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 Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe.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

Oh, wow. I have a little reading for this guy.

Evidence Based Labor and Delivery Management

And, he handed it to the husband??

October 19, 2009 | Unregistered CommenterMomTFH

People forget that OBGYNS are SURGEONS!

I'm not too surprised by this doctor's "birth plan", because let's say you are a highly-trained neurosurgeon, wouldn't you too feel insulted and find it condescending if your patients came in and told YOU how to do your job and perform brain surgery? Many women do want this high-tech interventionist surgical birth, just look at Jennifer Hudson who compared her elective C-section to a "workout at the gym" and talked about how painless it was. Some women want and demand the early inductions and CFM etc., especially if they spent $50,000 and 5yrs to conceive via IVF (per the NYTimes article) and that pregnancy is their 1-shot at becoming a parent.

Women should really NOT be expecting a surgeon to stand with hands-tied-behind-back, they should choose Midwives as really this is the most suitable provider for expectant moms and laboring women. I respect this Doc for being honest, but I still find it sad that women keep going back to OBGYNS and then complaining instead of picking a Midwife as their partner in birth.

Folks, you can't change a man, you can't hope that a Surgeon is not gonna behave like a Surgeon.

October 19, 2009 | Unregistered CommenterCrystal

I am a surgeon (not OB) myself and I fired my own OB at 36 weeks for this kind of high handed hijinks. When I had to figure out on my own how to evaluate whether the contractions I was having (starting at 29 weeks) were something about which to be worried, I knew something was wrong. When the MFM I went to see agreed with me, the OB backed off and then immediately started telling me when he would induce me when he saw fit and I would have an IV, etc. etc. or "your baby will die". FIRED...on the spot.

At 45 years of age, I chose to have my baby at the hospital where I practice because it was close to the children's hospital and I was superstitious enough to believe that if I was close, my baby wouldn't need it. I went into labor spontaneously at 38 weeks, 3 days, delivered on my hands and knees 3.5 hours later without any interventions at all (my dad and I were the only two doctors in the room). Got to the hospital 1/2 an hour before she was born and went home 2 hours later (had to wait for pediatrician to get to hospital to sign baby out or insurance wouldn't pay for the use of the L&D room).

PS It took over a year to get the bill straightened out...insurance company couldn't believe we didn't go to rooms/nursery and hospital couldn't figure out how to just bill for the use of the L&D suite for two hours.

October 19, 2009 | Unregistered CommenterKIm

When I first interviewed my OB for my first son she told me all about how she was natural birthing friendly, etc etc. But in my 3rd trimester when I was taking my Bradley classes and was much more informed, I asked her more educated and pointed questions and essentially found out that her views were exactly as this OB's. That send me running for sure. It was awful to find all of this out mid-my 3rd trimester. It was beyond stressful and upsetting. I switched to a midwife and had my first at a free standing birth center and the second at home. I was soooooooo thankful I had my first at a birthing center as I positively know that it would have resulted in a c-section had I been with my original OB. And my second went so fast he would have been born at home no matter where I'd planned to have him. Thank goodness I'd planned to have him at home, even the midwife missed the whole labor and came in when the baby's head was half out!

October 19, 2009 | Unregistered Commentermomomommmy

Wow. He definately has some brass ones, but I have to agree that at least he is upfront about it. If only all OBs would be that upfront about their intentions, I think that a lot less women would be delivering with OBs, and instead would be looking more towards home. I also agree that it's the old smoke and mirrors routine that fools so many mamas into feeling safe.

My son was born via a very unneccessarian, and at just over halfway through my daughter's pregnancy, I fired him and hired a midwife. It was bar none one of the best decisions I've ever made.

October 19, 2009 | Unregistered CommenterKelly

I think A LOT of docs think that....although it is refreshing in some ways (honesty and clarity are a plus) it does not make him THAT much better. A scared set of soon to be parents may still go right along with anything and everything because of the blind trust that doctors (and many health care providers) think they deserve. I hate it, I hate what this letter says to women and what it means to babies. I hate it!!

October 19, 2009 | Unregistered CommenterNaomi

Sounds like she was just lucky this time.

October 19, 2009 | Unregistered Commenterbabybloo

I firmly believe that birthing babies is women's work. Noone knows or understands the process like a woman. I don't trust a man to tell me what position I will be most comfortable in for birthing my child. As most women will tell you, there are no rules and all women are differant when it comes to their labour and delivery. How dare this man think that he would know more about the process than a mother who has done this twice before! This was so scary, but then again, thank goodness he told her upfront so that she was able to make more appropriate arrangments.

October 19, 2009 | Unregistered Commentergill

I too found this horrible, allthough, as a third-year OB/Gyn resident, not shocking. What I actually found most shocking was his last point that c-sections would be done at his discretion and were not negotiable.

That is never true. A c-section (or any procedure, including IV starts, episiotomy, vacuum-assisted delivery, etc.) without the patient's consent is legally considered assult and battery, even if done for fetal indications.

So essentially that whole document was false propaganda. Although, it is certainly nice when you know up front what a provider is planning to do to you.

October 19, 2009 | Unregistered CommenterMegan

As horrible as that document is, I'm definitely glad this doc was upfront about his highly interventive approach. At least it gives his patients a chance to say, "Where is the nearest exit?" and find a new care provider. Honestly, I don't think there is any point in arguing with a doc like this (or anyone of this mindset) even though his beliefs are clearly in opposition to research, patient autonomy, and common sense. You can't change the mind of someone this hard-headed and ignorant. But you can certainly change care providers if you don't buy into his "birth plan." Too many docs pretend to be natural birth friendly, or pretend to believe in patient choice, only to spend 9 months subtly (or not so subtly) coercing a woman into believing that her body is defective.

October 19, 2009 | Unregistered CommenterLori
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