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 Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe.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