I do a lot of reading in my spare time. Books, blogs, online forums, and articles written in the news, all mainly about birth, pregnancy, parenting, parenting issues, yada yada yada. While making my usual blog rounds this morning, I came across a post with a sample letter that a blogger had come across. At first I was hoping that this sample letter was a joke. But as I read further, I realized that this was an actual letter that a woman’s OB/GYN gave to her during pregnancy. This letter was found on a forum of allnurses.com and reposted on Unnecesarean.
Below, I would like to share the letter, as well as make comments on the points that the doctor made as “his birth plan” (Mind you, he is not the one giving birth, his patient is, he gets no say in her choices as a laboring woman.) Thankfully the woman who was on the receiving end of this letter immediately found a new provider.
DR. ________ “BIRTH PLAN”
Dear Patient:
As your obstetrician, it is my goal and responsibility to ensure your safety and your baby’s safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. (Yet the United States has the highest intervention rates, one of the highest cesarean section rates, and HORRIBLE maternal and fetal death rates. Out of all the industrialized nations in the world, we rank LAST!!) The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.
* Home delivery, underwater delivery, and delivery in a dark room is not allowed. (No, instead of the parents being comfortable, the Doctor will not work harder or not be comfortable himself in order for your experience to be positive or what you want. Also, if you wanted home delivery, you would not be seeking the care of an OB/GYN, at least in the United States, other countries around the world like The Netherlands (which has a lower fetal and maternal death rate) has OB/GYN’s that deliver at home, 1/3 of all their births are home births.)
* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. (You mean, the guidelines put in place to make an OB/GYN’s job easier on themselves and hospital staff? Not information based on scientific evidence?) I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. (ACOG is basically a trade union for OB/GYN’s, they are not a college, not an institute of higher learning, and most of their recommendations are not based on scientific evidence, which has been pointed out by several different organizations, and publications in recent years.) Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe. (I would love to know which organizations the Doctor was speaking about here, because in my time in the birth community I have never come across anything along these lines, but I have come across many that promote natural birth, which I guess you can say is “outdated” in today’s society.) You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes. (Because Your Doctor is boss and all! LOL)
* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby’s well-being. (Your right as a patient is to have anyone you feel necessary with you during your labor. Because your doctor may disagree with them, or what you want for your labor, does not mean these people need to leave. It is your birth, it is your right to have anyone with you. By attempting to “run out” your labor support team, the doctor is not doing you anything but an injustice and putting you in a venerable position.)
* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby’s well being. (So basically, they have the IV access open to pump you full of pitocin or other induction drugs when your body doesn’t progress fast enough for the Doctor. I have seen it before, women given pitocin without their consent or even knowing it was being given to them. Your body knows how to birth, and will facilitate the changes it needs to in the time frame that is right for you and your baby, not what fits the agenda of your Doctor, which is often an 12 hour deadline.)
* Continuous monitoring of your baby’s heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby’s heart rate are not allowed. (Continuous fetal monitoring, over the 30 years it has been taking place in the Obstetric Community has not improved maternal or fetal outcomes of births, even ACOG released a study earlier this year stating that.)
* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion. (There is no scientific based evidence or studies that have shown the rupturing of membranes to be helpful, or help progression in your labor.)
* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor. (Really? Because the most recent studies on epidurals have shown they also hold many risks to mothers and babies, just as any form of anesthesia has the chance for risks. Also, epidurals that are administered before 4cm or what is considered to be active labor increases your risk for labor to stall, fetal distress, and increases your risk for a cesarean section for non progression.)
* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. (Really because I have labored before and being flat on my back was the most uncomfortable position for me.) It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery. (This is also incorrect, while laying flat on your back this decreases the pelvic size and also constricts the contract between your spine, and the nerves that are directly connecting to your uterus. In turn your uterus is not functioning at its maximum potential and can cause weak contractions, or other kinds of distress to you or the fetus. In reality, the lithotomy position is the most comfortable for the OB/GYN. God forbid he/she had to get onto the floor to deliver your baby while you are on a birthing stool or your hands and knees.)
* Episiotomy is a surgical incision made at the vaginal opening just before the baby’s head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby’s head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby. (Episiotomies are greatly outdated and shown in many studies to have no medical benefit for mother and baby. Scientific evidence points that a mother tearing on her own is safer, heals better, and causes less damage/trauma to the vagina.)
* I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby. (Again incorrect, several scientific based studies have shown that delayed cord clamping is beneficial to the newborn, and can make a huge difference in their health in the first hours of life.)
* If your pregnancy is normal, it should not extend much beyond your due date. (You mean that date that is infamous for being wrong in up to TWO weeks in either direction? Even with Ultrasound measurements in the first trimester.) The rate of maternal and fetal complications increases rapidly after 39 weeks.(HUH???? Where the heck did you come up with that??? Even ACOG, the trade organization this Doctor quotes for his recommendations state that a pregnancy is NOT over due or in DANGER until 42 weeks gestation BY this guess date better known as a due date.) For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section. (Incorrect again, labor induction raises your risk for a cesarean section by 40%.)
* Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns. (Actually IT IS negotiable, without the mothers signature on that consent form, you are performing an illegal procedure.)
That is the full text of the letter, and the mothers reaction letter was even more heart warming since she basically ran screaming from this provider when she read this. As any educated person would. But what I find most frightening about this whole letter, and situation in general is, there are actually Doctors out there in the United States that are practicing like this with recommendations and information that not only is disgustingly incorrect and not backed by real scientific based evidence, but harmful for mothers and babies, not helpful.
This is another reason that I strongly encourage birth classes, reading, and educating yourself during and before pregnancy because you may find yourself victim to a provider like this, and believe exactly what they say because of course, they have MD after their name.
