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I agree that your SIL is not out of the woods and doesn't really get it. This OB shouldn't cut her if she starts to tear, as that will make things worse, not better. Your SIL needs to understand that and REFUSE to consent to an episiotomy if she doesn't want to be cut.
 

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I just feel like I have to give a major reality check here.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">this is not shaping up to be a good scenario at all. Your SIL already knows what this OB is capable of--basically, of doing whatever she damn pleases</td>
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Your right Ms Black. 90% of the OBs I have met/worked with do WHATEVER they damn well please. Unless you are very sure about yourself and very outspoken they get away with doing whatever they want because they will turn things around to make them necessary. They do this to the point that most people would NEVER know what is necessary and whats not.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">so now we know this OB doesn't practice evidence-based medicine, and in all likelihood she will do the episiotomy, give the standard "You were about to tear upwards" lie, and call it a day</td>
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Exactly right. Most OBs cut one without even a warning. When they are all gowned up and standing in front of the mother while she is in the lithotomy position (which she will be in) you won't even be able to see her doing the cut. I've seen this a million times. And when mom and dad are in the throws of finally pushing out the baby after hours and hours of laboring and pushing most don't object. Thats reality. Because in the throws of birth people have a very hard time arguing, etc. Thats why you pick a caregiver where that will be less likely.<br><br>
Informed consent is a joke in OB. You sign a form when you enter the hospital and you are basically signing a far reaching consent that the OBs, nurses, etc can do whatever is "necessary" to ensure a "healthy" mom and baby. And unless you are very knowledgeable, nurses and doctors can make you think pretty much everything they are doing is "necessary." Scare tactics can and are used. You know how many people I have heard say "my c-section was actually necessary, it was an emergency (or replace c-section with any intervention)? Most are not necessary inteventions.<br><br>
The reality is that if people want the best birth experience (and safest, etc) they should <b>NOT GO TO OBs!</b> Most OBs are ignorant and a product of their reality, their training. If people care they should go to a midwife. That is the ONLY way IMHO to ensure you are getting great, needed care (and even that can be a little tricky).
 

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<div>Originally Posted by <strong>Christy1980</strong> <a href="/community/forum/post/9666124"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">They really don't want to switch b/c they don't feel that they have enough time to build up trust w/ anyone else...She is stuck w/ a certain hospital b/c of her insurance, so she can't go anywhere else.<br><br>
I think the OB is in a partnership type practice, and maybe she won't the one 'on call' when SIL delivers. But still...They feel stuck with her, and want me to watch her and stop her if she tries to give SIL these things.<br><br>
I plan on talking to the OB when I get there, go over the birth plan quickly, and tell her that SIL flat out refuses an episiotomy or pit injection. That the thought of either one terrify her. Is that enough? What can I do? What can I say?<br><br>
BIL expects me to yank the scissors out of the OB's hands if she tries an epi. I don't really know what to tell him, either.<br><br>
Help! what do I say to these people!</div>
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Please let me help you not to make a first timer error. You have zero authority to speak to the OB. Only she and her husband can. I would tell you SIL that she needs a new OB. Call a local Bradley teacher or midwife to find out who the friendly ones are. IF they won't to that they need to go to the managing partner of the practice and make a formal complaint against what this doctor did. What she committed was simple assault, performing an invasive and painful procedure without informed consent. I would suggest they tell the partners that they want to have her excluded from their labor and the promise that they will have another doctor be on call for their birth if this OB is on when they go into labor. They should suggest to the managing partner that if the practice can't accomodate their birth plan and insistance on informed consent to procedures that they will move forward with a complaint to the hospital where this doctor has privileges as well as to the state medical board.<br>
This doctor will not be better in labor, she will be worse. As doula, all you can do is suggest what the husband or she can do. But honestly if this doc shows up I would totally expect failure to progress because of emotional dystocia from you SIL who feels totally scared and betrayed by this doctor. PLEASE encourage them to change to a midwife or natural friendly OB, but don't let them just roll over and accept this. IF she thinks the prenatal was traumatic she aint seen nothing!
 

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Discussion Starter #45
I talked to SIL about filing a complaint and finding a new OB, and she was annoyed/angry at me for suggesting it. her exact words were, "I'm not going to file a complaint (about the stripping) until after I have the baby," (presumably not to piss the OB off and have her retaliate during the birth in some way...<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/eyesroll.gif" style="border:0px solid;" title="roll">), and, "I'm not changing DR's 4 days before my due date!!"<br><br>
there is NO talking to her about changing OB's, she will not switch or even entertain the idea of switching. And now, "looking back at it," she does not think the stripping was that big a deal, she was expecting it to happen, just not at that particular appointment.<br><br>
I told her that she will have a high chance of an episio, and she said she's willing to risk it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug"> She decided, (with some gentle prodding from me) that her DH will be at the foot of the bed, and he will not allow an episio...and she knows he will be watching the OB closely. I'll be up by her head, lifting her shoulders and supporting her torso while her mom and DH will be holding her legs. SIL did say that she would like to try and squat to deliver, and the OB actually said that would be fine.<br><br>
Can an episio be done in the squatting position? If not, then I will gently convince SIL that's how she needs to be, lol.<br><br>
so that's that. She will not change Dr's. She is willing to risk the episio, and there's nothing more I can do to convince her otherwise at this point, her mind is made up. All I can do is be there for her and her DH and help them cope with labor and delivery, all other decisions are up to them. I told SIL this today, and she understands my role as doula and accepts her own responsability for her healthcare.<br><br>
and I should have had "s around where SIL said that BIL was being "too overprotective of her lady parts" b/c those were her words, not mine. That is her opinion of her DH's attitude toward the whole thing.
 

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I'm sure other more learned women will say more, but I think at this point, you are clear, and the parents are clear, and the best you can do is just go in with them and give them support. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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You have done all you can. Now, you go and support her emotionally and make the experience as positive as possible. Some people just have to learn the hard way, and some never learn at all. I have been forced to learn as a CBE that the saying "You can lead a horse to water but you can't make him drink" is one of the truest ones out there. I see women making these decisions that directly lead them away from the birth they want over and over and over. All I can do is present the information. It's her birth and if having a positive experience isn't worth the effort of switching to her, then it shouldn't be worth a lot of agony on your part. She's made her bed, now you just hope for the best and do what you can while you're there.
 

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Best wishes for your SIL's birth. What a tough situation.<br><br>
Just for those of you who think stuff like this won't happen with a midwife, I had a CNM strip my membranes with no consent and no warning at 37 weeks. I thought I had been very clear with my wishes too. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:
 

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One of the most well-renouned midwives in my area stripped my membranes at 39 weeks without consent as well. She told me, as she was doing it, what she was doing. I would not have consented had she asked.
 

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<div>Originally Posted by <strong>cfiddlinmama</strong> <a href="/community/forum/post/9680930"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Best wishes for your SIL's birth. What a tough situation.<br><br>
Just for those of you who think stuff like this won't happen with a midwife, I had a CNM strip my membranes with no consent and no warning at 37 weeks. I thought I had been very clear with my wishes too. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:</div>
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a MW stripped mine, too, at 39 weeks, after I had said, "DO NOT strip my membranes!" and then she did it anyway, saying that she was 'inspecting my pelvis to see if the baby would fit,' then told me my baby wouldn't fit and said I'd need a c-sec...this was at a practice that had 8 MW's and 4 OB's.<br><br>
Yes, she is making the decision, I can't change her mind. She will get support from me, and lots of encouragement. I will do my best as a doula for her, and her DH. Her decisions only effect herself and her healthcare, and she knows that and seems to understand.<br><br>
I have resolved the guilt and anxiety I feel toward this birth, and I am now excited and ready to go, lol. SIL had another appt today and was 3cm and 40% effaced!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/yikes.gif" style="border:0px solid;" title="EEK!"> she is feeling lots of pressure and the baby is engaged and ready!! So maybe this weekend?? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin"> what do you guys think?<br><br>
thanks again, and I will be back with the birthstory if you would like to hear it.<br><br>
PS-OT- I'll be on and off all weekend, so feel free to offer any other doula-worthy advice!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> I packed a "doula bag" with massage tools and oils, some lolli-pops for SIL, and some granola bars for BIL, Grandma, and me. I also made up some "don't ask me if I want pain meds" signs for SIL's door, (she wanted them). ANything else I should take?
 

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I just have to ask, especially for those of you who were under the care of professional midwives, WHY were you subjected to so many pelvic exams? And knowing what you know, what did you even allow them to happen in the first place? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/headscratch.gif" style="border:0px solid;" title="headscratch"> Surely you have to consent to a pelvic exam for this to happen? Regardless, I think the OB should be reported by someone, anyone, sheesh, that just sounded like a horrible experience. I really hope the baby just races out on the way to the hospital.
 

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<div>Originally Posted by <strong>Christy1980</strong> <a href="/community/forum/post/9666124"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">They really don't want to switch b/c they don't feel that they have enough time to build up trust w/ anyone else...She is stuck w/ a certain hospital b/c of her insurance, so she can't go anywhere else.</div>
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It is important to remember that this then their choice and they are then accepting this doctor. If they do not agree with her practices they do have choices. They could leave (ask around within your local doula community to see who is a good doctor - if there is a good and natural doctor they do not need to worry about the relationship as much). In my opinion they do not have a good relationship with this doctor anyhow since she did this without their permission and is not accepting their wishes. As for insurance - yes I understand that this might be where their insurance says they need to birth, but there is always the choice of homebirth with a midwife - it might cost money, but it is still a choice. Giving in to birthing where their insurance says they must go is also a choice and it sounds like one they are willing to take.<br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>Christy1980</strong> <a href="/community/forum/post/9666124"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I think the OB is in a partnership type practice, and maybe she won't the one 'on call' when SIL delivers. But still...They feel stuck with her, and want me to watch her and stop her if she tries to give SIL these things.</div>
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This is not within your scope of practice and I would make sure that your family knows this.<br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>Christy1980</strong> <a href="/community/forum/post/9666124"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I plan on talking to the OB when I get there, go over the birth plan quickly, and tell her that SIL flat out refuses an episiotomy or pit injection. That the thought of either one terrify her. Is that enough? What can I do? What can I say?</div>
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Again this isn't your place to go over the birthe plan with the healthcare provider. That is the mothers place to do it. It also is not your place to talk for your sil - it is her place to tell her provider she does not want an episiotomy. Speaking for your client is a great way to get the boot out of the room and to be looked upon as the doula who works outside of her scope.<br><br>
I think as a doula you need to explain to them that they have choices and one of their choices seems to be the one they want to take - staying with the provider and allowing her to do what she wants by not speaking up about their desires.<br><br>
It is important to learn how to empower mothers to speak for themselves and make decisions for themselves. Teach her how to stand up for herself as it is out of your scope to do it for her.<br><br>
Remember not making changes when you know things will go bad is still a choice!!!
 

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<div>Originally Posted by <strong>khaoskat</strong> <a href="/community/forum/post/9666797"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Have the home/office number of your family attorney in your cell phone. If the OB starts going for the Pit and/or the Scissors, pick up your cell phone and tell the Ob that you will use the phone to call an attorney to file assault charges if s/he goes forward with this.</div>
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This is not the doula's place and is outside of her scope. The mother/father could do so, but not the doula. I understand that the doula is family, but she is also acting in the capacity of a doula so she needs to stay within her scope and role.
 

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<div>Originally Posted by <strong>veganf</strong> <a href="/community/forum/post/9686339"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I just have to ask, especially for those of you who were under the care of professional midwives, WHY were you subjected to so many pelvic exams? And knowing what you know, what did you even allow them to happen in the first place? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/headscratch.gif" style="border:0px solid;" title="headscratch"> Surely you have to consent to a pelvic exam for this to happen? Regardless, I think the OB should be reported by someone, anyone, sheesh, that just sounded like a horrible experience. I really hope the baby just races out on the way to the hospital.</div>
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I only had one exam, at 39 weeks, because I was curious. It would have been easy to decline (and I should have).
 

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>veganf</strong> <a href="/community/forum/post/9686339"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I just have to ask, especially for those of you who were under the care of professional midwives, WHY were you subjected to so many pelvic exams? And knowing what you know, what did you even allow them to happen in the first place? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/headscratch.gif" style="border:0px solid;" title="headscratch"> Surely you have to consent to a pelvic exam for this to happen? Regardless, I think the OB should be reported by someone, anyone, sheesh, that just sounded like a horrible experience. I really hope the baby just races out on the way to the hospital.</div>
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Just thought I would chime in from a (student) midwife's perspective....if you find a midwife who doesn't even DO vag. exams prenatally (except by mother's request), then you don't have any exams to even decline and don't have to worry about anyone stripping your membranes. It becomes a non-issue.<br><br>
It makes me pretty mad that any care provider, and especially a midwife, would strip membranes w/o consent. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/censored.gif" style="border:0px solid;" title="censored">
 

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<div>Originally Posted by <strong>Christy1980</strong> <a href="/community/forum/post/9686127"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">SIL had another appt today and was 3cm and 40% effaced!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/yikes.gif" style="border:0px solid;" title="EEK!"> she is feeling lots of pressure and the baby is engaged and ready!! So maybe this weekend?? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin"> what do you guys think?</div>
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I think it could be anytime in the next, oh....2 weeks? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> Seriously, this is why I don't believe in routine prenatal vaginal exams. They tell you nothing (but numbers). Lots of women walk around at 2, 3, 4...even 6 cm without having labor start for days or weeks. And, then a woman could have a posterior, firm, closed cervix one day, and a baby in her arms the following day. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">
 

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PS-OT- I'll be on and off all weekend, so feel free to offer any other doula-worthy advice!! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> I packed a "doula bag" with massage tools and oils, some lolli-pops for SIL, and some granola bars for BIL, Grandma, and me. I also made up some "don't ask me if I want pain meds" signs for SIL's door, (she wanted them). ANything else I should take?[/QUOTE]<br><br><br>
Yeah, give the granola bars to the mama. Lollipops are not enough in labor to provide energy. Feed her when no one is in the room. fess up only if a cesarean becomes necessary! The signs will annoy the nurses, I don't advise them. Simply have a polite discussion with your nurse immediately upon arrival about asking her not to ask the "what is your pain on a scale of 1 to 10" every time she enters the room. Lots do. And also not to ask if she wants pain meds. That usually does it with a good nurse.
 

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dont be worried at all about feeding the mama.<br>
they dont like to make it known, but even if a mother has fasted for 24 hours, they can't guarantee that the stomach is empty, as pg and labour slows down digestions, so anasthesiologists will always assume the mother has something in her stomach anyway. If she wants to eat, let her, and let her eat whatever she wants.
 

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Discussion Starter #59
thanks you guys.<br><br>
No baby yet! I haven't talked to her today, I don't want to bug her b/c I know she's getting 1 million "how are you feeling today?" calls from family and friends, lol.<br><br>
To clear things up, since its still being discussed:<br><br>
1) I am NOT going to go over the birth plan w/ the OB.<br>
2) SIL understands her rights and options, and has decided to stick w/ her current OB, despite objections from her DH and warnings from me.<br>
3) SIL understands my role as doula and knows what my limitations are as far as helping her in delivery.<br>
4) I do not plan to speak to the OB directly, except to introduce myself to her and explain things that she says (medical terms, etc) to SIL and BIL, so they can speak up about what they want/don't want.<br><br>
So I hope that clears up some of that! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"><br><br><b>veganf</b> ~~I was at a MW practice that was run by OB's -- they had 8 MW's and 4 OB's. Some of the MW's were more OB's than MW's, if that makes sense. Others were very gentle MW's...none were allowed to do homebirth, it was "too risky" insurance-wise <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/angry.gif" style="border:0px solid;" title="angry">...anyway, the MW's that were more like OB's were always the ones to see me after about 34 weeks...and it was standard practice for them to say, "take off everything below your waist, sit here, and the MW will be with you..." I was a 1st timer, I didn't know I could refuse a vag exam! my DDC friends here on MDC were also having vag exams, so I just thought it was normal!<br><br>
now I know better, and when you know better, you do better, right?
 

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To answer the question about why I was getting pelvic exams with the knowledge that I have... I was 19. I had a wonderful CPM with my first at home. I had a horrible CNM with my 2nd at the hospital. This was my third with another CNM/hospital birth. I didn't know to refuse vag exams. There's also a double edged sword of wanting to know if anything was going on too. I had already been having prodromal labor. I also always turned into a good little patient and submitted to authority. I thought I was prepared, but really I wasn't at all. So I now make it known to the women I talk to that they don't have to agree to a vag exam at all. Nobody told me that, it's just what you do.<br><br>
On the other hand, my friend had these midwives who were so opposed to routine exams that they wouldn't check her when she wanted them to. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy">:
 
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