For most women, pregnancy and childbirth are one of the few times we let other adults tell us what we are “allowed” and “not allowed” to do with our own bodies. It’s time to change our language around this to reflect the legal and ethical reality that it is the patient who chooses to allow the provider to do something—not the other way around—and to eliminate a word that has no place between true partners in care.
We hear the word “allow” used regularly, by well-meaning care providers and family members, and by pregnant women themselves. During my own pregnancy, I was told I “may or may not be allowed” to hold my baby immediately after he was born, depending on what hospital staff was on shift. It struck me as so odd that I might be in the position of asking to hold my own precious baby, especially when I’d chosen to hire these care providers. Who was allowing whom here?
Most recently, it has been all over the media following the March 2014 release of guidelines for lowering the primary Cesarean rate from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine:
“Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation’s obstetricians say.” (NPR.org)
Or:
“That may mean that we allow a patient to labor longer, to push for a longer amount of time, and to allow patients to take more time through the natural process.” (CBS News Philadelphia)
For women giving birth in the American maternity system, these guidelines are welcome, but they are no magic bullet. Medical practices take years and even decades to change, and while that happens, what assurances do women have about the care they are receiving today? Is it ethical to hold women to what an individual provider will “allow,” with the full knowledge that not all providers are practicing to the standards science show is best for moms and babies?
These are not rhetorical questions. In the U.S., outdated, non-evidence-based practice is routine and accepted; Cesarean section rates vary ten-fold among U.S. hospitals; and those rates vary fifteen-fold among the low-risk population. Over 40% of hospitals defy national health policy by “not allowing” vaginal birth after Cesarean, to the detriment of hundreds of thousands of mothers and babies. The United States is the only developed country in the world with a RISING maternal mortality rate. One factor in that rise is our overuse of surgery for childbirth. We simply cannot operate on the assumption that the surgeries women are receiving are always in their best interests, or that of their babies.
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But it’s about more than just a stand-alone decision around whether to do a Cesarean. There’s a sequence of events leading up to that possibility, and many women have been relieved of their decision-making well before that time. When women have been given messages all along that they are not the authority in their own childbirth, it’s easy for a care provider to make a unilateral decision about surgery. What woman, who has experienced nine months of language like “we can’t let you” and “you’re not allowed” is going to suddenly have the wherewithal to refuse an unnecessary surgery—or to even know she has the right to do so?
The truth is that women, like all other U.S. citizens, have the right to make decisions about their bodies based on informed consent—a legal, ethical standard which requires the provider to convey all of the information around a suggested procedure or course of treatment, and the person receiving the procedure or treatments gets to decide whether or not to take that advice. ACOG states clearly about informed consent in maternity care: “The freedom to accept or refuse recommended medical treatment has legal as well as ethical foundations. . . . In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying” (ACOG Committee on Ethics Committee Opinion No. 390 Ethical Decision Making in Obstetrics and Gynecology; Dec 2007, reaffirmed 2013).
This stands in stark contrast to women being told they are “not allowed” to decline potentially harmful interventions like continuous electronic monitoring in a low-risk pregnancy, or to make an informed decision for a vaginal birth rather than a surgical one–or even to eat, drink, or go to the bathroom in labor.
At its heart, this language is about a lack of respect. It’s how we speak to children, not competent adults. It’s a sloppy way of skipping meaningful and necessary conversations about what should be a common goal for both mother and provider: a healthy, happy birth.
It’s also a reinforcement of deep cultural beliefs about women as passive objects, not full owners of their bodies nor representatives of their babies, and having lesser decision-making capacity than those they’ve hired to support them. These ideas will take time to change. But birth is a great place to start.
Words have power, and we can take back that power in some simple ways:
– Don’t stay silent when you hear this kind of language in casual conversation. Say something—even if it’s just a little something. Don’t let it go unnoticed.
– Be gentle while you are being firm. Remember that most people are just repeating something common and accepted, and they probably haven’t thought much about it. Make it your goal to inform, not convince.
– Choose to give your business to providers who use respectful language. If you’re hearing this language during pregnancy, you can be pretty sure you’re going to hear it during childbirth—and that can be a problem. You can’t act like a mother when you’re being treated like a child.
– Partners, stand up for your loved ones. When she is vulnerable, be her voice. There is no one better positioned to be a vocal advocate for her and her baby.
Today, American women are gambling with their bodies when they give birth, with a one in three average Cesarean rate in facilities where practices vary widely, even among individual providers. And we are tying women’s hands when we continue to reinforce this dysfunction by using words like “allow” to describe an outdated dynamic that doesn’t recognize us as competent, rights-bearing adults.
The legal authority in childbirth lies with the woman giving birth, not the providers of care. Yes, they are a team, but of the two, it is the woman who truly bears the rights and the risks of childbirth. Our words should reflect that reality.
A former communications strategist at a top public affairs firm in Baltimore, Maryland, Cristen Pascucci is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and former vice president of the national consumer advocacy organization Improving Birth. In that time, she has run an emergency hotline for women facing threats to their legal rights in childbirth, created a viral consumer campaign to “Break the Silence” on trauma and abuse in childbirth, and helped put the maternity care crisis in national media. Today, she is a leading voice for women giving birth, speaking and consulting around the country on issues related to birth rights and options, and working on a documentary about mistreatment of birthing women.
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As a Doula, I’ve often found it’s frustrating that a medical professional will cite that something is a “hospital policy”, which is a hard thing to argue with. My clients have often been labeled “non-compliant” for wanting to eat, walk freely, or drink water rather than have an unnecessary IV. On a recent birth, one client’s nurse said, with a wink and a hushed tone, “I was a non-compliant too!” It’s sad to witness this kind of labeling without any medical basis. It’s frustrating to argue with “hospital policy” and what that “allows”.
A hospital is meant to be for sick people. A mother is not sick or diabled during this natural time. The govt. and business community and laws may call your time with baby after it is born a period of being disabled but in reality it is a precious time of bonding. The birth experience itself is a time where the mother can, if allowed to, experience a deeper state of conscious awareness beyond pain or pleasure. And the pregnancy period is a time of bonding, nurturing, caring, preparing, and loving herself and her baby. Hospitals are not set up to allow for this sort of care and therefore should be used only as a last resort for healthy strong knowledgeable, women who take care of their themselves rather than wanting others to take responsibility for their health.
“Hospital Policies” do get in the way of a natural experience.
Jennifer, this is beautiful! May I quote you on my doula FB page? http://www.facebook.com/lisahartbirthdoula.
Thank you!
Why are you seeing a doctor or going to a hospital? You are perpetuating the myth that your doctor and nurse are your enemy and it takes a patient to set them straight. When I had my children there were some doctors in the practice that I like more than others. But I can say that none of the five doctors I met through the pregnancy, not any of the nurses from the OB’s office, through the labor, delivery or post partum period treated me poorly or spoke down to me. I would never have had my child anywhere but a hospital. Praise God, my three kids were all healthy. My sister’s daughter was rushed to the NICU with meconium aspiration. She would have died had she been born at home. So maybe a hospital is a great place for a potentially sick person. And no, I am not in health care. I’m just tired of these people who help us being bashed by people who think they know better.
Brittany I totally agree! Like it or not, giving birth can still be a life or death proposition when things don’t go according to plan. And these people are miracle workers then. Yes, giving birth is a natural occurrence, but we have the option today to prevent many of the deaths that occurred in the past due to complications. And then there’s the ugly side of lawsuits, even when no negligence occurs. The human body is not a perfect machine, and it’s not always someone’s fault. So many of the “rules” have come about because of frivolous lawsuits and the need to protect health care givers against them. It’s a fine line for them, and they truly are not given enough credit for their dedication and expertise.
Oh gosh.
I’ll take your anecdotal response and raise my own.
My OB told me, and I quote:
“We can’t let you go past 41 weeks, 0 days.”
And…
“You’ll need to labor according to the curve. That means you’ll need to dilate a centimeter every hour or so.”
And…
“It’s hospital policy that you have an IV upon admittance. We can compromise with a hep lock.”
And…
“It’s hospital policy that you have continuous electronic fetal monitoring. But I can arrange for you to get the wireless version, so you have more mobility.”
“Let” (basically a less formal version of the “allow” verbiage discussed specifically in this blog post.
“Need” (I have to labor according to the largely debunked Friedman’s curve? Really? Or what consequence if I don’t?)
“Hospital policy” that was never portrayed as optional, or that I would be able to refuse, only that the doctor himself could provide a little – heavily circumscribed – wiggle room for me.
Yeah, he was a nice guy and I liked him, but that is exactly the sort of physician-patient relationship this blog post is about. It’s not that he was moody or threatening or any such thing. He was pleasant to be around. But he was also complicit in denying me agency and choices within the established medical system, made all the more egregious because he was promoting/enforcing some non-evidence based approaches. I had to fire him and search around – while in the third trimester – for someone who would promote actual evidence-based practice over “hospital policy” and allow me to make an informed judgment on risk and reward based on available evidence… one based on my own best interests, not the hospital’s litigation and insurance interests.
If I had remained with that practice, and went to the affiliated hospital, I would likely have experienced unneeded interventions… at least pitocin and very probably a c-section. I ended up having a natural vaginal birth (no IVs, no hep locks, no induction or augmentation of labor, no pharmaceutical pain relief, etc.) with intermittent auscultation and no, I definitely did *NOT* dilate a centimeter every hour or two.
That OB I quoted above wasn’t my “enemy”, but the system in which he works, and his alignment with that, is not designed to consider me an autonomous individual with dignity and specific rights to choose and deny treatments and care, based on evidence and a personal calculation and assumption of risk, rather than a cookie-cutter industrialized approach to birth. It’s just not. Let’s not let our personal feelings and unique individual experiences get in the way of a more objective look at the system as it stands.
Anecdotes aside, America has some of the worst maternal mortality and morbidity of developed countries, and the statistics are such that it can’t all be explained away by blaming American women for being more overweight.
Hospitals are fine, life-saving places, and there are certainly some circumstances where a birthing woman is wise to be there. And yes, even in what are low-risk births, there are some unexpected circumstances that can rarely arise where the immediate availability of hospital resources is advantageous. However, it’s important to realize that birthing mothers en masse routinely going to hospital entails real risks as well as rewards. For a large majority of women, the unnecessary interventions in birthing leads to an unneeded increase in adverse outcomes. That reality has to be weighed as well.
As for the idea that “baby would have died from (X) if we hadn’t been in hospital”, I’ve learned to take that with a grain of salt. Sometimes that may be true and sometimes it may not depending on the underlying reason for the complication and the availability of basic treatment in the space of time required to get to hospital facilities. Sometimes the reason the baby had a complication can be attributed to interventions performed during labor that increases the stress on the baby and wouldn’t have occurred otherwise. Also, sometimes people at the hospital just say the darndest things. For example, I was told by the head nurse upon the c-section birth of one of my children that I wouldn’t have been “able” to deliver him vaginally because his head circumference was so large. He was born via c-section because I had severe pre-ecclampsia at 40 weeks and inducing labor was unlikely to be effective given my Bishop score that day. I had no gestational diabetes, nor was he unusually large (8’3″), and his head circumference was perfectly normal, although measured “large” as a neonate only if you’re comparing it to the circumference of a baby whose head has been molded – and temporarily narrowed – through passage through the pelvis and vaginal canal. And my pelvis is perfectly normal as well, with the demonstrated ability to expand during the birth process, as expected. If I hadn’t been the type of person to look into things, I may have just accepted the nurse’s word for it (she being the medically trained one). Even though her word for it was more a bunch of hokey than anything else.
I like modern medicine. I’m glad for the medical profession, in general. I have multiple friends who are physicians and family members who are nurses. They are wonderfully dedicated people, who had to endure some terrible conditions in their training/residencies to make it through to their chosen careers in healthcare. I have a great respect for them. I’m not an anti-doctor or anti-hospital ideologue. I am more than happy to be in, or go to, a hospital when the circumstances clearly call for it.
As a nurse..i totally agree with all you have said!
As a nurse I have had many a patient who has a birth plan and expects us to follow it- no matter what.
Whether you like it or not, there are times when the medical professional do know best and need to intervene . If a baby is in severe respiratory distress or has no heartbeat no amount of skin to skin or bonding will help that.
Then the parents are glad I said they can not have the baby on their chest – at least not until after the code is called and either – the baby is saved or not.
And the ultimate responsibility would fall in me if I “let” her hold her unresponsive baby and it died.
It’s about a heAlthy baby not the mom at that point .
In response to kt,
That is exactly why many women come to the hospital to give birth. In case of emergency, they are in the hands of the most highly trained professionals to intervene based on their expertise. This means circumstances such as a code, seizure, cord prolapse, loss of FHR variability, etc…However, “failure to progress” is not an emergency. Neither is a large baby. But they are treated like it. We should be able to trust the professionals to be able to differentiate between the two. But that is not the case. Everything is treated as an emergency by using fearmomgering in order to limit lawsuits. Many woman eventually find out the truth. That maybe if they had been given a little more time, been a little more informed and supported, allowed to change positions, etc…there wouldn’t have been such an “emergency” after all. It is this type of treatment that causes women to loose their trust in healthcare providers to make the call that is right for them.
Well said.
Man…women today are so damn close minded. This article is straight on. Nurses (not all) can be such pains and pushers. If you like that, you’re out of your mind. Having a baby is not life threatening, we are taught that in this modern society and we are lied to about old stories. Women have a special gift and they seem to have become dependant, lazy, and unwise.
I am sadden about this! I dont want to be told what to do as an adult…I want to be supported and encouraged. And if there is an emergency, that’s when they can step in.
You women today are so dependant on science (not all science is useless) and not your natural instincts. I can go on but I will not. This article is indeed true in many ways…nurses (not all) need to be there for women with compassion and encouragement. Hospital are for emergencies…And having a baby is not one, Unless it’s high risks….meaning life or death.
Most of the time inducing labor is to much (more pain the real contractions) for most women and then you get an epidural because of the pain… then baby’s heart rate down…than cesarean.
When labor goes to slow for the hospital…they induce (some of the time)! I have seen nurses constantly push pain relief on patients that said they were fine.This is sad.
It’s nice that some of you had a so called good experience…but not for all. So don’t condemn… Because this article didn’t condemn…!
I too appreciate modern medicine and the doctors I’ve encountered over the years, However, they do tow the party line. Seem to truly enjoy their position of authority over the vulnerable, laboring woman I think. We are literally in the most helpless position with them at the helm telling us what to do.
It’s good to see some progress is being made in at least spreading this very important message.
That’s fantastic that you had great experiences, but there are plenty of women out there who had choices taken away from them during birth or were subject to obstetric violence. Your positive experience does not negate those negative experiences. My provider WOULD NOT ALLOW my family in the room with me, despite the hospital’s policy of four family members or support people being int he room. He threatened to call the police on me and have me escorted out if I did not consent to pitocin. He broke my water despite my telling him not to. The doctor lied to me about the circumstances of my labor so that I would consent to a procedure that I did not want, and then he admitted later that he lied because he knew it was the only way I would consent. When I told him it hurt the way he JAMMED HIS FINGERS INTO MY VAGINA, he told me the pain was in my head and I needed to see a psychiatrist. The nurse threatened to call CPS on my husband and I if we did not consent to certain testing and shots for our newborn. So good for you that you think other people’s experiences are invalid, but perhaps we think that yours are and maybe you are just the type to accept whatever is done to you without asking questions. Some of us expect to be treated like human beings and we expect to have the right to make decisions for ourselves and our children without being bullied or threatened. I will never ALLOW anyone, doctor or not, to tell me what I am “allowed” to do again.
That’s awful and it’s real insensitive of that so called “nurse” kt to say such things, if she paid attention to the media then she would know that there are multiple news stories of women delivering healthy babies outside of a hospital setting. I’m only 22 and i’m single so having kids is not something I need to really focus on right now but when I do have kids i’d choose a home birth over a hospital anyday!
That’s absolutely horrific. I despise these doctors who so enjoy and abuse their authority over women.
Being treated disrespectfully makes for a humiliating birth experience. It’s got to stop.
Please be respectful of others opinions. Some people have been through horrors you couldn’t imagine, as I have, and it’s perpetuated by a healthcare system that results in HIGH MATERNAL MORTALITY rates. Not just other people thinking they know better than someone else. Doctors count on women fearing the unknown, and they play on that fear to manipulate women into doing what they want them to do. I was not informed of the FULL risks of repeat csections, and I’ve done my homework (not Google) to know the full risks of repeat csections. And I would not have had a csections in the first place if it weren’t for a practitioner trying to convince me that my body couldn’t do what it was designed to do (which I found out later was a lie). So unless you have hard evidence that all doctors always act in the best interest of mom and baby, I wouldn’t question others for expressing their concern. Do your homework: home births are sometimes MUCH safer!
I am so glad you had satisfying experiences in the births of your children and thankful your sister baby was able to be saved by hospital staff. Unfortunately this is not everyone experience in childbirth. Your story is not the only story. I was sexually assaulted by an anesthesiologist claiming to be a nurse coming in to check my cervix. He was later fired. I was physically forced to lay on my back by nurses when they walked in the room and saw me sitting on my shins in the labor bed. I was told no when I requested that the pitocin be turned off. I was told that my not consenting to things like episiotomy didn’t matter. Doctor said it was her choice not mine.
As I said before YOUR story is NOT the ONLY way things go.
Meconium Aspiration is often caused by hospital interventions. https://midwifethinking.com/2010/10/09/the-curse-of-meconium-stained-liquor/
Home birth is often safer.
Funny you should refer to pregnancy as being “potentially sick”! Poor you!
Huh…that’s interesting. My son who inhaled his meconium at our home birth did not die. He was in perfect health. 🤔 I’ve done two hospital births and one home birth. All babies were fine and my home birth was by far the most successful.
Sorry, but simply swallowing meconium did not mean he was guaranteed to die without intervention. That’s more obstetric talk. They tell us how they saved our babies and us all the time. The heroes.
Brittany, I’m so glad you felt supported and the people taking care of you listened and took great care of you. I, being a labor and delivery nurse am proud you were able to have that care and thank you for feeling like you need to stand up for us. As that I work with people in this fielding as I am one as well, I have seen Providers and nurse take advantage of patients in many different ways. I have also used the words “well, it hospital policy” before and I’m not going to lie, it makes me feel ashamed because it sets up situations were the people I take care of do not have a choice and I want everyone to have a choice. Being a person in your own body, you do know what’s best for you. Its on the provider to explain the risk, benefits, and alternatives for everyone so they can make an informed decision and whatever that decision that the women makes is what is best for her. We may not agree with it and have our own bias (everyone has their own bias), but it is our job to support the people that come in to us and there are many ways to safely get a baby here that doesn’t adhere to hospital policy. Hopefully this gives a little insight from a Labor and delivery nurse who’s been in the game for 8 years, I will also continue to grow to make my peoples place a safe space to bring their little tiny tots into this world. Sending good vibes to you and your beautiful family
Sadly, if you choose to birth your child at home, you now run the risk of CPS showing up to take them from you. You can be arrested, lose custody of perfectly healthy and happy children, even if no allegations have been laid against you other than giving birth at home. If you are not under the care of a licensed medical professional, CPS can and does come and take your baby from you for medical neglect. Even if there is nothing wrong with the baby! There was an incident of this in the news just recently and the young couple is still fighting to get their child back. All because they gave birth to a healthy baby at home and did not immediately go to a hospital.
Lona can you site the news story pertaining to your post so others can read it?
Unfortunately hospital staff has also (tried to) pressure parents into unwanted medical interventions by stating they are causing medical neglect to the baby. One woman had her newborn taken away from her by CPS for this reason because she refused to consent to a C-section. granted, no one mentioned in the article that this particular facility had a 50% c-section rate.
While I understand the push for a more natural non-medicated turn for birth that is happening, there are some situations where a managed “medical” delivery is warranted. sometimes birth can go from quiet and serene to immediate need of medical intervention in a blink of an eye.
I would not want to risk me or my babies health for the “granola momma” experience that mothers are wanting. I would whole heartedly put my body and trust in a skilled OBGYN who is not afraid of the Operating table, because when things go sour with mom and or baby seconds matter. I’d hate to be the OBGYN having to explain to the father or the mother’s waiting friends and family why the baby did not make it or worse off why mother is dead as well.
I think the real question we need to be asking is why are the obgyns that are coming out of medical school today afraid of the Laboring woman and the use of the OR?
I got my birth records from my first son last year because I was switching to a more supportive place for my second. I was disgusted to read that I was non compliant and the other negative language they used towards me. I ended up going from a natural birth to being knocked out for a c-section because of their ridiculous rules. The anesthesiologist who contributed to this was even “no longer working there” shortly after. So happy that I stood up for myself and switched for my second!
Im in your corner but as an LD RN, i will cut some corners and never use that statement “hospital policy” and cringe when I hear it too. I will say this however..when we have a license to protect and we dont follow policy, the only thing backing us is to chart what the pt refuses. If we dont and something bad happens..if we dont have it charted that it was explained as to reason and pt understands and refuses..a lawyer would have us for lunch. I hate that its like that..but it is. That being said..what i dont “see” ..like you taking a drink…can sometimes be overlooked..wink wink..but I agree that pts should be informed and then choose.
Rachel, I was recently told that my fiance and the father of my baby is “not allowed” in my prenatal visits, after our ob-gyn said he could be there. I had a massive panic attack and we had to get the hospital administration involved to allow him into the nuchal translucency ultrasound. After that the tech said it would be 45 mins but her test took less than 10.
I am giving birth with a midwife, at home or in a birth center next time. I had a normal labor with my son, but the hospital didn’t want to listen to me and my birth plan at all. I was supposed to have a saline lock so they could do the Group B Strep antibiotics, and then disconnect me when the antibiotics weren’t going. The nurse refused to disconnect me from the monitors or the IV. I was unmedicated, so I was supposed to be allowed intermittent monitoring. In my hospital, it is customary to break the water at 6 cm. When I said no, my nurse kind of panicked. They didn’t seem to know how to handle the fact that I didn’t want the epidural or my water broken. My labor progressed normally, but at 9.5 cm, the nurse purposely broke my water, despite my insurance that she didn’t. My husband told me he has seen her try to break it at 6, even when I said no. She wouldn’t get her fingers out of me, despite me telling her that she was hurting me. I was bleeding heavily, and I think it’s because of the way she was pushing on my cervix. They tried to attach me to oxytocin without my permission, at the conclusion of my labor, but my IV had been ripped out during the final stage of labor, because she had insisted I couldn’t be unattached from the IV. Aside from the medical personnel, my birth was beautiful and I wish I had video taped it. I actually enjoyed my labor and delivery, despite having back labor the whole time.
I don’t see anything in the article about the mothers absolving the caregivers of liability for less than optimal outcomes, when the mothers contradict the “suggestions” of the caregivers during labor, childbirth and newborn care.
No doctor is going to risk her job by having medical decisions made by a maternity patient in the heat of the moment. At the malpractice trial, when the John Edwards plaintiff lawyer asks the doctor why a C-section wasn’t performed when it was medically indicated, resulting in brain damage and lifelong disability to the child, do you think a jury will give a rat’s ass to the response, “Well, the mother screamed that she did not want a C-Section, even after the 18th hour of labor.” Anyone listening to the mother’s wishes rather than standard medical practice will lose their license, their insurer’s money, their malpractice insurance.
Fix medical malpractice lawsuits, like Texas took steps to do, limiting “pain & suffering” payments and limiting lawyers’ fees, and then maybe doctors will sit and talk with you about your preferences concerning split-second decisions of life and death.
I think you need to examine the issue and the article a little more thoroughly. The examples I used were: eating, drinking, and using the bathroom in labor; choosing a VBAC; declining CEFM as a low-risk woman; and holding your own baby after it is born. None of these is remotely a “split-second decision of life and death.”
And liability certainly influences some of these hospital policies, practices, and preferences–but as the woman giving birth, my priority is my safety and my baby’s safety, not someone else’s liability concerns. Moreover, some would say that many of these liability-based policies are completely irrational, as they actually contribute to worse health outcomes on an individual basis.
One way to relieve some of that pressure would be to “allow” (ha) women options for birth that don’t involve high-risk surgeons and high-overhead facilities. Unfortunately, most of the states where consumers are begging for these options are blocking those options in favor of the existing medical monopoly on childbirth.
Kind of puts women and babies between a rock and a hard place.
p.s. You can use the word “preferences” in reference to what women want all day long, but legally and ethically speaking, they carry weight. Women are human beings, and human beings have rights over their own bodies. At least, in civilized societies, they do.
I understand completely what your article is about and I do encourage women to let us know what they want when they come in to have their baby.
But working as a nurse in this field I have seen one too many times when a woman is pushing or close to delivering and the baby isn’t coming, it’s obvious based on the fetal heart rate that the baby is compromised and not recovering from the stress and they continue to refuse interventions. Interventions such as a vacuum an episiotomy or forceps and the baby does finally deliver but with significant stress over time. Then the baby gets transferred to another hospital equipped to treat babies born compromised. It’s sad that women read articles like this and choose to birth in a hospital and then refuse to listen to any of us because they just want to be “in control” of their own birth. When things are bad they are bad and we aren’t just using these interventions for fun. We told a mother that she needed interventions an she told us she would take her chances and the baby was transferred out on the brink of death. It was extremely sad and when something like that happens the entire unit feels the sadness.
I think a key thing with this is being able to fully trust your providers. I have had 4 completely natural, unmedicated births in a hospital setting. The first 3 times I did not fully trust my provider to respect that whenever possible natural was the best option and I ended up almost not getting to the hospital in time because of interventions that had happened with number 2. I found someone for my forth that I wholeheartedly trust enough because I see how she views and strives to practice with all women under her care and I knew that she and I believed the same things and were on the same team. Despite the fact that I wholeheartedly want completely natural births. I am in a position that if my midwife told me I needed a C-section I would do it without losing any sleep. Part of the reason for this is she doesn’t fight me on stupid stuff like eating during labor or requiring that stupid, distracting IV that keeps you from being able to concentrate.
Here’s part of the problem with “baby wasn’t coming”…we need to know the circumstances. Was mom birthing on her back or the “classic” semi-reclined position? (Equivalent to pushing a bowling ball uphill.) Was she given the option to stand up or squat- opening the pelvic outlet by over 10%, or even roll completely to her side? I know many doctors/midwives who basically refuse to deliver in those positions, even if it means that a “stuck” baby would slide right out. OR, yesterday I attended a delivery where the baby was crowning and the nurse literally told mom to “STOP! The doctor isn’t in the room! You can’t deliver the baby yet!” Well, it took the doctor a good ten minutes to arrive, and during that time, baby’s heart tones began to drop. Was baby “stuck” because mom had an epidural- a medical intervention- in place and couldn’t feel when/how to push? I think that’s the point so many on here are trying to make…all too often we portray interventions like the ones you mentioned- episiotomy, vacuum extractions, etc- as life saving, when they may not have been necessary if the laboring mom would have been “allowed” to choose her birthing position and birth her baby the way her body is directing, free from unnecessary interventions.
Also in my daughter case she was told to wait and they left my grandson in the womb to long and he almost died and still has complications
What position was the Mom pushing in? Guarantee her bottom was flat on the bed. Worse position to labor or birth in. We are.told not to lay on our backs for an extended period of time during our pregnancy due to the compression of the blood flow to baby and yet we are expected to lay on our backs during labor and delivery at a hospital. This means that the baby is fighting to remain oxygenated and the contractions on top.of it make.the blood.flow and oxygen level decrease further constricted the baby’s ability to “breathe” No wonder babies are in distess.
That’s because you cause distress on purpose. You crank up the drugs until the baby’s heartbeat goes haywire, then tell mom she has to have a c-section so you can get home to your dinner or go on your vacation. Don’t believe me? Look at the numbers of babies born via c-section on Friday or before 3 day weekends, or during the weekend for that matter. Are weekends so much more inherently dangerous or do the almighty caregivers just want to cut and go home?
So as long as the patient is deemed competent by what authority exactly? The soon to be mother has complete control over the situation? Like maybe a competent mother decides that she has to hold her baby immediately, even though it can’t breath, like maybe its joking on fluid which I know never happens but still. We have no standards for “competent” people, but we do have standards for medical doctors right?
You are deemed competent until ruled otherwise in a court of law or until you are no longer conscious or are unable to think clearly due to drugs (street or medical)
The vast majority of attempted vaginal births that end in a csection are not life or death split second decisions. Many times a woman is told she is not allowed to labor anymore and must be sectioned simply because her membrane has been broken for 24 hrs or that her pelvis is too small, when all she needs is more time for baby to get into position. Many csections happen because hospital policy doesn’t allow for active labor to go 3 days, as some women do and need to.
If woman were ‘allowed’ to walk around, lean over a bed instead of iie on her back, eat or drink, have the lights dimmed, helped to be made to feel relaxed etc. and not given drugs that induce labour because the labour is not going according to the hospital and doctors schedule, the situations the Sandiego nurse is discussing would not happen as frequently. I have experienced what Mandy is commenting about for myself so I know these things happen.
Would a judge really award a malpractice suit to a mother suing her doctor for not giving her a c-section that SHE REFUSED? Not likely. If so, heck yeah we need to work on this. But I’d need to see evidence that this had ever happened — my guess is that this is an assumption based on fear.
You’re acting like this is a complicated, difficult decision, whether a doctor should cut open a woman who is screaming “NO” or not. It’s very simple. The patient refuses — you don’t treat! Just like attempting to resuscitate a person with a DNR is called “assault.” Medical treatment is only permissible where there is consent. You can assume consent if you are relatively certain the person would consent, but if they actually said no …. THEY SAID NO.
What we need is more women suing their doctors for forced cesareans. Because apparently unless a doctor is afraid of being sued, he can’t possibly be expected to do the right thing.
Yes there was a case at a hospital I worked at that involved a woman refusing a c-section. A midwife and a doctor repeatedly urged that she needed a c-section because her baby was in distress. She kept refusing. When she finally allowed them to perform one, her baby had already been deprived of oxygen and was later diagnosed with cerebral palsy. She sued saying that she wasn’t in her right mind to refuse a c-section and that they should have just performed one earlier anyway. The jurors sided with her and she won. That hospital had to create a c-section refusal consent form because of that case.
Yes, women do win and have won for not getting c-sections they refused. It’s an example of bad law. You cannot have both the right to say “no” and the right to blame someone else when you made that decision. It’s disappointing. When women sue for “not being forced” to do something, it’s a reinforcement of exactly the wrong things.
Your replys are being covered by your lovely photo, I can only read the bottom half of your replys x
Well yeah, if the patient refuses recommended care, you document. Just like there’s a form for a DNR.
Well said
I mostly agree but what has happened and ive seen it once…pt refuses cs…then fjnally consents when its clear that the baby is in jeopardy..said baby dies in the nicu..mother sues bc “the doc should have told me the baby could die and i would have said yes sooner…he knew better than me..i was in pain so i was under duress and coukdnt really grasp the seriousness..he should have convinced me”..that is the litigation that does happen..
We now have to protect ourselves from the system that is being paid enormous amounts to supposedly care for us.
And that’s why I hired a midwife. To avoid all the above bs. Doctors are to worried about themselves to worry about you and your baby. Sure some, a small few, procedures are justified. But rarely. It’s all about the all mighty dollar.
Um 18 hours of labor Is not long… It’s quite normal to labor between 24-48 hours. I had an all natural birth and labored 12 hours total, that’s fast for a fist child!
My first labor was about 12 hours active labor too. Completely unmedicated.
100% agreement with the anonymous commenter here. There are some things which should be allowed but there is a point in time when trained medical professionals should step in. I highly doubt every mother out there has been trained in obstetrics. It is hard to make parents informed when there is literally just minutes to save an infant because of a rapidly dropping heart rate. Would l love to see parents doing their own research? Yes. However, the amount of material out there is daunting and there is sooo very much that is just garbage. The average lay person (most of us) wouldn’t know what was fact vs fiction. No one is doubting there needs to be changes made to the medical profession’s way of handing labor and delivery but there also needs to be a change in this nation of, “This is America. The land where you can sue anyone.”
Obstetrics is not about giving birth. It is about managing complications when birth goes wrong. You don’t have to be trained in obstetrics to give birth anymore than you need to be a car mechanic to ride a bike. In fact, when it comes to supporting women in childbirth, midwives have much better outcomes than obstetricians in their field of practice.
Yes there is a TON of garbage out there–but there are some wonderful resources, too. As a woman giving birth, I work that much harder to find the quality information; I don’t just throw my hands up in the air and give up, and hand over all my decision making.
You are in the minority..i work with mostly indigent population..they do what ever the dr says..they have no interest in doing thing i suggest to help labor progress naturally,they want an epidural as soon as tgey walk in the door,they want to be on there back the whole time and whine if you disturb them to turn every 30 mins ,rarly do they want to breastfeed or do skin to skin..they want momma or other family to hold the baby as soon as its wrapped up and only concerned about when is there meal coming. I love informed pts that want to help themselves and have done some research..that would be great!
Too many hospital births are complicated by doctors using unnecessary interventions for their own convenience and paycheck rather than doing what’s best for mom and baby. Those interventions more often than not lead to c-sections. Doctors should stay the heck out of the way unless there is a REAL emergency rather than creating emergencies because they think birth can’t happen without them.
Yes, I totally agree. My oldest was born on Super Bowl Sunday…I was at a small military hospital and had seen a midwife the entire pregnancy. My baby decided to come on a day that there was no midwife on call. Water broke, and contractions were regular and strong. Went to L&D to be checked, and sure enough doc said “it is time”. Unfortunately, I had a male doctor assist with the birth. What a huge ordeal that was. Jacked me up on Pitocin to ensure I delivered in a “timely manner”. What a joke!!!!!!! Second child was born at a larger hospital and a midwife assisted….easy breezy! She let me labor as long as possible before admitting me and I received no meds to “speed things up”.
I agree that malpractice reform is due. You may not understand that depending on what stage you are in labor or how you are moving through stages 18 hours IS normal and healthy. Also, women who feel empowered during their birth experiences feel that they made informed choices and are less likely to sue vs. a woman who felt they were bullied, disrespected or forced into decisions. The facts show that obstetricians and hospitals practice outside of evidence-based science the majority of the time. America doesn’t have a good maternal system and the woman are not the problem.
I agree! A hospital lawyer once said, “I’d rather defend an assault case than a dead baby case.” If this wasn’t such a litigious society, perhaps women would be “allowed” to call more shots in childbirth. A mother may be able to “fire” her provider at any time if he/she doesn’t follow her wishes but a provider would be prosecuted for “abandoning the patient” if he/she “fires” the patient at the same time.
Lorie, find me an assault case 🙂 The reality is that lawyers won’t take those cases. Assault or battery in childbirth isn’t something women have been able to get traction on in the legal system, from what I have seen, and I have a pretty good idea of the lay of the land. As an example, there’s this case, where a woman repeatedly asked questions and finally said “no” to an episiotomy, while her doctor belittled her, and he cut her anyway–12 times: http://www.bit.ly/nodontcut. This was caught on video; there is no question about what happened in that room. Yet, almost 2 years later, this woman hasn’t been able to find a single lawyer who will take her case, out of dozens. (There is one possibility right now for a lawyer, but he has not committed.)
As far as patients and providers divorcing, another perspective on that is that women often find it very difficult to find someone to take on their care in late pregnancy–which is when the abandonment issue most often comes in to play, after the provider suddenly presents conditions and non-negotiables on the delivery. Prior to that time, the provider CAN fire a patient with a letter; I believe they must give 30 days notice, but, yes, they are absolutely (generally) free to fire a patient. And I hear about it happening all the time. “If you don’t consent to this test, I can’t continue your care.” “If you don’t sign this VBAC consent forms with a slew of conditions I’ve never mentioned before, I can’t continue your care.” “If you don’t come in for this procedure, find yourself a new doctor.”
Perhaps providers can be prosecuted for abandonment, but realistically, I’m not sure that really happens very often. What I see much more commonly is that women are stuck with providers who don’t support them, unable to find someone else who will.
She won her assault case. So yeah, it happens, and now will likely happen even more.
That’s it cover your ass instead of doing the right thing by your patience….the mother should not have to be told when to push if they can hold there baby and such….
It’s called informed consent. I’m sorry but you are wrong. If the mother says no to an intervention the physician is not liable as long as the mother has full disclosure.
In a perfect world maybe..but pts do sue with informed consent..if there is a bad outcome they say the doc should have convinced me or somehow didnt do a good enough job at telling me what was happening and as a doc he has more knowledge and knows better.
Beautifully written! Thank you for giving voice to this problem! I’m sharing this with everyone!
I agree Molly.
I fired my midwives at 37 weeks because they couldn’t “allow” me to give birth without an ultrasound. I was bullied and berated by the clinical director to the point that I ran out in tears. She tried to bully me into an ultrasound and thought id cave. I didn’t. I ran out and hired midwives who delivered my son safely and competently 6 days later. Even midwives can bully. If you feel like your care giver isn’t supporting you FIRE THEM!
Good on you. Your child will know in their heart of hearts what you did for them.
Delivered is another word we need to erase. Birth is not a passive event. You BIRTHED your son, the midwives did not “deliver” him. Great job standing up for your son!
I love the quote in the documentary The Business of Being Born, it goes something like “doula’s don’t deliver babies, midwives and doctors don’t deliver babies, mom’s don’t even deliver babies. Pizzas are delivered. Babies are birthed.”
My Favorite too! Ana Paula Markel!
My amazing DE midwife corrected my husband quickly when he asked if he would be able to “deliver” our baby. She told him, in a caring tone, that I, the mother, would be the only one delivering the baby, but that he could catch, as long as it was all going okay.
YES! I’ve been saying it for four decades. Give birth, be born. Birth your baby, come into the world. I agree with the view that babies are born; pizzas are delivered.
The vaginal exams were unnecessary- we said no- we paid upfront for home birth- signs on fridge- no using Mother’s juice- Sign on door – go away Mother in labor- they left-husband and wife midwife team- said are relationship wasn’t solid- our dr said don’t do anything till you see head crown- perfect birth- automatic- head turn- one shoulder born- me and my man- baby came out smiling-
Rachel I am very happy that you delivered a healthy baby but what if things didn’t turn out positive? Who would have been at fault? The midwives you ‘fired’ the new midwives or you for not listening to advice of professionals? I am just thinking that if something went wrong as is does quite often that you wouldn’t be feeling the same.
Obviously the midwives she hired would be at fault. Duh.
When you enter a hospital, you make the hospital legally responsible for the outcome of your pregnancy. You are in a position to sue them for any adverse outcome, or any outcome you don’t like. You make a contract that while you are within their walls, they are vulnerable.
The doctors went to medical school. The nurses went to midwifery school. The nurse practitioners received intensive training as well. ACOG Guidelines are predicated on what is known as “Evidence-Based Medicine,” that is to say, they are looking at studies and case reports, and using all available evidence to reach a conclusion. In short, they know more than you. So they are ALLOWED to use the word ALLOWED in their literature.
You state that you feel that you are being treated as if it is not your body. Imagine it was a car. You could park your car in any garage you wanted to, and bring your car to that garage to park. But what if you indicated to the staff of the garage that they could be sued if there were some damage to your car. Now imagine that it was a high risk car, one that barely fit between the support pillars. They might even still let you park there, but they almost certainly would not let you park it yourself. You would park there under their rules.
Of course it is your body. But don’t try to have your cake and eat it, too. Just because you happened to have a healthy baby in spite of your reckless behavior is irrelevant. As long as you put them under the legal obligation to provide you with a healthy baby, then it is their right to guide you in any way that they feel is necessary to reach that outcome.
Jane, your premise falls apart on three bases: 1. Doctors, midwives, and nurses may NOT be practicing per ACOG guidelines (or NIH recommendations, or WHO recommendations). The evidence is overwhelming that many, many of them are not. 2. Doctors, midwives, and nurses may NOT be providing care that is solely based on patient need or best interests. We know for a fact that liability concerns have led to more Cesareans on a provider level; that liability-based policy (like VBAC bans) have led to more Cesareans on a hospital level; that things like scheduling constraints and needs of other patients impact practice; that tradition alone impacts care–why else would over 90% of women be put on their backs to push? There’s no scientific evidence to support this 100-year-old tradition, but it’s still in full effect. 3. “Law” and “liability” are two different things. Patients have rights, period. Liability is something you deal with when you set up shop and take patients. I’m not saying our legal system is perfect, by ANY means, but I am saying that you better be real careful when you use “liability” as a reason to violate “law.”
A better analogy would be: There is only one parking garage, and you have to use it if you don’t want your car out in the elements, and it’s expensive. But you aren’t allowed to drive your own car in for liability reasons, even if you have a spotless record and care deeply about your car–more than anyone else; a valet has to do that. Half of the time these valets are perfectly competent and nice; the other half of the time they scratch your car and leave cigarette butts in it. Your car is damaged and you’re paying a premium for the service.
No one cares when you complain, because “at least it didn’t rain on your car.”
Then maybe if you should keep you and your body at home and deliver..that way when something does go wrong..you have no one to blame but yourself. get real people. Even the most uncomplicated pregancy can result in a bad outcome. There is no way to say 100% that nothing bad is going to happen..so do every healthcare worker a favor and just stay home..then when the bad outcome does happen..hire a lawyer and sue yourself.
Jan, your comment is not helpful or rational. Women want the best outcomes for themselves and their babies. Home is not a viable or the safest option for everyone.
Yes, there is absolutely no way to eliminate all risk. Which is exactly why I would think people who are focused on liability would appreciate women who want to make and take responsibility for their own informed decisions–rather than putting a medical professional in the position of taking on the liability for unilateral decisions made without informed consent of the patient.
What about the women who are not simply “not allowed” but who are outright threatened with CPS bring called and having their baby taken away? I think all of it shows not only how little we value birth in our society but how little we value women.
I love the view point. I just lived this yesterday in the pediatrician’s office with my 18 year old child. The said that I needed to take that child, now adult, to the Psych ER or the pediatrician would call 911 to take her. It was like we were not allowed any other option. I took her out to the car to talk about her options and she chose something different. The Pediatrician called today to harass us about not going since she told us we had to. Where was our chance to choose in all this? Why was I chided for a choice we made together? It was as if we were not allowed to go against our provider who has only seen my child 2 times in 2 years. We live together and walk problems together, and it angered the care provider when we did not do what she, the professional, said. What has happened to us that we have blurred the line of power the care professional has? I want us to stop being bullied and to take the power of choice back. I appreciate the concern and professional opinion, but don’t override the other options or make me feel bad for my choice.
hi Rebekah, good on you both! have you heard of The Emotion Code…its really helpful and totally natural way of getting back in to balance. many practitioners listed on the website. all the best, anna.
You said your child was 18. Did the doctor not realize that and 18yo is legally entitled to make their own health care choices, unless adjudicated by a court of law?
A physician has moral & legal obligation to report ANY person that may cause harm to themselves or others. I don’t know your daughter’s situation but if this was the case, they did the right thing by insisting and if they didn’t call 911 they failed…
That actually depends on the state you are in. In Alabama, for instance, the legal age of majority is 19. Until a person reaches 19 years of age, they are still legally considered a minor, and the decision rests on their parent or legal guardian.
We encountered something similar with our internationally adopted 7 year old special needs daughter a few years ago when we brought her home. It was a dentist and he DID call CPS on us because well, he just knew best. It was absolutely ridiculous. Praise God we had a great Social Worker who was put on our case and could see right away that the accusations were unfounded. But it was scary. I am so sick of self righteous professionals and am extremely leery now of any professional that can wield such power. The Justina Pelletier case is a prime example of Dr. bullying.
I totally feel for you..i wish i had more info to comment accurately..but if a profession feels a pt is a danger to themself or others,it is there oath and legal responsibility to take a psych issue seriously and is the reason for a PEC in a hospital..I think she came across too aggressivly rather than telling you exactly why she felt this way and her concern..but this isnt like..refusing to get an ultrasound.or have a surgery..this could mean life or death for which she is responsible..but i dont have the facts so i hope that it all turned out ok for yall.
I know this post is years old now, but Rebekah, your story reminded me about how my father protected me when I was in a similar situation. From the bottom of my nonreligious heart, bless you, bless my dad, and bless parents like you.
In my case, I had been fighting suicidal thoughts for years. My doctors knew about it, my family knew about it. I had so much support. But I was also a moderator of a suicidewatch forum, and having recommended student counseling to others, I thought it was the responsible thing for me to use those services myself so I would have a better understanding of the experience.
Never again. The staff made it clear that they didn’t know how to handle my situation, which is why they wanted to escalate directly to involuntary hospitalization. Despite my explanations, despite outlining my treatment plan and giving them my doctors’ numbers, they held me for nearly 8 hours without my consent. They threatened to call the police, despite the fact that I was fully lucid, had firmly stated I had no intention to harm myself, and at no point had even so much as raised my voice. I was the most compliant “non-compliant” patient you could imagine! They finally allowed me to call my father, who showed up to defend me.
I’ll never forget how he fought for me. I remember him demanding that “they couldn’t do this!” as I sobbed that that, yes, they legally could. Don’t get me wrong: I’m sure the staff cared about me, I’m sure they were worried about my safety. But my overwhelming impression was that they cared about avoiding liability more. Hell, they basically said as much themselves when I told them how their actions were causing me significant harm, to the point where it was damaging the progress that I had made up to that point. “I know, but if something were to happen…” I understand that it’s not an easy choice. But at the end of the day, they hurt someone who they were responsible for protecting.
After sharing my experience, I discovered it was the norm for that place.
Shortly after that event, I resigned from my moderator position. I just couldn’t cope with the possibility that I, too, had harmed those I had intended to help. How many people had I promised hope, only to leave them more wounded and vulnerable than before? I realized that the responsibility was more than I was willing to bear.
It hurts my hearts to reflect on these times, but I’m grateful to say that I’m doing better than ever now, despite my struggles. And I know my dad will always be right there beside me, every step of the way.
Thank you again for sharing your story. The world is a better place with parents like you here.
http://www.home-farm.org/reflections-on-may-2014/
This is where I ‘allowed’ them to give birth
http://www.home-farm.org/birth-story/
Is how they did it!!
No doubt the origin of all this is the patriarchal system and when it took over from midwives. It was all about control over the women and their bodies. They were deemed feeble minded and less evolved than men and only breeders of course. This take over began calling women giving birth as patients – even though they are not ill. You think its bad in USA, try Ireland where suffering is deemed good for the mother’s soul. Take dentist Savita and how she was forced to die in agony, because this was deemed best for her. She was medically trained and knew her body.
http://en.wikipedia.org/wiki/Death_of_Savita_Halappanavar
Herbal medicine, aromatics, homeopathics excluded from medical school curricula – 1910
UNITED STATES AND GERMANY –
__________________________
Following the Flexner report on the nation’s medical schools in 1910 (which was paid for by the Carnegie Foundation), almost all homeopathic medical schools in the United States were squeezed out. Herbal medicine, including the use of aromatics, was excluded from medical school curricula. Petrochemical drug companies became the major underwriters of all medical colleges in the United States. More importantly they also became the major funders of the American Medical Association and therefore 90% of all medical research.”
Flexner was accompanied by an AMA official for most of his travels and his report had devastating effects on minority medical schools as he recommended closing 4 of the 6 (what he called “negro”) schools along with all 3 of 3 women’s medical schools.
Their (AMA, Carnegie Foundation, Rockefeller, General Education Board) aim was to reduce the number of physicians, close all non-allopathic schools and close proprietary medical schools. This was achieved..
Bias in Flexner Reporting
http://www.ruralmedicaleducation.org/model/medsch/bias_in_flexner_reporting.htm
American Medical Association desires circa 1900 – Rockefeller General Education Board desires -Carnegie Foundation Wishes
decrease number of physicians – Favors Specialists – Against proprietary institutions
improve quality and reputation of physicians – Promote research – remove homeopathy and other competition
History of heavy allopathic funding
. As can be read on page 20 of the second edition book Clinical Aromatherapy, Essential Oils in Practice by Jane Buckle, RN, PhD, “It was in 1930 that a partnership was formed between Rockefeller in the United States and Faben in Germany and so the petrochemical pharmaceutical industry became a major economic and political force.
http://www.ruralmedicaleducation.org/flexner.htm
http://hansenschoice-greenhealth.com/2008/12/22/a-history-of-essential-oil-use-through-the-ages/
Conspiracy theories aside… “Muh patriarchy” has nothing to do with this.
Well said. I appreciate attention being brought to this. This is why I feel I was called to this work. As a woman and mother who had very specific desires and plans for my own children’s pregnancies and births, and having been lucky enough to find a midwife that respected me, and respected my choices… I try to make it clear in every step of my practice that the reason I am there is to provide women with the information and resources so that they can make their choices in care. And it is very liberating 🙂
Thank you for helping women give birth naturally, if they wish to Kat. Much appreciated.
I am curious, if you have looked into the link between the way our culture views pregnancy overall with the way that practices take place. We live in a culture were it is a women’s right to “choose” if she wants to continue a pregnancy once she is pregnant. In a culture that allows women to get pregnant unnaturally, IVF. The side effects of these (plus more) effect the way pregnancy is seen. The culture of today seems to want without knowing the consequences of their wants.
I have had two children in the last 3 years. I don’t remember what I was “allow” or not during the birth process. But I know that I had quick births and never had an to worry about being told I was laboring to long. The one time I did eat during labor (within an hour or so of when I started to push) I threw it all up. I wish the nurses would have been more firm about saying no to me. The medical teams should know more about the birthing process since that is their job. However I feel that the culture we live in is more of the problem then the medical teams.
I have often found it interesting that laypeople get very passionate and opinionated about pre-natal care and L&D, but freely accept a doctor’s recommendations surrounding every other medical decision without a second thought (cancer therapies, broken bones, heart attacks, etc). I suspect that these people often state, “but women have been giving birth for millennia without doctors !” And while that is true, I would gladly compare mine and my colleagues outcomes data in the last 50 years against that of Biblical times.
While I do agree that some hospital policies are a little silly (being unable to eat, not allowing intermittent monitoring or ambulation) — women of today have no one to blame except for their mothers and grandmothers (and their lawyers) for this. Hospitals have made many of these policies based on reactions to liability claims — they are protecting their own butts. These are not proactive policies, but reactionary policies.
Also, while you do cite informed consent in your article — one could very easily argue that informed consent in its strictest definition of the term is not possible for someone that does not have the necessary medical education. As an OB/GYN, I have watched several women die unnecessarily because they refused treatment for their cervical/ovarian cancers — and why did they refuse treatment; because some news article by Oprah or “the Today Show” said that eating some foods/herbs was all they needed. These women thought that they were “informed” in their decision to forego care, but I would argue that they weren’t as they did not fully understand the gravity of their decision. The same situations arise on the Labor and Delivery unit all the time. Can a woman who requests TOLAC after 2 prior sections understand the gravity of a uterine rupture at a hospital with no anesthesiologist on call in the hospital (thus requiring a 30 minute delay while the anesthesia drives to the hospital)? Does the woman that refuses vaccinations for her newborn (after seeing a special by former playboy playmate Jenni McCarthy), really understand the gravity of that decision — is she really “informed” in her informed refusal ?? Does she, or the child have to pay the consequences of that decision ??
While it is difficult for the layperson to fully understand it — although rare, sometimes an OB/GYN has a responsibility to protect a woman from herself and her misinformed medical opinions. It is not derogatory or from a lack of respect, but simply a fact.
And as for the care in America — while our outcomes are lacking in comparison to other civilized nations, no other nation in the world has to deal with the embarrassing amount of diabetes, hypertension, and morbid obesity that the American OB/GYN is forced to deal with.
John, I don’t have time to reply to each of your points, but I’d like to note a few things: 1. Re: the “why” and “how” of some of these hospital policies that you chalk up to liability, you might first take a hard look at the history of OB. It is jam-packed with experimentation on unknowing and non-consenting women, and with massive scientific failures–and… not necessarily all in the past. Some of the policies we see today are outdated by decades. By outdated, I mean they are more than “silly,” but at worst, are inhumane, harmful, and even dangerous. 2. Can only patients who are also doctors in that specialty make informed decisions about an area of care? That doesn’t seem reasonable…. I don’t know who these women are dying from lack of treatment because they watched a television show, but I don’t know anyone who makes casual decisions about childbirth. And the decisions of a few don’t remove the legal and human rights of all women. It just doesn’t work that way. Is there a communication problem that some women aren’t giving weight to what you are saying? Is there some reason they are not hearing you–or are you not hearing them? I certainly don’t know you or how you practice or communicate, but I will offer that I couldn’t get a solid, evidence-based answer to save my life from an obstetrician or nurse about my pregnancy or plans for childbirth, just things like “This is how we like to do it,” or, “Don’t you worry about it, we’ll take care of it.” Answers like that are not answers and don’t inspire confidence in patients. 3. You seem to skip right over the human and legal rights of the individual in a quest to protect women from themselves and babies from their own mothers. Maybe in 1947 that would have been culturally appropriate, but it’s not anymore.
The interventions used in a hospital Labor and Delivery unit are used for reasons, like I said before not for “fun.” And yes I do see once and awhile a patient pushing for hours and the doctor asking them would you just like me to use the vacuum because the baby will come out quicker and the patient agrees. BUT that is not something happening ALL the time, and the patient is explained what can happen when they use something like that, and it is not forced at all just asked of the patient. And these “dangerous” interventions you are speaking of…I’m not sure what is so dangerous about fetal monitoring. What is so scary and harmful about seeing the heart rate and contractions? Is it that the mother may question what is happening when they see the heart rate dropping continuously? I see it not as harmful but as a tool to see inside that belly and get a better understanding of how that baby is feeling. If I see variables I know that there is a high probability that there is a cord around the neck and we can prepare for that. I can tell how well that placenta is functioning during labor by what I am seeing, so its not harmful in my opinion.
I have never told a patient that she was not allowed to use the bathroom. What I do is tell them I want to see how far dilated they are because if they are far along, it may not be the need to use the bathroom and actually its the baby ready to be born. If I check them and all is well, they use the bathroom.
I have seen numerous times a patient eat something or they are constantly drinking water and then they get to 7cm or more and start vomiting it all up controllably…and who wants to remember that as a part of their experience?
Like I said in a previous comment, I have seen far too many deliveries gone “bad” because a patient doesn’t want to listen to anything their medical team has to say. Its the “experience” and the vaginal delivery at all costs. Then what happens 10 years down the road when the baby has some form of mental condition because of the stress endured on them during labor? Are they going to come back and say that we as the medical team didn’t forcefully push for a vacuum or forceps or even an episiotomy knowing that was what was better for that baby? The mom comes into labor not as one patient but as two.
Some how mothers come in thinking they are fully informed due to crazy information posted on the internet (not saying this article is crazy by any means) and then they get a doula that isn’t medically trained and they think we are lying to them somehow. I make sure I always explain everything that is going on and anything else that I can because no one wants to come in to have a baby scared and fearful of the medical team taking care of them.
Hi San Diego nurse. On the fetal monitoring front, surely you’re aware that continuous electronic fetal monitoring has a high false positive rate and is one of the leading reasons for unnecessary cesareans due to alleged fetal distress? This aside from the fact that it requires strapping women on their backs to a bed and telling them they can’t (or may only rarely) move, which is inhumane and in no way conducive to moving a baby out of your birth canal. You could not pay me to wear an electronic monitor when I become pregnant. The only reason electronic monitors were adopted by hospitals decades ago is because of the medical industrial complex around having the latest and greatest technology in order to out-do your peer hospitals, and because the idea of knowing the baby’s heartrate at every second sounds nice. Conveniently, it’s a great way for doctors to convince women they need cesareans, and there have even been articles published in which OBs admit that they use the monitor to get patients with long labors off their hands before the shift ends. To my knowledge the only studies supporting the accuracy of electronic monitoring are those that have been funded by the manufacturers. The evidence in favor of electronic monitoring is so bad, that the U.S. Preventive Services Task Force issued a recommendation saying that continuous electronic fetal monitoring should NOT be used in low risk women. And there are many studies out there showing (and ACOG agrees) that intermittent ascultation is safe and that babies born to women who have that form of monitoring rather than electronic are not anymore likely to be born with problems. Again, you could not PAY me to wear one of those, and patient’s legal right to say no trumps any hospital policy that all patient’s must be hooked to the monitor.
It’s thinking like yours “you could not pay me to wear an electronic monitor” that has led to increased fetal deaths and complications. Where does it say that the birth experience is about the mother? It’s not! It’s about delivering a healthy child. Thinking just like yours led my sister-in-law to also refuse fetal monitoring because she wasn’t going to have some doctor make her have a c-section so he could make his tee time. Well I’m very sorry to say her baby went into distress and was still born. The baby was a full term baby with no other complications. It was devastating to our family. I’m tired of reading articles where everyone talks about the mothers experience. When you decide to become a mother it stops mattering if you are comfortable, eating, walking around or anything else and the ONLY thing that should matter is having a healthy baby – no matter what it takes!
Finally someone with a common sense brain… well said San Diego Nurse!
It’s hard to respond to statements like these when the premises are so factually inaccurate.
Continuous fetal monitoring in low-risk (healthy) women has long been debunked. It does not improve fetal outcomes, but it increases the likelihood of C-section, which is an increase in morbidity and mortality for mothers. The fact that it is so widely used defies science and medical ethics. This is not in dispute. I am really concerned that you do not know this, as a maternal healthcare provider.
Monica, generally speaking, the baby’s experience is directly tied to the mother’s experience. When a mother is in distress, it negatively affects the entire birth process. That means the baby. Confining women to bed is not only inhumane, unethical, and medieval, it is HARMFUL to women and babies. When women can’t move around, get comfortable, get what they need to have stamina and to relax and to do the hard work of labor, they can’t give birth as well. “Not giving birth as well” means things like fetal distress, arrested labor, malpositioning, shoulder dystocia…………. It is an incredibly problematic assumption to make that the worse the mother has it, the better the baby must have it.
The main point of your post that I take issue with is the ” informed consent” comment. I find it very offensive that you think that women are not capable of forming an educated opinion. Perhaps it is the caregiver who is not explaining risks/benefits clearly? Both times I’ve been pregnant, I’ve searched for evidence at the source, peer-reviewed medical journals and studies. I also discussed my choices, concerns and questions (as well as benefits/risks) with my doula (who is also intelligent and educated) and my OB & was encouraged to do so by my OB. I had to shop around for both these professionals to ensure that my values & intelligence would be respected. Suggesting that women’s opinions are only formed by watching Oprah and hearing Jenny McCarthy….isn’t just wrong- it’s terribly insulting to those of us who take the time to research and learn about what’s best for our babies and our bodies.
Well correct me if I am wrong but I don’t think he was talking about you or women, he was talking about INDIVIDUAL women that he knew, or at least sort of knew. I don’t think he said or communicated in any way shape or form that women are not capable of forming an educated opinion either. Is reading a bunch of peer reviewed medical journals really going to give you that much confidence in your first child birth though? Is it going to educate you to the point where you are going to make the best decision in any situation that comes up, in the moment, possibly under a lot of stress, emotion, and pain? Nobody does this for anything else in their life. With this kind of logic anyone can jump right in and be your midwife, they don’t even have to know anything about anything, as long as they have hands and muscles, and coordination you’re good right?
If you don’t like the idea of being responsible for delivering someone’s baby and/or don’t know how to deal with all of the possible complications after reading peer reviewed medical journals, I really don’t understand why you know what is best for your baby and your body. Especially when your information could be coming from the same place or person who is delivering your baby.
Even a person who makes stupid decisions has a right to choose. We have the right to smoke, even though we all know it’s bad for us. We have the right to go skydiving. And yes, we all have the right to choose what treatments we undergo.
I know doctors like to imagine that their decisions are infallible and it’s only patients (specifically, women) who are too dumb to make good choices. But doctors make errors too — thousands die every year from medical errors. And when it’s my life on the line, I have the right to choose which risks I’m going to take — the known risks of a recommended treatment or the unknown risks of something else. I’m the one who’s going to die if I choose wrong. No one else can take that decision away from me.
Ya I know, you probably think you have the right to choose the life or death of your baby, and make life altering decisions like circumcision too.
Sheila, it’s not only your life that’s on the line, it’s your baby’s as well. If you make the wrong decision, you might not be the only one who dies. While you are the only one who can make the decision for yourself, you are also the only one who can make the decision for your baby. It’s imperative that it’s the correct one.
I think the issue with labor and delivery is it’s not just the mother whose life is at stake. The Dr. is responsible for 2 lives and it could be tricky if one life wants something that the Dr. feels may jeopardize the other life. It’s a different situation and I believe that’s why the stricter rules of ‘you can’t’ and ‘you’re not allowed’ are imposed for L/D unlike skydiving or smoking. But then again, we allow abortions at will, so why not let the mom make the decisions during L & D? Abortion Dr’s aren’t held responsible for ending a life, so why should delivery Dr.’s potentially be?
Hello John. It is unfortunate you hold the view that doctors must act against women’s wishes to save them from themselves. If you are not aware already, it is the law in every single state that when a doctor takes any action on a patient’s body without consent, it constitutes assault – not negligence/malpratice – assault. In such a case, there often is no limit on the amount of damages the patient may recover, both with respect to non-economic damages and punitive damages. The Supreme Court of the United States has also recognized clearly that every person has the fundamental right to decline medical treatment, for any reason or no reason, and many state and lower federal courts have ruled expressly on this issue in the context of pregnancy, holding pregnant women cannot legally be forced to undergo any procedure against their will, no matter how strongly doctors believe she is harming herself or her baby. It is the autonomy of the individual over his/her own body that is paramount and protected without question under our constitution and state laws. Surely you would agree that even doctors cannot predict outcomes, so it does not make sense to recognize any set of circumstances where a doctor’s view on what to do with a woman’s body or baby should win out over her own. There have been cases where hospitals have secured court orders (which were granted erroneously and later overturned) to forcibly perform cesareans, and the woman and/or baby died days thereafter. Yes, there will occasionally be women out there who don’t know what they’re talking about, just like every other right is subject to abuse by fellow citizens that embarrass us to no end (right to free speech, right to bear arms). But it doesn’t mean we don’t have those rights at all. Doctors that do not understand the law, or their ethical obligations to their patients, are not only embarassments to their otherwise noble profession but are putting themselves and their hospitals at risk of liability as pregnant women become a more highly educated, highly motivated population with respect to medical evidence and the law. All ACOG’s position statements/committee opinions/practice bulletins are available online, as are studies published in obstetrical journals. There are also non-profits with PhD level researchers behind them dedicated to translating obstetrical literature into easy-to-understand pamphlets and articles for pregnant women. So, OBs no longer have the monopoly they once did on medical knowledge – if you can read, you can inform yourself and make an intelligent decision about your care, and in fact you may know more about your doctor in such case, since many of you appear not to have gotten the memo on all sorts of things, like how routine use of episiotomy has been essentially discredited for nearly a decade. Also, there are attorneys such as myself that hope to make pregnant women aware of their legal rights and instruct them how to use those rights vis a vis their providers to protect themselves from non-evidence based and/or coercive care. As a result, OBs need to be prepared to contend with highly educated patients and answer their questions with meaningful information rather than dismissive non-answers, paternalism and possibly force. Doctors have the schooling yes, but there are bad, out-of-date doctors out there just like there are good, up-to-date doctors, and women, who are now informed enough to be a force to be reckoned with, must (and do) have the right to say no to those doctors and be respected, or else sue.
Well then what is the issue. If women have the legal right over themselves and their baby already, than why are abortions not legal everywhere?
As a fellow OBGYN I’m so glad that you said this John, I completely agree. While my aim in women’s health and particularly obstetrics is to try to give a woman the chance to make an informed decision in keeping with the standard and safe practice of medicine, it becomes excedingly difficult at times when women’s fears and expectations are based on stories from well meaning friends and empassioned blogs. what mother wouldn’t want to do what’s best for her baby, but its so hard to decide when she is given bad or warped information. One woman’s terrible experience is broadcast and many other women are scared, so they will avoid what they think are the risk factors. It’s frustrating for them and is frustrating for me and my colleagues who are trying to keep two people safe.
If I could give one piece of advice to the readers of this article it is that pregnancy, labor and birth are very different for every woman and the nuances are complex. Every woman should talk with her provider about her desires, her idea of what she would LIKE her experience to be, but do so with the understanding that it takes years and years to be an expert in the field – and we really do want to keep you and your baby safe. Communicate, discuss and in the end trust those you’ve chosen to take care of you.
To those who feel the need to vent their frustrations with the field of obstetrics, of course you should do so, there are things that need to be improved. But please remember your words are powerful to a pregnant woman who is looking for guidance; you can install real fear and distrust. It’s an emotional issue and that can be difficult to overcome once the seed is planted. Be thoughtful in what you write.
I’ve been working in L&D for 20 years but mostly in Canada. Informed consent is a difficult subject. I often wonder why docs are deferring to the patients opinion about matters like forceps vs c/s. I feel like a woman in a crisis should hardly be choosing which is the best course of action to take. She is terrified should the doctor not recommend the correct course of action?
On the matter of hospital policies wow… I often tell moms that this is the policy but I’m not running a prison and they can choose for themselves what they would like to do. I also discuss with them how considerable pressure may be placed on them to conform … But they of course have the right to choose.
But I also have to chart correctly when a patient goes against what is in the policy and procedure manuals. I as the nurse am legally responsible to uphold policies. Very tricky business. Are patients coerced at times yes I think they are. More dialogue is required tho when the relationship is adversarial it benifits no one.
Lisa, you are not legally responsible to uphold arbitrary policies created by a for-profit institution. You ARE legally responsible to not violate the rights of the people you care for.
Check out “Don’t Cut Me Again! True Stories about Vaginal Birth After Cesarean (VBAC).” It’s on Amazon.
Such interesting contrasts. I was never denied anything with my babies in hospital. Fortunately my obstetrician sent me for a pelvic X-ray, because I have very small feet, and knew that often indicated a small pelvis. So it is, 21/2″ too small and tilted as well, so a caesar was necessary. Bubs came early, not turned, dropped or head engaged, weighed 6lb 4oz., but his head was so large the drs checked for encephalitis. He was fine, but his fathers family- he’s 6’2″ tall and his family have large skulls, so without an interactive and intelligent ob, I would not be here to tell the tale….after 24 hours first stage labour that I thought was Braxton Hicks contractions, he was firmly tucked under my ribs,
Son number 2, new ob. Says, try natural, even though I had explained previous experience. Anyway, I decided to go with a second Caesar. Just as well, he was three weeks early and already 6lb 11oz with an even bigger skull and very long body. I had miscarried his twin at three months, and although I grieve for the possibilities we missed, I would have had to have a very early surgery.
Babies given to me as soon as possible, big cuddles, then given to dad, and they were checked before I held them Apgars were excellent and I had ten days in hospital with both babies, best thing ever.
Appalling to see mothers and babies sent home before feeding can be establishe and mother properly recovered. They were the bet of the good old days, there is only twenty months between my two and the surgery, and I was fine and the babies great, so glad I had such a wonderful time and all went well!
I wish I had known more about our bodies and having a baby… There is a great read about how petocin can actually counteract with delivering naturally and, instead makes a woman more susceptible to having a c-section. It seems we are having women get induced too soon when there medically is not a need for it.
We had our first child a little over five years and after not dilating any after being on petocin for many hours and having my waters forcibly broken, I was told that a c-section would be my best option. My obgyn was a very good doctor, so I trusted him. When he cut me open, he said he had never seen a woman so small and that I couldn’t even deliver a twenty month old. I would love to find out if this is really possible as I thought our bodies are meant to expand during delivery.
Five years later, with a total of three c-sections under my belt, I desire to find out if someone can really be too small and if I can have a natural delivery safely? It seems there are actually more risks with more c-sections than performing a vbac.
Labour for three days?! Not me, an asthmatic with a scoliotic spine and a too small tilted pelvis, and very large sculled babies. That sort of cruelty can lead to to fistulas of the bladder, bowel and vagina, where every thingis rippe, and drips urine, faeces and fluids. Huge repair jobs can ensue. I’m 58 now, and remember a different world of babies and mothers. Help every time for me. I’ve since had to have a radical hysterectomy for fibroids entwined in the muscles and tissues at the top of my womb. They were causing breathing, digestive and period nightmares. Then, a full tummy tuck to remove huge amounts of stretched skin and scar tissue but no fat, I am small and slim. I feel so much better, but every step of intervention was my choice, with my husband and specialist. Realistically, not every birth is magazine perfect and results in a yummy mummy three weeks later! My great grandmother died in child birth having her seventh child….I’m wise enough to realise that natural is cute if you can manage it, but alive is better, even with lots of help, I don’t feel a failure( stupid notion) for having help with birthing, I feel blessed to be here tossed my adult children alive and well!
Yes, Kelley, there is a national push to decrease/eliminate the use of non-medically indicated inductions, by large organizations like the Joint Commission, the American College of Obstetricians and Gynecologists, and others. I suggest you connect with http://www.VBACFacts.com for excellent information about repeat Cesarean and vaginal birth after Cesarean. Their Facebook page is here: https://www.facebook.com/pages/wwwVBACFACTScom/44134673920
I can’t comment on your particular case except to say that maybe learning more now about what happened in that first C-section would help you understand. Check out some of the information at http://www.evidencebasedbirth.com. Yes, the pelvis does usually expand during labor/birth. There are also some great general resources here: http://www.improvingbirth.org/resources-info/ and, specifically, about induction, etc., here: http://www.improvingbirth.org/induction-c-section-vbac-facts/
Kelley, I was told I was too small to ever give birth after the cesarean with my first. I went on to give birth to 3 babies, including one who was just over 9lbs and had a 15″ head. Doctors do not have crystal balls. I suggest visiting ican-online.org.
Excellent! As a woman who chose home birth for my children partly as a result of hospital policies AND a person who believes mightily in the power of language, I find myself sending out a hearty cheer for this piece! Thank you!
I’m also a doula and I’ve had to watch a lady labor hard for 18 hrs with no food or drink. She cried and pleaded for something but was denied over and over even though she was low-risk and progressing well. It was heart breaking and now I encourage dads to pack a cooler of things “for him”. I won’t give her fluids or food, but I won’t rat on her either. It’s just cruel!! And the policy on this varies WILDLY from hospital to hospital, even doctor to doctor. I’ve read the research and it’s not nearly as dangerous as they make it out to be. I’m glad to read articles like this that encourage women to take responsibility.
Great posting, I wish every American woman could read this! <3
Well Anon, I see where your coming from. A jury nor a judge is indeed not going to care what a mother says in the heat of the moment. However my answer to that is simple “Home birth” Not every person needs to give birth in a hospital. Ideally I would like to see legislation that protects HCP’s from legal backlash should a medical intervention be withheld due to a patients request, but lets be honest with ourselves, it just wont happen anytime soon because the powers that be have their own agenda. So my question is if this is such a huge problem then why is home birth being so ostracized? Not every person that becomes pregnant needs to give birth in a hospital. its certainly cheaper, and it would cut down on the C-section rate.
I’m an obstetrician- but a mother first. Posts like this are tough to read- from the mother in me. I had a son who died shortly after birth. The discussion I had w/ the OB was trying to avoid a C/S w/ a first baby. Now every day, I wonder if I could hear him laugh, hear his voice, or touch him again if I would have had an elective, or even emergent C/S.
What I ask all of my patients is this: what is the end result you want to have? Childbearing is dangerous, and can be deadly- for mother and baby alike. If you had to choose, do you want to do everything we think we can in the best interest of the baby or do you want to have a birth story that reads like you had planned? Of course we all want you to have the fairy tale magic birth is AND a happy baby- but what if?
Nothing is fail proof that has humans involved. EFM isn’t 100% precise, C/S aren’t perfectly safe, neither are Vag deliveries. Heck, walking down the street isn’t without risks. At the end of the day is it more important to have a healthy, happy baby that you can watch grow- or do you want to feel good knowing that things went as you had planned?
So your baby went to a warmer and a caring skilled nurse suctioned out his mouth for the first 20 minutes of his life- CONGRATULATIONS! HE’S ALIVE! Thank that nurse.
So your doctor recommended a C/S because your baby looked like it was under stress from all ways we have of judging that. Now you have a scar- CONGRATULATIONS- YOUR BABY IS ALIVE!
Now go love on those little ones, they’re a gift, a privedge, and will grow before you know it
This is all my humble opinion only- of course
My name is ashley. I worked for an ob/gyn. I myself have had 4 kids, he has delivered two, my twins. He never once said to me, you CANNOT do this….he may have said, “take it easy on x, y and z.” He was the one who said, “I would feel better knowing you are having twins, to be followed by the dr that followed my wife when we had twins.” I worked with this man, saw him intimately interact with patients who conceived after years of infertility, or after conception, have no heartbeat after no heartbeat after no heartbeat. And when they got that heartbeat after 25 weeks, that man would work heart and soul to keep you as pregnant as you can be. He treats EVERY SINGLE patient as if it were his wife walking thru that door. He is the best physician I will ever meet in my life.
Ashley, that is awesome 🙂
This made me cry. Thank you for sharing there are providers that keep this mindset throughout the duration of their practice.
We all have a right to choose. We choose our doctors our hospital and what we want done to or for us. A doctor who spends years and years learning what is safe and what has failed in the past should also have the right to choose. To choose not to treat you or deliver your child if they feel what you are asking is unsafe or your choices make them uneasy about preforming what they need to in the most positive way. Not for liability reasons, for their soul. If we expect people to continue to venture into the field of health care, we need to remember that they too have the right to be heard or to walk away. I went through many doctors before I settled on one I felt was like minded. That is my responsibility.
Jenn, we do have the right to choose, and that’s why I encourage every woman to find a provider who is a great fit and who practices evidence-based care. Unfortunately, not all of these practices are administered by the providers (doctors or midwives) that we hire. Many times, it is the nurses who are tasked with these protocols and traditions, and quite often, the doctor who actually attends a woman’s birth isn’t the one she’s been seeing throughout pregnancy.
When doctors choose to enter the profession, they agree to abide by the legal & ethical tenets of the profession. One of those is the RIGHT of ALL patients, yes, even the pregnant ones, to decide what treatments they will or will not accept. NO MATTER WHAT THE DOCTOR THINKS THE OUTCOME MAY BE. Everyone has the right to refuse a treatment. To say pregnant women do not have that same right is to reduce pregnant women to incubators with fewer rights than every other competent adult.
I can’t even with these comments, especially from medical professionals, who think they have the right to make decisions for other competent adults. YOU DO NOT HAVE THAT RIGHT! STOP IT! Stop lying, stop manipulating, and stop forcing your OPINIONS on other people’s bodies. You have the right to give information, the right to discuss pros and cons and the right to transfer care if you really, truly have a problem with woman’s choices. That is IT. Learn to take no for an answer.
And while you’re at it, start practicing EVIDENCE based medicine, not the superstitious, “we’ve always done it this way” bs that is the way the majority of obstetricians and OB wards operate. Go read ACOG guidelines and start abiding by them. Keep up to date on important research, like the value of delayed clamping, etc.
“To say pregnant women do not have that same right is to reduce pregnant women to incubators with fewer rights than every other competent adult”
Actually it’s worse than that. If my brother needed a kidney to save his life and I did not consent to that procedure, even though my brother would die as a result, they could not take a kidney from my body, EVEN IF I WAS DEAD! If a person does not consent to donating their organs after death it is against the law to harvest them, so in actual fact, saying that a pregnant woman does not have the right to refuse treatment, even if that would directly lead to the death of her fetus would be awarding a pregnant woman with not only less rights than any other adult, but with less rights than a corpse.
Ok, so my answer to you is, who makes the decision when the mother isn’t able to? I have worked as a L and d nurse for 15 years. I cannot tell you the number of women that come in with no knowledge. I teach childbirth classes and I do so to give knowledge and choices. Out of 1500 deliveries a year we see about 10% in class. That Is The Case Here As well. I have 4 children, all natural with the first 3 no iv and no interventions. It is because I was educated in my choices. Not once was I told I wasn’t allowed.
More then that who should be responsible for keeping the baby safe when the mother has made horrible, selfish decisions her entire pregnancy? I am talking about women who use drugs like they are candy. It is a current and rising problem.
Yikes! Please don’t go to a doctor with your crappy attitude. Yep, I’m married to an anesthesiologist who spends the large majority of his time taking care of people (80-100 hrs/week) and when not at work, still reading and reading so he can be a better physician. It irritates me to no end when people act like this. You want respect – well, start giving it.
Sorry, that’s not how it works. If doctors want respect, they need to stop acting like bullies with God complexes who completely ignore evidence based research and start acting like partners who actually have some idea what the heck they’re doing and LISTEN to the women who will be most affected by the outcome.
All of these comments that rotate around the difficulties of practicing informed consent in an emergency situation are missing the overall point of this post. Most of the examples used in the post concern telling a pregnant/laboring woman that she is not “allowed” or the doctor will not “let” her do XYZ, mostly concerning things that take place in non-emergency situations (eating and drinking in labor, getting out of bed during, switching positions, scheduling an induction, refusing continuous EFM, etc.). There is a real problem with language like this. It suggests that the doctor/midwife/nurse is in charge and the mother is a subordinate. It belies a very paternalistic and controlling attitude and fails to treat the mother as a capable and active agent in her own care.
The problem is that this attitude of paternalism and control does not stop at non-emergency situations and gets transferred to those emergency ones, where mom may have a preference such as “no episiotomy.” I can’t speak to individual anecdotes from the delivery room (which really don’t give us any hard data anyways). What I know is that I looked at episiotomy rates and c-section rates for every maternity hospital within a 20-mile radius of my home (North/Northwest Suburbs of Chicago), and found that rates varied from 4.1% to a ghastly 34.6% for episiotomies, and 22.1% to 39.2% for c-sections. There was no correlation between level of perinatal unit (I, II, III or IIIc aka IV) and higher/lower rates. These dramatic differences cannot be explained by population changes over such a small area; they are practice variation. So unless the hospitals with higher rates had better outcomes (which I very much doubt), this translates to a lot of doctors who are cutting unnecessarily. Sorry, but this problem has nothing to do with dumb patients who got their ideas about birth from Oprah and are refusing truly life-saving interventions.
Finally, picture this. A female soldier in the military complains that, when she was in Iraq, a fellow male soldier raped her. You shrug and tell her, “All that matters is that America is safe.” Or, “You should just be grateful that you’re alive. In earlier generations, when we didn’t have the technology that we do now, war would have killed a soldier like you.” Insanity, right? We should be able to have both a safe America AND a military force where female soldiers don’t have to worry about rape, right?
Well, that’s how the rest of us feel when you tell us things like, “All that matters is a healthy baby” or “you should just be grateful that your baby is alive.” Yes, birth is dangerous. Yes, the marvels of modern-day obstetric medicine are to be credited with making birth a relatively “safe” event in our day and age, with saving the lives of mothers and (especially) babies. Modern medicine has made birth safer, healthier, and more comfortable. But to use that to dismiss real problems with maternity care in America is every bit as callous and irresponsible as telling a female soldier that her rape doesn’t matter because America is safe. So please stop with the “all that matters is a healthy baby” nonsense.
First let me start by saying that the emotional effects that a rape victim lives with after the rape far out weighs the emotional effect that a mom who has not been allowed to eat, drink, go to the bathroom or has had an episiotomy lives with. That is really a demeaning statement to victims of rape.
Second, The things that you are talking about, are your own fault, if you don’t do your homework ahead of time to see how your Dr, Midwife, etc…handle them. Stop blaming that on your birthing staff. You should have checked that out ahead of time. More often than not they are doing their job. There are times in your life when someone is going to tell you what to do. You can’t always be the boss.
Is your pregnancy about you or your child? If it’s only about your experience, your rights, maybe parenthood isn’t for you.
And when it comes down to it, it is all about delivering a healthy baby. Talk to my daughter who just delivered my grand daughter, Macy, stillborn at 38 weeks. She’d give anything to have her child. Once you lose a child it puts things in perspective. The things that you are talking about just aren’t important.
One more thing, while you say that the post is about the things that aren’t life threatening, I didn’t get that from it. They were mentioned but I believe c-sections and allowing a mother to labor longer were too. You should probably Reread the post.
Connie, actually, more women come out of childbirth with PTSD than survivors of 9/11 came out of that. Does that sound like it’s not devastating? I have had several conversations with women who experienced rape and “birth rape”–and they use both of those terms. Please check out this article (http://www.improvingbirth.org/2014/08/vid/) and campaign (https://www.facebook.com/media/set/?set=a.705655609507930.1073741854.255657527841076&type=3) for more on the trauma that women suffer when their sexual organs and bodies are violated in childbirth.
You cannot blame the victims of manipulation, coercion, and force for being manipulated, coerced, and forced. Certainly women should do their own research, and they do, but it is almost impossible to guarantee exactly which provider you will get when you deliver (most rotate call) and not possible to know who the hospital staff will be. Options are very limited for many women. They take the best they can get.
Of COURSE it is about having a healthy baby. It is demeaning to imply otherwise. I do not know any mother, ever, who has chosen an “experience” over the health of her baby. In fact, *safety* is the primary reason women are asserting their rights in childbirth today:
“In the U.S., outdated, non-evidence-based practice is routine and accepted; Cesarean section rates vary ten-fold among U.S. hospitals; and those rates vary fifteen-fold among the low-risk population. Over 40% of hospitals defy national health policy by “not allowing” vaginal birth after Cesarean, to the detriment of hundreds of thousands of mothers and babies. The United States is the only developed country in the world with a RISING maternal mortality rate. One factor in that rise is our overuse of surgery for childbirth. We simply cannot operate on the assumption that the surgeries women are receiving are always in their best interests, or that of their babies.”
I have personally witnessed mothers choosing the “experience” over the health of the baby. I’m not sure if they don’t trust us as the healthcare team or if they really believe that it will be fine and they will have the experience they looked for despite the health of the baby. I once had a mother that chose to give their baby an IV for glucose control in a newborn over giving a bottle of formula. She could have spoon cup or syringe fed the formula but CHOSE an IV. An invasive procedure over formula. The sugar was dangerously low and something needed to be done. People who do not regularly work in this field don’t really have a full understanding, but seem to have strong opinions anyways.
I understand that you have personal experience of people choosing things that you don’t agree with. However you don’t have the right to shout someone down for their choice. I tried to get an elective c-section as my pelvis was so painful I was incontinent, and they said no. Their policy was vaginal birth, their policy was that I wouldn’t see a doctor or midwife until I’d been checked out by a junior, their policy was whatever. I gave birth in a side room with a junior who was convinced I wasn’t in active labour. She didn’t get a chance to check as the baby was crowing before she knew. After the birth the staff told me to get on with it when I was howling in pain, the pain of a damaged pelvis after an unqualified practitioner leant on it was worse than birth let me tell you. Am I grateful for their advice? No it was wrong, they treated me like a child and didn’t believe the pain I was in, years later it’s not fixed. I wish I’d had someone like a dula by my side fighting for me, I might have a healthy baby and be able to pick that baby up.
I disagree that the analogy is demeaning to victims of rape. I think it is your own assertion that is demeaning to trauma victims by saying having your vagina cut open against your wishes can’t possibly be as traumatic as rape.
Second, The things that you are talking about, are your own fault, if you don’t do your homework ahead of time to see how your Dr, Midwife, etc…handle them. Stop blaming that on your birthing staff. You should have checked that out ahead of time.
I did. I gave my doctor a one-page birth plan which clearly stated my intentions of eating and drinking in labor. He went over my birth plan and said nothing about any policy of not allowing laboring women to eat and drink. I also toured the hospital in advance and asked many questions about policies and practices in the L&D room. I still wound up with a bullish nurse who tried to tell me that I wasn’t “allowed” to eat in labor, and when I asked why, she just kept saying “because YOU CANNOT.” My own provider came in and softened the request to “you can eat in early labor, but could you not eat in active labor?” I sat there and thought, hmm, any reason we couldn’t have gone over this when I presented the birthplan?? (I ate what I wanted when I wanted, btw.)
Furthermore, some women wind up with unfamiliar providers in the delivery room. My doctor had sworn that he would be at my delivery, had even said that he didn’t think I would need a doula because he would be there to support me. One month before my delivery, he sheepishly admitted that his sister was getting married right around my due date and he would be out of town for 7 days before my due date and 3 days after. So he only had about a 50% chance of actually being present at the delivery. Luckily, my son was 9 days late, so he was there. But if he hadn’t been, it probably would have been a doctor I’d never met before.
My pregnancy was about having a healthy baby, but having a healthy mother needed to be a very close second. My first was born with physical problems and disabilities that I didn’t handle well because I was recovering from a traumatic labor. My decidedly unhealthy baby really needed a healthy mother, and she didn’t get that because the goal of “healthy mother” got sacrificed in the quest for “healthy baby.” I did everything I could to make sure that didn’t happen with my second birth.
Marvel of Modern day medicine has made childbirth relatively safe. 1 in 4 pregnancies end in miscarriage, stillbirth and infant loss at birth. That doesn’t sound relatively safe to me.
I said modern-day medicine makes birth relatively safe. I did not say that it makes the entire pregnancy process safe for both mother and baby from conception to postpartum. You arrived at that 1 in 4 rate by adding the miscarriage rate, which modern medicine has barely touched. Deduct miscarriages and your death rate is going to plummet far, far below 1 in 4.
BIRTH was a major killer of women in every era and every culture up until the advent of modern obstetrics, and the survival rate for the baby was even worse than for Mom. These are facts.
I’m glad to see you writing about this. I am sad to see the young women around me who think that medical intervention in childbirth is normal. They routinely accept epidurals, and generally go with whatever their doctors tell them to do, including C-sections for convenience.
Childbirth is not a disease! I think most women and babies would benefit from home birth. Babies should not have to spend time in a place where every disease and bacteria are in abundance. When we had our 4th child, there was an outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital nursery. Our own home would have been much safer for the baby, but regulations on the midwives forced us to either give birth in the hospital or have an un-attended home birth. There are times when medical intervention is necessary, but that should be the exception, not the standard procedure.
We had four children between 1988 and 1998. I was 32 when the first was born and 42 when the last was born. Children number 1 and 4 were born in Arkansas and number 2 and 3 in New Jersey. In order to avoid all the “you’re not allowed” and “you must”, we sought out midwives and tried to have our children at home. However, the midwives had strict regulations and were prohibited from attending home births for women of “geriatric maternal age”, which affected 3 of our 4 births, so we were only able to have one child (the first) at home. We had one in hospital with a midwife attending and two in the hospital with doctors attending. All births were “natural” without drugs or IV’s other medical interventions.I am fortunate to have a husband who is a strong advocate, who helped me through all the births.
In my opinion, I received much better care from the midwives than the doctors. The midwives offered constructive prenatal care, and took time to ask questions about my diet, listen to my answers and suggest healthy recipes. Prenatal care with the doctors involved ultrasounds and blood tests. The doctors clearly held to the medical model of childbirth. The doctor for the third child was not very patient. He wanted me to come in on the day that he had office hours so he could break my water. At one point he decided to do an internal exam, without asking me, right when I was having a contraction! It was very painful and I was so mad I screamed at him and jumped off the table. He wanted to use pitocin to speed things up and he was not happy when I refused and the baby wasn’t born until 3am. For the 4th child, I decided to avoid spending time in the hospital as much as possible, so I delayed going until I was pretty sure the baby would come within an hour. She did (no doctor in attendance:) and we went home as soon as I could get my rhogam shot.
In addition to the other benefits, Midwives charge much less than doctors for prenatal care and delivery.
Hello! Thank you for this article. I am practicing as a Midwife in Germany and can truely say that communication and the “how” in communication has the potential to create trauma (besides the practice…:-( ) Though I can completly follow your train of thougt in regard to the use of the word “allow”, one thing I do not understand in the slightst is, why you as pregant women allow the ACOG to refer to you with the word “patient”. Even though pregnant women may be finding themselves in a medical system whilst beeing cared for, they are not ILL as pregnant women or as women giving birth. So they are not a patient. If women are paying the caregiver they may be called client, but certainly they are not a patient! I prefer to refer to a women I am caring for with the term “woman” and most of my fellow german colleagues do the same. Refering to women in childbirth as “patients” is already giving the impression that something is wrong with their “condition”. Sorry, but I really think the problem does not just finish with the word “allow”. That may just be the top of the iceberg. Please excuse any grammar mistakes – I am not a native speaker 😉
My midwife refers to all of us as clients. I love that for sure. I’m not sick!
This is a wonderful article, thank you for writing it, it’s so important that women realize their power in the process of labor & birth. Some comments below the article from others blew my mind, but that doesn’t surprise me… Women know what they need in labor and that should be respected, not argued with. Beautiful article. I am a birth doula and childbirth educator – sharing with all my clients.
I’ve been a labor nurse for 11 years now. I know that I have not experienced it all because there will always be something new. However, have you ever had to hand a mother a newborn baby and say I’m sorry for your loss? Do you truly think it just effects the families? Have you ever seen the look on a older child’s face when the doctor tells his family his mommy isn’t coming back home? You can preach and read all but the fact is you have not lived in our shoes either.
I’m a mother and a nurse. I’ve had preterm and term babies and the way I chose to deliver may not be yours. That is fine by me. The only thing I ask is that you and your baby leave healthy. An iv is not always necessary to be used….agreed, but do you want to be the one that we can’t get delivered in time because of it? I truly do not care if you birth standing on your head in the dark. I DO care that you child can read in first grade and you are there to see it.
You are not the one standing there defending the beginning of your shift till the end.
Are you disappointed about a c-section that’s fine, but remember you are the one that got to take a healthy baby home. Did you miss out on something? Maybe but tell that to the family who has their nursery empty when they got home. TRUST ME. Life can be planned all you want but as you know it doesn’t always work that way. So instead of morning your loss of a vaginal birth, celebrate the new life you have in your arms and be grateful!
I think you have missed the point of this article. Also, not wanting an IV etc does not mean a mother or her baby will die, so let’s not talk about the worst case scenario (if a mother or her baby dies it’s not because of an IV, let’s be clear about that). One of my clients lost a full term baby despite listening to her doctor 100%. Not bringing a baby home or for a mother to not return home is a terrible tragedy that has NOTHING to do with the fact if the woman is or is not respected during childbirth. Stop disrespecting women and their choices in childbirth. The ignorance of doctors and nurses is why I chose home birth. I have two healthy sons and two beautiful, empowering, life-changing experiences to treasure forever.
Not having an IV does not mean the mother will die, but in the event she begins to hemorrhage (uterine arteries pump 1/2 liter of blood per minute), her peripheral veins will collapse due to the shutting of blood to major organs–heart, brain, lungs, kidneys–once that begins to happen (faster than you can open your IV supplies) there will be no vein in which to start that IV, which means no way to replace the rapidly depleting blood volume. So yes, she CAN die without an IV site. She doesn’t have to be hooked up to anything, but access is a nice thing to have, just in case. It can be removed within an hour of delivery.
LOVE!, Labor RN Perspective. 15 years on L&D and I could not have put it better. Most women are very level headed and get it when labor throws them a curve ball and we have to detour from the “plan”. Others are fixated on their “experience” to the point of putting themselves and/or their baby at risk. My advice for birthing a baby is advice I would give someone for life in general. Just when you think you’re in control, life has a way of turning you on your head: Roll with it.
I love this post. I was using a midwife for my last pregnancy (the same one I used for my previous two). We found out it was twins at 13 weeks and of course so many people started asking how long she would “let” me go. Um…until my babies decide to be born! I ended up with a c-section because my babies were both breech. My midwife was confident in helping me birth them breech but I unfortunately went into labor at 36w1d and she is, by law, not able to deliver in her birthing center before mama is 37 weeks. So I had to go to the hospital and of course none of the doctors would “let me” attempt vaginal breech delivery of twins. My options were c-section or leave AMA and have an unassisted birth of breech twins. Yeah, I was not comfortable with the second option. 🙂
So frustrating. I wrote this for a group of ladies from whom I heard “my Dr won’t let me…” just one time too many: http://shineonyoucrazymama.com/2013/05/15/concerning-birth-and-fear-and-doctors-and-fear-and-pain-and-fear-and-plumbing/
I understand what you are saying, I do. But how does the Physician protect themselves from a malpractice lawsuit? We are so ready to blame everyone else in this country.
There are terrible, incompetent doctors but there are really good ones too. I believe the choice you make is when you hire your Dr or Midwife. As the patient you need to take a little more time to make sure that the physicians, etc… and you are on the same page. If you don’t like what they are saying and doing, it’s your own fault for not doing your research. Sometimes things happen, no ones fault they just happen. We are so ready to blame someone. If the birth staff does act to soon, we’re upset. If they don’t and the something happens to us or our child we’re upset and ready to hire a lawyer.
Yes we have the right to say what happens during our birth experience. Just be ready for your physician, midwife, etc.. to also have the right to say I won’t be a party to this and walk out when your need them most.
As my husband says, “Opinions and Rights are like butt cracks, everybody has one.
Physicians readily admit that they protect themselves from malpractice suits on a daily basis–by, sometimes, subjecting women to unnecessary and even harmful interventions. It is interesting to note, however, on this issue, that malpractice reform hasn’t significantly affected the practice of defensive medicine: http://www.obgyn.net/malpractice/defensive-medicine-persists-after-malpractice-reform?cid=newsletter&GUID=317A83ED-B364-42A1-AF49-E7E6AF274113&XGUID&rememberme=1&ts=29102014
As I commented above, it is not possible for a woman to be 100% in control of who attends her birth. Most practices rotate call; sometimes providers have other clients; and even in a homebirth, there is the chance that a transfer to the hospital may be necessary. There ARE wonderful providers out there. And there are the providers who have gotten us to where we are today. It is prudent of any woman giving birth to carefully choose her provider–and then she can’t do much more than hope and pray that she gets that provider when the time comes, and that the provider has been honest about how he or she practices.
Amen, Connie! I’m so glad that we are past the “just follow the doctor’s orders” mentality without any sort of input or participation on the patient’s part, but I feel the pendulum has swung so completely to the other extreme as to be ridiculous (and dangerous! So often I take care of patients who have consulted with Dr. Google or other completely unqualified and unreliable sources and take those opinions as gospel, completely disregarding the counsel of their OB or CNM.
Nicely written. It’s very frustrating for me as I’m stuck- after 2 c sections- wondering if I should have a third child (which id love) because I just… Can’t… Schedule a major abdominal surgery for no medical reason… But finding a provider who would “allow” me to vba2c is difficult at best. It’s been very disempowering, even when I tried to VBAC prior and the (ccan approved) midwife said “well maybe your body isn’t made to deliver babies.” I’ve had low risk pregnancies, no issues during labor except failure to descend in the amount of time the doctors thought appropriate.
And the obgyns/midwives are just one person/company that begins to process of disempowering mothers… It continues with the disrespect of being told what to do/shamed by everyone and their brother over making decisions they don’t agree with, rather than giving moms evidence based information and allowing them to make an informed choice. It’s scary how we are put right back in “our place” as women when we have children.
We are told our whole lives that we can be powerful women and make a difference and that we are equal to men, then we make babies and suddenly it’s okay to randomly grope a strangers belly or tell her how to live because she is no longer an equal person.
I was told, after 14 hours of labor with my epidural wearing off, that I wasn’t “allowed” to grunt/be loud/scream when I was laboring down and pushing. I thought it was crazy someone telling my what I was and wasn’t allowed to do in the moment that I had to be my strongest. And then, after an extremely traumatic birth for both mother and child, the doctor and nurses casaully saying “you probably should have had a c-section and your daughter wouldn’t have had low apgar scores.” As if I didn’t feel bad and guilty enough that she was the healthiest little feus ever, kicking and happy as can be, to know that her birth was so traumatizing for her and it didn’t have to be. Well, I know now…and I probably won’t ever kick the guilt for being “not allowed” to be the best and most informed laboring woman I could be.
It just amazes me that the same medical people who will fight for your right to KILL your baby because it’s “your body, your choice” will then try and force you to do what THEY want you to do, whether it’s best for you or the baby or not. I was told with my third that if I didn’t deliver her by 9:00 when the next doctor came on I would be “forced” to be on my back in stirrups as that was the only way he would deliver a baby and was told very clearly that I would have “no choice” in that. That is the WORST position to give birth, and it triples my pain when I lay on my back! Thankfully, I delivered (standing up–something none of the them had EVER seen) an hour before he came on duty. Making me lay down with my legs up in stirrups makes birth harder on me and the baby–this was purely for the doctor’s comfort and it angers me the number of women who don’t know there are better ways and that really do have a choice! I’m fine with intervention in emergency “do or die” situations. I am NOT okay with not being “allowed” to do something because they just don’t want me to or it’s “protocol”.
By the way, my doctor with my fourth didn’t like it, but I refused the sugar test. I knew I didn’t have gestational diabetes and I had a blood sugar monitor at home that I used regularly to make sure my levels were okay. If I took the sugar test I would have “no choice” but to drink the nasty drink they had there (others let you do it with juice or a coke, but this office wouldn’t), and I knew I would either pass out, throw up or both (I’m extremely sick for the entire nine months). I got so sick of hearing other mothers ask, “How did you get away with that?!”. Granted, many women need to be tested and I’m not against the test itself, but I had no history and no symptoms and I DID have the ability to test my sugar regularly. She still tried every visit to make me take the test. I would just smile and say “No.” and promise to tell her if my sugar ran high at all. It never did. I did have a great doctor over all, though. She was fine with my birthing plan and made sure she was at the hospital to deliver my baby. We ignored the nurses and did our own thing and though I had a long labor, the actual birth was short and sweet and I gave birth to a perfect, healthy baby. Of course, then the pediatrician made us stay in the hospital an extra day because I made her mad when I refused a shot for my baby that she didn’t need. Ugh! I get so tired of the God complex so many doctors have!
This is why with my 5th child I did exactly this, fired the OB late in pregancy, 3rd trimester. With my 1st she was a natural birth as was my son who was my 2nd. But my third was an emergency c-section due to his heart stopping 3 times during labor despite internal monitoring which showed it really had stopped, he was clinically gone 3 times before he was born, don’t get me wrong I do no regret the c-section as in this case it saved this child’s life. My 4th was a very fast and easy vbac without a day complications or fights from Dr or hospital and nylon went smoothly. With the 5th I had to switch to a new OB due to insurance changes. The first I went to reassured me me they were ok with another vbac this time around. I went for my first few visits and uktrasound. Then at 21wks I got a call from office staff to inform me they needed to schedule my c-section since that was required due to a previous c-section irregardless of my previous vbac I was told I was not going to be allowed to have a vbac this time. I hung up the phone on her and never went back. I found a supportive provider elsewhere who was wonderful. He let me labor longer then he would normally let someone with a vbac because as he said in his words I had done It before and he knew I could, he said normally he encourages mothers to go for c-section after 12hrs in a vbac after water breaking. But in my case he allowed me to go beyond due to my insistence I was fine, 16.5hrs after my water broke she was born healthy.
I’ve been an L&D nurse for 20 years. Due to my husband’s profession (and later mine), I’ve worked in a variety of settings. Rural hospital, serving a poor socioeconomic class, to a high-risk facility with very educated patients. I’ve worked with great OB’s, a few shady OB’s, and midwives (all of which were awesome, btw). I’ve done tub births, low risk-low intervention births, to extremely ill, preterm, high-risk births, and everything in between. I even delivered my neighbor’s 10th baby at home (not planned), then watched the ambulance crew do some unnecessary interventions that landed them in the hospital longer than necessary (septic work up for a cold baby that was only “cold” because of the unnecessary oxygen they blew in his face…I wrote the ambulance company a letter to let them know what I saw). I’ve seen c/sections done (imo) for convenience, and I’ve also seen mother’s with unrealistic expectations and demands that put her life and the baby’s life at risk. My experience is varied, and I can appreciate all of the comments in this thread. I will advocate for my patients all day long, and will go to bat with the docs and the facility if need be. I don’t care if you want an IV, because in an emergency I can get one in in 5 seconds (even with bad veins thanks to my time in the NICU). Intermittent monitoring? I’m all for it. Want to walk? Fine by me. Eat and drink? Ok, just know that it may come back up during transition. (I once had a patient throw up her orange juice right down the front of my shirt. As it was running down between my boobs, all I could think was that it was still cold :). Labor down if you want, push when needed, yell, scream, I don’t care, it’s your birth, your experience. I even convinced a doctor once to take on a new patient that wanted a TOLAC, while she was in early labor because her OB refused…he wanted to do a c/sec. (It was already scheduled, but she went into labor on her own and decided she wanted to try…she successfully VBAC’d 10 hours later with the help of the new OB.)
Truthfully, at the end of the day, your doctor, nurse, and healthcare team want what you want: a positive experience and most importantly, a healthy mom and baby. We may approach it differently, but we do want the same thing in the end. That’s why it is imperative to be informed…about evidence-based research, about your doctor, and about the facility you are delivering at. Because, this is a litigious society, and we do have policies and procedures in place that are sometimes a result of that alone. If you are informed, you will know what to expect for the most part, even when emergencies arise. But I’ll be honest, very few patients in my experience are truly informed. Most patients do not seek this information. Some are marginally informed, but often have conflicting data. For instance, they want an epidural once in active labor, but still want intermittent monitoring and to be able to walk (usually not possible together). I used to teach childbirth classes, and very few couples attended (maybe 5%). These classes are a perfect opportunity to get to know the hospital staff and policies/procedures that may impact your experience. (Hopefully you already have discussed your wishes with your provider, and your provider’s practice preferences and statistics). My advice, be informed, write a (reasonable) birth plan so we know what you want, but be ready to compromise if medically necessary. And, put the time in picking a provider and hospital that can and will help you with your birth goals. Childbirth isn’t a disease, but it can go downhill fast and unexpectedly, so you need to be able to trust that your healthcare team is helping you make truly informed decisions. Cheers, and good luck to you all!
I simply cannot convey how sick and tired I am of hearing women blame their doctors. Do you doctor bashers think they spent over a decade in school just to bully people? And why the hell don’t you switch doctors and/or hospitals if you’re not happy with the one you’re with? If you think you can handle birth better then stay at home and birth there. But don’t go crying if your baby dies or is born with any disabilities because you were too selfish and idiotic to get proper prenatal care. I always rather liked the idea of midwives and such until a family member became a doula then got sucked into the rising cult of midwives. And when I refer to midwives I mean those practicing in the US. Every other developed country that has midwives requires them to go to college to complete at least a few medical courses. So all those statistics midwives love to throw about? Research how they fare here in the United States specifically. All the emotionally enriching hippie crap in the world isn’t going to do you a darn bit of good if your baby is dead or seriously injured. No matter how you mash it, it is exponentially SAFER FOR YOUR BABY to give birth in the hospital. I wouldn’t gamble with the best odds on my child’s life, which is exactly what you do when you don’t get the right medical care during pregnancy and delivery.
Wow, what an attitude. While I can understand what you say, I do have to question your statements, particularly the one where you talk about gambling with your child’s life when you don’t get the proper medical care during pregnancy and delivery. What, exactly, is proper medical care? Ultrasounds, tons of medical tests, internal exams, induction of labor for any reason at all? How about being restricted in movement, starved, etc, during labor? Epidural, EFM, and lithotomy position during labor and delivery?
Had I delivered my first in hospital, I would have been sectioned. Large baby, malpresentation, long labor, the list goes on. Without food or water I would never have been able to make it. With an epidural and lithotomy I would never have been able to move that nearly 16 inch head out of my body. I chose a home birth after a LOT of research. I didn’t know how big my baby was, but I knew that my body was designed for birth. If my baby had been distressed at all, we would have transferred to hospital in a flash, but there was no need.
With baby two, I chose birth at home again. Water birth this time. Much shorter labor, smaller baby. No stitches.
Eight years later, three months ago, I gave birth a third time, again at home. Healthy babies, all three times.
I did lose a baby before this last one, but no medical care could have saved him. The miscarriage happened at six weeks, before a first prenatal appointment would ever have been scheduled. I have never accepted any prenatal screenings at all, not ultrasounds, not early panel, not genetic testing. No glucose testing, nothing. Only iron had ever been tested, and only with this last one did I allow a blood test for type and Rh factor. I already knew what my blood type was, and my rh factor, but had never been tested to verify that, so my midwife wanted to verify.
Doctors dislike it when women think for themselves. We can’t be experts without all those years of schooling, or so they tell us. I chose to become informed. To learn, to study. I have read hundreds of thousands of pages of information, medical texts, studies, anecdotes. And if something went wrong, where there was a medical need, I’d go to the hospital. But ONLY then. It is NOT exponentially safer for mom or baby to birth in the hospital, unless there is a known problem. With all of the disease, bacteria, God knows what else in hospitals, why would a healthy, low risk mom want to go? Many choose not to to, as I did, for the same reasons.
Bottom line, you can put down midwives all you like. Make remarks about hippie feel good crap, all you like. The fact remains that the best of the hippie midwives, Ina May Gaskin, has a much better record than most, if not all, OBs. I have had three births with midwives. All were good. Dangerous? No. A gamble with my child’s life? Most definitely not.
While I agree with some aspects of this article, I wonder if you could touch on the reality of the plethora of birth injury related law suits, and how that impacts what physicians recommend to their laboring patients. It won’t cut it in court if a physician says, “Well, I told the patient that prolonged labor with premature rupture of membranes (or whatever issue) could lead to fetal distress/infection/death. She knew and chose to continue laboring.”
There are so many birth-related lawsuits that every single physician in the US, even if they are not an OB, has to pay into a Birth Related Injury Fund on a yearly basis so that the burden isn’t solely left to the OB doctors. Otherwise their cost of malpractice insurance would be prohibitive to their practice of medicine.
Unfortunately, lawyers, and people who expect perfection from medical professionals, have significantly shaped how medicine is practiced.
After being bullied by the Maui nurses at the hospital (they literally laughed at our birth plan and tossed it aside as irrelevant), my husband and I demanded out of the locked maternity ward. We signed papers that we were not complying with doctor’s orders and went to our midwife’s house where we had a beautiful, natural birth – zero issues despite all the fear/threats the medical staff had been promoting. Having a home birth was the best thing I’ve ever done in my life. A glorious moment that I recall vividly five years later. The birth was an experience I will relish the rest of my life. And it set me on a the track to believe in myself and question medical interventions across the board. Just like in birth, the more I question, the more I discover, the healthier we are. My empowering home birth equaled a revenue loss in the medical community that continues today.
I was absolutely dumfounded recently to see photos of mothers giving birth in American hospitals. They were all laying flat on their back with their feet in big metal straps, with their knees at their ears and four alien-looking medical professionals between her legs. What in God’s name are you doing America?
You’re sitting discussing what to do when the baby doesn’t come and distressed heartbeats… Why not avoid much of this in the first place by letting the fricking women up to give birth in a reasonably natural position. I don’t think I could even poo in that position let alone give birth.
I just assumed American birth was like it is here so I literally could not believe what I saw. It’s horrendous and it actually hurts my chest how I feel for these poor women being forced into this position.
Ugh! I gave birth to my third baby half-squating, half-kneeling in my living room and my two midwives (wearing their normal clothes and NO MASKS) lay on the floor below me, even though i pooed on them, and touched the baby for approximately 3 seconds before placing her in my arms and then went away and had tea and toast before they even had a look at her (other than apgar, 9/9 if you’re curious).
I appreciated this article, and found many of the comments interesting.
I think a big part of the problem is how black-and-white we’re forced to be. Not all doctors have god complexes, not all healthcare providers are more concerned about emptying a bed than your emotional wellbeing. However, the reality is that the healthcare system forces even the most well-meaning professionals to put other priorities ahead of the mother and baby.
Of course they want to keep mum and baby safe, but the other, less tangible aspects can easily get shoved aside; I’m talking about the mother feeling that she’s being treated like a human being, about feeling like she is being respected and has control over her body and the situation. This is where we get the mindset of ‘Why are you complaining? You have a healthy baby.’
Why should the bar be set so low? Since when did a healthy baby and living mother become the definition of a successful birth?
There are many truly caring healthcare professionals out there, but because there are those who are not, for a large variety of reasons, mothers in labour have to go into that situation at the hospital prepared to deal with one of the bad apples. Hence why they feel the need to ‘stick to the birth plan at all costs’, or demand reasons for certain procedures, etc. Because if you could be certain that you have a team of only the good kind of professionals, you could sit back and relax and trust everything that they did was definitely necessary and definitely for the best.
Sadly there are too many professionals who sideline the mother’s needs and feelings because let’s face it, building trust with her, explaining everything you’re doing, letting things happen naturally where possible etc are all things that take much more time and effort than doing it the textbook ‘hospital policy’ way. Why encourage and persuade and reason a child into swallowing their medicine, when you can just put it in a syringe, stick it in their arm and have it over with in 10 seconds? Sure, they’ll cry and will never want to hear the word ‘medicine’ again, but come on, you only have so many hours in a day, the child wasn’t going to listen anyway, and they got the medicine they needed. They should be thanking you.
This is the attitude that, unfortunately, some of us have had to deal with, and it leaves those women feeling understandably betrayed, angry, and defensive in future situations.
This is NOT black-and-white, this is a whole heap of greys that should be sorted through rationally, clearly and sensitively. Every situation is different, and sometimes there is more than one solution to consider. Protecting a baby does NOT need to be at the cost of the mother’s dignity and human rights. Home birth should NOT be the only way to avoid having all control taken away from the mother, especially when home birth is next to impossible in some countries due to a lack of midwives or other reasons.
And the scaremongering helps no one. Stick to facts. They are the antidote of scaremongering.
Coming back to read this article once more after a few years and loving it as much as I did the first time. I am a birth doula and work in hospitals and home birth settings. Although I have only been practicing for four years (which is like a minute in the birth world!) I am happy to say that every client I have assisted has been able to deliver naturally with no interventions and perfectly healthy outcomes for mother and baby. I have had a wide spectrum of experiences with hospital staff. Some (the minority) are utterly respectful of parental choice and only need to hear it once before they back away. Unfortunately it’s been my experience that the majority are so indoctrinated by the fear mentality of modern medicine that they continue to badger laboring women despite already having refused once, twice, more times, and signed a release of liability form. This happened to a mother I assisted 48 hours ago. She refused a saline block/IV, refused it again, signed the consent form, then when the poor woman was transitioning and in tears, a half dozen staff filled the room and continued to badger her, trying to convince her to get her blood drawn, because she was a “high risk VBAC” (she was actually a perfectly healthy athlete actually who had a cesarian in her first birth because of horrible hospital practices) and they hadn’t been able to get a sample from her saline block (because she had refused). I don’t know about you, but I can barely get my blood drawn when I’m not transitioning. I’m so glad I was able to bring her focus back onto me and help her push her baby out, which literally happened about five minutes later. Someone above commented meconium aspiration — I have seen this happen most commonly with mothers who have been given pitocin which can cause unnaturally strong contractions potentially leading to stress on baby.
Great post! We are linking to this particularly great article
on our site. Keep up the great writing.
As a practicing Ob-Gyn…
It is a patient’s right to refuse ANY treatment. Its against the law to cut anyone (c-section, episiotomy) without their consent in this country, correct?
That being said, it is up to the physician to intervene when necessary and to provide the proper recommendations based upon what is presented in front of him/her.
When a patient refuses treatment as in a cesarean section, we VERY carefully document our rationale for the recommendations. We are also careful to make sure that the patient fully understands the possible complications, sometimes even asking her to write out the possible complications in her own handwriting.
If there is an adverse outcome due to timeliness, AND WE HAVE HAD THEM, I have NEVER lost a case.
Sure, some of my colleagues are afraid of losing a case, however I’m suspecting that there was a lack of documentation on those charts.
My message for patients:
You have a right to refuse ANY treatment, however when your baby is not alive, or worse, severely brain damaged or injured, please don’t waste the time and money attempting to sue someone. You expressed your right to “not being told what to do”
My message for doctors:
In an emergency situation when the baby is in jeopardy, CLEARLY document your recommendations and hope for the best.
Doctor in New York, yep. Providers should not be held responsible for the informed decisions of their patients when there is a bad outcome. If only ACOG would provide professional support on this!
Also in New York, though, recently a woman lost a lawsuit when an on-call doctor refused to attend her planned VBAC (her supportive doctor was not present) and documented the following: “I have decided to override her refusal to have a C-section.” Her bladder was nicked during the forced surgery (I say “forced” literally, as she was rolled back screaming and crying), giving her grounds to sue. In what I see as an unfortunate perversion of the law, our courts do not recognize forced surgery as a harm *in and of itself* as pertains to pregnant women. She lost her case.
https://www.theguardian.com/us-news/2017/oct/05/new-york-staten-island-university-hospital-c-section-ethics-medicine
Cristen – I’ve been involved in perinatal care since 1983 – as a RN since 1986, doula, and now a nursing director for an LDRP unit in a hospital. I read this article when it first came out, and I re-read it regularly to remind myself of how important it is to keep “allow” out of our conversations with patients. I read policies and procedures so very differently now, and I write new ones keeping this in mind. I just want to say THANK YOU for this.
Thank you for putting things in perspective. Indeed, it is the patient who chooses to allow the provider to do something – not the other way around. Husbands should be informed of the implications of the interventions too. Birth, for men, is something they can assist and support their wives. Nowadays, more and more want to be in-the-know.
Finally, I see a real advocate for women’s rights during pregnancy and labor and delivery. I even see women tolerating being sutured ( for tears, episiotomy) without local anesthetic by lazy or misogynistic doctors ( 99 percent are male ) Your work is incredibly important; thank you!
I really wish more women thought about their rights and spoke up for themselves. Hopefully your message will spread.
I’ve been wishing I could do exactly what you’re doing. Maybe in my next life. Keep at it please.