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Sunday
Jun052011

This is Informed Consent?

Recently, I was asked to view a blog post on the Babies in Bloom site, written by Amber Plyler of Heath Springs, South Carolina. She is a doula, a midwifery student and an admitted “birth junkie.” Amber’s post, now pulled, was entitled “GBS+” and began this way:

“There are many various tests that pregnant women in America are recommended, encouraged, and sometimes coerced into doing. Testing for GBS (Group B Strep) is one of those tests.”

Right out of the gate, this lays out Amber’s prejudice against GBS testing. She goes on to malign routine testing, saying it is a:

“highly inaccurate way to judge if a woman will be GBS+ in labor seeing as GBS results can change depending on the day and you may not be + during labor even if you tested + at 32 weeks.”

While her information is incredibly inaccurate (testing is done between 35-37 weeks, not 32) and she has zero place as a doula to give a recipe for Hibiclens use (incorrectly and dangerously, I might add), the biggest irk I have about this piece and others like it are the promotional aspects that are designed to sway a woman’s thinking towards her own. I certainly share my thoughts and opinions (loudly and freely), but when I’m counseling a woman, I am as middle-of-the-road as I can be, offering each option as clearly as possible so she is able to have all the information with which to make her own decision. This piece by Amber was being touted as an educational piece, something for women to look at as an “option.” Her bias was showing.

If you decide to stand your ground, you’ll most likely be told that you’ll be given IV antibiotics during labor in the hospital –‘just in case’.”

Note the inflammatory language?

Here is my comment to her post:

First of all, it is so far out of a doula's scope of practice to recommend, offer, teach, suggest a treatment for Hibiclens, I'd personally like to see this post removed. If you are a Certified Doula with anyone, you are surely extremely outside the bounds of that contract. 

Secondly, you must live in some crazy world if they are testing at 32 weeks. IF the women are being tested at 32 weeks, their OBs, CNMs and midwives are asking for a buttload of lawsuits and are seriously putting women and babies at risk... if not just the risk of GBS infection, but at risk of not having all the information they need to make an educated decision. 

Thirdly, the Hibiclens wash does not Not NOT go IN the vagina. AT ALL. Suggesting that any douche go IN the vagina, especially in labor and ESPECIALLY with ruptured membranes is asking for an infection/possible embolism. GET YOUR INSTRUCTIONS RIGHT. 

Do you see why doulas aren't equipped to give this information? You think you've got it all wrapped up after talking to a local midwife, but maybe talking to many midwives, some nurses and even listening to a doctor or three would help you have balanced information with which to share with your client. 

As providers, we are so not supposed to shove our agenda down the client's throat. We are supposed to offer options and let the women choose what works for them. One of my major irks about (too many) non-nurse midwives is they 'sell' the treatment they are good at or are allowed to do. All too often, it has zero to do with what is truly safer for the baby, but is all about the midwife. 

I've recommended the Hibiclens wash as well, but after learning even more and talking to parents who've had GBS-infected babies (and learning about two homebirthed babies that died from GBS), I'm much more inclined to recommend the antibiotics. Antibiotics are sucky, I agree, but sick, NICU-kept and dead babies are even worse. 

However, women should be given TRUE Informed Consent. ALL the information; not just the information that's the crunchiest or easiest to employ.”

I hope my message is heard.

Reader Comments (66)

"Almost anyone dishes out "medical information" or opinions to expectant mom's. "

You know who doesn't dish out medical information to expectant moms? (no apostrophe) Medical students and residents in training, who wait until they know what they know and are licensed before giving out advice.

"Do you think everyone should just shut up and not talk about anything? I agree I needed to research more, and admitted that. How is that so wrong and horrible?"

Because you came to the conclusion that you needed to research more only after your mistakes were pointed out. Your behavior is not at all consistent with how intelligent, licensed professionals dispense advice. You can't just make up stuff, or go to know-nothing midwifery sites, copy stuff, present it with authority as though you've "researched" it.

"And your hopes I take several years to humble myself - I have several years to go yet! Tons of humbling, tons of learning, tons of mistake making I'm quite sure!"

Well, the sad thing is, you're not in the kind of rigorous program that will let you know when you've not learned enough. The 30 year old women that I know in the field of obstetrics had four years at the Dartmouths and Columbias and Johns Hopkins and Smiths of the world, then they went onto Yale or Johns Hopkins or WashU for medical school, and then onto residencies at top hospitals. It's fascinating to me that some women enjoy and crave rigorous learning environments, and others are content with programs that don't even merit the label of community college learning.

Nice one, Barb. I really wish people would think before their actions more often than not. Perhaps you don't care. Perhaps you feel the drive of hits to your blog makes it worth it. But now that Dr Amy has used your post and the doula's post to further twist the knife into homebirth and midwifery, you have potentially injured somebody's reputation and possibly her heart. Still without having read the original post in question, I do not know if I would have agreed or not, how accurate or inaccurate it was...but she is learning, she is trying, and she is not perfect. She is one of thousands who uses online resources to learn, teach, try, live, speak, listen. Some are not so accurate, some are grossly inaccurate, some are treasures. None started out as valuable as they become.

I've seen many inaccuracies here over the years, so you, like the rest of us, are not perfect either. You could easily have used her post anonymously as a way to springboard a discussion to suit you. But using her name, city and actual website may have made potentially permanently indelible scars. Now the box is opened, and you cannot control the damage. I really don't care to hear any bullshit about how "this is the 'net, this is the ride you get when you buy the 'net ticket..." It just was plain MEAN. MEAN. And unnecessary. You could have made all the points YOU wanted to make (even the INACCURATE ONES!) without naming someone else specifically.

Dr Amy doesn't need any help in her mission, that's for sure. But if you were willing to take the hit for any conversation you started, you might have given Amber the benefit of deciding whether she wanted to participate in that ride with you. What a novel concept that you might even have tried to talk to her privately, teach her what you know, what you think, point her to research, help her understand, point out why you think her post wasn't accurate or helpful and maybe begin a dialog to HELP....help midwifery, doulahood, birth, women...and yes, even an individual. And if you didn't feel it your job to help someone else learn from any mistakes they were making...was it really your job to try to destroy her?

There are ways to teach, help, even admonish without injuring. It is possible. Might have been nice for you to try one of them first.

June 6, 2011 | Unregistered CommenterVickii

Obviously, I don't see what I wrote *anything* like you do, Vickii. And it is not my fault that the SOB takes anything off my blog for her fodder. I'm not going to apologize just because she likes what I say sometimes.

Again, half thank me for speaking out and half (probably less than half, actually) are just as disgusted as you are. That leads me to believe I am in the right place and am perfectly comfortable with what I wrote. Sorry it irked you so much, but if I had to do it over again, it wouldn't have been done any different.

June 6, 2011 | Registered CommenterNavelgazing Midwife

Why are you worried about hurting someone's feelings? The doula in question doesn't seem to care that her information kills babies. Would you rather have a smug, know-it-all have hurt feelings or would you rather attend the funeral of a baby that should have lived? The only way that this misinformation is going to be eradicated is by people like NGM. She is taking a stand against the insanity, the rhetoric, and people like Vickii whose only purpose seems to be promoting homebirth midwifery. I commend you Barb, as you have found a way to support women while continuing to advocate for the safety of our precious babies.

June 6, 2011 | Unregistered CommenterAmanda

Lillian:
The reason someone is dosed so often is because that is what it takes for the antibiotics to actually kill the bacteria. If you are treating with ampicillin, it needs to be given q 4 hours, or it's ineffective, and creates superinfections. Like MRSA and VRE, which are deadly.

June 6, 2011 | Unregistered CommenterJulia

Oh, Amanda, you don't even know what you're talking about. And you don't even know me. I have so many purposes in life, and I do not "promote" homebirth midwifery. But yes, of course, I AM a homebirth midwife. And so? And NGM is in no position to take a stand against me. Not now, not ever.

Barb, I didn't think you'd apologize. I would have been surprised if you did. And I'm not surprised you're comfortable with where you are.

June 6, 2011 | Unregistered CommenterVickii

*looking around*

What? What is this about me taking a stand against you? Or not... "Not now, not ever." Where did that come from? I never challenged you! Wow.

Well, this isn't fun OR productive. I think it's time we move on.

June 6, 2011 | Registered CommenterNavelgazing Midwife

My homebirth midwife pulled this kind of BS with the "informed consent" sheets for Rhogam*, GD testing, and some other things too. The "info sheets" are anything but simple information, they are pushing an agenda, hard, using scare tactics. I think the woman was actually afraid of Rhogam. I wanted it prenatally at 28 weeks and she hemmed and hawed and stalled until it was too late. She kept guilt tripping me basically, saying "the effects on the fetus are UNKNOWN you need to really think this through!" Then she didn't do the blood test after my PPH to make sure I got enough postpartum, and I ended up sensitized. My next two pregnancies were roller coasters handled by Maternal Fetal Medicine. WTG, midwife!

*(Having been through three pregnancies as an Rh- woman now it baffles me why so many NCB die hards choose THAT hill to die on! It's so much less risky to get the pokes than to have white-knuckle high risk pregnancies and babies who spend months in NICU and get exchange transfusions!)

June 7, 2011 | Unregistered CommenterBranwen Maeve

I have to agree with Vicki. I think the way NGM has gone about this, and has done this throughout the years, is completely wrong. Its one thing to teach/instruct in a professional manner by addressing it privately with the individual or even in a public forum without names attached, but its quite another to publically shame someone and try to use it as an excuse for doing it all in the name of teaching. Maybe you should work on your own self worth NGM, so you don't feel the need to repeatedly tear others down while trying to make yourself look great. I never saw the original blog, but I do believe there are ways to teach and educate someone with integrity and professionalish versus pubically calling someone out and potentially causing life lasting damage for someone who has obviously been glad to correct her mistake.

I know one of your favorite things to say is that anything published on the net is free game and open to criticism. Have you ever heard the saying 'just because you can, doesn't mean you should'?

June 7, 2011 | Unregistered CommenterJill

You gotta have thicker skin than this to be a midwife, and you got to make sure you can defend yourself. Show up in an L&D ward with a GBS+ transport who has ROM for 18 hours and stand there while the on-call screams at you and threatens to have you reported in front of your client, and see who's going to hold your hand through your "journey to midwifery". You're going to have a client who loses her trust in you, and is possibly traumatized by the whole fiasco, and a L&D staff who now knows you as risking your clients lives and bringing them train wrecks. Not cool. And believe me, they will tell her, every chance they get, you nearly killed her baby. You need the respect and support of your transporting hospital more than you need the respect and support of some random people on the net if you truly want to provide safe, continous care for your mamas.

Like it or not, we need to practice within the standard of care of our communities. Believe it or not, the vast majority of OBs, CNMs and L&D nurses have the mama and baby's best interest at heart. They may have a very different approach, but they generally want the same thing we do.....a healthy, live mother and a healthy, live baby. Protocols have not been simply pulled out of someone's ass just to sabotage birthing women and MWs. They may not apply to every individual situation, and it's up to the provider to be judicious about when to act upon them, but we need to be aware that they may be appropriate in a given situation.

Beyond that, Amber's name, city, and business are listed on her blog. She made her info public, and anyone searching for Hibiclens+GBS could have stumpled upon it. Unfortunately, many, if not most, women get their "info" from the web, and especially from blogs and message boards.
Which brings to mind a MDC fiasco I was witness too, and also had personal knowledge about as I was consulted with by the MW in question, and ultimately caused me to discontinue membership. Without going into too much detail, the woman lied to her provider, lied to MDC about her well-being, and had dozens of MDCers, INCLUDING some who were MWs themselves, villianizing her MW, encouraging her to continue lying to her MW and back-up OB, encouraging her to UC, telling her to "trust" her body and her baby, and ultimately nearly cost her baby his life.
One particular MW who was most vocal about the situation, I messaged personally, and suggested, gently, that she shut the fuck up because she had no clue what this lady's risk factors were, had not seen her chart, did not know the MW who was caring for her, how she practiced, or how hard she and the back up OB (a most wonderful man who was bending over backwards trying to help her have a natural birth) were trying to give her the birth she wanted in spite of all the risks involved. She messaged me back, all hurt and offended and asked me why I "singled her out" and "personally attacked" her when she wasn't the only one giving advice. Because, when you sit in front of your computer screen, representing yourself as a professional and giving medical advice on a public forum, you are responsable for the outcomes of this lady and others who will read it and think, "A midwife said it, so it must be true".

June 7, 2011 | Unregistered CommenterColleen, LM

Hey thanks for this post. I've only been reading your blog a short time but I have come to appreciate your willingness to put what you've really, really learned out there.

I've lost a baby to medical error in labour. I don't think people quite understand what they are weighing the "risks" of antibiotics against.

Yes we all have a responsibility around not overusing abx, but treating a strep infection is not the same as taking them for every little cold when you don't have an infection. My new little guy has hydronephrosis and has been hospitalized with two UTIs. Abx have saved his kidneys. We've had thrush, which gentian violet helped with, and we're both on priobiotics - no big deal.

As for the debate about homebirth activism - it is only posts like this which make me hope for homebirth _at all_. It is posts like the other that have set me against it. People who think leaving ignorant and dangerous advice to stand is protecting activism are very very wrong.

Thanks for all you do.

June 7, 2011 | Unregistered CommenterJenn

Colleen, I love you,

June 7, 2011 | Unregistered CommenterAmanda

Oh Colleen, if MDC made your blood boil, whatever you do, don't go looking at diaperswappers!

June 7, 2011 | Unregistered Commenterms. doula

NGM-
Thank you so much for bringing attention to Amber's blog and this very important issue. You are a very brave woman to stand up to the status quo of protecting all midwives at all costs, no matter what misinformation they're giving. Lives are at stake! I don't support doctors who are irresponsible, and we shouldn't support midwives (or doulas) who are, either. Thank you for your courage and integrity.

June 7, 2011 | Unregistered CommenterGuest1

Yeah, yeah, yeah... been there, heard that. So y'all don't like my writing style. Read somewhere else. Read someone else. Don't keep thinking you're going to shame me into changing. Get over it.

IT'S THE WAY I CHOOSE TO WRITE.

You can not like the If-it's-on-the-Net-so-it's-Fair-Game "excuse" all you want, but it is and that's the way it goes in my world. *I'M* fucking fair game! Who's defending MY honor?! Puhlease. Suck it up and stand behind what you write.

I write as a writer, not ONLY as a midwife-monitrice-doula.

Hmmm... this deserves a blog post of its own. Then you can send me shaming nastygrams again! Woo hoo!

June 7, 2011 | Registered CommenterNavelgazing Midwife

a good informed choice agreements list ALL data without inflammatory language. I used the CDC info in my GBS handout and offered treatment plans that started from the most interventive (transfer to the hospital for IV antibiotics) to the most benign (herbs and probiotics/garlic). HOWEVER, I always used studies to back up what I was offering. It is UP TO THE PARENTS TO DECIDE THEIR PATH.

I hate that women are judged based on what risk she feels ok with. :(

July 26, 2011 | Unregistered Commenterpamela

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