Jan 292013

“I don’t know how they can just let you monitor your own blood sugar like that.” – OB to mother being seen by midwives and monitoring her own blood glucose levels with a home monitor.

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 January 29, 2013  informed consent, Midwife, OB  Add comments

  28 Responses to ““I Don’t Know How They Can Just Let You Monitor Your Own Blood Sugar…””

  1. Um, whats the alternative? Come into your office for blood draws 3x a day?

  2. Well, OB, what’s YOUR protocol for women with gestational diabetes or Type 1 or Type 2 diabetes? Do you go to the mom’s house and monitor it for her?

  3. Again with the “let” ! Yes, doc, my midwives actually trust me to make my own informed decisions and don’t “let” me do anything. They also trust me enough to know I won’t cheat on the blood glucose tests if I do them myself. What do regular diabetics do anyways, live in the hospital or monitor their own blood sugars at home?

  4. But Dr house is where everyone gets their medical training from and he said everyone is incompetent and everyone lies

  5. Even my husband’s relatives who are diabetic (type 1 and type 2) have to go to the dr’s office to test their blood sugar 4-8x per day. Oh, wait…

  6. Uh, millions of people all over the world monitor their blood sugar every day. Pharmacies sell the meters over the counter. I could go out and get one right now and start monitoring my sugars if I really wanted to. It’s not rocket science.

  7. Yeeeeahhhh…my 11-year-old nephew has been doing this multiple times per day, every day, since he was diagnosed with Type 1 diabetes at age 4. (Obviously, my sister helped a lot and continues to help at an age-appropriate level.) So not really sure why it’s so shocking.

  8. This is mine! A bit of background: I’m currently working with an awesome midwife with a birth center. I have a history of preterm labor (at 32 weeks) due to an unmanaged case of gestational diabetes that my previous OB did NOT tell me I had (and therefore ended up with PROM at 32 weeks due to my poor nutrition). This time around I’ve been monitoring my sugars since the day I knew I was pregnant and I have passed my glucose test with flying colors, so I have successfully managed to NOT have GD this time around. I really contribute that to having more control over my pregnancy instead of trusting an OB giving me info on a need to know basis.

    I’m 33 weeks and this past weekend I had a stomach bug that resulted in very uncomfortable muscles under my rib cage. To be safe and make sure baby was ok, I went to a local hospital to make sure everything was on the up and up and to make sure I wasn’t dehydrated or anything. They had me to to L&D so that the midwife on staff (not affiliated with my birth center) could check me out.

    After explaining my history to her and the nurse, she started going on and on about how I shouldn’t be with the birth center, due to my history (when in fact, I go there BECAUSE of my history), and saying how LAY midwives (she put a lot of emphasis on the LAY) aren’t like she is. She was all, “Well *I* have medical training and have been a NP and I’m a REAL midwife…” yada yada yada. Good for her.

    THEN I told her that I’ve been monitoring my blood sugar since the very beginning and I don’t have GD, and I really believe that working with my midwife there really made it all that better since I had better control over my whole pregnancy. This made me feel really comfortable working with the birth center, cause I feel like this pregnancy was better managed. By myself.

    That’s when she scoffed and said the gem above. As if how DARE I take care of myself in my pregnancy.

    She also said that if I have to transfer to the hospital during labor if anything goes wrong then, “you aren’t their patient anymore, you become our patient and they have no more control over you anymore, we have the control.”

    So, here’s hoping I make it the next 4 weeks and I don’t have to push my baby out in that hospital. If I go early again, I will, cause they have one of the best NICU around. But, it’s obviously not my first choice.

    I was just really offended by her and her disrespect for my choices and the midwives that I work with.

    • “You become our patient and they have no more control over you anymore, we have the control.”

      And did she even show a flicker of awareness that talking to a potential client like that might be, I don’t know, offputting?

      • I know…especially since when we were talking I was emphasizing the fact that I LIKED having control over my pregnancy. I know I don’t have med training like SHE does (just typing it the way she was saying it) but I do know I don’t want GD and PROM and only I can make that not happen.

        • No matter what happens or where you give birth; THEY don’t have the control, YOU have the control. If she isn’t aware of that ask for a second opinion from the hospital’s patient advocate. Actually, since she has already explained her feelings on the subject, I would go on and call him or her so you can get to know the hospital’s policies and your rights in a proactive way.

          • Since it wasn’t actually labor and I was really only there for a short time, I just filed it in the WTF section in my brain. If I DID go into labor there I would make sure she wasn’t going to be near me, or even if I didn’t have a choice, I would advocate for myself pretty well. My real midwife would switch to being my doula, so she would still be there, and *I* would let her have a say, cause I trust her experience.

          • That woman majorly overstepped and basically threatened you, IMO. I’m not one to give much thought to the “what ifs” when planning my births, but this would be a time I would make an exception. If I were you I would talk to the patient advocate now so you have the knowledge prior to having a need to go to the hospital.

          • I would also register a complaint with the hospital today. The administration should point out to her that the patient bill of rights says she is a consultant and has no control what-so-ever and needs to shut her freaken mouth!

    • The actual truth is that according to the patient bill of rights, you the patient still have control. You don’t become their property just because you step into the hospital.

    • It’s uncanny, I was on the phone with a hospital midwife (working in ABC rooms) and when I mentioned I was tracking my own blood glucose and BP, she asked if I was a nurse or midwife. And then concluded since I was neither then I have absolutely no records.

      Because apparently I need medical training in order to read a (automatic!) BP cuff or a glucose meter.

      • Yeah, that is weird! I suppose they really think that they’re the only ones who know anything!

        Ha, I have a cuff, too…I should have thrown that in there, just for kicks.

      • Contrast that with my husband, who tracks his own BP and blood sugar, and whose doctors are always so pleased he keeps records of all his readings.

        I guess if men got pregnant they’d turn into idiots, too.

      • Does this also mean that if we track our menstrual cycles, but don’t have a medical degree, that our records are somehow less meaningful or accurate?

        Don’t they ask you the date of your LMP in order to spin the magic due date wheel? And if, since you have no medical degree, your charting records have no meaning or merit, then why do they bother asking for the LMP date in the first place?

        And if that’s the case, then why have a magic due date wheel at all? I mean, if you are going to assume that your patient is an idiot, then why talk to them at all?

      • Because we know all hospital records are error-free, as they’re generated in hospitals where mistakes never happen. But if you write down those same numbers at home, the gremlins come take the numbers away, and your records become blank again.

      • That just makes no sense to me. I had GD with my last pregnancy and my doctor had me track my own sugars and just asked me to bring in the numbers at each visit so he could…*gasp*…add it to MY RECORDS. OMG he trusted a PATIENT to do something for HERSELF.

        I mean seriously wtf do these people think diabetics do, go to the doctor every time they need their blood sugars checked??

    • Since it’s recent, I still stew over it a little. I think the part that mostly offends me is that she says my midwives “let me” control my sugars (and pregnancy). Like they can stop me, lol

    • Couldn’t agree with you more about the “let me” thing. We’re not children…we’re just GESTATING children. So, stew away.

      And another thing that caught my attention here; diabetics and people with BP problems are routinely trained to take and record their own readings, and they’re using the same kinds of automated machines they’d use in hospitals. However, they’re not capable of reading and writing down those numbers themselves. But medical providers will trust medical and nursing students on their very first days of clinicals to read and record those same machine-driven numbers. And those are considered “accurate”.

      I can understand if you were using a normal BP cuff and stethescope at home, that they would want to know your background. But the very people who pray to the gods of the continuous EFM machines…which are NEVER wrong because they’re machines and not fetoscopes/hand-held dopplers and pairs of hands & ears…will not trust a patient’s own machines.

      Guess the hospital/office machines and their students & employees are the only ones with such trustworthy magical powers. My bad.

  9. Gee, how do any of us lowly peasants know to take over-the-counter or prescription medication without a doctor holding our hand?! How does my father-in-law monitor his diabetes in his own home on a daily basis?! I guess we just dumb, folks. We just dumb.

  10. I don’t know why this is such a hard concept for people in OB. I bought a meter and monitored my sugars periodically during my last pregnancy, not because my sugars were high, but because I was spilling sugar into my urine, which seems to be normal for some women. Mymidwives wanted. Org to look for an actual problem, and to have and he records in case I saw a doctor or hospital who questioned their care. I was monitoring several weeks before my GTT, which was normal. I am a nurse who often works with diabetic patients, and this is what we ask of them. What it the issue?

    • Its a combination of two biases in decision making. First, is the negativity bias, where we tend to weight negative memories more than positive ones. I’m sure some of your non-compliant patients made a huge impact. The second is confirmation bias, where we tend to blame things that go wrong on whatever we expected to make it go wrong (You had a big baby? Undiagnosed GD even though you tested and your sugars were always good) Human nature, but you think we’d learn to step away from our bad experiences. I even see it on this site, when people comment “that’s what you get for seeing an OB/delivering at a hospital.”

    • I don’t get it either. Could this midwife possibly not have someone in her life that is a diabetic who monitors at home? It is normal standard practice for diabetics to monitor after the dease has progressed to a certain point. There are TV commercials with free monitors that “hurt less” on almost daily.

      • Did she just give away her ignorance at how blood sugar tests work? She may have “medical” training but I would guess she’s not very smart. Someone has to graduate at the bottom of the class.

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