Friday, June 25, 2010

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 Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe.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

12 comments:

  1. Damn, their birth plan is AWFUL.

    You know, you mentioning this woman not having a lot of support in her life makes me think about the mothers I've worked with who would have been alone in labor, or alone with an unsupportive/sleeping/abusive/whatever partner/family member, if it wasn't for the doula. By "banning" doulas, these practices are cutting out the only real support those women might be able to bring with them to the hospital.

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  2. As I've posted on other blogs regarding the banning doulas thing: "No Doctor, she's not my doula, she's my sister, whom I will have panic attacks without."

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  3. Infuriating.
    Absolutely ignorant.
    Frightening.

    I have no more words.

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  4. Rebecca, that is EXACTLY my client's situation. I will be the only person giving her support. I cannot believe health care providers would rather leave a woman to fend for herself the 83% of the time labor and delivery nurses are not in the room giving her direct one-on-one support (let's not even joke about the doctor him or herself giving that support, unless you happen to have that incredibly rare species known as medicus mirabilis) than have their authoritah threatened by the presence of a doula. Blows my mind.

    Molly, based on this info I shared today, I actually know of one local doula who is already having to consider attending an upcoming birth incognito, just as you describe.

    Amy, right there with you, though I do have some more words. Not many of them good, though.

    UPDATE: Check the addition onto the post to see yet another culprit, as shared by The Feminist Breeder, pretty much right as I was writing this very post. It's endless, people. ENDLESS.

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  5. I can't believe this stuff exists. I had no idea that there were places that were so anti the birth that we had. If I walked into an office and they had a sign like the one above or a dictated labor plan (one size fits all type) I would walk out. More women need to lobby for the availability of natural childbirth and any related services---it is MY body and this is OUR birth!

    Thanks for posting.

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  6. YUCK! while I CAN beleive it exists (because if a patriarchy exists, its definately in the medical field), I have a hard time figuring out why more women aren't running the other direction. Even women who don't want a natural or traditional birth or a doula. Any institution that demands a family giving up that much control is one to be wary of!

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  7. Wow, infuriating, but sadly not surprising. No doubt, providers who jump on this control-freak bandwagon will cast themselves as "progressives" standing up to the stereotypes that the natural/healthy birth promoters have had to content with for years (ie., that we're all dreamy hippies more concerned with "feelings" than facts, with the experience than the health outcomes, etc. How depressing. The fact remains that doulas here and elsewhere will continue to have education and advocacy as one of our primary responsibilities in our practices. As for certain Erie providers only allowing "approved" doulas, that's interesting news. What's up with that? Familiarity perhaps? But still....did your gal say why? I would prefer not to have to assume an alias, but I would. Ridiculous.

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  8. Good old WomanCarePC of Arlington Heights. What a shizzy birth plan. I should re-write it for them if only to remove the many typos.

    And people wonder why I choose homebirth. If I have to walk in to some place with a set of "requests" of what I want and hope that those requests will be followed...I'm already on the defensive. Not conducive to having a smooth birth.

    At home...the midwife goes with the flow of what I want (as long as all is well, obviously) and I don't have to worry about being on constant alert to not have something I don't want done, done.

    We've come so far and we've still so far to go.

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  9. I just used a quote from that "birth plan" in a blog post about the lithotomy position for birth. Thanks for sharing this. You can see the post at http://writeaboutbirth.com/index.php/2010/11/02/lithotomy-position-%E2%80%93%C2%A0why-giving-birth-on-your-back-makes-no-sense/.

    Funny how this OB "knows" what is comfortable for ALL women during birth, isn't it? Apparently, (it must be a he!) known better than birthing women themselves. Very patriarchal indeed.

    Olivia

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  10. It boggles the mind, truly. And I marvel that there isn't a greater outcry from feminists.

    My mom fought battles for natural home birth in the 70s and we are still facing the same ones today! I blogged about it because my midwife is being charged with a felony when her only "crime" is going to home births.

    http://gombojavfamily.blogspot.com/2012/12/the-most-politically-controversial.html

    We better speak up while we still can!

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