An OB's Birth Plan

  1. Hello,

    I've been a member here for a long time but don't post because I decided nursing school with young children at home wasn't something I could personally pull off. I'm 26 weeks with my 3rd (1st 2 were hospital births) and at my last appointment my OB folding a piece of paper in half and handed it to my husband. He told us it was information on hospital policies and things and we could discuss at my next visit. All I saw was the title Dr. ________ "Birth Plan" and I was amused because I know that birth plans can be irrational and badly researched. After I read it I was less amused and now plan on finding another care provider. I do believe the OB is a good doctor and I plan on sending a polite but honest letter and I would also like to cite research in order to leave some possibility that he will rethink his position. I am having trouble finding research.

    DR. ________ "BIRTH PLAN"

    Dear Patient:

    As your obstetrician, it is my goal and responsibility to ensure your safety and your baby's safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.
    * Home delivery, underwater delivery, and delivery in a dark room is not allowed.
    * I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the
    I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of "Natural Birth" promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.
    * Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby's well-being.
    * IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby's well being.
    * Continuous monitoring of your baby's heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby's heart rate are not allowed.
    * Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.
    * Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.
    * I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.
    * Episiotomy is a surgical incision made at the vaginal opening just before the baby's head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby's head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.
    * I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby.
    * If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section.
    * Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.
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  2. 57 Comments

  3. by   Jolie
    I'm sorry that this physician did not share this information with you at the first prenatal visit.

    Best to you in your search for a new provider, and may you have a healthy and uneventful delivery.
  4. by   ElvishDNP
    Honestly? This guy sounds pretty paternalistic and I would vote with my feet. I could argue so many of those points, but what his 'birth plan' sounds like it is essentially saying is "This is what makes my life easiest, and it's my way or nothing."

    http://www.guidelines.gov/summary/su...AND+monitoring

    http://www.guidelines.gov/summary/su...AND+monitoring

    http://www.guidelines.gov/summary/su...ring=amniotomy
    (this last one is long but very very good)

    These come straight from ACOG guidelines. I think this dude is full of himself (and a few other things)...and I'd hightail it straight to another provider if that is in any way feasible. Good luck, and I'm sorry you're dealing w/ this in the middle of your pregnancy.
  5. by   HeartsOpenWide
    Aside from the fact that many of the statements in this OBs "Birth Plan" are bold face lies; I am glad you are getting some one else. I am just like WOW! So sad in so many ways. (the OB not you moving on, Kudos to you!)
  6. by   midwife228
    Oh my. I am speechless, though not surprised. Your provider is no different than many or most OB/GYNs; maybe I should give him points for honesty; many tell their clients whatever they want to hear and then proceed to do exactly what yours is telling you he will do. I hope there are midwives in your area; if you want options in your birth that is your best bet. I am not saying this just because I am a midwife; I felt that way when I was an L&D nurse, and before that when I was having my children and could not find a midwife. A book that you might find helpful is " A guide to effective care in pregnancy and childbirth" by Murray Enkin (and others). It has lots of references to actual research. Your current doctor does not seem like he is going to be open to anything other than his own narrow ideas but it may be helpful as you look for another provider. I wish you the best and would love to know how the rest of your pregnancy and birth experience go!
  7. by   RochesterRN-BSN
    Sorry ....but I was a L&D nurse out of school for a bit in a hospital that did 300+ deliveries a month. I hate to tell you this...yes most doctors don't actually type this all out and call it a birth plan and this is a bit weird...most talk about this stuff --to you and your spouse/partner.........HOWEVER, that being said........I can't say as I disagree with one single thing in this "plan". Yes it is blunt but it is to the point. He is there for your and your babies best interest and I think you took this in the wrong way. Especially if you liked him in person, if he had good bedside manor. I hate to say this but this is how most docs practice even if they don't put it into writing like this doc did. I might suggest that you find a midwife. And honestly I am a huge believer that at home deliveries are just stupid. I have seen bad things happen REALLY fast in what was EXPECTED to be a totally normal and routine delivery. Times when if that delivery was going on at home both mom and baby would have died!!! A matter of a few minutes between --all is good and holy crap get into the OR NOW!!! We got about 10 seconds to get this baby out....I've seen a mom go into DIC and end up almost dying and in the ICU for weeks afterward--totally unexpected. That is a HUGE risk to deliver a home. Stupid if you ask me. As far as the Bradley method-- done by the book so to say this plan is a huge pain in the butt!! And my biggest problem with it is that it tells not to have a baby getting the meds that are standard to give on delivery-- The shot of Vit.K which is needed for the baby to be able to clot his own blood--adults produce Vit. K in the intestinal tract, by bacteria there...this does not happen right away in babies. They should get Erythromycin ointment in the eyes to prevent infections from causing blindness......this method tell parents not to allow these meds......the other benefit the baby gets from the shot is that yes they cry a bit...but in a brand new baby that is good, the crying helps them to clear their lungs....I have seen babies that didn't cry at all until that shot, despite many efforts and this was what got them crying to clear the lungs.....something they have to do.
    So despite the fact that this is a kind of inpersonal and blunt way to tell you what he needs to be able to care for you the best way he knows how.......I totally agree with everything. Sorry. Too many woman forget that childbirth is serious and babies die and moms die when doctors are not allowed to do everything they can to protect thier patients. OBs are suied a lot and if your baby died you would be the first to sue if this stuff was not done.
    And really things like being required to have an IV.....I always have though this should be done. Its there if you need it in an emergency. No wasted time. Your life and your babies are worth it.
    I would have no problems working with him as a nurse
    nor would I have any problems with him delivering my babies........of course if he also had a good bedside manor. I would know that me and my baby were safe and getting the best care possible. And BTW I have had 2 of my own and so this is a mom speaking too!! lol -- I wis I would have had an IV early --they blew mine 3 times in a row and then it was too late to get my epidural.
    I really think if you like this docs bedside manor and he seems nice you might want to rethink this........he may be a really good doc. I worked with many that were wonderful and the patients loved and yes they said these things a little more nicely but most of them had the same ideas!!!
    good luck and I hope all goes well with the delivery!!
    I hope my honesty helps......
  8. by   yelnikmcwawa
    Quote from psychrninny
    so despite the fact that this is a kind of inpersonal and blunt way to tell you what he needs to be able to care for you the best way he knows how.......i totally agree with everything. sorry. too many woman forget that childbirth is serious and babies die and moms die when doctors are not allowed to do everything they can to protect thier patients. obs are suied a lot and if your baby died you would be the first to sue if this stuff was not done.
    to each his own....it sounds like this would be a good doctor for you, but not the op. i firmly believe that having faith and trust in your birthing professional is an important factor in having a positive birth experience. if this letter makes the op feel uncomfortable, she will undoubtedly not be comfortable at her birth. if any complications would arise, she will go home with a sick feeling in her stomach since she let that a**hole near her. and that feeling will last her a lifetime.

    this doctor sounds very narcissistic and misogynist. :angryfire he got into ob because he couldn't hack neuro or ortho surgery, and he's angry that he has to work with a bunch of women all day who ask "too many" questions. in his mind, he probably thinks "how dare they want to have any control over their birth experience!" ohhhhh, the audacity!!!!!!!!!i'd run from this guy and find a midwife!
  9. by   HeyJude
    I have to admire this doc's candor but do not agree with his stance on so many things. The evidence strongly suggests that many of the things he is intent on doing are either a) not helpful; or b) downright harmful.

    And honestly I am a huge believer that at home deliveries are just stupid. I have seen bad things happen REALLY fast in what was EXPECTED to be a totally normal and routine delivery.
    And on the flipside, I have seen things happen in hospital deliveries resulting in very very bad (unnecessarily so) outcomes that would not have happened had the delivery occurred at home. The evidence strongly suggests that home delivery is safe in low-risk pregnancies, and in many industrialized nations, birth takes place at home all the time, with very very few preventable bad outcomes. Have you by chance looked at Ina May Gaskin's numbers?

    As far as the Bradley method-- done by the book so to say this plan is a huge pain in the butt!!
    A pain in the butt for whom? It's her birth experience, not mine.

    And my biggest problem with it is that it tells not to have a baby getting the meds that are standard to give on delivery-- The shot of Vit.K which is needed for the baby to be able to clot his own blood--adults produce Vit. K in the intestinal tract, by bacteria there...this does not happen right away in babies.
    This is not quite the catastrophe it's being made out to be. The human race survived for many many years without Vitamin K. It does little or nothing to prevent early onset HDN, and the incidence of late-onset HDN is around 7 in 100,000 in babies that don't get the Vit K. Did I get it for my son? Sure. But do I get all in a hot mess if parents don't want it? Not at all.

    They should get Erythromycin ointment in the eyes to prevent infections from causing blindness....
    ....infections that mom has been tested for (at least in my facility) upon admission. If she comes back GC & Chlam negative, there is absolutely no good reason to give the drops. Again, I got them for my son. But the next baby, I might forgo them. No need to treat for an infection Mom doesn't have.

    Too many woman forget that childbirth is serious and babies die and moms die when doctors are not allowed to do everything they can to protect thier patients
    Forgive me for disagreeing so much, but too many doctors and nurses (I'm including myself here) forget that childbirth is a normal, common experience that has worked well for millenia, if not millions of years. Women and their babies are made to be able to handle it. The Creator is not a careless mechanic. Babies die and moms die when doctors intervene too much too. We have got to get out of this collective mindset that normal vaginal delivery is a retrospective dx.

    And really things like being required to have an IV.....I always have though this should be done. Its there if you need it in an emergency. No wasted time. Your life and your babies are worth it.
    You know, I didn't have a problem with having IV access during my labor. But there are several nurses/midwives on this board practicing in other countries that do not routinely put IVs in laboring women....and have never had a problem getting access when seconds count.

    I am sorry if this comes across as a personal attack on you, because it's not. I just strongly disagree w/ many of the ideas. It's been my experience that we cause more problems than we fix with all our interventions, well-intended though they may be.
    Last edit by HeyJude on Mar 4, '09
  10. by   midwife228
    Amen!!
  11. by   midwife228
    I could not agree with you more!!
  12. by   Jaybird310
    My first question is why didn't he discuss this with you on your first visit? Most of this type of thing was discussed with my fiancee and me when we had our first appointment with the OB that would be delivering our baby (she was living in another state when we first found out she was pregnant and after telling her doctor she planned to move 4 months into the pregnancy, he didn't feel like discussing birthing issues and proceedure was nesscary). Now my second question is why was the paper handed to your husband and not you? I know personally that I feel like all of that information should be presented to my fiancee. While some of the things we might need to discuss, she is the one who will actually be going through labor, not me. It almost seems like a sexist move. That action actually makes me more uncomfortable than the whole issue with the birth plan. If you're not comfortable with it find a new doctor. That's the best advice anyone could give you. I know after something like this my fiancee and I would have to have a long discussion about if this was the right doctor for us.
  13. by   yelnikmcwawa
    Quote from Jaybird310
    Now my second question is why was the paper handed to your husband and not you?
    Because he's misogynist!!!!!
  14. by   Jaybird310
    Quote from yelnikmcwawa
    Because he's misogynist!!!!!
    If this is a true statement then my fiancee would have to do some serious convincing if she really wanted this man delivering our baby. The idea of a misogynistic OB delivering my child and handling my pregnant fiancee just makes me uncomfortable.

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