Posted by My OB said WHAT?!?.
Oct
5
Posted by My OB said WHAT?!?.
“If That’s The Type Of Birth You Want, You Should Consider Home Birth.”
“What is that book? ‘Gentle Birth Choices?’ What does *THAT* mean?…. If that’s the type of birth you want, you should consider home birth.” – OB to mother at 37 week prenatal, when mother stated she wanted an intervention free birth.
There are 46 comments to this post.
Jessica had this to say,
Oct 5, 2011 @ 2:35 pm (Quote)
Well let’s consider the first word in the title. Gentle. Meaning you won’t poke me with needles, cut my body, manhandle me, yank my baby out of me or yank her placenta out, you’ll speak to me in a relatively quiet and soothing tone while I’m in labor and I won’t have to endure the screams of “PUUUUUUUSSSSHHHHH” as I’m birthing, etc.
Birth. As in, I’m giving birth. You are not delivering.
Choices. This is that little thing called informed consent. I get to call the shots, you get to provide the services. This can be done in a hospital setting, believe it or not. It just requires a tiny bit of effort on the part of the doctors and staff.
Better yet, you’ve got about 3 weeks until I’m due. Why don’t you read the book yourself?
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Sarah Reply:
October 6th, 2011 at 6:41 am (Quote)
You’re right, it is very possible. My last birth was rough, but with an awesome doctor. I was manhandled, but only because I requested it. I had extensive cervical scarring and was afraid I would end up with a section if he didn’t massage it out for me. It was incredibly painful, but every time he worked on it, he stopped as soon as I asked him to. I did end up with an epidural, but only because *I* asked for it, it was never suggested, much less pressured. I knew I was losing the ability to relax during contractions and I could feel myself holding back in spite of my intentions. Sure enough, I went from 4-10 in minutes as soon as it was in allowing me to get out of my way.
I was never yelled at to push and a medical student, guided my OB and with my permission, guided my baby into the world as I pushed her out. She was placed immediately on my chest and nursed for the next two hours. So yeah, a hospital birth, even induced, can be gentle.
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To be fair, this is kind of a big thing to spring on an OB at 37 weeks of pregnancy if it hasn’t been discussed previously. OBs have a right to manage births in a way they are comfortable with, and we have a right to not choose OBs who manage births in a way we don’t want. But to expect an OB to totally change their philosophy with no notice is a bit much.
I guess this strikes me as going to a naturopathic doctor and asking for a whole bunch of prescription drugs. It’s just not what they do. In the case of OBs, it would be great if they did, and I think education should move that way. But it’s not now for most, and expecting an OB to do a complete 180 and do things they might feel are dangerous based on their experience and knowledge (even if flawed) with no forewarning really seems unreasonable to me.
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BeckyJ Reply:
October 5th, 2011 at 2:56 pm (Quote)
Uhhh….no it’s not. Someone going over their birthplan with their OB shortly before their due date makes it more likely that they would remember your wishes. Would you discuss your birth plan at 15 weeks gestation? Or when you are gearing up to have the baby?
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VW Reply:
October 5th, 2011 at 3:02 pm (Quote)
Actually, yes, you should be discussing these things at 15 weeks or whenever so you can choose the right care provider. Not that people don’t change their minds or learn new things, but generally, it’s a good idea to discuss your preferences early exactly so you can avoid this kind of situation.
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C Reply:
October 5th, 2011 at 3:03 pm (Quote)
actually, I think the earlier you discuss these things, the better. that way, if you don’t like the answer, you can find another provider. at 37 weeks, no one but a homebirth midwife will likely take her. and every mother should birth where she feels safest.
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Eileen Reply:
October 5th, 2011 at 3:06 pm (Quote)
If I was seeing an OB I’d bring it up as soon as possible and repeatedly, but definitely have hit the high points by 20 weeks gestation. If not talking through a whole birth plan I’d at least be talking through ideas to make sure the OB is on the same page as me. By 37 weeks I should know that my doctor is OK with minimally-interventive births, because it’s not standard so if it’s important to me I need to make sure it’s true. I agree it makes sense to talk through specifics of my actual birth plan closer to the due date, but it shouldn’t be the first time the doctor has ever heard I’m not all-for interventions.
PS This is why I said “if it hasn’t been discussed before.” If the doc has been telling her it’s fine and he’s supportive the whole time, and pulls this when discussing the birth plan, well that’s a whole ‘nother problem. I was only speaking to the case if mom has no idea what the doctor’s philosophy is and has never shared hers with him. Alternately, maybe mom has no choice of doctors, etc. I’m not saying mom is automatically in the wrong or the doc is totally right (I wish all OBs were OK with non-interventive births!), just that in one situation I can see this not just being an evil doctor.
Another analogy: to me this is like going to a midwife for prenatal care, and then at 37 weeks asking how soon you can get the epidural after never having indicated you want medication for your birth previously. Some midwives work in/with hospitals and are fine attending women who want epidurals, but most aren’t. You can’t just assume any provider will do whatever you want, especially when it is contrary to the typical care for their profession.
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C.Pratt Reply:
October 5th, 2011 at 3:07 pm (Quote)
Imho most people don’t prefer to change care providers late in pregnancy, it can be pretty scary. Also, some practices won’t take patients on after a certain date. Given these facts do you still think it wise to wait until the last few weeks to discuss it with the OB to establish some sort of understanding? But, I agree completely that an end of pregnancy refresher is a good idea 
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BeckyJ Reply:
October 5th, 2011 at 3:10 pm (Quote)
I think it wise to interview the physician first to see what they are comfortable with, but that’s never fool proof either. They are human and can also be liars, just so they can keep a patient.
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Jess Reply:
October 7th, 2011 at 10:10 pm (Quote)
And still, Eileen’s point remains. The fact that a doctor can change their stance at the last minute doesn’t mean there’s no point in discussing it early. If you bring it up at 15 weeks and they are already hostile, then you know IMMEDIATELY to find someone else. Sure, they may pretend to be on board until the end and then switch gears, but you can’t predict that either way. At least by TRYING to discuss these things early (“interviewing”, as you’ve said) you have a better chance of finding a doctor who shares your philosophy.
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Mama Wrench Reply:
October 5th, 2011 at 5:01 pm (Quote)
Not every woman has that option, for one thing — and many women don’t have control over which OB in a practice will be the one attending. Maybe she hadn’t seen this particular OB previously because she’d seen the others in the practice.
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Eileen Reply:
October 5th, 2011 at 5:04 pm (Quote)
I totally agree, and I tried to (briefly) address that in my second comment. I am not saying this mom is automatically in the wrong. I’m just saying, more often than many of the MOBSW comments, I can see this not entirely being a case of the awful OB.
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Wendy Reply:
October 5th, 2011 at 5:02 pm (Quote)
Eileen, let’s get some context from the OP first. A woman could enter into a big OB practice. Early in her pregnancy, she sees an OB who understands her wishes and tells her they’re hunky dory. Later another OB tells her something else. It’s becoming increasingly en vogue to consolidate obstetric practice into these big, Wal-Marty clinics (often run by giant hospitals or health care corporations) and have patients seen by five different doctors. That’s just one example. There *could* be some other context surrounding the OP’s circumstances that we’re overlooking.
Also, there are some wee holes in your naturopath v. OB analogy. OB’s don’t honor many childbirth-related requests (e.g. low interventions) simply because they don’t want to. Naturopaths don’t fill prescriptions because they legally cannot. Also, while we should take for granted that a naturopath will offer natural remedies, we should NOT take for granted that OBs are doing such anti-evidence practices as denying food and drink to women during labor, inducing for big babies, or applying and overusing such interventions as electronic fetal monitoring. The former is to be expected; the latter is unacceptable.
Finally, people can and do complain about naturopaths, saying that *their* interventions are anti-evidence. But seeing a naturopath is very much a free choice made by people who can afford it. For healthy, low-risk women seeking prenatal care in some regions of the country, and for those wanting to make sure that insurance will cover them, an OB is all too often their only choice. A lot of us post here precisely because we want to make this “only choice” more bearable for women. No woman should have to enter an obstetrician’s office “expecting” someone who won’t support evidence-based, low-intervention childbirth.
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Eileen Reply:
October 5th, 2011 at 5:09 pm (Quote)
I agree with everything you said. I was NOT trying to say mom is automatically in the wrong. I was saying if this had never been discussed, and at 37 weeks a mom pulls it out of nowhere, I would give an OB some slack just due to their surprise. Despite the community here, most women do not want the kind of childbirth we do, and many who do don’t end up with OBs. I think it’s safe to say such women would be a very small percentage of an OB’s case load.
I agree, the analogy isn’t perfect. Was thinking off the top of my head. Just saying going to one professional and expecting a difference in philosophy from the norm with no prep is not always reasonable. We may like it to be, and I agree with your last paragraph and I wish the current OB philosophy WASN’T the norm. However, today it is. We can work to change that, but we can’t be shocked when it is the case.
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Mama Wrench Reply:
October 6th, 2011 at 1:59 am (Quote)
Do you have any evidence to back up the claim that “most women” don’t want noninterventive births? Because the data I’ve seen, regarding c-sections anyway, is that most women want to avoid interventions as much as possible unless medically necessary. I think that if all OBs were required to disclose the likelihood for interventions to change an otherwise ideal vaginal birth into a surgical one, most women would agree that interventions are to be avoided.
“Most women” are probably not passionate about birth, but I think most would agree that you shouldn’t take medicine if you’re not sick. Physicians just take advantage of the fact that “most women” trust their doctors to tell them all the side-effects of their actions or inactions.
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Jess Reply:
October 7th, 2011 at 10:17 pm (Quote)
Perhaps that’s along the lines of what she means. “Most women” do not want to be at odds with thier care providers, so they go into childbirth with that “I’d like to go as natural as possible IF I CAN” mentality (that’s what I have see 90% of the time on massive, mainstream pregnancy forums.) Most women probably do not go into it armed with natural birthing literature and a determination to accomplish it come hell, high water, or angry doctor. And I would imagine that on the ocassion that an OB *does* have one of those women walk into their office, they’re probaby not exactly excited about or prepared to make the kind of exceptions that those type of mothers are fighting for. But…..at least this doctor was honest. Unfortunately, it’s the truth in most cases. If that’s the kind of birth you wanted, you are barking up an odd tree, because that’s not the norm here! Gotta give ‘em credit for telling it like it is, if nothing else….
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Mama Wrench Reply:
October 5th, 2011 at 5:18 pm (Quote)
OH I almost applauded in my chair! lol
There are SO many women who, for one reason or another, must see an OB. That is exactly why there needs to be a standard of evidence-based care with which OBs must be compelled to comply.
For several reasons — financial and professional — I must see an OB. After one traumatic birth that resulted in a c-section I would MUCH rather birth with a midwife in a birth center, but I simply can’t do it. I should not be in the situation I am now, not knowing whether my physician will even respect my choices for birth or attempt to manipulate me for his own convenience. Respect for the patient’s wishes, no matter WHEN they are presented, should be the default, not the exception.
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Jess Reply:
October 7th, 2011 at 10:21 pm (Quote)
It shoudl, which is where I DISAGREE with Eileen. An OB does not have the right to ONLY practice in a way that they are “comfortable”, they have a professional obligation to offer any valid alternatives to their patients….because the patient has the LEGAL right to those options. And you are correct, ti should not matter if the mother brings it up when she shows up in labor, she should be respected, her beliefs and her preferences should be respected. Sadly, that’s not how it works. It SHOULD be, but it’s not. And at this point, we have to plan accordingly. It’s not right, but it’s reality.
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Weep Reply:
October 6th, 2011 at 4:41 am (Quote)
When I was 15 weeks along with my first I just had my first check up listened to the heart beat. I had not read one book on giving birth only a few things about being pregnant. I think I was around 35 weeks when I made up my mind how I wanted it. Is that strange? No because I am sure you can not know what you want in such an early stage of a first pregnancy. Why is an OB so hositle to being empathic and respectful? Thats what the point is here. My first pregnacy I did not even write a plan. I was having the baby at home anyway. However, meconium told us to go to the hospital. And I still regret that in my later stage of my pregnacy I didn’t go there and told them about my wishes of having a gentle birth. It was the worst exeprience I endured. It still feels like I was stripped of all my dignity and I was treated as a malfuncting vessel who could not give birth to a baby and that I needed a couple of heroes in the hospital to help with that.
And of course the baby can be in distress when it poops, but this was not the case as it turned out to be. Her heart rate was absolutely normal.
I absolutely think that everyone should go to the hospital one might end up, when there are medical complications and discuss the birth plan in the case of medical intervention. Because it is, as I have noticed on this forum, there where a womens rights are violated the most. And it is good to know that this OP did not have to count on this care giver as one who would respect her rights to physical en psychological integrity. She could still make a run for it.
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I hope the OP took the doctor up on that and had a home birth. :#)
The doctor’s attitude is more problematic. The subtle mockery in “what does THAT mean” and “what is that book” are meant to belittle the mother for reading The Wrong Books and being stupid, misled, or gullible.
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For a second I thought this was Thoughtful Thursday
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Kate, Ren's Mama Reply:
October 5th, 2011 at 4:31 pm (Quote)
Me, too! When I just saw the title, I thought the doc was actually advocating for home birth! Alas, the rest of the the quote revealed the doctor’s lousy and condescending attitude towards low-intervention birth 
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This very well could have been my OB. All along the pregnancy was we can meet your needs and what you want for a birth. Given that they had midwives employed at the office that I saw routinely I believed them. I was told early on that we would discuss my birth plan at my 36 week appointment. Needless to say I found out very differently at that appointment, but it was too late to switch (I developed preeclampsia later that week and had an induction). As many first time mothers find out, there are a lot of smoke and mirrors in the OB world, it is just at varying times the curtain is pulled back.
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first time mommy had this to say,
Oct 5, 2011 @ 5:38 pm (Quote)
well gee I’d love to but oh gee I don’t think that’s an option. My apartment complex is much much too tiny (I’d want a home water birth if I had a homebirth and there is NO room) and besides the walls here are PAPER THIN. I can hear my neighbors turn the pages of books that’s how bad it is here. Plus, I don’t trust the disrespectful kids who run around like idiots here.
So while yes a homebirth would be nice to consider, it is not an option for all women. Be thankful you’re getting “business” and let the women birth how they want to birth.
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I took books in with me all the time. I never got a single rude reaction. It seems like a good way to get the doctor to show his/her true self. Of course that was later. With my first pregnancy I assumed the doctor was looking out for my best interests and never questioned a thing.
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I would actually challenge the OBs to read the darn book. Seriously, how can they not? At least read the reviews if not the entire thing, as this should fall within their professional responsibility to keep up to date on their patients’ knowledge. I would want to know what my patients are thinking.
I established my background with my last OB from the get go – I think I owed her that – because I understand the medical model of care. I am a NICU nurse. But I wanted, and got, a natural birth in hospital. I had no choice but hospital because of the financial aspect. And I told the OB that, and I researched the “hospital rules” for laboring patients before going in. I knew, beforehand, what the nurses were required to do and what was optional. (Like EFM – required for 20 mins, but continuous was NOT required, nor did I have it continuously.)
Then I kindly made sure I delivered two hours after admission because less time in hospital means fewer interventions! And yes, I know we don’t have absolute control over that last thing.
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Arzt4Empfaenger had this to say,
Oct 7, 2011 @ 7:16 am (Quote)
Well, fair enough, I appreciate the honesty. That was exactly the reason why we went to the birth center in the end.
Hospitals do have a lot of forensic hind thoughts, more than necessary, but that’s a different issue. While I hate it, I can understand why there’s often too much done (by people who are afraid to take even small risks aka have no balls).
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Original Poster had this to say,
Oct 7, 2011 @ 10:42 am (Quote)
A few quick comments: I live in a small town in which only 2 OB practices exist. They are both large and have several OBs which ‘cover’ births and you do not have any choice in your care provider. They also both have patients seen by CRNPs (who cannot attend deliveries) until the 3rd trimester. Lastly, both the OB practices in my town literally fired all of their midwife staff when I was 36 wks pregnant with my 1st child.
There is a homebirth midwife locally, but she was booked for the month I was due AND my 1st birth was so medically managed (forceps delivery) that I did not feel comfortable birthing at home. Also- I could not afford to pay out of pocket for a homebirth and having an unassisted birth does not appeal to me.
The doctor who said this to me was meeting me for the first time in the pregnancy and greeted me with these words, not “Hello I am Doctor Suckface…” She also took the liberty of starting the conversation about the book/birth plans/etc without an open mind or listening ear. Her questioning of the book was VERY condescending and clearly disapproving.
Lastly- to tell a woman who is days away from giving birth that she should switch providers (in order to achieve her ideal birth) is asshatery at its finest. There are several very classy ways in dealing with the situation and she chose the low road. Her ‘suggestion’ of homebirth was not a proactive, compassionate one. The conversation could have just as easily went like this,
‘Hi, I am Dr. Suckface. So nice to finally meet you… How are you feeling? Any complaints? Okay, great. I see you have a book with you today. Can we talk about that…’
‘Okay, so what I understand is you’d like an intervention free birth. I support your right to have what you want, but I need you to understand we have certain protocols, etc we prefer to adhere to. Is there a compromise we can reach? Can I offer you consoling in another birthing option?’
It’s not about being an ‘evil OB’ it is about being a kind person and effectively communication with patients. NOT BULLYING.
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Jane Reply:
October 8th, 2011 at 4:16 am (Quote)
I’m sorry. We were in a very similar situation at one piont (only one practice took our insurance in the city) but we were fortunate enough to be able to change insurance companies in order to ditch them.
Bullying has no place in medicine. I’m sorry you had to deal with that.
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Add Your Comment.
Is it really all that hard to wrap your mind around the concept of an intervention free birth? Really? It is not heart surgery or cancer treatment or even bunion removal. It is birth, women have been doing if for a really really long time with out OBs meddling.
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