. The practice that my midwife worked for had recently changed their policy so they could no longer see patients who had been diagnosed with Chronic Hypertension. Her hands were tied and she would no longer be able to be my midwife. Let me tell you, I sobbed. I broke down right there and couldn't stop myself from crying. She was so compassionate. She suggested an OBGYN who she knew would support me in the decisions I made and practiced on more of the “natural” side of things. She had the office staff call and make me an appointment so it was all set and even gave me her cell phone number to check in after my appointment. She did everything in her power to support me without being able to actually be my midwife. Yet, there I was, more than halfway through my pregnancy, having to meet a new provider and feeling an overwhelming sense of uncertainty for the future. I was scared, sad, angry, and felt completely defeated.

Shortly after this I was speaking with a friend and she suggested that I reach out to her home birth midwives. The worst they could say was “no”, right? So that's what I did. I made an appointment to speak with them and went into it fully believing I would be told the exact same thing. I wanted to be sure to give them all the information I could about my previous birth, my BP and my health. I called the OB's office who I saw for the birth of my daughter and requested that they send me all of my records from my pregnancy. I read through my records and I was really confused. My BP, while slightly elevated when initially taken, was always back to normal when they took it again 15 minutes later (look up White Coat Syndrome if you want to learn more about this phenomenon.) So basically, my BP was never high enough to be diagnosed with gestational hypertension. (ACOG defines gestational hypertension as a BP of 140/90 taken on 2 separate occasions at least 4 hours apart.) In fact my BP at my appointment where they scheduled my induction was only 128/70, perfectly normal!

In preparation for my upcoming meeting, I was tracking my BP religiously. It was always low, which I assumed was a good thing. It can be normal for your BP to drop slightly during pregnancy. However, one day I was driving my daughter to swim lessons and I started feeling extremely lightheaded. I had experienced this to some extent through this pregnancy, but this was different. I pulled over into a home depot parking lot and had to close my eyes for a moment. I took my BP and no wonder I wasn't feeling well, it was a whopping 80/50. I sat there in the car with my daughter watching Moana for probably an hour before I finally felt well enough to drive home. The next few days my BP continued to be low and I continued to feel sick. I was frustrated with the situation and I was in between providers, and so I made the decision to stop taking my BP meds. (Another note that this is not something you should do! You should always talk with your provider before discontinuing a medication. Looking back I should definitely have made an appointment to speak with someone before making this decision).

Finally, I made it to the meeting with yet another provider. I told them all about the long string of events which had led me to them, we went over my blood pressures from my previous birth and talked about why I wanted a home-birth. I was thrilled, to say the least, when they said they would take me on as a client! These midwives monitored my blood pressure regularly and thankfully it never went back up. I continued the rest of my pregnancy perfectly healthy and my son was born at home at 38 weeks. I had finished off this pregnancy exactly how I imagined; a calm, peaceful, safe home birth.

Looking back on this journey it would be easy for me to feel like I had fallen through the cracks. Unfortunately, this type of thing happens. Were any of these providers malicious? No! Were any of them neglectful? No! Did they all want what was best for me and my baby? Of course! Sometimes you just have to look at the bigger picture to see what is and isn't possible. I want to make it clear that I was not in the mindset of “I want a home birth and I'm going to find someone, anyone, who would tell me yes.” This was a well thought out decision and it turned out to be the best decision I could have made.

It can be hard to advocate for yourself. When you view your provider as someone who is in a perceived position of authority, it can be intimidating to question them. But let me be 100% clear that nobody has authority over your body, other than you. If you have questions, ask! If something doesn't feel right, speak up! A good provider will welcome your questions and give you all the information you need to make an informed decision. So speak up and ask questions, I promise you won’t regret it.

Have your own experience with advocacy in pregnancy? I’d love to hear about it.

“In giving birth to our babies, we may find that we give birth to new possibilities within ourselves.”

-Myla and Jon Kabat-Zin

Have questions about how I can help you have a more positive birth? Let’s chat!

Consultations are always free