Ok, I've been gearing up for this for a while...once it's all written out, it will probably end up being far less daunting than I expected. I want to write about the fucking hell it was to find adequate prenatal care. I also want to emphasize "adequate," because I have not found good or even great care, simply care that will do until I have to figure out where the fuck I'm having this baby so I can finally be done with this entirely awful medical situation. I'm not sure I'll enjoy writing about this, but I need to write about this, so here goes...
A bit of background; Since I had a miscarriage with my first pregnancy, I knew that I didn't need or want prenatal care in my first trimester. The rates of miscarriage are so high that it seemed pointless to go see a doctor to tell me 1. I'm pregnant (which I knew) and 2. I should alter my diet and behavior accordingly and wait for the second trimester (which I also knew). I did have a really hard time with anxiety, but since I had no mental health care provider, there wasn't much point in seeing a doctor who could do nothing about it, and as would prove to be true, probably only make it worse. So I waited. I became very anxious and by week twelve, I went to a free ultrasound clinic (it turned out to be a pro-life clinic) for a confirmation ultrasound. I saw the baby, it was alive, everything was medically there, and I went back to waiting. I had planned a road trip that would go from week twelve to week thirteen, and I had not made appointments before I left. Because of this, I ended up being slightly behind what I thought was the ideal schedule, which made me anxious and defensive... rightfully so, because I was treated like absolute shit.
I booked an appointment at the Summa Women's Center or something similarly named in Akron near city hospital. The practice had midwives and doctors and nurse practitioners. They see a variety of patients, but I surmised they see a lot of low-income patients based on the waiting room the few times I visited (for appointments and to get my records). The appointment setter was somewhat shocked at how late I was to getting to a doctor and fit me into the schedule quickly, this really should've been a sign.
I went, saw a nurse or orderly or technician type person who weighed me and took my blood pressure. She was nice. Then I went to see the nurse practitioner. I don't know what they do, honestly. Before the nurse left, she instructed me to take off my pants, which I would not do. Pelvic exams, especially early in pregnancy, are very common, but they are largely unnecessary. I was not about to have hands in my vagina because of tradition or routine and not for a reason, so I was firmly in the "pants on" camp. (All women should take this approach, as there is no medical reason to have a pelvic exam early in pregnancy or even throughout pregnancy. If someone tries to threaten you with pelvic malformations, calmly explain how you don't suffer from Rickets.) The nurse seemed surprised, but she left.
At no time did anyone take my medical history.
This is an important thing to note, because medical history should trump routine ALWAYS. And because, you really cannot care for a patient whose medical history you don't know. There are SO MANY things that can come up in a medical history and so many family history items to consider when faced with prenatal care that not taking a medical history is, in my mind, medical malpractice.
(Sadly, the definition of malpractice requires the neglect of the doctor to cause harm. So being mean and abusive and causing stress...none of that officially counts as medical malpractice, which is the only reason I haven't seriously pursued a case against Summa and this shitty nurse. It would take so much time and energy that I don't have. Someone else needs to start a class action suit, and I will happily lend my voice, but I cannot lead the charge.)
The next person to come in was a student. I think she identified herself as such, and I'm totally fine with students and teaching hospitals. It's very normal for care around here and I welcome it. I'm not ashamed, embarrassed, or feel my body needs to be a secret. The student was AWESOME. I was so comfortable with her that I went on and on, until she stopped me because we were getting too involved and the official nurse practitioner needed to be there. My comfort with the student was misplaced. Because I was so open with her, she gave the nurse practitioner all the information I shared, which was not good. Since I hadn't yet met the nurse practitioner, I hadn't been able to read her, and therefore, I was more free than I should have been. I told the student I would not have a pelvic exam as I did not need one (which my medical history would've made clear). I told her I wasn't taking prenatal vitamins because I was eating real food. These two items were the real sticking points of the first fight. I also said I wasn't interested in any genetic testing, no ultrasounds, just nothing that wasn't necessary unless there was evidence it was necessary. This is my stance and my philosophy and it should be respected, but it was not.
The nurse practitioner came in and the atmosphere in the room changed. She was quite tall, bigger build (not fat, just built sturdy), blonde. These physical features and her demeanor are why I will proceed to refer to her as Fraulein Bitch from here on out. She came in MAD. I mean, MAD. She came in already against things I had said, already deciding that I was high risk and irresponsible, already with an opinion about how women should go about her medical care and why her philosophies were right.
She dismissed my desire for no genetic testing saying, "I wasn't interested in it either, so it's fine." And went right into the pelvic exam, which I continued to refuse. I told her, flat out, I didn't need a pap smear or any STD testing because I was not at risk. I was shocked to find that she didn't just believe me. And since no one bothered to take my medical history, this woman wasn't going to believe me. She kept trying to force me into it, finally blurting out, "IT'S TO SCREEN FOR CERVICAL CANCER!"
Let's take a moment to analyze how inappropriate it is to shout "cancer" to anyone, but in particular someone who is in for a prenatal visit, who has zero risk factors for cancer, which you would know if you had taken a medical history. The sticking point here is the STD testing and the pap smear. The reality is, doctors like to screen for gonorrhea, chlamydia, and HPV. The "cervical cancer" aspect has to do with HPV, the other two have to do with passing the infections on to the baby via the birth canal. However, a thorough medical history would highlight that I have only ever had three sexual partners. Combine that with my age and I am squarely in the "zero risk for any STD (STI)" category. I mean, laughably so. FURTHERMORE, since I had already had a full battery of STD testing and a pap smear just two years before, when I started dating Adam, and everything was negative, I was extra, super, guaranteed totally free from any STD, including HPV, and was certainly at zero risk for cancer. But no one took my history, so there I was, being threatened with a condition that would compromise my desire or ability to carry a baby to term because Fraulein Bitch decided that routine was more important than actual patient care.
After she yelled those words at me, I gave her a very quick and thorough (my sexual history can be given quickly and thoroughly) history of my sexual experience to ASSURE HER that I was not at risk and would not need a pap smear. It was then that she tried to give me the "pelvic abnormalities" bit. And y'all, I almost bought it. At that point, I consented. Because by then, I had already been bullied and threatened and ignored and I had not heard about pelvic abnormalities. So I was game. I would've gone through with it right then with no further explanation, but by this point, Fraulein Bitch had decided that SHE WAS UNCOMFORTABLE WITH ME. (She noted this in my chart, so I know it to be true.)
I'm so glad I didn't relent. First of all, any serious pelvic abnormality would've come up before when I've had pelvic exams. You can't just have a misshapen pelvis, have pelvic exams, and not have anyone notice. Secondly, this sort of reasoning is bullshit. I would've had to have some sort of bone disease or defect, or maybe had like a serious injury that involved my pelvis, in order to have a pelvis that couldn't deliver a baby...which wouldn't matter anyway, because the solution is a c-section. The main reason anyone ever had pelvic abnormalities that prevented them from delivering a baby (and don't believe the baby is too big, 'cause it's not) is because of RICKETS. MOTHERFUCKING RICKETS. But since we fortify our milk with Vitamin D, nobody gets rickets in America. Therefore, nobody has deformed pelvises that can't bear children. Therefore, any excuse to try to get hands up in your pelvis or give you a c-section because of a large baby IS A DAMN LIE.
This woman is not only misinformed but also just generally stupid. You'd have to learn in medical school that pelvic abnormalities are due to rickets, since that is the only reason there has ever been cause to examine the general public of women who are pregnant. This alone, makes me think Fraulein Bitch should be fucking fired, since she's clearly too fucking dumb to do her job. Motherfucking common knowledge. Sadly, she is not alone in her reasoning. It is EXTREMELY common for women to receive pelvic exams and pap smears early in their pregnancy and also later in their pregnancy and THERE IS NO MEDICAL EVIDENCE FOR THIS PRACTICE, and ample evidence why it's dangerous.
So anyway, Fraulein Bitch was so mad at me that she was just shouting and threatening me...but she was also so uncomfortable with me that she would fill my charts with sarcastic commentary. She told me I would "have to" submit to a pelvic exam at my next visit. And sarcastically stated she wouldn't need to "prescribe" prenatal vitamins for me.
OK, 1. Prenatal vitamins are not better for you than real food. The only thing they provide is folic acid, which isn't even absorbed well through vitamins and you just have to eat a salad every day to get plenty of fucking folate. Furthermore, the U.S. and other developing nations ALREADY FORTIFY BREAD WITH FOLIC ACID specifically to reduce the occurrence of neural cord defects...WHICH HAPPEN BEFORE YOU ARE PREGNANT ANYWAY. So, unless you have never had bread and also never had spinach, you don't need prenatal vitamins. They don't provide you with nutrients you can't get from actual fruits and veggies (like oranges) and they increase your likelihood of morning sickness and constipation. So really, just eat fucking real food. 2. NO ONE CAN FORCE YOU TO SUBMIT TO A PELVIC EXAM. That's called rape. Threatening you with a pelvic exam you don't want is sexual assault.
Many more things happened in this first appointment. It was tense and awful. I attempted to present myself as an intelligent human being who was capable of making informed decisions. I told Fraulein Bitch that I knew I was at risk because I was "old and fat". Those are my words and at 39 years of age and weighing in at about 220lbs (maybe less) while being only 5'1", yes it is true. I am old, which you can't change. And I am fat, which you can't change once you're pregnant. AND ALL THE MEDICAL LITERATURE WANTS TO ASSERT THIS IS A PROBLEM. But since you can't change it and the only thing you can do is try to get me to eat better, why are we even addressing it? Oh probably because I came in to my first appointment so late that everyone thought I was a crack whore who was too fucking stupid to realize she needed a doctor to grow a fucking baby.
Ladies, you don't NEED a doctor to grow a baby. Your body is gonna do that just fine...or not. You MAY need a doctor to administer testing which might inform you as to whether or not your baby will come out totally healthy or have any number of illnesses that your genetic makeup might cause. You also MAY need a doctor to pull the baby out of your vagina...or cut it out of your abdomen. However, YOU DO NOT NEED A DOCTOR TO GROW A HEALTHY BABY. Your body is gonna do that. A doctor is just gonna look at it and say, "Yep, it's growing." Just eat better and maintain an exercise regimen, and you'll be doing your body and your baby huge favors in terms of positive outcomes.
I tried to tell Fraulein Bitch that I had done a ton of research which lead me to my decisions, but she did not fucking care. What I would learn from this and subsequent visits is that doctors and nurses have already decided how I should handle my pregnancy. They don't actually want to inform me of my options and let me make decisions. They want me to sit down, shut up, and be quiet as they shove their hands in my vagina and screen me for all kinda problems. Doctors really, really, really don't give a shit about who I am or what I believe or what my actual risk factors are, they just want to treat me like every other assembly line pregnant person.
And as I will tell you later, when shit gets really deep, almost all women I know will submit to this.
The problem is twofold; doctors who care more about routine, and women who are uneducated and let doctors treat them like routine.
But all that is info for another post. What matters is I left that office feeling worse than I did going in. I was also lied to. Fraulein Bitch told me I'd need blood work to make sure I didn't have a dangerous blood type, and while I refused STD testing, she didn't tell me they would also run an HIV test, Hepatitis tests, and a full toxicology, whether I wanted it or not. I would find this out after I read my charts full of shitty commentary from her. I would find out from another doctor that this practice is state law. I would be told by someone who I thought would be a friend, but who really wasn't a friend, that this was all a matter of course and of public health because "women lie". Which means, the state government (generally across the board, as I've learned) believes that women are going to come in with drugs in their system, riddled with STDs, and then go on and just lie about it, passing all these things onto children who will then require extensive medical care, which will... I don't know what? Because they can't force a pregnant woman who is HIV positive to terminate anyway, so what is the point of making broad sweeping laws that ignore the history and rights of the patients?
And yes, even the Amish, a zero risk group, have to pay for these tests out of pocket. Just to show you how ridiculous prenatal care has gotten.
Prenatal care, as I would learn, is not actually about women at all. It's about the idea that a fetus is more important than the women carrying it (we'll get into that) and it's about "public health" (whatever that means) and it's about routine. For me, that also means it's about standing my ground and fighting for what would be adequate care by a variety of doctors who could not care less about me as a person.