In thinking about my son’s birth recently, I’ve also been thinking about my midwives’ practices regarding their record-keeping and more importantly, their record-sharing.
As I’d stated before, when I went to the office to have a prenatal visit, I weighed myself and tested my urine, and told her the results. I’ve heard that this is not an uncommon practice in some midwifery practices, and even some doctors are having their clients handle these parts, or perhaps even more. I’ve heard of midwives or doctors having all of their clients that are due about the same time come in as a group and tell them the standard stuff while the women are all gathered together in one room, while still having one-on-one time for individual concerns. Not only does this foster a sense of community and friendship among the pregnant women, but it also tends to make the women have more care and concern for their own health and wellbeing — giving them a sense of ownership over their health, rather than turning it over to someone else. I’m sure it also saves time, because instead of having to spend five minutes with each client telling them the same things, they tell all the clients (maybe 10 of them at once) in that same five minutes, which leaves much more time free for real concerns.
My midwife did not act as if my medical file was her private property, and even asked if I wanted to see it, and showed it to me to make sure everything was accurate. When I got near term, she gave me a full copy of my chart for me to keep at home — that way if anything happened and I had to go to the hospital without her (the typical scenario would be something like my water broke and there was meconium in it, or I could feel the cord prolapsing into my vagina), I would have a complete copy of my records to give to the hospital at admission. Thereafter, at each visit, she copied the latest sheet(s) and gave them to me to supplement or replace the previous sheet(s). I don’t think I received a full copy of my birth chart in the postpartum time, but I’m sure she would have supplied it to me had I asked. In fact, HIPAA regulations require health professionals to maintain a copy of the records and to supply them to you on demand (although they can charge you a reasonable fee for copying and mailing them). There are a few exceptions to this:
The Rule excepts from the right of access the following protected health information: psychotherapy notes, information compiled for legal proceedings, laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access, or information held by certain research laboratories.
Another exception is if the doctor believes knowing the information could be harmful to the patient; but the patient still has the right to appeal that decision.
When I was pregnant the second time, I requested and received the full copy of my records of my first pregnancy and birth. The midwife charged $20 for copying and mailing them, which I think is reasonable, considering the time it must have taken to find the records, copy all of the papers, and then mail them off. I purposefully did not review the birth records when I wrote Keith’s birth story the other day, because I wanted it to be what I remembered, and not what other people wrote about it; but I will probably look at it soon and blog about that.
I can’t think of a down-side to requesting your records from your pregnancy and birth, except that you may read something your doctor or nurse wrote that you wish you were blissfully ignorant of. It is this potential ignorance that spurred me to write this post. I’ve read several recent things — some blog posts, some comments on other blog posts — which made me realize how important it is to have a real understanding of what happened. Here are some of the things I’ve read recently, as well as other bits of birth stories or books I’ve read in the past that are floating up in my mind:
- a current L&D nurse who knew almost nothing when she first gave birth, and ended up with an infection, and doesn’t know what kind it was nor how she got it. Since she’s a nurse, she should be able to decipher the medical language and scrawls and find out, if they still have the records from so long ago. It might not make much difference to her life right now, but if, for instance, she finds out that she acquired the infection from some hospital practice, it may motivate her to be extra-cautious so as not to do the same to another woman
- a woman whose only “indication” for a C-section was that she was insisting on a natural birth
- another woman found out that her C-section was because her father who was in the waiting room repeatedly told the doctor that if anything happened to “his little girl” or the baby that he would sue the doctor for everything he was worth (hmm, no pressure on the doc, huh?!)
- a woman who was told she was “stuck” at 2 cm or 5 cm or whatever for several hours so she needed a C-section, and her chart contradicted that — she was, in fact, dilating normally but for some other non-medical reason her doctor wanted to perform a C-section on her, so she was never told that she was progressing
- one woman found out that after her C-section, that her uterus was pulled out of her body to be repaired and then put back in (not too unusual, actually, but disconcerting for her to find that out, nonetheless)
- some women have found out after the birth that the IV running into their hands, which they assumed was empty since they gave no consent for any medication, in fact had drugs (such as Pitocin) in it
- other women have discovered that they were given Cytotec or some other medication that they had specifically refused
- one woman found that her postpartum hemorrhage that nearly caused her to bleed to death before she could get back to the hospital was caused by her having been given Cytotec against her knowledge and also against her primary doctor’s explicit orders (another OB was at the hospital at the time of her birth and he gave it to her after leading her to believe that he was not using it)
Even if there isn’t anything as dramatic as this in your pregnancy or birth records, it would still be a good idea to have a copy for your own benefit. For one thing, if you had to transfer care, you’d have your records to take with you; or if you were just curious or were having a bit of trouble remembering exactly what happened, it would be there in black and white. Having read my own labor and birth through the eyes of both the midwife and her assistant/doula, I can testify that it is pretty neat to see that perspective. Of course, I would imagine the records would be quite different from a hospital birth compared to a home birth. I know L&D nurses are usually busy or downright hectic, so they may have time only to chart the basics (and would do that in medical shorthand, which you might not be able to read); whereas at a home birth, the midwife would attend to one woman only at a time, so might have a little extra time to write down more than the medical side of birth (blood pressure, temperature, fetal heartrate, etc.).
If you get your records, I would encourage you to do so as soon as possible because it may be that there is something confusing to you, or downright illegible, and you can imagine how difficult or impossible it may be to try to determine what happened or what was written many months or even years later. But if you can “strike while the iron is hot”, and get the records within a few weeks or so of the birth, you may be able to get things explained if something is unclear. Try doing that 5 years after giving birth at that hospital, when the head nurse has just retired and the nurse in charge of your care at the time has not worked there for over four years.
If things are written in “medical-ese”, you may be able to figure them out with just some rudimentary knowledge of acronyms or medical jargon. I worked at a pharmacy for over 5 years, so most of the medical shorthand was already very familiar to me, or I could figure it out. Other terms may not be quite so obvious, so you may need some help — especially if the handwriting is sloppy.
If you think there was something fishy about your care, it might be preferable to review your records with somebody other than the caregiver — someone who would be honest and have nothing to hide. I think about the story I blogged about recently, of the woman who had an unnecessarian when her previously breech baby had flipped vertex, and the doctor decided against having an ultrasound right before surgery to confirm the baby’s position. When the woman was in recovery, the doctor came in to visit her, and explained that the baby had actually been head-down… but he said it in a way that made it sound like the baby must have flipped right before surgery; and he also made it sound like the baby was too big (at less than 8 & 1/2 lb) to fit through her pelvis (which was previously said to be “gynecoid” — the “best” shaped pelvis for birth) and would likely have needed a C-section anyway. Fortunately, after the doctor left, the husband asked the nurse point-blank if that was an unnecessary C-section; she took a deep breath, tempted to lie or mislead them, as the doctor had, and told them the truth — yes, the C-section was unnecessary. Had this couple just blindly accepted what the doctor said, the woman might have assumed that her body was “broken” and unable to birth babies that were just a bit larger than average (but not yet “macrosomic”). While it may seem like a small thing, it may mean the difference between her attempting a VBAC or choosing a medically unnecessary repeat Cesarean, if her second baby’s estimated fetal weight is the same as her first baby’s birthweight. After all, if the doctor tells you that your pelvis would not be adequate to birth an 8 lb. 5 oz. baby, would you attempt to give birth vaginally to a baby who was likely even bigger? These women did, but many women do not.
So, in summary — your records are yours, and as the saying goes, “knowledge is power”; so why not get some more knowledge about your own body? It also may surprise you what went on “behind the scenes” at your birth.
(This poll can be answered more than once, if you had different experiences with different births.)