And Here I Thought the Kingsdale Anti-Doula Letter was Bad
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!
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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
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!!!!
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 ..The Lessons of the Boondock Saints and Tanya Lewis Lee
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).
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!)
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.
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 ..Weekly News Round-Up- New Blog Template Edition
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.
You know I’d be up for a collaboration, Martha!!
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.”
“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.
You forgot one: “vaginal” was mentioned only once.
And I think that’s a little more than telling. (Great idea, by the way!)
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 ..On My Mind
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 ..News
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!