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Sunday
Oct182009

An OB's Birth Plan: Obstetrician's Disclosure Sent One Mom Running

 

A pregnant woman posted a document she received from her obstetrician to a forum on AllNurses.com prefaced with the following:

I’m 26 weeks with my 3rd (1st 2 were hospital births) and at my last appointment my OB folding a piece of paper in half and handed it to my husband. He told us it was information on hospital policies and things and we could discuss at my next visit. All I saw was the title Dr. ________ “Birth Plan” and I was amused because I know that birth plans can be irrational and badly researched. After I read it I was less amused and now plan on finding another care provider. I do believe the OB is a good doctor and I plan on sending a polite but honest letter and I would also like to cite research in order to leave some possibility that he will rethink his position. I am having trouble finding research.

 

Here is the doctor’s alleged birth plan that this Texas doctor hands out to his patients.

 

DR. ________ “BIRTH PLAN”

 

Dear Patient:

As your obstetrician, it is my goal and responsibility to ensure your safety and your baby’s safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.

* Home delivery, underwater delivery, and delivery in a dark room is not allowed.

* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.

* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby’s well-being.

* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby’s well being.

* Continuous monitoring of your baby’s heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby’s heart rate are not allowed.

* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.

* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.

* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.

* Episiotomy is a surgical incision made at the vaginal opening just before the baby’s head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby’s head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.

* I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby.

* If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section.

* Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.

 

The woman returned a few days ago to update what she decided to do after reading this doctor’s full disclosure about his extreme medical births.

Here I sit holding a healthy almost 4 month old baby boy and part of me wants to send a thank you card to this doctor because if he hadn’t been so extreme I probably would have had a hospital birth and almost everything he listed would have been done because that’s just the way things are at hospitals here and it’s hard to argue when you’re in labor. I was so irritated with the hold OB attitude after his “birth plan” that I went almost to the complete opposite and had a midwife assisted birth in an extremely low tech birth center. Toward the end (I went to 41+5) I had many moments where I wished I had stayed so I would have someone who would “enable” me to risk my health, the babies health, and my low intervention birth and just get that kid out of there. It’s hard to resist going the super intervention route when you’re exhausted, uncomfortable and just done being pregnant and it’s a pity doctors are so ready to take advantage of this or at least ready to humor you without disclosing the risks. As it was I went to the birth center at 12:30pm (after 24 hours of steady labor), had him at 3:20pm in tub with nothing hooked to me and doppler monitoring done after every few contractions, no pushing instructions and I delivered an 8#15oz baby on my side in tub without a tear and went home at 6:20pm. It was amazing that left almost entirely to my own devices (the only thing they had to make me do was drink water in between contractions I never would have thought of it by that point) I knew exactly what my body needed to do even if it went against their advice. I prolonged the pushing stage by raising the pitch of my screams so that not every contraction would be too productive and I think that’s what allowed me to deliver him with no tears even though I have a problematic episiotomy scar. I only had a “skid mark” or two and didn’t even need to use the peri bottle when I urinated. I don’t think this birth hurt any less than my previous two hospital births but it was just so much better.

Thanks all -especially to the wonderful L & D nurses who advocate for their patients and not just for the OB and the hospital.

 

What would you like to have known in advance when choosing a care provider for your birth?

 

(Photo credit (unaltered): www.legaljuice.com)

 

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Reader Comments (74)

OMG! Head for the hills, ladies!

It's scary, but at least he's up front about it! There are many doctors with similar stances, but you might not know it until you are in the throes of labor.

I love how birthing in the bed is the "most comfortable" and "open" position for a woman to birth in. Someone is more comfortable, but it's likely not the mother. Oh, and then everything is his discretion. What choice does the woman have? Oh, she can have the epidural as early as she likes! Awesome!

Kudos to her, she should send that letter. I would.

October 19, 2009 | Unregistered CommenterKathryn

That really is the only choice, isn't it? Women can choose who they bring to support them but they may be kicked out at the whim of this doctor.

Maybe they can choose music they listen to or when they apply their own chapstick.

October 19, 2009 | Registered CommenterJill

Surely, this is a joke. I very much doubt that any obstetrician would routinely hand out a document like this.

October 19, 2009 | Unregistered CommenterRéka

It's stunning, & a depressing statement how bad things are, that he still has patients since he's clearly uneducated. If only more of them stated their ignorance & disrespect so clearly, though.

October 19, 2009 | Unregistered CommenterLisa

WOW. Yes he's honest, but that was so upsetting to read. He is so far off base it's criminal!!!!!

October 19, 2009 | Unregistered CommenterLauren

Actually, I am very impressed with the doctor. Let's not forget he is also controlled by the hospital's policy. This doctor seems to be quite happy and really does not care what women think of him. He is doing his best to inform his patients of the care they will receive. And it is UPTO the woman to either maintain her rights to her own body or signed them off to him, with his practice operating from the view that birth is dangerous, women are not to be trusted and are incapable of giving birth without high-risk obstetrics techniques managing every aspect. Lets face it ... there is a certain kind of male that goes into obstetrics ... one arrogant misogynistic prick who thinks he's a God and likes to get away with murder. The exceptions prove the rule.

October 19, 2009 | Unregistered CommenterVeronika

Totally ludicrous.This is almost unbelievable except we know it's what they really think!

October 19, 2009 | Unregistered CommenterDesalie Lowe

Amazing to read this when i compare it to what i learned in my midwifery training and still learning every day at work. Whats the point in observing a baby´s heart beat at any minute when we all know that they can overcome a certain stress and they are made for a stressful birth to adapt to life outside the uterus. It´s well needed.
lying positions - what a joke, exactly just comfortable for him!
I can´t believe that his c-section rate is low, not with this birth plan, he is working against any nature - maybe thats why he didnt publish his rate, probably its not 30 but 28 % - amazing!
well, this really annoyed me that we have to accept these people who are obviously doing no good for women but being in a job position where they are supposed to support childbirth! In a non selfish way!
Why are men allowed to assist a birth anyway or treat women in pregnancy and childbirth and postnatally - what are their qualifications - they will never experience any of the circumstances they are supposed to treat!

Greetings from Austria where childbirth is still a little bit more in the female hands! just a little sadly!
I would recommend sewing - America is sewing for everything, so why not start here where it matters!

Nina

October 19, 2009 | Unregistered CommenterNina

THis is just jawdropping! I know we all know that this is what OBs really think...but it's just so shocking to see it laid right out plain as day! I guess I am just too used to the smoke and mirrors! What an arrogant man....I"m glad this mom had proper warning so she could seek someone who was not completely full of himself to attend her birth!

October 19, 2009 | Unregistered CommenterJill

There's this part of me that wishes that all OBs would hand out documents like this to all of their pregnant patients. Of course, not all of their "birth plans" would include the same points and preferences. (Because some of them would, you know, reflect evidence-based maternity care and other silly stuff like that.) But then women would be able to know--to REALLY know--ahead of time just where an OB stands in regard to medical intervention and management during labor.

And holy jeepers, this OB's conceptions of 'normal' and 'necessary' and 'comfortable' are way off base!

October 19, 2009 | Unregistered CommenterBirthingBeautifulIdeas
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