Doctor's Birth Plans and Doula Bans: Think it's not happening in your area?

This is a bit of a "round-up", but I couldn't let the hot (read: infuriating) items that have been circulating in our circles the last few days go without mention - especially since this very issue was brought home to me yesterday in a client meeting, live and local and in-our-faces.

Before I get to yesterday's incident, here's a little background from a while back.

Once upon a time (last November), this sign prohibiting Bradley Method and/or "doulah"-assisted births from a practice in Utah was shared on The Unnecesarean, and everyone had a semi-good time roasting it in appalled mockery:

This came on the heels of one OB's disclosure to his patient, who fortunately took it for what it was and RAN FOR THE HILLS, as of October. Excerpts:

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 Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe.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

Amazing. Trust me, it goes on and on, I just had to crop it for length.

So just the other day, this letter from an Ohio practice came to light, courtesy of Birthing Beautiful Ideas. Same crap, different zip code:

The team at Kingsdale Gynecologic Associates is so pleased that you are expecting. We look forward to helping you enjoy your pregnancy and hope to provide a meaningful and safe birthing experience.

Because of concerns for increased risk to you or your baby, the doctors at KGA have made a thoughtful, unanimous decision not to allow doulas to participate in the birthing process. It has been our experience that they may serve to create a state of confusion and tension in the delivery room, which may compromise our ability to provide the safest delivery situation possible for you and your baby.

Again, with safety in mind, we have created a Kingsdale Birth Plan (which can be viewed in the obstetric packet provided at your initial visit), outlining the philosophy of our doctors with regard to labor and delivery. It is our opinion that other birth plans are unnecessary. We feel that our many years of obstetric experience in a setting of modern day challenges (larger babies, more difficult deliveries) enable us to provide sound judgment with regard to each woman’s particular needs during her course of labor.

Thank you for your understanding in our hopes of facilitating a safe pregnancy and birth process.

Patient’s signature

________________________

She goes on to post a revised version of this letter (make sure to check it out, it says everything I would have said and more), and then, the next day, shared a copy of the actual "Kingsdale birth plan" this practice offers. Click over to read it itself in all its chocolately paternalistic glory.

To top it all off, The Feminist Breeder had JUST posted this unknowingly prescient piece the extremely revealing chart found in Marsden Wagner's book "Born in the USA", exposing the downright contempt many (of course not all) OBs have for patients who dare to think for themselves.
It both precipitated and underscored the garbage from the Kingsdale practice that hit the net the following day.

So, with all this buzzing in my head, I went to meet with a really wonderful young mother and prospective practice labor support client. She's very interested in having doula support, as there's not a lot of other support in her life, and has several pressing reasons of her own that she'd like to pursue a natural birth if at all possible. Hasn't read a whole lot yet but is very eager for information (I lent her "Your Best Birth" to start with) and is starting a childbirth ed course next week. All sounds good, right?

Well, she's also slowly figuring out that she may have to change care providers, as they recently informed her that she is allowed to use one of two pre-approved specific doulas - anyone else would be prohibited. I would have been more stunned if I hadn't just read and re-read all of the above, but as it was, I just had to sigh and shake my head.

If I were one of the two approved doulas, I wouldn't know whether to be flattered or appalled. (I'm not at all insulted at not being included, as I literally haven't even gotten started attending births in the area yet.) Frankly, I'm leaning towards appalled. I'd want to know WHY I was kosher and others weren't - was it because I was most likely to go with the hospital ride and not make waves? It's also possible that some other doulas had been too confrontational, perhaps, and gone beyond our scope of practice. Could it be a combination of the two?

Regardless of the reasoning, I'd so frustrated by all of this. It seems like we've been making progress with educating the public about doulas, and improving doula training, and increasing access - but then, what good does it do if more and more OB practices are issuing official kiboshes on us when it comes time to actually go into action? The bottom line probably does fall to the consumer.

Readers who are appalled at the Aspen Women's Health Center, the Kingsdale Gynecologic Associates, the doctor in Texas, and the group practice here in Erie - don't assume it's not also happening in your own backyard. We advocates can blog about this stuff until we're blue in the fingers, and we will and do, but it really comes down to the individual women themselves. Mothers who care about their births (no matter what their own goals are), have to stop patronizing care providers like this, and let them know why.

P.S. This was one of my entries for the Unnecesarean's Photoshop contest:

P.P.S. But wait! There's more! The Feminist Breeder and I basically simulposted today, and in her latest, she shares YET ANOTHER doctor-generated mandatory "birth plan", this time from the Chicago area practice WomanCarePC. I can't even be buggered to quote it here - click on over to read, it's exactly what, by the end of this post, you'd expect. But I will quote TFB herself, echoing my sentiment on using our power as consumers:

We all want to believe that it’s just angry women making hostile accusations toward well-meaning OBs and hospitals. Calm down honey, it’s all in your head. However, it’s pretty hard to ignore when the obstetricians are the ones sending out their patriarchal beliefs in writing, and then asking pregnant women to sign it.

There is a solution. Fire them. Take back your body. Refuse to be treated as a wombpod. Let them know that we ARE consumers in this process, and if they won’t treat us with respect, then by golly we’ll get our birth attendants elsewhere, thankyouverymuch.

*****


In medical billing courses, you’ll learn about the birth process.