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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 Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe.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)

I don't know if this is a real OB's birth plan, but I know what she means about thanking the dr!

My OB verbally tearing apart my well thought and researched birth plan (we took Bradley too, I think this turned him off to supporting us as well)

He told me "patients like you tie our hands behind our backs" " why did you come to me if you didn't want my help!"

Thankfully, we took a good childbirth class where I learned about my birthing options and their safety. And at 36 weeks I switched to a midwife who was patient with my poorly progressing labor. I neded up with a beautiful water birth in a free standing birth center followed by a perfect homebirth and a career in the birth world as a doula, childbirth educator, placenta encapsulator, and at the root of it all, an advocate for true informed consent!!

THANK YOU DR.(BLANK) for being so heartless and mean to a 36 week pregnant woman and taking away all her trust in her caregiver! It was the best thing you EVER did for me!

www.anewlifebeginsdoula.com

October 19, 2009 | Unregistered CommenterHallie Dedrick

I do hand it to the OB for being forthright. It is up to the patient to decide if this is the level of care that they are comfortable with and to seek other options if that answer is "Hell no!"

That is why we need to be modeling healthy body image and engaging in open communication about reproductive cycles with our daughters (and face it, our sons, too) from the day they are born. Having the vocabulary, the know-how, the self respect and the confidence to know how miraculous your body is the best remedy against the medical model who thinks that your body is inherently flawed. But how many momma's buy his crap bc they believe it just as much as he does? THAT is the sad tragedy here.

Thanks for posting this and reminding me yet again why my fifth birth in a few short weeks will be another midwife attended homebirth :)

October 19, 2009 | Unregistered CommenterJustine

I think it's real, and one reason I think that is that I received similar instructions (albeit not written) from an OB I once saw. Also, do you notice the obstetrical nurses backing this doctor's idiotic statements up 100% and bashing things like Bradley method? Yes, care providers do believe these things and yes, there are some arrogant enough to actually write them down and give them to patients.

October 19, 2009 | Unregistered CommenterMorgan

I do think this is real, it is not the first time I have heard of something like this - there was a practice (in VA I think?) who had a "we do not allow doulas at births" sign posted at reception. And I had a verbal conversation just like this, ("I will do whatever I think is medically necessary...I prefer not to have doulas at births...") with an OB I was interviewing for my first birth. I was grateful to her for her honesty as it made my decision very clear.

I agree with BirthingBeautifulIdeas and others - I would LOVE it if every OB who practiced this way wrote it down and handed it out. The smoke and mirrors is what puts us in a bad place, not knowing we need to change care providers until its too late. Knowledge is power - you can vote with your $ and go elsewhere.

October 19, 2009 | Unregistered CommenterMegan

Megan, you just reminded me of a comment in which someone told of a practice in Florida that doesn't do vaginal birth. At all. It's a pure c-section practice and I guess women are told that upfront.

October 19, 2009 | Unregistered CommenterJill--Unnecesarean

I wouldn't run from this doctor, I would spontaneously develop the skills to fly. This OB obviously hates women. I too wish that every doctor that felt this way put it on paper. There are even worse out there that think this way, but do everything in their power to decieve you into thinking they're going to do this your way. I'm so glad she switched.

October 19, 2009 | Unregistered CommenterMartha

Did you notice he handed his "birth plan" to her husband, and not to her?

October 19, 2009 | Unregistered CommenterLinnette

I agree with the others - at least he's honest, even if that whole letter was full of BLATANT LIES (not to even get into the paternalism and downright chauvinism). Just to name one example, among the treasure trove he provides - the lithotomy position "provides maximum space in your pelvis" and "is the most comfortable position for you"? Now, WE all know this is utter bullshit, but I fear for all the patients of his that don't know what a total crock it is.

But again, yeah, at least it's honest right off the bat.

October 19, 2009 | Unregistered CommenterDou-la-la

SCARY. I am afraid for the women who have this OB.. and others just like him.

October 19, 2009 | Unregistered Commentermichele

Wow. I flinched at first when the doc handed it to the husband, I knew that right there meant it would be bad. But wow
, I didn't expect it to be that bad. I don't know that I would have controlled myself from slapping the doctor after reading that. Did they change the oath somewhere so that doctors are bound to prove their own godhood by crushing the silly women who need them rather than the old fashioned oath to help those in need?

October 19, 2009 | Unregistered CommenterSummer
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