I have a consultant appointment and growth scan on Monday 24th Oct at the diabetic obstetrics clinic and there are some issues which I would like to talk about then so I am writing in the hope that you are able to give me enough time on the day. If the clinic is too busy for this conversation then I would be happy to receive a reply via letter/email. If a written response then please could I receive a reply by Nov 10th as I have a midwife appointment in which we will be discussing home birth.
As you are aware we are planning a home birth. This obviously means that we will be rejecting routine induction on the grounds of my being diabetic which has been mentioned at previous appointments. We would like to make it clear though that if any problems do become apparent or even mildly suspected then we are happy to accept interventions as needed. We have, however, done our research on this subject and believe this is the best option for us as things currently stand. Our baby and I are healthy and have had no problems throughout the pregnancy. My blood pressure and blood sugar (both hba1c and self monitoring pre/post meals) are well within target and so far our scans have all been normal. Im sure you know the counter argument to the policy of being induced at 38w, but the most striking statement to me is that the RCOG state that its based on common practice rather than solid evidence.
As per the NICE guidelines we would like to have tests of fetal wellbeing from 38w and would like some information on how these are done ie frequency, what the test is looking for and more practical issues like where in the hospital are the tests done, who will be doing it etc.
We understand that it is the medical professionals responsibility to ensure that we are aware of all the risks however we have found that risks have been repeatedly brought up even when we have demonstrated that they are something we are aware of. This has led us to lose trust in the team which is a dangerous place to be in case there are any interventions which I really DO need, we are less likely to believe someone who we dont trust which may lead to delays in accepting necessary treatment.
We would like to resolve this situation and propose a solution. At our next appointment in which I will be 32w pregnant we would like to have a full discussion of all the currently relevant issues, risks and benefits of our options, anything else which you might want to bring up at all (however please ensure that this is evidence based practice) with the aim to have a balanced and frank discussion. After this discussion we would like a note put in my maternity notes, prominent enough so that future health professionals will notice it, to the effect that the risks of x y and z have been explained and need not be repeated.
If the situation changes of course then we are happy to revisit the issues, if I develop high blood pressure, or pre eclampsia or the tests of fetal wellbeing discover some problem then by all means tell us what the risks are but as long as we both continue to be healthy we see no point in repeating the issues we are adults and are able to make informed decisions.
Our worry is that approaching 40w is a vulnerable place to be. I would like to come into the hospital for tests as offered but if they consist of a Dr repeating the risks of our actions each time I come in with the aim to basically scare me into changing my mind then I feel that I will have to disengage from such tests which may mean that some real problem IS missed.
Our view is that we have made our decision based on our current health situation. If this changes then we can revisit the issues, if it (hopefully) doesnt then we see no need to change our mind and repeatedly warning us of the risks seems to be trying to tap into our naturally heightened emotional state which will develop further as I reach full term.
We would also be grateful if someone from the team was able to discuss self monitoring of blood sugars both during labour and after birth. I self monitor at the moment and believe I have good awareness of my patterns, however, I know that these may change during labour. We also would like advice on what equipment we can use to monitor our babys sugar levels at home.
I hope that you see that this letter is meant as a way to resolve the issues which we have had with the clinic and work towards a relationship of trust and support. We have made our plans and would like to feel like your staff are able to support us in our path, whether they agree with our choices or not.