Kaiser Prenatal

Today, I saw a nurse-midwife at Kaiser for a prenatal visit. I checked in and was given a stack of forms to fill out. There was one form saying that Kaiser understands many pregnant women have a strong preference to be cared for by only female medical staff, and that Kaiser does their best to honor that request, but in the case of a medical emergency, it may be necessary to receive care from a male provider. I wonder if this form is something specific to the Bay Area, since there is such a large Muslim and conservative religious community here?

A few forms were about genetic screening, which we had long ago decided not to do, so I left them blank. I also refused to sign the consent form to be drug tested. And then, just for fun, I decided to fill out only about half the prenatal health history form, leaving blank all the info that I knew was irrelevant and/or none of their business.

While I waited the 30 minutes it took to be called back to see the nurse-midwife, I felt so anxious and wished I had thought to bring someone with me. T would have been great because we could have laughed together about the ridiculousness of the forms. Having my mom or Louis there would have been nice, because I knew I was preparing for a confrontation and I felt very lonely. My heart was pounding and I tried not to touch any of the germy surfaces in the waiting room.

Finally, I was called back. Before I could see the CNM, though, the medical assistant looked over my forms and the battle began. She asked me to fill out everything completely and I politely said, "no thank you." She asked me if I had received any care this pregnancy and I told her I had, at home. She looked at me like I was crazy. She said she was going to have to ask someone about the forms, since she had never seen anyone refuse to sign them before.

While she was figuring out what to do, I got to see the CNM. She was so nice! I knew she would be, but my visit with her was even better than I had expected. She stood up and shook my hand. She said, "Hi, I'm Mary Ann. I'm a midwife." I said, "Hi, so am I. I'm Jennifer :)" She said she had seen my name in her schedule and she had been so looking forward to meeting me. She was so warm and friendly. After chatting with her a bit about my practice, she gave me her personal card with her home address and phone number and made me promise to keep in touch professionally, and to let her know if I needed anything personally. I traded it with one of my cards and she said she would be sending patients my way. We even talked about setting up a doula program at Kaiser Hayward.

While we were talking, another medical assistant interrupted us as she came in to talk to me about the forms. It was kind of upsetting because she was clearly trying to intimidate with her presence. She asked why I hadn't filled out all the forms and I explained I was planning a home birth and receiving care elsewhere and that I respectfully refused to sign. I calmly and politely explained that I was there to meet the CNM and establish my existence as a pregnant Kaiser member, so that a chart could be created in the event that I would need to seek medical care during the pregnancy or birth.

She said that in order to establish a chart, I needed to fill out all the forms. So, I gently took them back from her, grabbed a pen, and drew a long diagonal line across the forms I refused to sign. At the bottom of one, I wrote, "I refuse genetic screening" and signed my name. Not knowing what to do, she accepted the "signed" forms and gave me my copies.

Then, she said I needed to have a "confirmation" in their system before my chart could be set up. She said the confirmation they require of all newly pregnant women is a vaginal ultrasound (because apparently that's the only way they can tell if a woman is actually pregnant). Unbelievable. When I said I didn't want a vaginal ultrasound, she asked how I could actually confirm the pregnancy. I told her the urine pregnancy test was positive, I heard heart tones at 12 weeks, and I have clear signs and symptoms of pregnancy (all of which count as verification of pregnancy for birth certificate purposes). At that point, she got very flustered and said none of that counted, since I didn't have any formal verification. I then got an image in my head of Louis smacking his hand saying, "papelitos!" and wanted to laugh.

She explained that it was necessary to confirm the pregnancy (with vaginal ultrasound) so that if I showed up at 34 weeks, for example, they wouldn't be scrambling to find my information. I asked her directly if that meant that refusing the vaginal ultrasound meant I would be denied care if I showed up at the hospital at 34 weeks. Still flustered, she said no, of course not, because I could always refuse the ultrasound. Well, then! Duh, what's the big deal? She said it would just take the staff time to find my records and there wouldn't be any lab results, and, and...

So, I pulled out my lab results and handed it to her. She glanced at it and told me my prenatal panel was missing some information that Kaiser includes, so it wasn't complete. Really, a comprehensive prenatal panel for a reputable national laboratory isn't sufficient? I asked her what was missing, other than the drug testing, and she couldn't tell me.

Finally realizing she wasn't getting anywhere with me and that the more flustered she became, the calmer I was, she wisely decided to leave. I just straight up told her I didn't appreciate her making the process difficult for me and that I knew my wishes were completely rational and justified. She just said she had never seen anyone refuse either the signing of forms, or the "mandatory" vaginal ultrasound. She honestly didn't know how to handle it and half-heartedly apologized for making it difficult.

Finally alone again, the CNM apologized over and over for the whole encounter, as well. We talked about how I could make the whole thing easier for my future clients, since I'm certainly not the only person wanting a home birth and concurrent care. She was great because I believed her when she said she and the other midwives got it, and only the medical assistants had an issue with it because it complicated their paperwork. At least I really felt like she was an advocate. We talked shop some more, then we wished each other well and I was on my way.

I've been thinking about the whole "we've never had anyone refuse this before!" comment I kept getting. First, I find that hard to believe. Second, if it is actually true, it's so incredibly pathetic. It feels like Kaiser staff purposely take advantage of the vulnerability of pregnant women to scare them into doing whatever is convenient for Kaiser. I could see (well, kind of) how a newly pregnant woman might actually think that a vaginal ultrasound is somehow helpful to the health of her baby and not think to question it. I could also see how women could fill out way more personal info than is really necessary, because they don't know the process and why it's being asked. I'm so glad I became a midwife before getting pregnant! But even if I hadn't, I'd like to think I would still be questioning everything.

As my parents can confirm, I have always had issues with authority. Tell me I have to do something and you'll get, "oh yeah? watch me" in response. (Actually it's no wonder I did become a midwife). What has changed recently, though, is that I'm not being difficult for the sake of being difficult. I feel incredibly protective over the baby already, and I will not subject him or her to anything that may be dangerous or unhealthy, and that especially includes so-called medical care. I will not be bullied or intimidated. I am not scared about any part of this process, so I don't feel the need to have tons of invasive testing and I'm not concerned with anyone else's convenience.

Goodness, I'm becoming a mama bear.

As I left Kaiser today, I had a chat with the baby. I apologized for my faster than normal heart beat and the stress that I brought on. I explained that we would only be coming back to Kaiser if the baby's health was in jeopardy, so I vowed that we are going to do our best to stay as healthy as possible. I was super thrilled when I got the slightest little nudge in agreement from baby. We have a deal.