Posted by My OB said WHAT?!?.
Dec
10
Posted by My OB said WHAT?!?.
“…I Can’t Prescribe Anything For You, No Matter How Bad It Is.”
“Sorry, but the only thing you can do for your cough is take Robitussin and drink warm tea with honey. I can’t prescribe anything for you, no matter how bad it is.” – Midwife in training to mother.
There are 48 comments to this post.
mom of 5 had this to say,
Dec 10, 2011 @ 10:06 am (Quote)
Or mullein leaf or tea to help with congestion, licorice root or lobelia extract to relax the bronchial tubes, a basic steam tent, eucalyptus essential oil. Don’t forget your basic immune system boosters: vit C, garlic and the always controversial colloidal silver. 
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K Reply:
December 10th, 2011 at 1:42 pm (Quote)
Why assume that herbal remedies are safer than pharmaceuticals?
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Leah Spencer Reply:
December 10th, 2011 at 3:51 pm (Quote)
The simplest way to explain it is that herbal and pure essential oils are natural, stuff from your local drugstore are synthetic.
Your body assimilates the two differently. Pharmaceuticals are designed to deceive our cells and send signals that trick the body into constraining symptoms. Because they blindly attack these symptoms, they inevitably disrupt other functions in the body. AKA “side effects”.
An easy example would be how antibiotics often times cause yeast infections for women, because antibiotics blindly attack all the bacteria in you.
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Outside of asthma or some other chronic health problem, that’s actually true if you’re pregnant. Prescription cough meds are not safe in pregnancy. Natural remedies are usually helpful, though! In addition to the above, warm salt water gargles (gross, I know) work wonders for a sore throat and cough!
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Not too shocking, considering it was said by a midwife in training. Legally she probably can’t prescribe anything.
Here midwives are not allowed to prescribe medications at all (except prenatal vitamins and MAYBE laxative for after the birth)
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I’m guessing this was said in a dismissive tone, or that this was the extent of the conversation with nothing more discussed about natural remedies the mom could use at home. While I agree she probably shouldn’t be advocating for a prescription, she could have pointed the mom to other resources or turned it over to her midwife to address her concerns and suggest a prescription remedy that would be safe.
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Uh… Could you at least see if the mother has bronchitis, asthma, influenza, or pneumonia before you leap to conclusions there chief? I mean, yeah, for the symptom of coughing, there is only so much you can do. But what is CAUSING the cough in the first place? Maybe you should figure that one out and fix that too.
LOGIC! If all doctors had this, we all might die of shock!
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Dawn Reply:
December 10th, 2011 at 7:42 pm (Quote)
It was allergies. I have bad allergies in Texas, but not back where I’m originally from in Chicago.
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Kristin Reply:
December 11th, 2011 at 2:15 pm (Quote)
Oi! Tell me about it! If it float’s in the air and is not an animal, I’m severely allergic to it!! I had to take benedryl my entire pregnancy so my face wouldn’t be a swollen itchy wreckage and I could breathe through my nose at all. I have asthma too so I had concerns that if my allergies were not treated, I would develop an infection secondary to the allergies. A few years ago I eventually got pneumonia because my allergies caused a sinus infection that migrated into my chest, becoming bronchitis and then pneumonia… Not fun.
I’ve been told that local honey can help, but you have to take between 1-3 tablespoons a day, and I have to watch my sugars.
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Julie had this to say,
Dec 10, 2011 @ 11:24 am (Quote)
Kristin, I don’t know if it’s just me, but I don’t think it’s a midwife’s job to diagnose any of those things… At most after this she should have said “I recommend you go see your family doctor”.
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Lexie Reply:
December 10th, 2011 at 12:32 pm (Quote)
you have to be careful with that one. My midwife is really pissed at me for going to my family dr after breaking my tailbone and needing a refill on my asthma medication.
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SarahB Reply:
December 10th, 2011 at 12:49 pm (Quote)
My the OBs and midwife that worked with them always referred me to my family practice doctor for things like that so I just started going to him if it wasn’t pregnancy related. Even if it effected the pregnancy. My family practice doctor delivered my other three babies though so he was a prenatal care provider and he works for the same medical group as the OBs and midwife I saw.
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V Reply:
December 10th, 2011 at 12:45 pm (Quote)
That is exactly what I was thinking. A midwife trains for peri-natality. She is not trained to diagnose those medical conditions.
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K Reply:
December 10th, 2011 at 1:41 pm (Quote)
Certified nurse-midwives are trained as primary care providers and can handle uncomplicated asthma, bronchitis, and influenza, and to collaborate or refer when it’s complicated or there’s a possibility of something like pneumonia.
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Laura Reply:
December 10th, 2011 at 8:06 pm (Quote)
I found this to be true in my last pregnancy. I have asthma, which is usually mild. Last time though, my asthma went crazy, and became severe enough to be hospitalized. My CNM’s, which are normally pretty hands off, checked me out. Then I was referred to a pulmonologist. My midwives were trained, and able to handle my asthma when mild, but when it became something more, I was referred over.
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V Reply:
December 10th, 2011 at 9:18 pm (Quote)
Ok, good to know. Here we do not have certified nurse midwives, just midwives and they really do not deal with lung issues. Any non-pregnancy related issues they can suggest non-medicinal ideas to heal, but if you need meds you have to go to a doctor.
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I agree that really as a midwife in training isn’t going to be prescribing anything. I would bet there is more to this story.
While I was pregnant with my 4th, in the second trimester I had brochitis. I saw my family practice doctor (who had actually delivered my other babies but I was too high risk with my 4th) and he did prescribe codeine with phenergan for my cough because I was coughing so hard that I was having contractions when I coughed and putting me into preterm labor at 16 weeks. With a history of a 33 and 31 weeker, something needed to be done. After I had tried all sorts of natural remedies and was still having the problem. So while on occasion a prescription may be called for (the benefits of the prescription outweigh the risks) this particular provider wouldn’t have been the one to prescribe anyway.
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Yeah, I’m curious to read the pink link on this one. A midwife in training can’t write prescriptions anyway, so I’m curious to hear why this was taken offensively. I’m guessing it had something to do with the tone?
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Dawn Reply:
December 11th, 2011 at 5:51 pm (Quote)
She was overseen by a CNM who can write prescriptions. I came in on my normal visit with a bad cough, came in 2 weeks later for a follow up on my eating assessment and the cough was so much worse that I could barely talk, and called the next day with no voice. Once I finally talked to the CNM, I got help.
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Yeah. This is sound advice to me. I am scratching my head on this one. Why isn’t it in Thoughtful Thursday?! O.o
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Don’t forget the first sentence – “The only thing you can do is tea and Robitussin.” In context it sounds as though the midwife is saying there is nothing else the patient can do. (Which isn’t necessarily the case at all, even if this provider can’t help her with advice or a prescription.)
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I’m wondering if the midwife in training shouldn’t have gone and grabbed the midwife and gotten a second opinion on the spot.
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SarahB Reply:
December 10th, 2011 at 2:16 pm (Quote)
Good point. If you can’t prescribe anything for me and the only thing you can do to help me is to try tea and Robitussin, maybe you should consult someone who has more experience to make sure we aren’t missing anything.
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Dawn Reply:
December 11th, 2011 at 5:49 pm (Quote)
I tried to give the midwife student the benefit of the doubt and gave it overnight with her recommendations. I called the next day with barely any voice explaining that the cough had gotten worse overnight. She put me on hold and then *claimed* that she talked to one of the CNM’s who agreed that was all I could do. Funny thing is that 2 weeks later when I had seen that CNM for my regular checkup, she mentioned nothing abut being asked and told me I should’ve contacted them a day later to tell them what was going on and that I needed further assistance.
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Dorothy Kernaghan-Baez had this to say,
Dec 10, 2011 @ 4:04 pm (Quote)
I’m wondering the same thing….
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When i was pregnant with my daughter i started having random side/back pain. i thought it was in the area of my kidney, so after 2 weeks and no longer being able to sit comfortable or work comfortably without pain (much less sleep, walk, sit, or drive) i finally went in. Tunrs out, miss soccer player had knocked my rib out of place1 (looking back i think the posture of carrying a heavy backpack while i walked a mile to college probably caused it more than she did) and without any suggestions of other treatment, the OB i saw wrote me a prescription for vicodin on the spot and sent me out. I think waht he did was probably rather smart, because after about a week of OCCASIONAL use, like if it hurt and i couldn’t sleep, or if i was not going to make it through class because of the pain, i managed to baby it enough to get it back in to place.
so “i can’t prescribe you anything” means one of 3 things “i don’t have the power to do that” “its not safe to give you anything unless its proven that you are very ill and that the illness is more hazardous than the meds” or “i don’t really think you’re that sick so go away”… and given the context, it was probably meant the 3rd way or badly worded 2nd way.
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Kristie S. had this to say,
Dec 10, 2011 @ 6:53 pm (Quote)
I was sick with multiple upper respitory infections during my lest pregnancy. One that included bronchitis. I was coughing so hard I couldn’t sleep and it was really painful. My doc perscribed promethezine and codeine. I used it sparingly for 3 nights but it was a god send. My daughter was born safe and healthy. This mid wife’s attitude is unacceptable. There are solutions for pregnant women who are sick a d they include more that tea.
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I had been seen by this midwife-in-training during the beginning of my pregnancy, until I had a note put on my file that no more trainees were to see me, only the licensed midwives. For two visits, two weeks apart (first one was a follow up nutrition visit, second was my regular visit) I had been coming in with a cough so bad we could barely speak to each other. That evening, no matter what I did I could not control my cough. Warm tea, honey, lemon, Robitussin, any other OTC meds, nothing helped the cough and I woke up the next morning feeling as if I had been swallowing razor blades all night. I called back and she *claimed* she had talked to her boss, the owner/midwife, who confirmed there was nothing else that could be done. I spent the day crying and in so much pain. Tylenol did NOTHING. I still couldn’t stop coughing. I kept drinking water trying to flush it out, but swallowing was torture, almost as bad as when I had strep throat 6 years ago and was hospitalized for 8 days for it. I ended up literally gargling with a glass of wine that evening and that was the only thing that got rid of even a minimal amount of pain.
Two weeks later I was still practically hacking up a lung so I went in and talked to one of the other owner/midwives who did actually take the time to listen to my lungs to confirm there wasn’t a rattling and that it was allergies. She gave me the options of giving me a prescription for a cough syrup with codeine or Tessalon Pearles, which she determined for both the benefit outweighed the potential consequences. I took the Tessalon. I only needed it for 2 days in order to get back under control.
I was in tears and so much unneeded because I honestly felt that they weren’t willing to help when a patient truly needed help. I wasn’t looking for a drug “fix.” If seeing the second owner/midwife wasn’t going to help, I was about to go to my G.P. whether they would “approve” or not. Oh, and on my next visit with the first Midwife/owner, she told me that I should’ve called or stopped by the next day. I find it difficult to believe that the one in training actually did talk to her, seeing as there were no notes on my chart that I did call and she told me I should’ve.
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Dawn Reply:
December 10th, 2011 at 7:46 pm (Quote)
I should also add that even though she was a midwife in training, she was overseen by 3 certified nurse midwives.
Also, the cough was due to allergies. When the owner/midwife saw me, she did check my lungs and viewed the inside of my nasal passages. She could tell by my nose it was due to allergies. OTC remedies don’t work for me and normally I need a steroid nasal spray when it gets this bad. All I wanted was something to stop the cough because I could understand why taking an inhaled steroid wouldn’t be the best first option right now. I know this from 6 years of dealing with allergies in Texas (I’m originally from Chicago and have no allergy symptoms up there and moving back there isn’t an option for my family right now).
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abba12 Reply:
December 11th, 2011 at 2:19 pm (Quote)
I hate those sorts of doctors. Yep there’s a risk, but there’s a risk getting out of bed in the morning too. Sometimes the benefits outweigh those risks.
I had hyperemesis, and useless doctors who insisted it would just go away and I was fine despite losing 15% of my body weight. I ended up researching for days and finally self medicating with an OTC travel sickness med that happened to be made up of two of the most common meds for hyperemesis. Yep there were risks, I felt the risks were less than the risk of me fainting while standing and landing on my second trimester tummy from lack of… well, everything, as I almost had so often already.
The meds couldn’t stop it it, but in my research even normal meds couldnt stop it, it made it bearable.
You know, after I told the doctor what I’d done as I wanted a medical opinion of what long term usage of a medication meant for short term use could do, they looked up the medication on the same database I already had done, gave me the info I already had, and then honed in and paniced over the fact the medication put a small amount of caffine in to counter the sleepiness! They suddenly wanted to hand me medications just to stop me taking one that might have a tiny bit of caffene! (each pill was about a quarter cup of coffee and I took 4 a day, so a cup of coffee, not even slightly excessive)
Doctors are so weird about pregnant women and medications, it’s absurd. There are risks going without medication too you know!
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The Deranged Housewife had this to say,
Dec 11, 2011 @ 11:43 am (Quote)
Ya know, they’re so worried about that and yet, they practically push Nubain, Stadol, and an epidural on you during labor. What the heck?
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laurel Reply:
December 11th, 2011 at 2:12 pm (Quote)
To be fair, THIS midwife couldn’t do that because THIS one was still in training and unable to prescribe ANY medication.
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Dawn Reply:
December 11th, 2011 at 5:45 pm (Quote)
To be even more fair, there was always at least 1 CNM overseeing her seeing the patients *somewhere* in the building. It’s not a large building. It’s basically a birthing center that’s in a strip mall, so there’s no possible way it can be too large that a CNM couldn’t be contacted to write a script. When I finally saw the CNM, she even called the script into my pharmacy.
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Kit had this to say,
Dec 11, 2011 @ 4:44 pm (Quote)
I can’t reply directly from my phone, but I want to recommend taking a daily dose of local honey. My dad has terrible allergies and has been on allergy medications for years, to the point where he had developed a resistance to them and they were no longer effective. It took him several months, but with 1 tablespoon a day of honey, he has been able to completely wean off the medications. He is also diabetic, so he has to allot for it in his diet. It is a challenge for him, but so worth it.
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I’m pretty surprised by some of these comments.
I suppose my midwife could have said the same thing when I had a horrible cough, since she also doesn’t have the power to perscribe or diagnose non pregnancy related issues. But you know what? She did what a RESPONSIBLE care provider should do in that circumstance and referred me to my primary care physician to be further evaluated. Turns out it was a reoccurance of asthma (I had it as a child but haven’t had symptoms in years) brought on by the pregnancy. Ultimately I needed 2 different medications to bring it under control. Furthermore, she followed up about a week later, made sure I had been able to get in to the doctor and took the time to listen to my concerns about the medication. She pointed out that in an ideal world no pregnant women should take medication of any kind, however, it’s not an ideal world and sometimes the benefits of a medication outweigh the potential risks – a point some of you seem to be forgetting.
The fact that a midwife in training can’t diagnose or persribe medication isn’t the issue. The issue is that the OP was given the brush off and her concerns weren’t taken seriously when they should have been. A persistant cough can be a symptom of something that needs treatment, such as an infection or asthma (or in the OPs case allergies). It was irresponsible of this midwife to send the OP off without trying to find the source of the cough (a history of allergies should have been a BIG red flag), and making an appropriate referral, or at least consulting with her supervisor.
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Wendy Reply:
December 12th, 2011 at 1:56 pm (Quote)
This. It is their ethical responsibility to refer out for these cases.
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Dawn Reply:
December 12th, 2011 at 4:17 pm (Quote)
Christina, thank you so much! You should’ve seen the even worse remarks on FB from MOSW. No, she didn’t refer me to see a GP either. She didn’t even call the CNM in to take a look to see what we should do. She kept quoting how it’s unethical to test on pregnant women and that’s why we don’t know if medications during pregnancy are considered safe. Once I saw the CNM, she determined the benefits outweighed the potential risks and gave me a ‘script that ultimately did help about a million percent!
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karen had this to say,
Dec 12, 2011 @ 1:57 pm (Quote)
I was 6 months pregnant and had a horrible ear infection. I went to a doc in the box who handed me a script for amoxicillin and said, “if this doesn’t work, don’t come back, I can’t give you anything else because you are pregnant.” I ended up in the ER on New Years a couple days later with two perforated ear drums and a raging sinus infection and high BP from the pain. The lovely nurse practitiner called the ob resident to find am appropriate, safe antibiotic, gave me tylenol with codeine for the awful pain and a big hug when I broke down crying explaining how I felt and what the other doctor had said. I have NEVER let a doc blow me off because I was pregnant again. FYI, I ended up with a chronic condition, probably because of how far and severe this infection was allowed to go. Toughing it out is often far worse for mom and baby than some pharmaceuticals.
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She was a midwife in training, she probably COULDN’T prescribe anything legally. So what she was saying was true.
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Details Reply:
December 14th, 2011 at 11:36 am (Quote)
And you missed the part about how it is unethical of her to not call in the CNW she is training under and lie to the patient about having spoken to the CNM. If you are in such a hurry you can’t read the entire thread then why waste your time commenting 2 days after the pink link went up? Hmmmm?
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Add Your Comment.
I’d like to see some context for this. Given how much pregnant women are told that everything they put in their bodies is a risk, it sounds like this midwife is erring on the side of caution.
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