The disrespect is amazing.

And yet if we fail to sign and authorize even ONE piece of hospital paperwork, we get threatened and bullied.

hmm. out of context maybe? Easily could have been an intentionally ironic statement.

There’s something to be said for the honesty though. I’d rather know at a prenatal than at the birth.

In which case my reply would be, “Get the hell out of my room; I don’t want you touching me or my baby.”

I actually had an OB say something very similar to me, at a conference. And I *know* he’s a good guy. His take was that birth plans get between a patient and doctor, and his assumption was that he would have spent enough time talking to the mom and relating to her that he’d know what she wanted and be able to honor that, without a written declaration. And because he’s always practiced that way, he sorta felt birth plans were a hostile thing on the part of the patient. But then again, he also practices in an isolated way, and has no idea what kind of crap women are usually pitted against.

95% of the birth plan is probably put into effect (or not) by the labor nurses, so it might just chagrin the doctor to realize that the birth plan is actually in use.

But of course the doctor’s attitude is going to affect the nurses’ treatment of the mother.

How does anyone expect to be able to “plan” how a birth is going to go?

That’s pretty naive, and reminds me of a song…”If you wanna hear God laugh, tell him your plan”.

I wrote out a birth plan my first pregnancy mostly for the benefit of my husband (we had an unassisted homebirth) But I included what I wanted to happen in the case of transfer and different scenarios and a simple yet to the point reasoning as to why I chose that way when it was something a little different than what doctors are used to. I did it an a manner that was easy to read and easy to find the relevant scenario. I think a well-written birth plan has its place because if I couldn’t speak up for myself, my husband (or doula if I had one) would know my wishes.

I have truly debated over whether to bother with a birth plan this time around. It seems like all you hear is that no one reads them, finds them obnoxious and in the process, they find you obnoxious. I think my CNM is extremely receptive to my desires and she has never indicated in any way that she would not welcome a birth plan, but I still wonder if it is worth my time.

My sister (an ACNP) told me that she thinks that it’s likely that nurses react badly to birth plans because they are so busy that they generally don’t have time to read one- which I understand.

My goal right now is to create a detailed birth plan with my husband so that he can be an advocate on my behalf. From experience I know that I won’t be in any shape to respond to much of anything, but my husband can and will know precisely what I want in the event of all sorts of things.

In typing this I have realized that women see a birth plan as an acknowledgement that we are informed and have made choices about our care. In a way it is almost like an informed consent document, attempting to let a doctor know what we desire and hope for in a good birth experience. To have that completely invalidated by a doctor by being told that they “toss ‘em right out the window” is tantamount to being told that they don’t want your informed consent on anything and don’t care how good your experience is. Is it any wonder that intelligent and informed women are so disillusioned with the OB community?

To Dr. Fogelson, a patient’s perception is never wrong. That is why, we as medical professionals, need to be really careful in how we talk to patients. Maybe this on-call OB was trying to be funny to lighten the mood, but to a scared and nervous mom, I can see how it would not go over well. I am one to often use humor to make patients feel at ease, but you must use it in a positive way.
Of course this website is biased toward the patient, (thus the continued use of blog-ads from law firms that sue Obstetricians and hospitals), but patients deserve a forum to vent their frustrations. There are many medblogs out there that do the same thing. In an ideal world there would be mutual respect between practitioner and patient. That ideal seems to have deteriorated in recent times.

Who knows what he or she meant. Maybe its a misunderstanding or maybe the doc is a real ass. Could be either. Certainly there are a few docs that don’t listen very well / communicate very well.

Clearly every comment on the site is evidence that doctors and patients don’t always communicate very well. Something was said that made a patient feel marginalized or hurt or confused or some other bad feeling. In that way, they each represent a failure of the OB or other practitioners to communicate.

The thing that bugs me about the site is that people seem don’t take these as individual failures to communicate, but as evidence of malfeasance of the entire field of OB/GYN. I think a great deal of the audience already has bad feelings towards medical obstetrics, and then takes each entry here as some sort of justification for their feelings. There are misunderstandings in all human communication – taking each one as some sort of indictment of the entire field is unjustified and unfair. As an OB/GYN, the site reads to me as a echo chamber of discontent, where everyone is congratulated for hating their doctor.

I know a few docs that aren’t so great. I know a few that don’t communicate very well. But they are the exceptions. Most of the docs I know, and I, have devoted lives to learning the science of obstetrics and gynecology, and to serving our patients to the best of our ability. Sure, we may not always see eye to eye with the natural birthing community about what the best way to manage labor is (though most are not as far away as you think), but the accusation that OBs are untrustworthy, moneygrubbing, or any other hatred filled adjective you like, is completely unjustified and hurtful.

The feelings of the homebirth and natural birth community are often justified. We do perform too many cesareans. There are lots of reasons for this, and some seem stupid to those on the outside. But there are reasons, and on the inside they are not stupid. Some folks still do episiotomies on a regular basis, and that’s a shame. I think these issues and others are starting to be addressed, and social media and blogging has done a lot to help this. There certainly has been a lot of good dialog on my blog, and I am appreciative of the natural birth and homebirth community members that have commented there. I have learned a lot through those conversations, and in some cases have changed my practice and what I teach my residents because of it.

I don’t think that kind of dialogue happens here, and that’s a shame. In the very title of the site, it is clear that the point is not dialogue, but to expose OBs as incompetent, insensitive, and otherwise bad. As an OB that’s interested in dialog, that seems a shame. I challenge the creators of the site to open it up to positive comments, and give them equal space. Let people write about good things their OBs and midwives and other practitioners did for them. An not just on some special day of the week, but on an equal basis. Actually create an environment where people that had great birth experiences in and out of the hospital could share that. If nothing else, the dialog would be great for traffic.

I can completely understand Dr. Fogelson’s point. I would venture to guess that he, me, and AYC are the only medical professionals to have commented on this site. I have always taken this site as a way for patients to vent their frustrations, right or wrong. This site is a platform for venting. It is by no means a scientific or evidence based forum on birth issues. It is also a business venture for the owners, as evidenced by ads like these:
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Mitch: Do you mind me asking how it came to be that you were induced at 39 weeks if you hadn’t chosen to be?I think that’s what I’m confused about.Many here say they have been “forced” to do things against their will, and I most definitely have not seen that in practice.What I have seen is elective c-sections and inductions.

I’m interested in what folks here think about vaccinations and circumcision as well…as those are things I feel rather strongly about as well.

Ultimately, its true, the mother must walk into the hospital under her own power in order to be induced. So in that sense, inductions aren’t “forced” But there’s other factors. “The baby is measuring x pounds, and there’s a risk of shoulder dystocia if he gets any bigger, and thats if you can even deliver vaginally! You will most likely need a cesarean if we don’t induce by ___. We better induce now because shoulder dystocia can be deadly, or result in nerve damage”

Now really, whats a mom going to say to that, in the moment? Hearing that their baby might possibly DIE if she goes against her doctor’s advise? Its not always as simple as just saying no. Its scary to have that seed of doubt and fear planted. It is HARD to stand up to that kind of pressure. Especially without additional facts, such as ultrasound not being accurate to predict weight, and that even with big babies, SD is pretty darn rare and most of the time there is still a positive outcome.

You say you see more elective inductions/cesareans but not “forced” ones. I don’t doubt you see a lot of elective inductions. I’d bet the women who are thrilled to be induced early outnumber those who would rather wait for natural labor even if it meant going to 41, 42, 43 weeks.

And I know there are women who didn’t mind being induced in the first place, but after the fact (particularly if it ended in a cesarean) are now angry about having been induced unnecessarily.

And to answer your 2nd question, I am 100% against circumcision.

I would like to first say thank you to those in the medical community who are reading and commenting. I think that it shows that you care about your patients and that means a lot.

I don’t hate the medical community, although I hate it when a doctor goes on a power trip. They don’t all do it and I’ll even venture to guess that most of them don’t. Sometimes a brilliant, heartfelt doctor will be bound by hospital or insurance guidelines which counter the mother’s wishes and doctor’s willingness. Having said that, most women I know (I know it sounds like an exaggeration, but it’s not), including myself, have been a victim of bullying, exaggeration, and/or outright lies. We don’t usually complain because it seems cold to complain of such things when we have a newborn to appreciate. It is dismissed that our feelings during childbirth really matter. We love our bundle of joy, but some of the statements or actions leave us with emotional scars that can’t be seen. There were many factors in my PPD, but I believe my birth experience played a part.
What you see on this site is pain masked by hostility. Sometimes, that’s our coping mechanism. Many of us have chosen to educate ourselves since our experiences. Knowledge is a wonderful, powerful thing. It can, however, be misconstrued by the birth attendants as a threat of sorts. To put it bluntly, it seems that many medical staff prefer that women stay ignorant and keep their mouths shut. A complacent patient requires significantly less time than one who has knowledge and wants to have input into her birth, leaving more time for other patients (and I understand that often OB’s are stretched too thin). We don’t expect for everything to go perfectly according to plan, but we do expect to be given honest, realistic information when we (as a team) make decisions. We also expect doctors to keep abreast of new information and to be open to adaptation where needed. We *don’t* want to be bullied into making decisions we aren’t comfortable with. If we can’t agree, I am happy to sign an AMA form to cover your butt. I respect that you, your insurance, and the hospital need to protect yourselves. It’s a fair trade-off and at that point, if a problem occurs as a direct result of my decision, you will not be held responsible. …and no “I told you so”s. Tht’s just plain hurtful and counter-productive.

As far as this being an evidence-based forum, it is and it isn’t. Many of the posts aren’t a dispute of facts. They are simply stating traumatizing events based on how the mother felt. This is about bedside manner as much or more than anything else. It has been shown that a positive birth experience can have a profound effect on how smoothly labor and delivery proceeds. These statements, while “all in a day’s work” for the doctor/midwife/nurse, mean a lot to a woman in labor. I felt empowered at my non-hospital births, but the environment of the hospital alone made me feel very vulnerable. This was my 2nd delivery. Yes, we also speak up on unnecessary cs, epi, pit, etc. as if we know all the facts. Truth is, many of us *are* on top of the facts and could provide references. We don’t often state them here because we don’t feel it’s necessary. When OB’s are in a room discussing something they have discussed many times and there is a general consensus, they don’t list references either. (That wan’t meant snotty, but I can’t seem to find a better way to say it.)

I will say that I *strongly* believe cs and pit are horribly overused. No two ways about it. I agree that some of it is liability concern. Some of it laziness or personal preference. I had one OB say he preferred cs because it produced prettier babies. I wanted to know about the preference for a healthy mom and baby, however I was too dumbfounded to speak right away. You may see it that inductions and scheduled cs are increasing because of patient request. This is not what studies are showing, but based on personal experience. I’m not trying to be dismissive of your experience, but it doesn’t appear that your experience is representative of the greater population. In either case, if we want to see inductions and cs drop, we need doctors to encourage mothers to wait. That doesn’t mean not to give them an option, but encouragement can go a long way. Most women will go along with whatever their doctor recommends – even if it means a few more days in waiting. Also, present facts. Most moms truly don’t realize that there can be problems with early birth even though she is considered full-term.

Many times, I think doctors are taught that the medical way of birth is the only way and they don’t get experience in letting nature take it’s course. That’s sad because it can be so beautiful! My son was born before his placenta ruptured. How many OB’s have seen that? Over the years I have taught my doctors several things, sometimes even being in control of my own care (including ordering my own tests). This is when I had a very, very rare illness and not much was known about it at that time. Upon diagnosis, I did the research because my doctor had never even heard of it. My doctors have also taught me a lot and I respect their opinions and knowledge. We have a relationship that helps us both grow. I feel lucky to have had such doctors at times.

Mitch – You asked about vaccines and circumcisions…I will state my stance. I have chosen to delay vaccines at this time. I am not completely opposed to them (in favor actually), but I do believe the concern of harm from the vaccines is great enough to warrant such action. I try to take alternative precautions to reduce the likelihood of exposure. I hope that strong, conclusive studies will be done soon so that this issue can be put to rest one way or another. This was a tough one for me and I understand that you likely do not agree. Circumcision for me is black and white (now – it used to not be). I am 110% against it. There are no reliable studies that have shown a net benefit to RIC, leaving it a cosmetic procedure which should be left as a decision for the individual who owns the penis. I believe the risks greatly outweigh any potential benefits. A good question is why, if it reduces HIV infection, etc., does the U.S. have one of the highest circ rates and HIV rates outside of Africa and the Middle East? In my opinion, these should have a reverse correlation. And although I don’t agree with everything they say, no national medical association encourages RIC. I think education is key, not assumption of our son’s future sexual habits and cleanliness leading to very harmful surgery. I wish doctors would provide more information to parents before asking about circumcision. Many parents opt to do it because it’s “what you do” but are never made aware that there are very real possibilities of complications. Both my ex-husband and husband have defects from their circumcisions, not including missing many important nerve endings.

Good grief I said a lot. Sorry. I’ll just publish the book next time and mail a copy to anyone interested.

Okay, one last thing…

Please don’t be offended by the name of the site. It could just as easily be turned around to say “My patient said WHAT?!?”. I’msure you year a lot of doosies! (And I’m quite sure I could be nominated for a thing or two I’ve said!)

Michelle Potter: * Do provide encouraging, supportive care to moms who transfer from a homebirth.

Now, I’ll admit that I’m not overly familiar with this concept, but I have to say this. This may be the one thing you and I disagree on.

I’m not certain this is fair to a physician to expect them to welcome this patient with open arms when there would have been ample time to form a relationship long before the fecal matter hit the rotary oscillator, if you will.

Dr. Forgelson,

I hope you are still keeping tabs on this discussion. I can’t seem to reply directly to your post from my phone so I have to reply here.

I would really like to be able to veiw the recent studies you mention. It is very unlikely to change my personal opinion, but I would like to learn more. I also appreciate your bias. I have my own questions in that regard, but since my knowedge of the Jewish faith is minimal, explaining it would be like teaching a pre-schooler. I choose to accept it as is and form no personal opinion on the matter.

I agree that it makes sense for circumcision to reduce HIV/AIDS and HPV transmission, but my opinion is that it is unfair to 1) assume our boys will make choices to become high-risk for transmission, particularly before they are old enough to make their own choice about becoming circumcised and 2) to use a surgery on an infant to reduce a potential risk that can be better reduced by proper, consistent use of condoms (which should be used by circumcised men as well since circumcision only reduces the likelihood of transmission. I don’t see resources telling adults that if you’re circumcised, you don’t need to worry or use a condom, but when parents are on the fence about circumcision, this is a reason often cited. My point is, condoms need to be used either way and I feel parents are often misled into believing that the risk is high and circumcision is the best means to counter that risk.

I agree that we cannot simply say that because the U.S. has high circumcision rates and a high rate of HIV/AIDS is conclusive of anything. There are other forms of transmission (primarily sharing needles) that are not taken into account. Correlation does not prove causation. However, it does make me ask another quesion: if the difference is not due to circumcision rates, shouldn’t we focus efforts in other areas instead of frequently misrepresenting circumcision as *the* solution.

I also agree that intactivists are frequently convinced that hard feelings exist in *all* men but are repressed in many. I do not believe this is true, although I think that many men have more disappointments about their circumcision than will admit it. It’s the nature of men. I have talked to many men who are open about their feelings about their own circumcision. Many men are very happy. Many are not. I can’t imagine having such hard feelings, but some have even gone to the point of having sued their parents and/or the person who performed the surgery. I think that this fact alone should be indication for encouraging parents to leave their sons intact until he is truly old enough to make that decision for himself. It does seem, though, that Jewish men have theese feelings less frequently. Maybe it’s because they consider it a rite and it is a mark of pride? I don’t know. I should also say that I have one intact friend who is very pro-circ, but also one who was intact and in his 50′s the scarring from his forced retraction caused phlemosis (sp?) and resulted in adult circumcision. He is open about the fact that he is very unhappy with the difference.

The fact also remains that many doctors choose not to provide the possible risks involved with the circumcision surgery. Doctors have confidence in their abilities (which is great!), but accidents do happen and when they do, it is the infant (in infancy and/or adulthood) who suffers from it. Many moms have said if they’d really known how circumcision worked, they would have left their sons intact.

The defects I spoke of are as follows:

My husband has a skin bridge which in the 6 years I’ve known him (he is now 36) has become tighter and appears to be tearing at the glans. Sometimes it causes him pain during erection and it is always sensitive to touch. His scar is hardly noticible, and the doctor did appear to be conservative in how much skin was removed. He has also recently confided in me that he is disappointed that he didn’t have a choice. (I have gone out of my way to avoid him feeling this way by speaking only of it being unnecessary and not of the nerve endings lost.) His mom was relieved that we chose to keep our son intact as she has felt guilty for having circumcised her boys.

When my ex-husband was circumcised, too much skin was removed. His scar is nearly at the base of the shaft and is extremely uneven. So much so that it appears to be two different penises. Obviously I don’t think it is, but it really is *that* drastic of a difference. I don’t know if this has anything to do with why so much removed, but he is considered a “grower”. Because so much skin has been removed, his erections are very painful, causing him to lose erection quickly. He is also more self-conscious than most. Its unevenness also causes it to pull to the left at probably a 30 degree angle. He has also complained that he wishes he had been “left alone” (his words, not mine) and feels that it has affected his size substantially. It is painful enough and he is disappointed enough that when I learned about restoration techniques, I let him know about it even though we had long been divorced. We spent a great deal of money trying to resolve it years ago, but to no avail.

Neither of them have complained about a lack of sensation, but to be fair (and without putting words into anyone’s mouths), men who were circumcised as infants cannot attest to what the sensation difference amounts to. My friend who was circumcised in his 50′s is the only person I know who can fairly give this testimony. I know for fact that a circumcised penis is very sensitive. However, simple biology says that an intact penis, having thousands more nerve endings, will be significantly more sensitive.

There are also studies that have concluded that early experiences, both positive and negative, imprint on a person’s subconscious and can have an affect on a person’s future tendencies. Since I have limited knowledge regarding the specifics of these studies, I consider this a point of consideration, but not a driving factor in the choice to leave boys intact. I also question why female circumcision is strongly opposed and is illegal in the U.S., but the same is not true of male circumcision. Just a thought.

Again, I thank you for the conversation and I greatly appreciate your explanation of your position. If you’d like to continue discussing further, please feel free to email me directly. My email is shortcake34567 @gmail.com. I truly hope to hear from you, Mitch, or anyone else who would like to discuss.

I’d like to draw attention to some of the language I’m seeing here.

First of all, birth attendants don’t *deliver* babies. Women are doing the delivering. It’s called labor for a reason. Instead, birth attendants *catch* or *receive* babies.

Second, we need to abandon the language of obstetric *management.* Women don’t need *managed,*, thank you. Instead, midwives and physicians *attend* births.

And finally, we need to move toward speaking not of *patients* but of *clients* or *consumers.* Patients are passive; clients hold an active voice in the care that they are hiring providers to give them.

I thought of another language issue that I have, although thankfully I haven’t see it in this discussion. It’s the words “let” and “allow.”

“I never LET my patients go past 40 weeks.”
“You’re not ALLOWED to refuse electronic fetal monitoring.”

The efforts to control women can really get out of hand…

I guess Im odd, because my natural, non-augmented L&D was the worst of my 3…