And Here I Thought the Kingsdale Anti-Doula Letter was Bad

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And Here I Thought the Kingsdale Anti-Doula Letter was Bad

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Update: Apparently the Columbus media has been overwhelmed with the sheer volume of calls/emails regarding the doula ban.  The PR representative from DONA International has successfully scheduled several local media appearances for this week.  She respectfully asks that people now refrain calling the media at this point so that we don’t frustrate them and cause them to find doulas annoying (which is the very situation we are working against!).  Thanks for your understanding and support!

Please protect yourself and your surroundings from a sudden head-explosion: the Kingsdale Gynecologic Associates Birth Decree of Doom Plan is in.

I’ve spent a good hour or two transcribing this beast, and now I fear that all my cleverness has been zapped into oblivion by its inanity.

I’ve got nothin’ left.

So I’m going to ask you all a big favor: just as I made my own “edits” to Kingsdale’s anti-doula letter, I’d like you to add your own (snarky, sarcastic, evidence-based, empowering, illuminating, etc.) edits to their birth plan in the comments section.  What’s more, I’ll feature your (and perhaps a few of my) edits in my next post.

Fun, right?  It will be like a carnival of humor and disgust and birth-empowerment, with a few Columbus, Ohio OB/GYNs featured as the carnival clowns.

So without further ado, LET THE SNARK (AND THE HEAD-EXPLODEY-SPLODE) BEGIN!

*

Kingsdale Birth Plan

The physicians at Kingsdale Gynecologic Associates congratulate you on your pregnancy and hope that your journey through pregnancy, labor, delivery and beyond is exactly what you wish for.  Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience.

We recognize that this is a very busy time for you and your family and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.”  By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary.  If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them.

IV’s: Patients often ask us if IV’s are necessary in labor.  The answer is “yes.”  Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished through the labor process, the most important part is the “hepwell” itself.  If we run into an emergency situation where your life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access.  This is obviously a rare occurrence, but often an unexpected one.

Nourishment in labor: We usually limit women to ice chips and popsicles during labor.  This is not designed as an attempt to starve you.  Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous.  In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk.  Of course, we will give you nourishment and hydration through the IV as necessary.

Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor.  The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia.  Labor, unfortunately, is a painful process.  It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs.  Some labors are quite rapid and tolerable while others require a great deal of patience and intervention.

Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques.  The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes.  Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary.

IV pain medication: IV pain medication if available for use during labor.  The medication can often make women a little sleepy and is said to “take the edge off.”  It will not completely alleviate the discomfort of labor.  We try not to use IV pain medication close to the time of the actual delivery as it depress the baby’s drive to breathe.

Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals.  There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible.  The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby.  The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement.  The nurses will continue to help you with position changes that will facilitate the birthing process.

The choice to use anesthesia or not is ultimately your choice.  There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby.  Ultimately, we want the birthing process to be one you can enjoy and remember fondly.

Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well.  We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts.  We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times.  If we are concerned about the adequacy of labor or fetal wellbeing, we occasionally use internal monitors, which are more precise.  The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions.  The fetal scalp electrode is applied superficially to a baby’s scalp to get the most accurate fetal heart monitoring.  We will not use these internal devices unless we feel they are medically indicated.

Labor support: We do recommend that you have a good support person or two during labor.  We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with.  We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it.  The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible.  Your support person should be there to do just that–give support.

Mode of delivery: Our goal is to provide you and your baby the safest delivery.  We do occasionally need to do c-sections for delivery when it is necessary for you or your baby.  We never do c-sections for our own convenience.  If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail.  We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time.

Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing.  Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing.  We promise to use our medical expertise and experience to make the best and safest decision for you and your baby.  The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.

After delivery: The birth of your child is truly an amazing event.  We want you to be able to bond with your baby as quickly as possible.  If the baby does not require immediate resuscitation, we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord.  Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby.  This usually occurs in your room at the infant warmer.  If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together.  If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.  With c-sections it is often necessary to take the baby to the nursery prior to your own transport.  In these situations, we will try to get you to your room as quickly as possible to reunite you and your baby.

We hope that this clarifies many of the questions about the birthing process that you may have along the way.  Please feel free to ask questions and obtain clarification if needed from your individual provider.

“Birth is the sudden opening of a window, through which you look out upon a stupendous prospect.  For what has happened?  A miracle.  You have exchanged nothing for the possibility of everything.”   -William MacNeile Dixon



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105 Comments

  1. Ren
    Ren06-25-2010

    This is horrific.

    But what I think I am most horrified by is that as I read through this, I realized that the me of five years ago would have gone right along with it, not appreciating what the underlying messages were and what the likely result for my birth experience would be. Even when I was first pregnant I would have probably thought this all sounded fine and reasonable. By the end of my pregnancy, after I had done the research and prep I chose to do, I would probably have been more skeptical. Still, I don’t know that I would have changed doctors. But these people would have destroyed my birth experience. I know, because even though my birth experience was amazing and triumphant, the moments that were the worst were created by doctors and nurses behaving just along these lines.

    Only after giving birth, personally witnessing the hostility of some doctors and nurses AND the difference made by genuinely supportive doctors and nurses, only after watching friends go through various births (positive and negative) am I now capable of fully seeing this birth plan for what it is.

    So I read this and I mostly just feel really sad for all the women at that practice who just won’t have any idea at all that this “plan” is toxic to them.

    • Molly (First the Egg)
      Molly (First the Egg)06-25-2010

      Yes–THIS. My partner and I knew nothing about the physiology, history, & politics of pregnancy and birth when I got pregnant, and we really just got lucky. We happened to live five minutes from a freestanding birth center, I wanted more privacy because of trauma I experienced years earlier (in my first experience with a gynecologist), so I somewhat randomly ended up with midwifery care. And then I developed an interest in all these issues. But the first time around … if I’d just started out with this sort of practice … how would I have been confident enough to run away when these documents scared me? After all, I just thought BIRTH was scary, and that’s precisely what these documents use and reaffirm, right?

  2. Michelle Potter
    Michelle Potter06-25-2010

    Like Ren, what scares me most about this plan is that I would have found it reasonable only a few years ago. It seems like they’re saying they won’t do anything unless it’s really necessary – I wouldn’t have noticed the huge glaring problem where THEY make all of the decisions, and I’m just supposed to lie there and take it, trusting that if they say it’s necessary, gosh darn, it is!
    Michelle Potter´s last blog post ..Today on Twitter: I really want to go swimming. I…

  3. Eliza
    Eliza06-25-2010

    I’ve added my changes in here but can’t differentiate between the original wording and my changes.

    Kingsdale Birth Plan
    The physicians at Kingsdale Gynecologic Associates congratulate you on your pregnancy and hope that your journey through pregnancy, labor, delivery and beyond is exactly what you wish for. Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience.
    We recognize that this is a very busy time for you and your family and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.” By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary. Of course they aren’t necessary, please don’t do any research yourself, we will tell you everything you need to know! If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them. Please don’t do a separate birth plan so all of the NINE doctors can know what your wishes are for the birth of YOUR child, we will remember everything. Bwhahaha

    IV’s: Patients often ask us if IV’s are necessary in labor. The answer is “yes.” Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished through the labor process, the most important part is the “hepwell” itself. We give fluids to further compromise your birth experience, to fill your body up with so much IV fluid that it floods the system, therefore making it hard for you to make enough oxytocin to keep up due to the volume of fluid in your body. If we run into an emergency situation where the life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access. This is obviously a rare occurrence, but often an unexpected one.
    Nourishment in labor: We usually limit women to ice chips and popsicles during labor. Because this is evidenced based care! This is not designed as an attempt to starve you. Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous. How is this dangerous? Please show me the studies (yes, back to evidenced based care here) that prove that vomiting, something that every human on earth does at one point or another is dangerous. In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk. With a 32%+ cesarean rate, there is a 1/3 risk that you will NEED “emergency surgery” to birth your baby. It will save your/your babies life!!! Of course, we will give you nourishment and hydration through the IV as necessary.
    Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia. Labor, unfortunately, is a painful process. It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs. Some labors are quite rapid and tolerable while others require a great deal of patience and intervention. Basically what we are saying is that the only labors that are tolerable (and therefore able to birth without an epidural) are short labors. If you have a long labor (and we know what constitutes a long vs short labor) we are going to give you pitocin and probably pressure you to get an epidural because when we say patience we really mean pitocin.
    Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth day-long birthing class that teaches you about focal points and breathing techniques. Just skip over the part that talks about a birth plan. The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes. When they have time in between all the other parts of their job they are doing. Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary. We do hope you change your mind, it’s easier on us and easier on some of the hospital staff.
    IV pain medication: IV pain medication if available for use during labor. Don’t use a shower, which is about the same amount of pain relief, it would interfere with the rest of our requirements. The medication can often make women a little sleepy and is said to “take the edge off.” It will not completely alleviate the discomfort of labor. We try not to use IV pain medication close to the time of the actual delivery as it depress the baby’s drive to breathe.
    Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals. There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible. With an estimated 90% epidural rate in local hospitals you will more than likely have to wait for an epidural. The epidural anesthesia is the most common form of anesthesia for labor and delivery because it usually provides good pain control with little or no effect on the baby. The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement. The nurses (as long as they aren’t busy with other laboring women, tasks or god-forbid lunch!) will continue to help you with position changes that will facilitate the birthing process.
    The choice to use anesthesia or not is ultimately your choice. There may be situations where we will recommend certain pain management options, it’s easier to deal with a medicated laboring woman, for you in order to provide the healthiest and safest option for you and your baby. Ultimately, we want the birthing process to be one you can enjoy and remember fondly.
    Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well. We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts because it’s evidence-based care to continuously monitor a healthy woman in labor. We will occasionally (ie very rarely) allow intermittent monitoring during walking and the hospitals have protocols for these times. Our policy of continuous monitoring supersedes hospital policy if it’s in our standing orders. If we are concerned about the adequacy of labor or fetal wellbeing, we occasionally use internal monitors, which are more precise. The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions. The fetal scalp electrode is applied superficially to a baby’s scalp to get the most accurate fetal heart monitoring. We will not use these internal devices unless we feel they are medically indicated.
    Labor support: We do recommend that you have a good support person or two during labor (not a doula). We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with (not a doula). We recommend that you choose someone who will give you comfort when needed, (not a doula) let you rest when needed (not a doula) and who will add to your experience, not take away from it (not a doula). The super busy labor and delivery nurses and doctors (who show up at the end to “deliver” the baby) together act as “doulas” when they have time, in a sense that we will be your advocate to provide positioning options, as long as we are comfortable with those positions, the main one being on your back, pain control (epis and pit for everyone!) and pushing techniques (on your back) to make the process as easy for us as possible. Your support person should be there to do just that–give support.
    Mode of delivery: Our goal is to provide you and your baby the safest delivery. We do occasionally (with continuous monitoring it’s more that occasional, studies show it increases cesarean births) need to do c-sections for delivery when it is necessary for you or your baby. We never do c-sections for our own convenience, except when we do. If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail. We occasionally (when mom is pushing on her back) need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time.
    Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing. Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing because we can ALWAYS tell when a woman is going to tear. We promise to use our medical expertise and experience to make the best and safest decision for you and your baby. The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.
    After delivery: The birth of your child is truly an amazing event. We want you to be able to bond with your baby as quickly as possible. If the baby does not require immediate resuscitation, we will usually (unless you are one of the people who doesn’t fall into the usual pattern) place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord. Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby. This usually occurs in your room at the infant warmer. If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together. If desired, you may attempt “skin-to-skin” care and breastfeeding at this time. With c-sections it is often necessary to take the baby to the nursery prior to your own transport. In these situations, we will try to get you to your room as quickly as possible to reunite you and your baby.
    We hope that this clarifies many of the questions about the birthing process that you may have along the way (right, this could answer every question a woman has about birth). Please feel free to ask questions and obtain clarification if needed from your individual provider.
    “Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.” -William MacNeile Dixon
    Eliza´s last blog post ..Our Garden

  4. Linsey
    Linsey06-25-2010

    My favorite line is “If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.”

    Oh really? I just “labored” and produced this miraculous new life from MY womb and you, MR. DOCTOR will ALLOW me to have my baby and provide the warmth, physical support, and life giving nourishment my body is designed for and is statistically proven to support healthy babies!

    I also like how the wording of “attempt” indicates the probable failure to bond and breastfeed.

    This “birth plan” is TOXIC to the empowerment of women and healthy babies.

    • Knitted in the Womb
      Knitted in the Womb06-26-2010

      Linsey, it also seemed to me that “skin-to-skin” care time was going to be in the post partum room–where the delivery nurse wouldn’t have been inconvenianced by it.

      Also, regarding being re-united after a cesarean, my experience has bee that the OBs often have no idea how long the separation is–when I ask how long it will be until mom and baby are together, they look at me blankly. Just one hospital in my area (out of 5 with LDRs) has an active goal to get mom and baby back together quickly to get the first breastfeeding session done within one hour after birth.

  5. TheFeministBreeder
    TheFeministBreeder06-25-2010

    After the conversation yesterday, a photographer in my area sent me HER docs version of their “birth plan” – equally as awful as what’s above and ALSO requiring a signature! It’s terrible. The whole “we will cut you if we think you’re going to tear” stuff is such bad medicine it should be FREAKING illegal.

    I’m exhausted. I don’t even know how to fix this mess.
    TheFeministBreeder´s last blog post ..Independent Women Will Be Cut

    • Molly
      Molly06-25-2010

      “I’m exhausted. I don’t even know how to fix this mess.”
      Agreed! All we can really do is educate one woman at a time. Change in this field takes time. I’m just so baffled at the complete lack of evidence based care here.

  6. Beth
    Beth06-25-2010

    Here’s what’s funny to me about this. And it is funny. I nearly died after the delivery of my second child. Having the IV already in place didn’t do a damned thing because they needed, and couldn’t place, a central line. It’s all smoke and mirrors.

    I would avoid that practice like the freaking plague even without having another baby ever in my life. That is medicalization to an extreme that just makes me cringe. And you just know if they do it with birth, they do it with EVERYTHING ELSE, too.

    Though I’m smart ass enough that I’d hire a doula and declare her my new best friend (if I were stuck with that practice for some reason).

    • Kristi
      Kristi06-25-2010

      Beth – that was my first thought about the doula too, she would definitely be my friend! (I am facebook friends with a doula I used in another city, and the midwives I used, so…)

      In the Nourishment in Labor section, it says that vomiting during labor can be “miserable and dangerous.” What they really mean is that it’s a pain to clean up. :/

      • Emily
        Emily06-25-2010

        You’re totally right about them wanting to skip the clean-up. Dry heaving feels even more miserable than vomiting.

    • stunned
      stunned06-25-2010

      Thing is a doula IS your best friend….who the hell cares how long you’ve KNOWN her ;-P These docs are trying to make a distinction between support and advocate? They are one in the same…THERE IS NO DIFFERENCE!!! Just sickening to be so emotionally raped and the ‘newbies’ don’t even know what hit them ;-(

    • Lisa
      Lisa06-25-2010

      Beth…I had an IV placed during the prep for my last c-section (scheduled – long, painful story). It was a painful placement, and not fun…and when I got to OR, the anesthesiologist looked at it and said, “this won’t do – we need a bigger one, because this is inadequate if she requires a transfusion. This is major surgery, even though we like to pretend that it isn’t.” She rocked…but I was really pissed off. Yeah – you have to put in an IV, to give me fluids and in case I need a transfusion – but this is such a routine part of the “care” you provide that you can’t even be bothered to ensure it’s a big enough line!

      So, they left that one in, and sunk a new one in my other hand. I couldn’t blame the doctor, as I agree that I want a transfusion to be possible, should I require one – but it was all so asinine.

      That whole “plan” turned my stomach – not so much what was said (although some of that was really bad), as *how* it was said. I wonder if any of those people have figured out that birth (oops…I mean “delivery”) involves, as its most basic, TWO people, and neither one of them is a doctor (unless mom-to-be happens to be, of course). Ugh. Ugh. Ugh.

  7. Jo
    Jo06-25-2010

    I am currently pregnant and I’d give birth in my CAR before going to this hospital.

  8. Andrea G
    Andrea G06-25-2010

    “Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous.”

    Fist, how on earth is vomitting dangerous? Second, dry heaving an empty stomach is 100x worse than vomitting.

    I am one of those women who vomit during transition. I was allowed to eat so I actuallyy vomitted quite a bit with #s 1 and 2. With #3 labor went so fast I had an empty stomach (NOT because I wasn’t allowed to eat but because I simply wasn’t terribly hungry that day). The dry heaving was far worse than the vomitting and actually made things much, much worse. The Dr ordered the nurse to get me some crackers to hopefully help calm the belly. They helped a bit. With #4 I was induced (my BP dropped dangerously low and they couldn’t get it up). The Dr had me drinking and eating. Granted I was only allowed to eat simple foods that would digest easy (jello, soup) but I was allowed to eat!
    The nurse thought the Dr was a loon, but I am forever grateful that he respected my body and wanted a healthy, strong mom.

    • Lisa
      Lisa06-25-2010

      The “vomiting is dangerous” thing actually reveals their bias. They’re writing that, talking about labour and birth…but underneath, they’re *thinking* “c-section”. Vomiting is dangerous, because you’re going under the knife, mama. You *may* not (if your labour fits our timetable and you’re really lucky), but you probably will, and we don’t want you vomiting on the table.

      • Lori
        Lori06-25-2010

        True, they’re thinking c-section. The thing is, even that isn’t evidence based. The amount of stomach acid present even in a completely “empty” stomach is *still* enough to cause aspiration pneumonia so the whole point is moot.

        I want to buy a ticket for Henci Goer to pay a visit to these docs and drop the hammer on them. :-P

  9. Kara
    Kara06-25-2010

    Yeesh. Who in their right mind would read this and think “Ahh, this is gonna be a great experience?” I looooove how they say “nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible.” I guess by that they mean that they will say “Get and epidural, lie flat on your back to push when we shout at you…Oh, that didn’t work? Lets make this process as easy as possible by cutting out your baby…or else s/he may die!”

    • Emily
      Emily06-25-2010

      Yes, that sentence made me think that they have no idea what a doula does. Maybe they had a run-in with a really confrontational one? But to say “we’ll be your doula, please only bring people who will support you” just sounds…weird. And dreadfully uninformed.

  10. Shelley
    Shelley06-25-2010

    Patients often ask us if IV’s are necessary in labor. The answer is “yes.” The necessity of IVs during labor is self-evident because IV’s are used ubiquitously across the globe. All labors. Everywhere. Even in developing countries where babies are born in dirt floor huts. Do you really think you could get by without one? Have you ever heard of a birth where an IV isn’t used? I mean, how could the baby even get out? Clearly, IV’s are absolutely necessary.

    We usually limit women to ice chips and popsicles during labor. This is not designed as an attempt to starve you although you will probably end up hungry and grumpy. Women often get nauseated, and sometimes vomit, during labor, which is really yucky and we don’t even want to think about cleaning up vomit. We are medical practitioners and went to school for far too long to have to that. Besides, it totally ruins my day when someone pukes on my shiny shoes. In addition, if emergency surgery is required, (which is much more likely at our practice due to the cascade of interventions we kick off at “hello” by starting an IV) an empty stomach will predispose you to much less risk. In fact, when someone is brought into the ER with a life-threatening head wound that needs surgery, we can’t even operate if they just ate. We just have to wait and hope they don’t die until they digest their food. We can’t operate on a human being who has food in their belly. Far too dangerous. Of course, we will give you nourishment and hydration through the IV as necessary. Overall, it is just so much more convenient for us if you don’t eat while in labor. I know, I know, it will make labor all the harder for you, but this isn’t really about what’s best for you, is it?

    • Knitted in the Womb
      Knitted in the Womb06-26-2010

      Part of what gets me about the IV thing though is that they DON’T give nourishment through the IV at most births–just fluid & salts. In fact, as a doula, I’ve never seen anything with any significant caloric value hang on the IV pole (there are 9 calories in a liter of Lactated Ringer). So yeah, restricting a woman to ice chips and popsicles IS going to starve the woman–regardless of supposed “intent.”

  11. Slee
    Slee06-25-2010

    Its all there in the bit where they say that ultimately pain relief choices aren’t up to the mother and they will suggest what they feel is appropriate. Just like my last labor where they were up front all “we even have a shower & laboring whirlpool” and then during the nurse was all “oh, that won’t work, you want the epidural.” Yeah, I’ll be hiring my best friend for my next delivery too. Do you think they make you show proof of longterm best friendship? You know, signed yearbooks or bad matching tattoos?

    • Lisa
      Lisa06-25-2010

      Sadly, it wouldn’t surprise me if yearbooks were required. *sigh*

  12. Jen @ Two Embrys
    Jen @ Two Embrys06-25-2010

    We don’t do C-sections for our own convenience. It just happens that most babies start to decline right before we’re scheduled to get off work.

    We have a birth ball — but you can’t use it because you’re strapped to the bed with monitors.

    Unfortunately, with my first baby, I would have thought this was the most awesomest birth plan ever and signed my rights away without a second thought.
    Jen @ Two Embrys´s last blog post ..An Open Letter

  13. Kathy Skestos
    Kathy Skestos06-25-2010

    The physicians at Kingsdale Gynecologic Services congratulate you on your pregnancy. We know what’s best for not only your family, but every family. In fact, we know what’s best for the world. And that is to turn back the clock on decades of progress on human rights, women’s rights, and consumer rights to a time when institutions and authority were respected. By respect, we mean absolute control. Because we are gods. There, we said it.

  14. Angela
    Angela06-25-2010

    Wow…wondering if there is a birth network in Colombus, and if so, what do they think of this? What’s the back story?

  15. FoxyKate
    FoxyKate06-25-2010

    I think one of the things that sticks out at me is the attitude of entitlement that comes off in this whole thing – the “we will do it if medically indicated” mentality. Nary a word about informed consent.

    I am curious to know whether a signature on something like this could be construed as a consent form?
    FoxyKate´s last blog post ..Three bitches in a bathtub

  16. Sheila
    Sheila06-25-2010

    I wish my hospital had had this “birth plan.” Then at least I would have known what they had in mind! I had to fight to get out of having an IV, I was forced into continuous fetal monitoring (tying me to the few feet of space near the machine), and the one thing they promised me, skin-to-skin with the baby immediately after birth, they didn’t deliver because there was meconium and that apparently supersedes everything.

    Awful as these policies are, I’m glad they are at least putting them out there. I wish all hospitals and doctors would be this clear about their birthing policies.
    Sheila´s last blog post ..Marko gets less easy and more fun

    • Emily
      Emily06-25-2010

      The problem is that unless you’re already an educated birther, this plan would sound really nice. It is worded SO carefully, and it all sounds like the doctors just love you and have your very best interest at heart.

      We know that’s not true but that’s because we can sit here and parse through it sentence by sentence, comparing with all the study data in our heads. Most women can’t, and so they read the plan, sign away their rights, and find out far too late that this plan doesn’t mean what it sounds like it says.

      • BirthingBeautifulIdeas
        BirthingBeautifulIdeas06-26-2010

        I agree–and it’s also worded to make it seem as if any disagreement with their recommendations would jeopardize the mother’s and/or baby’s health and well-being.

        And while I do agree that all parents have a responsibility to research their birth options, I almost feel as if the research one would need to perform in order to reject (with evidence, data, etc. in hand) most of the recommendations in the birth plan would require far more work that any parent or layperson should be expected to do. That’s one of the things that is so infuriating about this “birth plan” and about most maternity care practice/hospital protocols that effectively restrict the reasonable birthing options that women should have.

  17. Sarah Dorrance-Minch
    Sarah Dorrance-Minch06-25-2010

    I am so glad I don’t live in Columbus any longer. I still have friends who live there. They all had high-intervention births that they were very grateful for. I wonder how many were “patients” of Kingsdale OB/GYN? I wonder how many of the other obstetric practices in Columbus are this bold about having an anachronistic, high-intervention approach? Good grief, I’m surprised I didn’t see anything on here about “poodle shaves” and enemas. Maybe the caesareans they “never do for their own convenience” are the modern upgrade of that particular routine procedure. Everything else, though – starvation, mandatory IVs, mandatory nutrient drips, episiotomies, forceps – good heavens.

  18. SylkoZakur
    SylkoZakur06-25-2010

    What if my support person is a doula? My husband was home w my children & I had no friends or family that could or would attend. A doula was my only choice. If kingsdale was my only option, I’d still hire a doula. I’ve had one labor doula free & I ended up laboring alone. The nurses only helped when it was pushing time.

  19. Rosie
    Rosie06-25-2010

    Bull! Bull! Bull! I haven’t seen so much, so deep ever!

    boohoo boohoo wahhhhhh! Crying for the mommies that are lied to and misled.

    Can you find my not so sarcastic edits?
    Labor support: We do recommend that you have a good support person or two during labor (but not a doula). We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with (but not a doula). We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it. Doulas only take away from your experience. The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy for us as possible. Your support person should be there to do just that–give support to the nurses and doctors opinions, demands, moods and fears.

    Who believes this crap? heaven help us! Dr. Sarah Buckley writes, Birth, she is dying. http://www.sarahjbuckley.com/articles/healing-birth.htm

    “This primal and unspeakably powerful initiation, the only road to motherhood for our ancestors, has been stripped of her dignity and purpose in our times. Birth has become a dangerous medical disease to be treated with escalating levels, and types, of technological interventions.

    What is worse perhaps is that the ecstasy of Birth- her capacity to take us outside (ec) our usual state (stasis)- has been forgotten, and we are entering the sacred domain of motherhood post-operatively, even post-traumatically, rather than transformationally.

    These deviations from the natural order, whose lore is genetically encoded in our bodies, have enormous repercussions.”

    Please reread this birth plan with the sex act in mind. Replace birth with “making love” and you will see how impossible it is for a woman to have a orgasim, oops I mean baby…

    ref: http://www.jashford.com/Pages/birthnatural.html

  20. Donna
    Donna06-25-2010

    I *really* want to make catty remarks throughout this piece of garbage. I just don’t have time to put the anger into the rewrite for which this is begging.

    So, highlights:

    The physicians at Kingsdale Obstetrical History Preservation Society are pleased that you have succumbed and will be remanding yourself into our hands. By doing so, you have chosen to keep history alive by allowing us to manage your baby’s birth based on a practice regimen which is fifty years out-of-date when compared to the edicts of evidence-based medicine! Our primary goal is to make sure you understand that you’re incapable of having this baby on your own, so that our practice can make more money.

    While your time concerns are of minimal importance to us – we’re certainly alright keeping you for at least an hour past your actual appointment time, biding time in our waiting or exam rooms to help you achieve that feeling of being a sequestered virgin bride or perhaps a fenced-in cow (you will be making milk soon, after all – although we’ll be happy to make sure you have no need for it by separating you from your baby immediately after birth for prolonged periods of time) – we find it’s simpler for everyone if we just tell you what to expect from us as your care provider. So, don’t worry your pretty little head. This is the only “birth plan” you’ll need. Or rather, the only one we want you to have. Same thing, really. If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them, so that we may move you to “stage two” of our pregnancy care, Scheduled C-section.

    [[snip]]

    “No one likes change but babies in diapers.” –Barbara Johnson, American author

    “History is written by the victors.” –Winston Churchill

  21. Jennifer
    Jennifer06-25-2010

    Having BTDT, I would love it if they could explain to me just how vomiting during labor is “dangerous”. I mean, I did request an IV because I was fairly dehydrated, but an otherwise alert, vertical, undrugged mama has pretty much ZERO risk of aspirating vomit.

  22. Lindsey Ann
    Lindsey Ann06-25-2010

    The worst part is that they call themselves DOULAS. If there is a doula ban, and they call themselves doulas, then therefore they shouldn’t be allowed to walk in the door, from the combination of these two letters. Honestly…I would love to have a child at one of these anti-doula places, just so I could give them a piece of my mind. Becoming a doula changed my mind about the whole birthing process, taking me from wanting a very medical birth to wanting a natural one. If they want to call themselves doulas, they should get certified at their own cost…make them sit through classes that tell them to do the opposite of this crap and if it saves one person from being brainwashed, then all the better!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-26-2010

      As a trained philosopher, I love your clever use of logic here. :-)

  23. The Mommy Blawger
    The Mommy Blawger06-25-2010

    As horrible and wrong as this “birth plan” is, I am really impressed by this hospital and its nurses, who are so knowledgeable about “positioning options” to “facilitate the birthing process”. If only the darned epidural would let you move, this might be extremely helpful.
    The Mommy Blawger´s last blog post ..Midwifery Legal/Legislative Updates

  24. gracie_lou
    gracie_lou06-25-2010

    i am grateful that we have a free standing birth center in topeka, kansas where i had a wonderful birth with my son.

    i wanted to share that there are some OB practices that actually encourage doulas. my friend’s provider in lawrence, kansas pays $150 towards all doula fees. that’s encouraging!!
    gracie_lou´s last blog post ..mothering

  25. Jenn Doula
    Jenn Doula06-25-2010

    Kingsdale Birth Plan (UPDATED 6/25/10)

    …exactly what you wish for (AS LONG AS YOUR WISHES ARE EXACTLY THE SAME AS OURS)…and a wonderful experience (ACCORDING TO OUR PERSONAL DEFINITION OF WONDERFUL, WHICH WE WILL PROCLAIM IS THE ONLY SAFE/HEALTHY WAY TO BIRTH).

    …help minimize the work ahead (SO PLEASE DON’T BOTHER TO CRACK A BOOK OR DO ANY PRENATAL EDUCATION ON YOUR OWN BECAUSE IT IS SO MUCH EASIER, FOR US, TO WORK WITH CLIENTS WITH NO OPINIONS REGARDING THEIR HEALTH CARE OR THAT OF THEIR CHILD) of you by providing our advice and philosophy in this “birth plan” (AND BY HIJACKING NATURAL BIRTH TERMINOLOGY LIKE “BIRTH PLAN”, WE HOPE TO LULL YOU INTO BELIEVING WHATEVER WE SAY)…If you have specific requests not discussed in this birth plan, please speak directly with (ANY OF THE NINE) care provider(S) about them. WE WILL THEN NOT TAKE THE TIME TO ANSWER YOUR QUESTIONS IN-DEPTH WITH ANY EVIDENCE-BASED INFORMATION, AND WILL REFER YOU BACK TO THIS SHEET…SO JUST KEEP READING.

    IV’s: …a rare occurrence, but often an unexpected one. AND NOW WE HAVE COMPLETED MUDDLED YOUR QUESTION ABOUT IV’S AND WHETHER OR NOT YOU CAN JUST HAVE A HEPWELL TO KEEP A LINE OPEN, OR WHETHER WE WILL MANDATE THAT ALL PATIENTS HAVE CONTINOUS IV FLUIDS THROUGHOUT THEIR ENTIRE LABOR.

    Nourishment in labor: …not designed as an attempt to starve you, ONLY TO HELP ENSURE THAT YOUR BODY AND/OR BABY WILL HAVE PROBLEMS ‘TOLERATING’ LABOR DUE TO A LACK OF HYDRATION AND NOURISHMENT (WHICH WE WILL THEN LABEL AS A FAILURE TO PROGRESS OR BABY IN DISTRESS AND SEND YOU OFF FOR A C-SECTION). …miserable but also dangerous. WE WILL NOT EXPLAIN THAT VOMITTING IN LABOR IS NORMAL (AND A OFTEN A GOOD SIGN THAT LABOR IS PROGRESSING). DON’T WORRY, THROWING UP BILE FEELS SO MUCH BETTER THEN THROWING UP FOOD!

    Anesthesia: …Labor, unfortunately, is a painful process BECAUSE WE WORK HARD TO ENSURE THAT ALL OF OUR PATIENTS END UP FEELING THAT WAY.

    Labor without anesthesia (GOOOOOD LUCK!): If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques. PLEASE DO TAKE THE TIME TO COMPLETELY FORGET ANY OTHER LABOR AND DELIVERY INFORMATION THAT MAY BE DISCUSSED IN YOUR CLASS, ONLY REMEMBER THE FOCAL POINT AND HOKEY BREATHING NONSENSE.

    Epidurals: …and The Ohio State University Medical Center (WHICH WE WILL BE LEAVING IN OCTOBER, DUE TO A ‘MUTUAL DECISION’ WHICH WE WILL NOT DISCUSS)…most common form of anesthesia for labor and delivery (COME ON…EVERYBODY’S DOING IT!) because it provides good pain control with little or no effect on the baby (AND THIS STATEMENT WILL ALSO SERVE TO MAKE YOU THINK THAT THERE ARE LITTLE OR NO SIDE EFFECTS FOR MOM OR BABY WHILE USING AN EPIDURAL). BY THE WAY, PLEASE DON’T ASK US OUR EPIDURAL RATE…YOU DON’T WANT TO KNOW!

    The choice to use anesthesia or not is ultimately your choice. WE’LL JUST KEEP USING THE WORD ‘CHOICE’ TO MAKE YOU FEEL THAT YOU ACTUALLY HAVE ANY CHOICE DURING YOUR BIRTH. …remember fondly. AAHHH, I SO FONDLY REMEMBER WHEN I WAS COMPLETELY STRIPPED OF ANY PARTICIPATION IN THE BIRTH OF MY CHILD.

    Fetal monitoring: …will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times. WHOA THERE, DON’T GET TOO EXCITED AND THINK YOU ARE GOING TO BE PART OF THIS ‘OCCASIONALLY’ CROWD! WE’VE GOT SOME SERIOUS SMARTS AND CAN THINK UP TONS OF REASONS WHY IT IS SAFER OR HEALTHIER FOR YOU AND/OR BABY TO HAVE CONTINUOUS EFT.

    Labor support: …good support person or two during labor (REMEMBER – NOT A DOULA OR ANYONE ELSE KNOWLEDGE ABOUT L&D). We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. NEVER MIND THAT THEY MIGHT NEED SUPPORT THEMSELVES – THEY’LL JUST HAVE TO WRING THEIR HANDS OVER ON THE COUCH. …will add to your experience, not take away from it (THOSE PESKY DOULAS JUST LOVE TO TAKE AWAY FROM A FAMILY’S BIRTH EXPERIENCE!). The labor and delivery nurses and doctors…to make the process as easy as possible. IF WE CALL OURSELVES “DOULAS”, DOES IT HELP ERASE YOUR NEED FOR TRUE LABOR SUPPORT?

    Episiotomies: …physicians at Kingsdale do not cut episiotomies solely due to “routine” practice. NO! THAT WOULD RAISE TOO MANY EYEBROWS, SO WE’LL JUST TELL YOU THAT IT LOOKS LIKE YOU’RE GOING TO TEAR THROUGH YOUR ANUS…A SURE-FIRE WAY TO GET ‘INFORMED CONSENT’ FROM A PATIENT!

    After delivery: If the baby does not require immediate resuscitation (YIKES – LET’S TOTALLY FREAK YOU OUT AND PUT SCARY IMAGES IN YOUR HEAD). …you may attempt “skin-to-skin” care and breastfeeding at this time (WE’RE NOT ACTUALLY THERE FOR THIS PART, SO IF YOU WANT TO TRY ALL THAT HIPPY TOUCHY-FEELY STUFF WE WON’T BE FORCED TO WATCH YOUR ATTEMPT).

    We hope that this clarifies many of the questions about the birthing process SO WE DON’T HAVE TO TAKE THE TIME TO DICUSS EACH CLIENT’S PERSONAL THOUGHTS AND QUESTIONS that you may have along the way. Please feel free to ask questions and obtain clarification if needed from your individual provider. WE WILL THEN, ONCE AGAIN, REFER YOU BACK TO THIS “BIRTH PLAN”. SHAMPOO, LATHER, RINSE, REPEAT (YOU’VE SEEN ONE BIRTH, YOU’VE SEEN THEM ALL)!

    • Jami
      Jami06-25-2010

      Spot on Jenn doula. If only your version would be the one they hand out to patients.. as some are too busy being obediant to read between the lines. sigh

      • Jenn Doula
        Jenn Doula06-25-2010

        Gosh…that was so fun letting my snarky-flag-fly!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-26-2010

      I love this, Jenn. And man, I’ve loved reading ALL of the revisions that people have made to this birth plan! I think I’m going to need to devote an entire week to including these revisions on the blog. We’ll fight the power with snarkiness and a hell of a lot of educational and informational empowerment!

  26. ASusan
    ASusan06-25-2010

    I birthed with an OB from their practice 2 years ago. I used a doula. Here is a brief point-by-point response IN CAPS. I tried to leave the snark out of it.

    1. IV’s: Patients often ask us if IV’s are necessary in labor. The answer is “yes.” EVEN THOUGH WE GAVE YOU A SALINE WELL – A COMPROMISE MADE BY YOU AND YOUR OB ON YOUR BIRTH WISH LIST – WE BLEW A VEIN, AND THE LINE WASN’T EVEN OPEN DURING YOUR EMERGENCY AFTER DELIVERY. WE QUICKLY PUT ANOTHER LINE IN YOUR OTHER WRIST WHEN WE NEEDED TO. NO PROBLEM. IF EMTs CAN DO IT AT THE SCENE OF AN ACCIDENT, OUR RNs SHOULD BE ABLE TO – AND CAN – DO IT DURING/AFTER LABOR IN A CLEAN, RELATIVELY CALM ENVIRONMENT.

    2. Nourishment in labor: We usually limit women to ice chips and popsicles during labor. THIS WAS POLICY OF THE HOSPITAL AND TO GO AGAINST IT REQUIRED THE PERMISSION OF YOUR OB. YOUR DOULA FED YOU FROZEN GRAPE JUICE AND YOUR HOMEMADE LABOR ADE. DESPITE 6 HOURS OF UNMEDICATED BACK LABOR, YOU DID NOT VOMIT.

    3. Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia. THE LABOR AND DELIVERY NURSES DID NOT SUGGEST OR HELP YOU WITH ANY CHANGES OF POSITION AND PRETTY MUCH LEFT YOU ON YOUR OWN, EVEN SO FAR AS TO HAVE YOUR DOULA POSITION AND CHECK THE FETAL MONITOR.

    4. Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques. THE CHILDBIRTH CLASSES WE ARE ASSOCIATED WITH AND RECOMMEND WILL TELL YOU ABOUT THE TYPICAL MEDICATED BIRTH. The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes. THEY MAY HAVE THIS SKILL, BUT THEY DID NOT EXECUTE IT. IN FACT, THEY ASKED YOU QUESTIONS ABOUT YOUR MEDICAL HISTORY DURING A PAINFUL CONTRACTION AND LOOKED ANNOYED WHEN YOU DID NOT ANSWER IMMEDIATELY. THEY LEFT POSITIONING, WALKING AND TOILETING UP TO YOU AND YOUR BIRTH ATTENDANTS. Although you will always be supported in your decision to labor without pain control, THE LABOR AND DELIVERY NURSES TALKED ABOUT YOU AT THE NURSES’ STAND AND IN THE HALLWAY. THEY DISCUSSED WITH EACH OTHER – AND IN EARSHOT OF OTHER PATIENTS AND VISITORS – ABOUT HOW LOUD YOU WERE AND THE FACT THAT YOU WERE THE ONLY ONE – OUT OF AT LEAST 20 LABORING WOMEN THAT DAY – WHO WAS DOING IT WITHOUT PAIN MEDS.

    5. Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals. … The nurses will continue to help you with position changes that will facilitate the birthing process. ALTHOUGH THEY DID NOT DO THIS IN THE PAST, THEY MAY HAVE CHANGED THEIR BEHAVIOR.

    The choice to use anesthesia or not is ultimately your choice. BUT OUR NURSES WILL COMMENT ON IT, SAY YOU ARE STRONG AND BRAVE, AND SOME WILL EVEN ROLL THEIR EYES AT YOUR CHOICE.

    6. Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well. We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts. THE MONITOR DIDN’T STAY PLACED, AND THE DOULA HAD TO PLACE IT EVERY 20 MINUTES TO GET A READ ON IT, WHICH THE NURSES DIDN’T BOTHER TO CHECK ON A REGULAR BASIS.

    We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times. THE NURSES COULDN’T PROVIDE FREQUENT ENOUGH SUPPORT TO FOLLOW THROUGH WITH THE PROTOCOL.

    7. Labor support: We do recommend that you have a good support person or two during labor. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it. The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible. THE L&D NURSES DID NONE OF THIS. I TRULY DON’T WANT THIS TO BE NURSE-BASHING, BECAUSE, FOR THE MOST PART, THEY DID THEIR JOBS. BUT THEIR JOB WAS NOT TO BE A DOULA, IT WAS – AND IS – TO BE A NURSE.

    8. Mode of delivery: Our goal is to provide you and your baby the safest delivery. We do occasionally need to do c-sections for delivery when it is necessary for you or your baby. We never do c-sections for our own convenience. THE OBs IN OUR PRACTICE WILL NOT TELL YOU WHAT THEIR INDIVIDUAL C-SECTION RATE IS, ALTHOUGH THEY WILL TELL YOU THAT IT IS A GOOD QUESTION. THEY WILL TELL YOU THAT THE OVERALL PRACTICE RATE IS BELOW NATIONAL AVERAGE (AS OF 3 YEARS AGO).

    9. Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing. THIS DID NOT HAPPEN AT MY DELIVERY, DESPITE IT BEING IN MY SIGNED-BY-OB-BIRTH-WISH-LIST. MY DOULA PROVIDED COUNTER PRESSURE – WITH MY AND MY OB’s PERMISSION. IT MAY HAVE HELPED REDUCE TEARING, BUT I STILL HAD A 3RD DEGREE TEAR. Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing. THE OB’s AT OUR PRACTICE HAVE A 50% EPISIOTOMY RATE WITH FIRST-TIME MOTHERS. We promise to use our medical expertise and experience to make the best and safest decision for you and your baby. BUT YOU HAD BETTER HAVE A SUPPORT PERSON WHO IS ABLE TO ADVOCATE FOR YOU AND DO MASSAGE/COUNTER PRESSURE. The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.

    10. After delivery: The birth of your child is truly an amazing event. We want you to be able to bond with your baby as quickly as possible. If the baby does not require immediate resuscitation, we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord. THIS DID HAPPEN AT OUR DELIVERY. Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby. I REQUIRED MANY COMPLICATED STITCHES AND THEY DID PUT MY SON ON MY HUSBAND’S CHEST FOR THE 20-30 MINUTES IT TOOK TO STITCH ME UP. This usually occurs in your room at the infant warmer. If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together. If desired, you may attempt “skin-to-skin” care and breastfeeding at this time. THE DOULA HELPED WITH INITIAL BREASTFEEDING.

    • ASusan
      ASusan06-25-2010

      Forgot to add that the OB chided me when I asked for a hep-well, saying that they no longer use hep-wells, and that the line is kept open with saline. Funny how they’ve gone back to using (or just calling them) hep-wells.

      • karen
        karen06-25-2010

        that is just a power trip. saline-lock, heplock, med-lock, hepwell, saline-well….they are all THE EXACT same thing. Only difference is what they are flushed with. :eyeroll:

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-28-2010

      Oh God, ASusan, I’m sorry that you had this sort of experience during your birth. And I completely understand why you chose to leave snark out of it–this was actually your experience, not something to make light of.

      Thank you very much for sharing it. I hope that other women can see not only the ways in which this sort of birth plan will play out during a labor but also how amazing and strong you were despite all of Kingsdale’s ridiculous practices. (I hope they see too the great way in which your doula supported you!)

  27. Birth Unplugged
    Birth Unplugged06-25-2010

    The things that are the most outright head-explode-y are the IV, ice/popsicles only, continuous monitoring, and the episiotomy thing. Some of their policies are not even in line with *ACOG* guidelines:

    ACOG on fluids during labor:
    http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm

    ACOG on fetal monitoring:
    http://www.acog.org/publications/patient_education/bp015.cfm

    The rest you have to kind of read between the lines to get the implication. Like how they imply that you have to have a fast labor to have a natural birth and how they send the message that using pain medications is The Way to enjoy your birth
    Birth Unplugged´s last blog post ..A Natural Third Stage?

  28. Noel
    Noel06-25-2010

    I don’t think I can write a response without cursing right now.

    Seriously, its like they are trying to freak women out.
    Noel´s last blog post ..Wordless Wednesday

  29. Katie
    Katie06-25-2010

    I don’t know why they even bothered making this birth plan. Why not just say: “We know how your birth should go, and we do not need your input about it”?

    I would leave a practice immediately if I was given material like this. I do live in the area of this practice, but I am not a patient there.

  30. Elizabeth
    Elizabeth06-25-2010

    Thanks so much for sharing this! I’m starting as a Ph.D. student at OSU in the fall, and my husband & I are thinking of trying for our second child later this fall/winter. I won’t waste my time with this OB practice! Yet another reason why I’ll be looking for a midwife instead…

    • Catie
      Catie06-25-2010

      Elizabeth, if you’ll have OSU insurance as a Ph.D. student the only midwifery option you’ll have is Professionals for Women’s Health. They are MEDwives, not midwives. Just a heads up.

  31. Denise Lucas (Obmomma)
    Denise Lucas (Obmomma)06-25-2010

    This whole issue of a “birth plan” developed by a practice makes me giggle! I am an ob nurse/women’s health nurse practitioner with over 30 years experience. I LOVED being with a woman in labor who wanted an unmedicated birth. I LOVED being able to assist her with positioning, achieve the goals in her birth plan and have a healthy, happy family at the end of the day. I worked with other nurses who shared my philosophy. I also worked with nurses who HATED anything except what the Kingsdale group had in their “birth plan”. I think they got kick-backs from anesthesia! (Not really!) The most important thing for any couple is to have an advocate. If that is the partner, great; if that is a doula, great. The mother needs to focus on birth and have others work for her in requesting a different nurse if the assigned nurse is not meeting her needs. Go all the way up the chain of command if you have to.
    It fascinates me that the providers at Kingsdale were able to get together on this “plan”. My docs usually can’t agree on lunch! I’m fortunate that the docs I am with now (as the NP) do focus on the woman and allow her to make decisions regarding her care.
    Interesting discussion–keep demanding choices that make sense to you. You have to be an informed consumer of medical care!

  32. Lori
    Lori06-25-2010

    On episiotomies- No mention that no matter whether the doc “thinks you will tear” or not, it is still YOUR CHOICE NOT TO BE CUT.

    On EFM- Where is the evidence that it improves fetal outcomes? Oh right, THERE IS NONE. All that EFM accomplishes is raising the c-section rate.

    On IVs- Again, where is the evidence that IV nutrition/hydration in labor is superior to food and drink “per os”? Oops, once again, NO EVIDENCE and even those a-hats at ACOG changed their recommendation to “allow” women more than stinking ice chips. Furthermore, what’s up with the “emergency” BS? Isn’t placing an IV like, I dunno, day 2 of med school or something? How bad is your training that you can’t place an IV quickly in an emergency situation? This is verbatim the conversation I had with my OB for my first pregnancy when I told her I’d be refusing an IV a heplock/saline lock (WTF is “hepwell” anyway?):

    HER: No, you don’t have to have the IV, but we give everyone a saline lock just in case.

    ME: Well, I will not be having a saline lock or IV because I plan to drink plenty of fluids in labor and eat as my body tells me. So just so you know, I’ll be refusing that.

    HER: Well, in an emergency, wouldn’t it be better to know we already have a line in and don’t have to waste time starting an IV?

    ME: In an emergency, I trust that you have the medical training to put an IV in rapidly. If you don’t have that capability, let me know now so I can find a doctor who does.

    HER:

    ME: Ok, so now we’re on the same page.

  33. Rachel
    Rachel06-25-2010

    Additions in parentheses. I didn’t get very far, there’s just so much to say, but I think you get the point. They skillfully formalized birth as their job and not the mother’s.

    Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience. (As defined by us, the professionals).

    We recognize that this is a very busy time for you and your family (so don’t you worry your pretty little head thinking about all this “hard” stuff) and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.” (Okay, we know it’s not really a birth plan, certainly not YOUR birth preferences, but if we label this document clarifying our preferences for practice then you can’t come to us with YOUR preferences. Yeah, you caught us, most of them aren’t evidence-based and a few are actually contrary to what the research says about best/safest practices, but dammit, this is how we like to do it and this way we don’t have to try to remember or pay attention to that pesky piece of paper you brought to remind us about your personal preferences and do things that are out of our comfort zone.) By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary (or at least much more easily dismissed). If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them (and assume that they will be ignored because, afterall, we’ve spelled out how it’s going down, there’s nothing you can do to change it).

  34. Courtney
    Courtney06-25-2010

    This is just sad. Calling it a birth plan and calling themselves doulas??!! Wow. If I was a patient, I would leave immediately.

  35. Charlotte
    Charlotte06-25-2010

    I didn’t have time for all of it, but here’s what I’ve got:

    We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia. Labor, unfortunately, is a painful process. It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs. Some labors are quite rapid and tolerable (and if you plan to birth with us and not have meds, you damned well better fall into this category because) others require a great deal of patience and intervention (and we are MORE THAN HAPPY to dish out every intervention in the book. If you labor gives us time for it, we’ll do it).

    Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals. There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible (and just to be sure you don’t inconvenince them, they will be sure to stop by your room before they head to the can, to take a nap, to eat a meal, or to attend another emergency surgery). The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby. The epidural will make you somewhat numb from the waist down (only if your definition of “somewhat numb” is “I feel paralyzed and can’t move my legs, which now have the weight of a ton of bricks,” but that’s beside the point), therefore you are generally not able to walk after placement (which means we have to trapped in the bed on your back, just the way we like you). The nurses will continue to help you with position changes that will facilitate the birthing process (so don’t be surprised when one of them hops up onto the bed, straddles you, and shoves the heels of her hands into your fundus because you’re not pushing hard enough).

    The choice to use anesthesia or not is ultimately your choice. There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby (like if you want to get up to go to the bathroom, whine a little bit, let out a peep of noise, or do anything to make our jobs remotely difficult). Ultimately, we want the birthing process to be one you can enjoy and remember fondly (so as long as you’re ready for the anesthesiologist to yell at you for being “earth woman” and don’t mind having a nurse straddling your chest and shoving your baby out, you’ll have a great experience).

    Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well (because even if you don’t believe it, our vast experience has shown us that your body is just itching to kill your baby, and we have to stand in the way of that). We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts. We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times. If we are concerned about the adequacy of labor or fetal wellbeing (because your contractions have to be strong enough that you can have your baby before my tee time, but gentle enough to keep your body from stressing out your baby), we occasionally use internal monitors, which are more precise. The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions. The fetal scalp electrode is applied superficially to a baby’s scalp (but only if your definition of superficial is “a pin screwed into the baby’s scalp) to get the most accurate fetal heart monitoring. We will not use these internal devices unless we feel they are medically indicated (or we want to speed things up because we have somewhere to be).

    Labor support: We do recommend that you have a good support person or two during labor. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with (just be sure this person isn’t a doula. We don’t allow doulas to attend our patients births). We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it (again, just be sure this person isn’t a doula. We don’t allow doulas to attend our patients births. They take away from our expereience as your provider and might make our lives more difficult by causing you to question our almighty word. No doulas allowed). The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible (for us, by helping you into positioning options, pain control and pushing techniques at are convenient for the physicians and staff). Your support person should be there to do just that–give support (but not in the form of helping you question our almighty word, just to be clear).

    Mode of delivery: Our goal is to provide you and your baby the safest delivery. We do occasionally need to do c-sections for delivery when it is necessary for you or your baby. We never do c-sections for our own convenience (it’s not our fault that your body failed to deliver the baby before our tee-time or Christmas dinner–it’s always better for mom and baby for birth to occur before important events in the physician’s calendar). If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail (but we will do it. You’re not allowed to ask questions…just listen to why you need c-section, then consent). We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time.

  36. MollyO
    MollyO06-25-2010

    We recognize that this is a very busy time for you and your family and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.” (Implying that a mom just COULDN’T POSSIBLY have time to make her OWN) By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary OR ARE TOO CRUNCHY. If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them SO HE CAN DETERMINE IF YOU ARE GOING TO BE A PAIN IN THE BUTT SORT OF PATIENT.

    IV’s: Patients often ask us if IV’s are necessary in labor. The answer is “yes.” WHY IS YES IN QUOTE MARKS??? Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished BECAUSE YOU ARE NOT A HEALTHY WOMAN GIVING BIRTH, YOU ARE A PATIENT WHO NEEDS FOOD THROUGH A TUBE through the labor process, the most important part is the “hepwell” itself. If we run into an emergency situation where the life (and the life of your baby DEAD BABY CARD!!!!) is in jeopardy, we do not want to lose time to intervene by not having IV access. ACTUALLY, SINCE WE NEVER KNOW WHEN ANYONE IS GOING TO NEED EMERGENCY SURGERY, WE”LL JUST PUT IN THIS IV LOCK WHEN YOU SIGN THE PAPERS. ACCORDING TO OUR LINE OF THOUGHT, EVERYONE, EVERYWHERE SHOULD HAVE A “HEPWELL” IN PLACE AT ALL TIMES. NEVER KNOW! This is obviously a rare occurrence, but often an unexpected one.

    Nourishment in labor: We usually limit women to ice chips and popsicles during labor. This is not designed as an attempt to starve you. LIARS!!! Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous. In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk. EVEN THOUGH VERY FEW C-SECTIONS ARE ACTUALLY DONE UNDER GA AND A GOOD ANESTHESIOLOGIST COULD PREVENT THIS. WE FEEL EVERYONE SHOULD HAVE AN EMPTY STOMACH AND A IV LOCK IN PLACE TO DRIVE THEIR CAR AS WELL. IT WOULD SAVE OUR BUDDIES IN THE ER LOTS OF TIME AND TROUBLE. Of course, we will give you nourishment and hydration through the IV as necessary.

    Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia. Labor, unfortunately, is a painful process. ESPECIALLY SINCE WE WON’T LET YOU HAVE ANYTHING ELSE NON-MEDICAL TO HELP WITH THE PAIN. It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs. Some labors are quite rapid and tolerable while others require a great deal of patience and intervention.

    Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary. AND WE’LL BE SURE TO REMIND YOU CONSTANTLY THAT MEDS ARE AVAILABLE, LEST YOU FORGET.

    There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible. DON’T WORRY YOUR LITTLE HEAD, YOUR DRUGS ARE COMING. The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby. THIS STATEMENT IS BASED ON WHAT? PAY NO ATTENTION TO THESE BABIES WHO CAN’T LATCH AFTER BIRTH AND ARE ACTING GROGGY. OH, AND DON’T LOOK BEHIND DOOR NUMBER TWO WITH THE FEVERISH MOM. The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement. OH, SHOOT, NOW YOU CAN’T USE THE BIRTH BALL. The nurses will continue to help you with position changes that will facilitate the birthing process.

    Ultimately, we want the birthing process to be one you can enjoy and remember fondly. FONDLY LIKE THAT GREATFULL DEAD SHOW, BECAUSE YOU WERE ON DRUGS.

    Fetal monitoring: In order to provide the safest possibly delivery,BASED ON ABSOLUTLY NOTHING we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well. We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts. AND MAKE IT IMPOSSIBLE TO MOVE MORE THAN THREE FEET AWAY FROM THE BED. We will occasionally allow PATRONIZING! intermittent monitoring during walking and the hospitals have protocols for these times. If we are concerned BECAUSE CLEARLY YOU HAVE NO IDEA WHAT IS HAPPENING IN YOUR BODY AND YOU DON’T CARE ABOUT YOUR BABY, SO WE’LL DO THE WORRYING FOR YOU about the adequacy IF YOU DON’T FOLLOW THE CURVE, YOU ARE WRONG! of labor or fetal wellbeing, we occasionally use internal monitors, which are more precise. The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions.BECAUSE ONCE AGAIN, WE CAN’T COUNT ON YOU TO TELL US WHEN YOU ARE HAVING CONTRACTIONS, ONLY THE MACHINES KNOW.

    Labor support: We do recommend that you have a good support person or two during labor. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. WE RECOMMEND THAT YOU START CALLING YOUR DOULA YOUR COUSIN NOW, JUST SO WE WON’T GET ANTSY LATER. The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible. EXCEPT THAT UNLIKE DOULAS, WE WON’T BE WITH YOU THE WHOLE TIME AND WE PROBABLY WON’T BE ABLE TO PROVIDE YOU WITH SENSIBLE ALTERNATIVES TO HOSPITAL POLICY. Your support person should be there to do just that–give support.

    Mode of delivery: Our goal is to provide you and your baby the safest delivery. We do occasionally OCCASIONALLY MEANS RARELY, WHAT WE ACTUALLY MEAN IS 30% OF THE TIME need to do c-sections for delivery when it is necessary for you or your baby. We never do c-sections for our own convenience. AT LEAST WE’D NEVER SAY THAT. IF WE PUT IT IN WRITING LIKE THIS, DOES IT MAKE IT TRUE?
    Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing. WE’LL JUST IGNORE THE EVIDENCE THAT SAYS CUTS TEAR WORSE THAN NATURAL TEARS. We promise PINKY SWEAR? to use our medical expertise and experience to make the best and safest decision for you and your baby. WE ALSO PROMISE TO SPEAK TO YOU LIKE A CHILD. The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.

    After delivery: The birth of your child is truly an amazing event. We want you to be able to bond with your baby as quickly as possible. If the baby does not require immediate resuscitation DEAD BABY CARD!!!!!, we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord. If you and your baby are doing well after delivery, we will try TRY? MORE PATRONIZING LANGUAGE to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together. If desired, you may (PERMISSION) attempt YOU CAN TRY “skin-to-skin” care and breastfeeding at this time BUT WE DON’T PROMISE IT’LL WORK. With c-sections it is often necessary to take the baby to the nursery prior to your own transport. In these situations, we will try DEPENDING ON THE TIME, WE MAY TRY HARDER to get you to your room as quickly as possible to reunite you and your baby.

    We hope that this clarifies many of the questions about the birthing process IN A HOSPITAL that you may have along the way. Please feel free to ask questions and obtain clarification if needed from your individual provider.

    “Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.” -William MacNeile Dixon
    I LOVE THAT THEY ENDED THIS WITH A BIRTH QUITE FROM A MAN. SEEMS FITTING.

    • Jessica
      Jessica06-25-2010

      I loved the comment about only the machines know when the contractions are or if they’re strong enough!

      I’d add a definition of all these fancy position changes that the nurses recommend: lying on your back where labor is most painful and the baby can’t turn. And pushing on your back with your knees by your ears because it’s easiest for the doctors to see and your body couldn’t possibly know how to birth a baby without them shouting at you, oops, I mean “coaching” purple pushing….

      Has anyone ever noticed that they spend your whole pregnancy warning you not to lie flat on your back because it puts cuts off the blood supply to the baby, and then they spend the whole labor and pushing stage with you flat on your back cutting off the blood to your baby and then having to intervene when the baby’s blood pressure falls….

  37. Jodilyn
    Jodilyn06-25-2010

    If you buy the hospital ticket, you will be on the hospital ride.
    Stay home!

  38. Eyes Open
    Eyes Open06-25-2010

    – Changes shown [[between double brackets]] —

    The physicians at [[Kingsdale Obstetrical History Preservation Society are pleased that you have succumbed and will be remanding yourself into our hands. By doing so, you have chosen to keep history alive by allowing us to manage your baby’s birth based on a practice regimen which is fifty years out-of-date when compared to the edicts of evidence-based medicine!]] Our primary goal is to [[make sure you understand how incapable you are of having this baby on your own, so that our practice can make more money. ]]

    [[While your time concerns are of minimal importance to us – we’re certainly alright keeping you for at least an hour past your actual appointment time, biding time in our waiting or exam rooms to help you achieve that feeling of being a sequestered virgin bride or perhaps a fenced-in cow (you will be making milk soon, after all – although we’ll be happy to make sure you have no need for it by separating you from your baby immediately after birth for prolonged periods of time) – we find it’s simpler for everyone if we just tell you what to expect from us as your care provider. So, don’t worry your pretty little head. This is the only “birth plan” you’ll need. Or rather, the only one we want you to have. Same thing, really.]] If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them]] so that we may move you to “stage two” of our pregnancy care plan, Scheduled C-section.]]

    — snip —

    Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia. [[Don’t expect us to actually help you into any of those positions – that’s what doulas do, and we find their "services" to be absolutely useless in the labor room. The only valid "comfort measures" are the ones WE provide.]] Labor, unfortunately, is a painful process. [[(Can you believe that some people think it’s possible to have an orgasm during birth? WHAT are they SMOKING? Hippies.)]]

    That’s all I can manage right now. Maybe more later when I’ve reconstructed my ‘sploded brain.

  39. ericka
    ericka06-25-2010

    seriously? they want YOU to have the best birth? it sounds like they want you to have their best birth. THEY will massage the perinium?? are you serious? so how many of them do an inadequate job and then tell you they have to cut? seriously? i flat out told my doctor that i didnt want to be cut. if i tore, i tore (which i did in 2 spots and i didnt have any trouble with that.)

    they will discuss c-section at the time they think you need one??? who in their right mind thinks that a woman is able to make a clear, thoughtful, FULLY INFORMED decision about a c-section when shes in the middle of labor, especially after you scare the crap out of her telling her she needs an emergency SURGERY to “save” her baby!?!?!?? !are you freaking serious?!?!
    they dont even inform you of the full information on a DRUG administered BEFORE you go into labor. why and how would they possibly inform you of all the risks/benefits of EMERGENCY SURGERY!!!!

  40. Rebecca
    Rebecca06-25-2010

    “Attempt” skin-to-skin! I love it! “You can TRY to open your gown, get all the blankets and clothes off your baby, and hold them for an extended period of time, but I’ll tell you, we don’t see it ACCOMPLISHED very often.” Hmm, I wonder why not?
    Rebecca´s last blog post ..Doulas, what do you give your clients?

  41. mamatried
    mamatried06-25-2010

    Great Eliza!! “….because when we say patience we really mean pitocin.”

  42. mary
    mary06-25-2010

    Kingsdale Birth Plan – additions in CAPS

    … Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience. YOU PAY US FOR OUR EXPERTISE, SO LET US DO OUR THING AND DON’T QUESTION US. OUR BEST ADVICE IS TO STAY OFF THE INTERNET. THERE ARE ALL KINDS OF CRAZY PEOPLE ON THERE.

    … By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary. WE WON’T READ THEM, ANYWAY. NOW WE ARE JUST BEING UPFRONT ABOUT IT. YOU’RE WELCOME. If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them. WE WILL INFORM YOU OF THE STANDARD OPERATING PROCEDURE YOU OR YOUR BABY WILL BE SUBJECTED TO “IN YOUR BEST INTERESTS.”

    IV’s: Patients often ask us if IV’s are necessary in labor. The answer is “yes.” WELL, NOT REALLY, BUT ONE-SIZE-FITS-ALL IS EASIER THAN EVALUATING SITUATION BY SITUATION. Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished through the labor process, the most important part is the “hepwell” itself. WE CAN COMPROMISE HERE TO GIVE YOU A FEELING OF CONTROL. YOU STILL GET A LOVELY POTENTIAL POINT-OF-ENTRY FOR STAPH, AND WE GET TO STILL EXERCISE CONTROL. If we run into an emergency situation where the life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access. IT ONLY TAKES 30 SECONDS, BUT PERCEPTION IS EVERYTHING, RIGHT? This is obviously a rare occurrence, but often an unexpected one.

    Nourishment in labor: … Women often get nauseated, and sometimes vomit, during labor, which IS ICKY TO BE AROUND AND CLEAN UP. HOW WE LONG FOR THE DAYS WHEN WE COULD GIVE YOU AN ENEMA SO WE DIDN’T HAVE TO DEAL WITH POO, BUT, IF YOUR LABOR IS LONG ENOUGH, YOU WON’T HAVE ANYTHING IN YOUR SYSTEM, ANYWAY. OH, AND WE GUESS IT can be not only miserable but also dangerous. IN THEORY. NOT REALLY IN PRACTICE. In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk. WHICH IS WHY PEOPLE ARE ADVISED TO FAST BEFORE DRIVING CARS, TAKING SHOWERS, AND ALL DANGEROUS ACTIVITY. Of course, we will give you nourishment and hydration through the IV as necessary. WE NEED TO GET A BAG OF FLUIDS IN YOU BEFORE YOUR EPIDURAL AND C-SECTION, ANYWAY. IT ALSO INFLATES OUR BIRTH WEIGHT NUMBERS AND ADDS TO SHOCKING DROPS IN BABY’S WEIGHT WHEN THEY PEE ALL THOSE FLUIDS OUT, ALLOWING US TO FREAK YOU OUT ABOUT NEEDING TO SUPPLEMENT YOUR BABY’S DIET WITH FORMULA.

    Anesthesia: It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs. NO NEED TO BE BRAVE/A HERO/THEY AREN’T GIVING OUT MEDALS. Some labors are quite rapid and tolerable while others require a great deal of patience and intervention. MOSTLY INTERVENTION. OUR BILL RATE IS TOO HIGH FOR MUCH PATIENCE. UNLESS WE ARE BUSY, THEN SQUEEZE YOUR LEGS TOGETHER AND WE’LL GET TO YOU “SOON”.

    Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques. WE HEARD GOOD THINGS ABOUT THOSE IN THE 80S, AND THE ONE ASSOCIATED WITH THE HOSPITAL WILL TELL YOU ALL OF THE STANDARD PROCEDURES, ALONG WITH A FULL HOUR OR TWO ABOUT YOUR EPIDURAL AND POSSIBLE SURGICAL DELIVERY. The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes. WHICH WOULD BE TOTALLY USEFUL IF YOU ARE THE ONLY LABORING MOM IN THE HOSPITAL. GOOD LUCK! Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary. WE ENCOURAGE IT. I MEAN, WE WON’T TIE YOU DOWN, BUT IT WOULD BE WAY EASIER ON US. AND YOU CAN WATCH TV AND SHUT UP IF YOU HAVE A WORKING EPIDURAL IN PLACE! TV!

    Epidurals: The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby. CONSIDER THIS THE “INFORMED” PART OF INFORMED CONSENT, AND PAY NO ATTENTION TO THE LIST OF POSSIBLE SIDE EFFECTS ON THE WAIVER WE WILL HAVE YOU SIGN DURING CONTRACTIONS. IT IS ALSO KIND OF A CASH COW FOR US. KACHING. The epidural will make you somewhat numb from the waist down, IF IT IS WORKING EFFECTIVELY. IF NOT, YOU MAY BE NUMB ON ONE SIDE BUT NOT THE OTHER, OR HAVE A “WINDOW” NOT NUMBED, OR, IF WE *REALLY* EFF IT UP, YOU MIGHT GET NUMBED *UP* AND GO INTO RESPIRATORY DISTRESS. ANY WAY, WALKING IS NOT ADVISED. ENJOY YOUR CATHETER. The nurses will continue to help you with position changes that will facilitate the birthing process. IE, IF YOUR BLOOD PRESSURE PLUMMETS, WE MAY ROLL YOU TO ONE SIDE OR THE OTHER. DON’T FREAK OUT- TOTALLY COMMON. WE ARE PROFESSIONALS.

    The choice to use anesthesia or not is ultimately your choice. There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby. ESPECIALLY IF YOU GET LOUD, OR THOSE FANCY BREATHING TECHNIQUES AREN’T WORKING FOR YOU. OR IF WE HAVE YOU PEGGED AS FAILURE TO PROGRESS AND WANT TO GET YOU SET FOR A LATER SECTION.

    Fetal monitoring: WE ARE GOING TO PUT BELTS ON YOU SO THE NURSES CAN TAKE CARE OF OTHER MOMS AND ONLY COME BACK PERIODICALLY TO CHECK ON YOU OR IF THE MACHINES TELL THEM SOMETHING IS WRONG. WE MAY SWITCH TO AN INTERNAL MONITOR IF YOU KEEP MOVING OR YOUR BABY KEEPS MOVING AND WE CAN’T GET A GOOD READ ON THE BELT. HAND HELD DOPPLER? BWAHAHAHAHAHAHA!

    Labor support: We do recommend that you have a good support person or two during labor. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. SOMEONE WITH NO MORE KNOWLEDGE THAN YOUR AVERAGE LAY PERSON, WHO WON’T QUESTION US, AND WILL ENCOURAGE THE HYSTERICAL BIRTHING LADY TO JUST DO WHAT THE DOCTOR SAYS OR THEIR BABY/GRANDBABY/ETC WILL BE AT RISK. IT IS BEST IF THEY HAVE AN EMOTIONAL INVESTMENT INTO THE BIRTH. The labor and delivery nurses and doctors together act as “doulas” in a sense THAT WE AREN’T, BUT that we will be OUR advocate to TELL YOU WHAT TO DO WITHOUT QUESTION. Your support person should be there to do just that–give support. AGAIN, NO QUESTIONS. NO DISSENT.

    Mode of delivery: We do occasionally do c-sections for delivery. If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail. WE WILL TELL YOU, IN DETAIL, HOW YOUR BABY COULD *DIE* IF YOU DON’T JUST DO IT. WE WOULDN’T SUGGEST IT IF IT WASN’T THE EASIEST OPTION FOR US. We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth. WE JUST GET REALLY TIRED WITH LONG DELIVERIES AND THIS CAN SAVE US, LIKE, TEN MINUTES.

    Episiotomies: During the pushing process, episiotomies, this safe procedure (CONSIDER THIS INFORMED CONSENT- DO NO ADDITIONAL RESEARCH), is sometimes required to facilitate birth and to SQUEEZE IN A VACUUM OR FORCEPTS.

    We hope that this clarifies many of the questions about the birthing process that you may have along the way. Please feel free to ask questions and obtain clarification if needed from your individual provider. JUST UNDERSTAND WE AREN’T CHANGING TO FIT YOU- YOU WILL CHANGE TO FIT US.

  43. The WellRounded Mama
    The WellRounded Mama06-25-2010

    If they “never” cut routine episiotomies and “never” do cesareans for convenience, they should back that claim up with details about their actual episiotomy and cesarean rates. Funny how they don’t do that, eh?
    The WellRounded Mama´s last blog post ..Happy Birthday to Me!

    • Knitted in the Womb
      Knitted in the Womb06-26-2010

      Well you know WellRounded, no OB EVER performs interventions for convenience–they are MUCH too selfless for that (and doulas, even when they do spend 30 hours straight at the hospital with a client…are EXTREMELY selfish, and are only in it for the money)…it is ALWAYS for the best interest of the mother. WHO is just crazy when they think that no more than 15% of cesareans are medically necessary, it is completely reasonable that some practices have such high risk patients that over 50% have cesareans.

  44. CAJ
    CAJ06-25-2010

    I basically read this at an attempted murder plan. Extreme? Not really…I can see lots or illnesses that can result from this type of ‘care’.

    Also, all we need is a few ppl to sue regarding birth trauma (post traumatic stress disorder PSTD is now recognised as a result of birth trauma) or even failed breastfeeding (as we all know not breastfeeding puts children at risk of many long and short term illnesses that are not only distressing for parents and children but will cost families, governments, health care SQUILLIONS), as by preforming births this way is shown to sabotage breastfeeding in most cases.

  45. sheila stubbs
    sheila stubbs06-25-2010

    “If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.”

    “you may attempt”?
    I get PERMISSION to ATTEMPT to hold my baby?

    “skin-to-skin” care
    in quotations like it’s some funky new idea they’ve just discovered that’s never been done in the history of birth!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-26-2010

      I too found the scare quote to be a bit…odd. Makes me want to send them to the Lamaze Healthy Birth Practice Paper on keeping moms and babies together after birth (and the SCADS of research that the practice paper uses to support their claims)!

  46. Dana
    Dana06-25-2010

    They took my daughter from me after saying I HAD to have a c section….they said because I had a temp of over 102 that she was at risk…they ran horrible tests, spinal taps….a IV line in her HEAD….my experience of giving birth was HORRIBLE and all went downhill after I developed a low grade fever. It is a horrible memory, and they let me hold her for a moment, covered in wires in IV’s and for 3 days I sat in an ICU refusing to go back to my room and holding her late into the night….DISGUSTING

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-26-2010

      Oh Dana, I am so sorry to hear that your birth experience was horrible for you. So many times, maternity care providers discount (or aren’t even aware) of the real trauma that women can experience during labor and birth, even when their babies are eventually healthy. I don’t know if you’ve ever checked it out, but Solace for Mothers (www.solaceformothers.org) is a wonderful place of support for women who have experienced birth trauma, in any of its many manifestation. (((HUGS)))

  47. Jen
    Jen06-25-2010

    I’d ask a simple question, “May I see the references that you use to justify this birth plan?”

    Its sad because I’m afraid many, many practices would really love to say this to their patients….

    I hope my daughter’s generation will benefit from our angst now! At least I know my daughter will grow up with a healthy body image, one that respects the amazing capacities she has – I don’t see her taking any of this “blindly”.
    Jen´s last blog post ..To those little lost souls

  48. VBACMommy
    VBACMommy06-26-2010

    Here’s the thing: This is pretty much how ALL hospitals think of it. They are just being upfront about it. Most women have birth plans that look pretty much like that anyhow. On the Support Person: It looks to me like they are trying to keep crowds out of the delivery room, and suggesting that obnoxious mothers/in-laws be not invited. If what one mom said about her doula taking care of everything is true, then the hospital ban is probably because of LAZY nurses putting them at risk for liability. As for the support given by doctors and nurses, it really depends on who you get, doesn’t it? My first VBAC was induced (because of unsound reasoning on the doctors part and stress on mine) My nurse was one my doctor had recommended I hire as a doula if I wished, but she was 7 months pregnant and not physically capable of helping me with positions much. I finally had an epidural. The nurse at the shift change DID help me change positions- she flipped me over from side to side every 20 minutes so that the baby would keep moving, lol. It wasn’t exactly the experience I would have wanted, so I found a new doctor for the next baby. I did things much more the way I wanted, because I’m a VBAC the hospital is much more strict- I HAD to have an IV, but they helped me maneuver it, I HAD to have continual monitoring after 5 cm, but they didn’t check how far I was until I asked, and then they got in awkward positions to hold the monitor in a useful place occasionally while I used a birthing ball. It really depends on your provider. Find one that believes that women know how to deliver, and you will have a good experience.

  49. Olivia
    Olivia06-26-2010

    I just couldn’t do it justice here. You inspired me to write my own post: http://tinyurl.com/snarkybirthplan
    Olivia´s last blog post ..About Me

  50. traineedoula
    traineedoula06-26-2010

    As a trainee doula, I’m horrified by this. But also proud to be british at this point!! I just completed a tour of my local hospital which included beanbags, birthing pool and a labour room that consisted of just mats and no medical equipment! True, the NHS need women to labour cheaply (minimal drugs and intervention), but it seems that this will benefit and empower mums to be!
    My labour experiences weren’t great (Lot’s of improvements since my last birth 5 years ago!) but my choices were pretty free! IV’s are unheard of here, unless for emergency and entinox (gas and air) is pretty much the preferred pain relief. If mum has laboured well, she will be home in 6 hours (as I was!) Money talks!!!!

  51. Jill--Unnecesarean
    Jill--Unnecesarean06-27-2010

    The two hospitals mentioned, Riverside Methodist Hospital and OSU had high primary cesarean rates in 2008. Riverside Methodist Hospital’s primary cesarean rate is 23.4% and OSU’s is 26.1%.

    It’s apparently someone else with hospital privileges performing the unnecessary cesareans. After all, it’s written in their “birth plan” that only occasionally perform cesareans. I wonder if they’d like to back that up with a definition of “occasionally.”

    Ohio 2008 primary cesarean rates (defined here as low risk, first time mothers) is linked in the signature if you’re interested.
    Jill–Unnecesarean´s last blog post ..The Lessons of the Boondock Saints and Tanya Lewis Lee

    • Knitted in the Womb
      Knitted in the Womb07-25-2012

      “Ohio 2008 primary cesarean rates (defined here as low risk, first time mothers) is linked in the signature if you’re interested.”

      Does Ohio really provide data on cesareans for low risk first time moms? Because the definition of a “primary” cesarean is typically the first cesarean a mother receives. To calculate the “primary cesarean rate” you divide the number of primary cesareans by the number of pregnancies with no prior cesarean and multiply by 100%.

      Typically the cesarean rate in first time moms is somewhere between 1.5 and 2 times the “primary” cesarean rate…but this number includes high and low risk first time moms.

      So looking at a real life scenario–myself and my 2 sister in laws…between us we have 12 children and 3 cesareans, for a cesarean rate of 25%. One of my sister-in-laws had a cesarean for her first pregnancy (breech, which makes her “high risk” for that and future pregnancies–the other pregnancies ranged from low to medium risk), so the cesarean rate for first pregnancy between us is 33%. She had a repeat for her 2nd pregnancy (and a VBA2C in the 1980’s for her 3rd baby–YAY!). My other sister-in-law (SIL) had her first cesarean for her 4th baby…so there are 2 primary cesareans–hers and the first sister-in-law’s. There are a total of 10 pregnancies that occurred “with no previous cesarean” – first pregnancy for first SIL, 4 pregnancies for 2nd SIL, and 5 for me. So that results in a 20% “primary” cesarean rate…with the 33% cesarean rate for first pregnancy fitting in very nicely between that range of 1.5-2 times the primary rate that I mentioned earlier.

  52. Celeste
    Celeste06-27-2010

    ANESTHESIA: Some labors are quite rapid and tolerable while others require a great deal of patience (which we lack) and (therefore) intervention (which we have in abundance).

  53. Celeste
    Celeste06-27-2010

    Nourishment in labor: We usually limit women to ice chips and popsicles during labor. This is not designed as an attempt to starve you; (starvation is just a pesky side effect of a diet containing only ice chips and popsicles.)

    Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous. In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk. (As a matter of fact, since you MIGHT get in a car accident on your way to work tomorrow, and if you’re in an accident you MIGHT get injured, and since that injury MIGHT require surgery, and since that surgery MIGHT require general anesthesia, and since while you’re under general anesthesia, you MIGHT vomit, and since if you vomit AND the anesthesiologist used archaic intubation methods you MIGHT aspirate your stomach contents into your lungs, and since aspiration IS a serious condition, you should eat only ice chips and popsicles for breakfast before driving to work tomorrow. And for lunch, before driving home. And for supper, before driving to the store. What the heck! Please refrain from eating anything but ice chips and popsicles forever–just to be safe.)

    Of course, we will give you nourishment and hydration through the IV as necessary. (Which of course means always, since our years of experience and medical expertise has taught us that ice chips and popsicles have no nutritional value whatsoever, silly!)

    • Knitted in the Womb
      Knitted in the Womb07-25-2012

      “Of course, we will give you nourishment and hydration through the IV as necessary.”

      Okay…show of hands…how many people here have actually seen a woman in labor who is provided NOURISHMENT via her IV? I’ve attended over 60 births, and while I’ve certainly seen a LOT of Lactated Ringer get pumped into women…I’ve never seen a single calorie containing solution pumped in via IV.

  54. Jessica
    Jessica06-27-2010

    Labor support: We do recommend that you have a good support person or two during labor. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it. {In other words, a doula!} The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible. Your support person should be there to do just that–give support. {You know, like a doula.}

    *sigh* I foresee more “family members” and “close friends” appearing in the labor room. ;-)

  55. Weekly News Round-Up, New Blog Template Edition « Women's Health News
    Weekly News Round-Up, New Blog Template Edition « Women's Health News06-27-2010

    [...] Beautiful Babies has two posts on the Kingsdale Gynecologic Associates in Ohio and its “birth plan” and apparent ban on doulas. One example from the “birth plan,” in the section on [...]

  56. RachelW
    RachelW06-27-2010

    One line that was very telling for me was “We promise to use our medical expertise and experience to make the best and safest decision for you and your baby.” They will make a decision about episiotomy *for* the woman, huh?
    RachelW´s last blog post ..Weekly News Round-Up- New Blog Template Edition

  57. Weekly News Round-Up, New Blog Template Edition « 3acne.co.cc
    Weekly News Round-Up, New Blog Template Edition « 3acne.co.cc06-27-2010

    [...] Beautiful Babies has two posts on the Kingsdale Gynecologic Associates in Ohio and its “birth plan” and apparent ban on doulas. One example from the “birth plan,” in the section on [...]

  58. Martha
    Martha06-27-2010

    OSU women,
    We need to organize and demand woman-friendly care. Which our insurance currently does not cover as Catie points out, our only midwife option is to have a medwive, even there you can’t be guaranteed a medwife for your birth. There is an OSU Women’s Place which has the purpose of advocating for women
    The Women’s Place
    (from their mission) Advocates policy changes that provide opportunities and address institutional barriers for women
    Provides a critical gender analysis of policies and practices that impact the progress of women at OSU
    Creates/supports initiatives with a direct link to institutional change for university women

    If any of you OSU women out there want to talk about this more, shoot me a message: marthanieset@gmail.com

    An institution of research should be providing evidence-based care options for women!

    …sadly this won’t happen until we demand it.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-27-2010

      You know I’d be up for a collaboration, Martha!!

  59. Celeste
    Celeste06-27-2010

    Let’s do a Word Count, shall we??? Below, I’ll list some words from this “birth plan” that stood out to me, followed by the number of times that word (or a related word or variation of it) appeared in the birth plan. I love word games–this should be fun!

    Medical Expertise/Experience: 4

    Danger/Emergency: 4

    C-section/surgery: 5

    Delivery: 6

    Safe/Healthy/Best: 8

    Pain: 12

    Necessary/Needed/Indicated: 13

    Aren’t word games FUN!?! I think it was incredibly thoughtful of this OB practice to do the “work” of coming up with a birth plan for all of their patients. Now that that time-consuming job is out of the way, the only thing left on the to-do list for expectant moms is to “check brain at door” when they arrive for their scheduled induction-soon-to-be-emergency-c-section.

    I just had an image come to mind of a remake/sequel to the old Stepford Wives movie. In the re-make, once the powers that be got a hold of the rebellious teenage daughter, her response to everything (complete with glazed eyes and Barbie smile) was, “I’m a very lucky girl.” Interesting that that is the image that popped into my head after reading this “birth plan” and imagining the type of women who are happy with this OB practice. “My doctor saved mine and my baby’s life. I’m a very lucky girl.”

    • AB Doula
      AB Doula06-27-2010

      “If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together. If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.”

      The words try and attempt really stand out and anger me. Why do they need to TRY to keep the mother and baby together. How hard is it to keep the mother and baby together especially if mother and baby are doing well as they indicate.

      The word attempt also really sets the tone here. This is promoting bottle feeding and poor bonding by suggesting skin to skin and breastfeeding are things that must be attempted rather than something that is natural and normal.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas06-27-2010

      You forgot one: “vaginal” was mentioned only once.

      And I think that’s a little more than telling. (Great idea, by the way!)

  60. Rachael
    Rachael07-03-2010

    I thought that this so-called “birth plan” was pretty bad. That was before I got Henci Goer’s Thinking Woman’s Guide from the library this week. And that’s when my head exploded.
    Rachael´s last blog post ..On My Mind

  61. Doulas Banned from Hospital « Enjoy Birth
    Doulas Banned from Hospital « Enjoy Birth07-07-2010

    [...] thing that really gets me is THEIR birth plan.     There are so many things wrong with it, but at least they are honest and mom knows what [...]

  62. Weekly News Round-Up, Another Three-Day Weekend Edition « Women's Health News
    Weekly News Round-Up, Another Three-Day Weekend Edition « Women's Health News07-11-2010

    [...] didn’t want to be called paternalistic, then they shouldn’t have developed a “birth plan” that includes, for example, language about episiotomy that says (emphasis added): “We [...]

  63. Weekly News Round-Up, Another Three-Day Weekend Edition « 3acne.co.cc
    Weekly News Round-Up, Another Three-Day Weekend Edition « 3acne.co.cc07-11-2010

    [...] didn’t want to be called paternalistic, then they shouldn’t have developed a “birth plan” that includes, for example, language about episiotomy that says (emphasis added): “We [...]

  64. Birth Plan Ban (and a shameless plug) | BIRTH SENSE
    Birth Plan Ban (and a shameless plug) | BIRTH SENSE08-20-2010

    [...] they perceive as disruptive to the doctor’s plan of care, are writing their own birth plans. Birthing Beautiful Ideas blogged about the Kingsdale Gynecologic Associates’ birth plan ban letter sent to all [...]

  65. Anne
    Anne09-03-2010

    So I’m clearly in the minority here, but I wanted to add my experience to the mix.

    I am a patient at Kingsdale and have been for two full-term pregnancies and a miscarriage. I feel the missing part of the discussion here is the importance of choosing the right doctor for you. I trust my doctor, therefore all the snarkiness about the doctor’s judgment for episiotomies, inductions, C-Sections, etc. get checked at the door. She’s a fabulous woman with excellent training, decades of experience and has three children of her own.

    Thus I am far more likely to trust her decision than my own regarding so many aspects of the birthing experience because while I’ve done this once or twice, she has literally hundreds (over a thousand?) of delivery experiences to draw on. On issues of personal preference (whether they clean the baby before putting her on my chest), my voice is the one that counts. On issues of my health and the health of the baby, she knows my preference but her decision in the moment carries the vote every time.

    My experience with my first birth involved an induction, internal monitoring, and almost a vacuum, but it was still such a beautiful experience I cried. My daughter’s cord was 3x as long as normal and wrapped around her neck 3 times and around her leg once (which explains the concerning heart rate we were seeing). Thanks to the doctor’s guidance and quick decision-making, she was born healthy and well and at the end of the day, that is exactly the doctor’s job!

    So I do resent all the comments that imply the doctors at this practice are in some way “out to get” women or ruin their ideal births. That’s just silly. Nobody endures 4 years of medical school and 3 years of training plus crazy hours for their entire career just to undermine the efforts of a woman to bring a healthy baby into the world. No, doctors are not infallible. Yes, they differ wildly in how they apply the medicine they’ve learned, but find a doctor that works for you! Mine works very well for me, thankyouverymuch. :)
    Anne´s last blog post ..News

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas09-03-2010

      Hi Anne–thank you for taking the time to share your perspective here! In all honesty, I’m not surprised that there have been people who have had a good experience with Kingsdale, and I’m glad to hear that you are one of them! (For what it’s worth, I know that a few local doulas were even surprised to hear that they were the practice with the doula ban and the rigid birth plan.) I also don’t doubt that they are highly trained professionals who can and often do make sound medical judgments in emergent or even questionable situations. I’m happy that we have OB/GYNs to attend to these circumstances!

      That being said, I still must disagree with their doula ban, some of the items on the birth plan, and the entirety of the spirit of the birth plan. Research consistently shows that doula support reduces the need for pitocin, vacuum, forceps, and cesarean section, all of which can carry certain risks for women and their babies. What’s more, some of the best evidence “out there” shows that for LOW RISK moms, many of the items on the Kingsdale birth plan are not medically necessary and/or beneficial, and some are even harmful for women and babies. And finally, taking away so much reasonable decision-making power from women before they even go into labor is unconscionable to me.

      So yes, in an urgent emergency, most (if not all) of the decision-making power should go directly to the care provider! But barring an emergency, I don’t see why women shouldn’t be able to make some (if not all) of these decisions on their own.

      Again, thanks for weighing in here!

  66. Lynda
    Lynda09-23-2010

    This is absolutely insane. But over here in California, it’s pretty crazy too — a study came out suggesting that C-section rates are WAY higher in for-profit hospitals than non-profit hospitals. Why? It has nothing to do with the women there (in fact, the non-profit hospitals probably end up with higher risk groups)… C-sections bring in more money. I cannot possibly fully express my disgust!

    http://californiawatch.org/health-and-welfare/profit-hospitals-performing-more-c-sections-4069

    –Lynda (I’m a farmer, and my husband and I are thinking about TTC, so I’m starting my research early… and leaning towards a home birth.)
    Lynda´s last blog post ..Letter to Jon Stewart 3

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas09-23-2010

      Lynda–thanks for sharing the California Watch link. I took a look at that last week and wavered between shock and disgust and…not that much surprise after all.

      Good luck on your TTC journey!! And GOOD FOR YOU for doing your research early! So many of us wish we would have done some better research the first time around…

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