Another OB practice bans doulas - Page 2

[ASusan]

Originally Posted by JessicaRenee

http://birthingbeautifulideas.com/?p=1932

Here is the birth agen--err, "plan".

My heart is racing after reading this letter, I am so angry.

I'll try to generate a response, because I can respond to almost EVERY point in their plan based on my experience with them.

[VillageMom6]

What I find particularly depressing is that the Kingsdale group includes several women OB/GYNs.

I expected to see a buch of paternalistic men... and I did... but there are also quite a few young women docs who "thoughtfully and unanimously" agreed to ban doulas and to support a one-size-fits-all "birth plan".

Makes me appreciate my hospital based midwives even more!

[paintedfire]

Originally Posted by JessicaRenee

http://birthingbeautifulideas.com/?p=1932

Here is the birth agen--err, "plan".

Wow. I've got nothing to say - seriously. I'm a freakin' lawyer and their birth "plan" has rendered me speechless.

Yowza.

[ASusan]

My comments to their birth plan (based on how my doula-assisted L&D went with an OB from their practice).

http://birthingbeautifulideas.com/?p...1#comment-1937

[*MamaJen*]

Originally Posted by ASusan

My comments to their birth plan (based on how my doula-assisted L&D went with an OB from their practice).

http://birthingbeautifulideas.com/?p...1#comment-1937

Oh my god, that is heart-breaking. I'm so sorry you had such a horrible experience with that clinic, and I'm so glad that you're breaking free.
God, I feel like you just told me that you got up the strength to break up with your abusive boyfriend.
I can't believe that they have a 50 percent epesiotemy rate among first time moms. That's just insane.

[ASusan]

Originally Posted by *MamaJen*

Oh my god, that is heart-breaking. I'm so sorry you had such a horrible experience with that clinic, and I'm so glad that you're breaking free.
God, I feel like you just told me that you got up the strength to break up with your abusive boyfriend.
I can't believe that they have a 50 percent epesiotemy rate among first time moms. That's just insane.

Overall, the experience wasn't THAT bad. It was a challenge to talk with the OB. For the most part, though, he was respectful of my questions and wishes. For example, I had no ultrasounds after the nuchal test at 12 weeks. He did tell me at 5 mos post-partum that I had the genitalia of a 50-yr-old (post-menopausal) woman and that I wouldn't have non-painful intercourse unless I used graduated cylinders, which he had never had to prescribe. I haven't been back since. I didn't use the cylinders and I finally had non-painful intercourse at 2 yrs post-partum. I think hormones related to breastfeeding were the cause of all that.

I have primarily posted the parts where my experience significantly deviated from what they say their plan will be.

It was a significant challenge to birth naturally at the hospital that Kingsdale uses. Most things on the new Kingsdale birth plan are in line with the hospital policies. During the tour of the hospital, I was the ONLY one - of 8 couples - asking questions. It soon became clear that ANY deviation from the hospital policy required permission from my OB. And now Kingsdale is being up front that they won't provide that permission. Maybe the plan was developed in part so that Kingsdale and the hospital could operate "seamlessly" together.

My doula was a great help. I can't say that the nurses didn't, couldn't or won't do their job. But I doubt they can or will act in the way the Kingsdale letter suggests. Maybe they acted that way (during my birth) because I had a doula and that freed them up to help other women because I had someone with me. Perhaps if it were just DH and myself, they would have been more attentive. (But I doubt it, given that the first nurse wanted to do my medical history as I was going through a contraction.) I had my OB's permission to eat during labor, and I brought food, but I didn't want it.

The one thing that REALLY bothered me was that it was my doula who finally suggested and administered counter pressure while I was pushing. Although I had discussed massage and counter pressure with my OB in advance, none of that happened during the actual birth. I can't help but wonder if I had more support during that time, I wouldn't have ended up with such a significant tear (resulting in a LOT of blood loss, a complicated suturing, 2 days without being able to stand/walk to use the restroom and a DH who now would NEVER consider a homebirth and may even question the use of a midwife because we "need" the expertise of a medical professional in case of an emergency - never mind that the emergency may have been, in part, created by the medical professional himself!!!).

The fact that the doula did do medical procedures - position and get a read on the intermittent fetal monitor and provide the counter pressure - makes it more likely that the hospital and the Kingsdale practice see doulas as over-stepping their bounds. Never mind that if the RNs and OB had been doing their jobs, the doula would not have had to do these things!!

[ASusan]

Here is my "birth preferences" (so-called as to not to offend the nurses and OB with the word "plan" - this wording was suggested by my doula). This is the document which the Kingsdale OB agreed to and signed 3 years ago. OB and I went through a few negotiations at that time to get it to the final version.

My comments as to how the actual event went are in italics. I made the notes about 4 months after the birth, to give to a friend who wanted a template for a birth plan.

Birth Preferences
parents' names and patient's medication noted at top

•Pain medications – Please do not offer. I know that many pain medications exist, and I will ask for them if I need them.

They were good about this. •Saline well, to be used only if I become dehydrated

I did have an iv put in upon admission. The nurse blew the vein, so that when I needed the iv after delivery, it was not functional. They needed to put a line in the other arm. •Vaginal exams – keep to minimum

oEvery 3 hours if making progress

I don’t remember how many exams I had during the 6 hours I was laboring in the hospital before delivery. It may have been only 2 or 3. •Monitoring

o15 minutes per hour

Although the doctor agreed to this, the nurses insisted that I wear the electronic monitor all the time. It worked far less than half of the time. To get a reading, my doula had to press it (hard) against my abdomen and hold it there through a contraction(s). It was painful and annoying and didn’t get any reliable data for anyone. •Labor Augmentation

oI would prefer to walk or use other natural methods to speed labor.

While I was allowed and able to walk, it turned out that I just didn’t feel like it. I hurt, was tired, and in pain. My doula had to encourage me to change positions and get up and move around once in a while. (This is important to keep the labor going; if you stall, they want to augument with pitocin.)
oI may consent to membrane rupture if I have not made any progress in at least 6 hours.

They left my membranes alone, and eventually they burst, maybe an hour before I delivered. •Episiotomy

oI would prefer to tear, rather than to have an episiotomy. Please use compresses, massage and positioning to help stretch the perineum.

I did tear quite badly. I had to be stitched up, and I lost quite a bit of blood. No one (doctor or nurse) offered to help massage, compress, etc. My doula did this (with my permission).

oI would like guidance in when to push and stop pushing so my perineum can stretch.

They just tell you to push, no matter what. The (hospital staff’s) goal is to get the baby out, not save your perineum. They aren’t interested in helping to time the pushes, other than to tell you to push during a contraction.
•Positions for delivery

oI would prefer to have a choice of position while delivering

My OB was surprisingly good about this. My doula brought a birthing stool, which I did not use. I ended up requesting the birthing bar be put on the bed. The nurses had problems finding it, and then installing it. But, I did use it, and ended up delivering him basically sitting up, holding myself up with the bar. •Other delivery concerns

oAssuming the baby is not in distress AND I am fully dilated, I would like to wait until I feel the urge to push before beginning the pushing phase

I’m not sure this happened. I think I just got caught up in the momentum of “get him out” and pushed like mad to have it happen. Were it to happen over again, I would have liked to wait more. •Post-Delivery

oWait until the umbilical cord stops pulsating before it is clamped & cut.

The OB clamped pretty much right away. He said it wasn’t pulsating, but I’ve never seen an umbilical cord in action, so I don’t know whether he was telling me the truth, or he just wanted to get it over with.

oDelay eye medication until after first breastfeeding

They did this without any problems.

oI want to labor down after delivery without pitocin to birth the placenta.

I did get pitocin, even though my ob agreed to this point in advance. •Breastfeeding

oDo not give artificial nipples or bottles of formula, glucose water, or plain water to infant.

As far as I know, this was respected. I kept baby with me the entire time, save for when he was examined by the pediatrician. •Circumcision

oIf we have a son, do not circumcise him
oDo not retract the foreskin

They may tell you that this isn’t necessary to state on a birth plan, but I wasn’t taking any chances!

[terra-pip]

Yuck...I can't even read that birth plan on the link all the way through...I would have to tell them exactly what I thought of them before I walked out.

Disgusting.

Of course I would walk out of any practice or office if denied my right to submit my own birth plan.

[Storm Bride]

Reading that "birth plan" made me sick...and angry...and feeling more than little defeated/depressed. My poor little girls...

[PoppyMama]

While I don't like that they're putting their foot down and closing dialogue what they are stating is not unreasonable for an OB practice. With my last child my OB sprung his "birth plan" on me at the beginning of my third trimester, I really had no idea that he felt that way, and I was so appalled I never went back. I'm posting my own post (so it should be ok) about it below. Truly shocking!
ello,

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.

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
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.

[VillageMom6]

Holy cow, PoppyMama, that "birth plan" makes the Kingsdale group look downright progressive!

How can it be legal for a doctor to say that all of those interventions will be done solely at his discretion? What about the informed consent of the patient?!

Again, about the only good thing I can see from these letters is that it gets their policies out there so wise women like you can run screaming from those practices!

[AngelBee]

So icky!

[honeybee]

I really wish a lawyer representing someone from their practice would call these people and remind them of a little thing called INFORMED CONSENT!!!

[terra-pip]

I can not imagine. I feel really blessed to have found an OB and Midwifery practice that insisits a woman present her own birth plan. They give me a questionnaire with questions like:
How do you feel about monitoring?
How do you feel about IV?
How do you feel about circumsision?

And on and on. It's discussed and then signed and then put in my charts and sent to the hospital as "standing orders." They also give me a lot of literature about their policy of avoiding episiotomies and what I can do at home to help...pereneum exercises, Kegals, etc. And everything I have ever written on this questionaire was honored in my second birth and in discussions this time as well. I hate hearing about these other places...and I'm so glad that even though I live in a small community with a sometimes unfairly criticized community hospital that there is a CNM and an OB who are so open minded and willing to ask me how I "feel"....and then to respect that!