Jan 302013
 

“If you need to transfer to a hospital for your birth, you are no longer under the control of your midwife. You become our patient at that point and then WE have the control.” – Hospital midwife to mother when discussing if or when a transfer became necessary.

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 January 30, 2013  CNM, Home Birth, Midwife  Add comments

  32 Responses to ““…You Become Our Patient At That Point & Then We Have The Control.””

  1. “You can show me where it says that in the patient bill of rights, correct? That informed consent no longer operates in this hospital?”

  2. This is mine, also…it’s the same story from yesterday, about monitoring my own blood sugar. This lady has another thing coming if she ever thinks she’s in control of me. Hopefully I can stick it out another 3 weeks and go to my own birth center and never see her again.

    • I don’t know if your midwife’s collaborating physician has hospital privileges, but it would be worth finding out so you could write a birth plan. If the collaborating physician signs the birth plan as his/her orders, then the hospital staff will need to follow the doctor’s orders.
      The horrible hospital staff may not even be working a shift during your hospital stay *if* you have to get transferred.
      I have the same problem where I live. Here, there are no midwives or birth centers for hours in any direction, so I have a wonderful OB who is very supportive of natural birth, which is my preference. I will be giving birth in the hospital and my OB and I work out a hospital birth plan that will become his orders for my care, so unless hospital staff want to disobey his orders, they give me the birth I want.

      • Good idea on the birth plan. I guess I’ve had it in my head the whole time that I’m going to the birth center, and my birth plan is pretty much on par with what they do. I’ve been procrastinating writing it so I need to get on the ball with it. I go see my collaborating doctor when I’m 36 weeks, but by then I’ll be able to go to the birth center. The midwife I work with would be there as my doula, if I transfer, so I know she’d be able to help things go along with my plan, even if it isn’t anyone’s orders (except mine!)

        • Hi Katie,

          I’ve been lurking here for a while out of curiosity and I’ve learned so much (even though I won’t have children for a couple more years). In my newfound obsession with MOBSW I came across this link from a midwife in her own blog, with a simple birth plan template. The comments are very helpful as well. Maybe it will make drafting a plan seem like less of a task?

          http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2008/10/25/updated-birth-plan-template.html

          Good luck!

        • Has your midwife spoken with you about what she actually does when she acts as a doula and given you a written copy? It is my understanding that doulas in general are great for encouragement and massage (which is also very important), but not necessarily great as an advocate (such as reminding Nurse Meaniepants what manners are or telling Dr. Cutty that he forgot to ask you about the episiotomy he’s getting ready to cut) because that kind of thing can get you banned from some hospitals. With midwives like this employed at your local hospital, it would be good to know what you can expect in the extremely unlikely event that your midwife switches rolls and becomes your doula. Congratulations and good luck. I very much hope everything goes according to plan and that any “what if” planning you do turns out to be completely unnecessary. :)

          • Not all doulas shrink from advocating for their clients. I actually once wrote letters of complaint on my client’s behalf to the hospital administration, head of obstetrics, and the doc’s practice when the doc disrespected my client’s wishes. My name is all over the place there. I haven’t gotten banned yet. I got yelled at by a nursery nurse for advocating (she called it rude). On the inside I’m scared of repercussions but I don’t show it on the outside, and I’d do it again, every time.

          • That is so great, I hope the OP’s midwife is like that too (just in case). And that I can find one like you if I ever get to have another child. :)

    • See this right here? This is why I want to be a hospital CNM. I trust the vast majority of CPMs and direct-entry midwives in their care protocols and I love CNMs who do out-of-hospital (in fact I’d like to do both at some point). But most women give birth in a hospital and they shouldn’t be taken care of by crappy CNMs who do a disservice to the whole profession with this BS!! And those going to out-of-hospital providers who have to come into the hospital for whatever reason, shouldn’t have to put up with it either!

  3. You can take my decisions away from me, then I sue and file complaints.

  4. Any Mass Effect fans suddenly hear Harbinger saying, “Assuming control”??

  5. RUN!!! Or have a very stubborn support team that won’t leave the room/your side for anything or anyone.

  6. Sounds like the nurse that made my friend decide to take her lawyer into the hospital with her.

    Yeah, she really had a lawyer in the delivery room. He’s a family friend and has been “the” lawyer for years. He introduced himself as “Friend’s Lawyer. I’m just here to make sure her rights are respected. And if they arent that we have EVERYTHING we need for… later.”

    • Hey, you may be on to something here. I’ve a friend who is a lawyer & a doula. What a great combination!

      • I was just thinking the same thing!

        • Yeah that is not adversarial at all….

          • I’m going to descend to kid-language and say:

            “They started it!”

            Seriously though, if nurses/hospitals/OBs/midwives/healthcare providers/etc. didn’t try to override mothers so much, no one would even contemplate this as a necessity. What should a person do when they’re going into a VERY vulnerable situation with an already adversarial staff? Complain later? Thanks, I’d rather have a lawyer with me.

          • I think it’s okay to be adversarial if you’re doing it in response to someone else’s threat. “We’ll have the control once you’re here!” is not respectful of the patient’s rights, and once they’ve laid down the gauntlet, I think it would be foolish not to come in with every possible tool at your disposal to protect your rights.

          • I don’t understand why adversarial is a bad thing in this context. Attorneys protect the rights of people. If you don’t like your rights protected, that’s your option.
            As an attorney, and as a mommy, I read through a whole lot of consent forms and informational forms that my and my children’s doctors want me to sign. A majority of the forms that I am told are merely informational actually contain language that when signed and consented to would lead a judge to believe that the patient consented to many medical procedures, treatments and exams – even prior to anyone knowing there is a need for those.
            Likewise, many of the consent forms, when signed and consented to would allow a doctor to completely control your medical care without your consent, no matter how invasive and unnecessary the procedure, treatment or exam is.
            I have never seen a form at a doctor’s office that I did not have to change to maintain my right to informed consent or refuse to sign.
            I mention consent forms, even before I mention how controlling and pompous some medical staff can be. Anyone who has read this website knows that there are many instances of medical staff misconduct due to god complexes, and the fact that many patients probably sign over their right to informed consent in the papers they sign in their doctor’s office prior to even seeing a doctor or having a known medical condition in need of exam and treatment.
            Many patients don’t know their rights, or know they won’t be able to stand up for their rights, but know that they don’t want the medical staff bullying them into procedures while the patient is in a vulnerable position. In this instance, it is perfectly acceptable to want and to have someone either videotaping the medical staff, or to have and advocate present (or both).
            Keep in mind, everything the doctor makes you sign before a medical procedure is ONLY to cover his/her butt in the event of something going wrong. It is not to help the patient. Lawyers draft nearly every consent form that your doctor makes you sign. In spite of that, patients don’t have an attorney explain the consequences and the loss of patient’s rights that flows from signing those consent forms.
            If you want to consider how adversarial the medical system is, consider all the forms you sign absolving the doctor of liability if a normal procedure goes awry. Consider that doctors lobby for tort reform so they don’t have to pay as much when they royally mess up a procedure, and their patient’s life. Consider how nearly every hospital policy is written by a group of lawyers NOT a doctor, in order to reduce malpractice liability. Those policies that the attorneys draft are not based on science, but are based on the statistical probability that a specific procedure will result in a injury that could be foreseen and mitigated. This is the exact reason that VBACs are difficult to get. It is foreseeable that injury will occur at a higher rate than that of mothers without a prior cesarean, a cesarean is considered “standard practice in the community” (that is medical community – evidence that ‘all the other doctors are doing it this way’ can absolve the doctor from much liability), a cesarean can mitigate the risks of a VBAC. You say, but the cesarean has risks of its own. The reason lawyers prefer a doctor to perform a cesarean is that principle above of “all the other doctors are doing it”.
            I’m not saying your doctor is evil for not wanting to give a VBAC, I’m saying your doctor is told what procedures will and won’t be covered under his/her malpractice insurance, and that influences his/her decision on what procedures he/she will perform. The doctor’s own lawyers dictate the medical care you receive.
            Has it occurred to you that this adversarial system is the result of doctors having a posse of lawyers in their corner, and not a result of a patient wanting anything more than his/her rights respected?

          • I agree. But if the hospital comes off as “we’ll stick to our standard procedures and ride over anyone who wants something different” then it’s hard not to want to fight back. Most hospitals at least make an attempt to be accommodating. This one seems to have missed the memo…
            I could see just introducing the lawyer as a ‘friend’, and outing him as the lawyer if it becomes necessary.

          • I don’t understand why adversarial is a bad thing in this context. Attorneys protect the rights of people. If you don’t like your rights protected, that’s your option.
            As an attorney, and as a mommy, I read through a whole lot of consent forms and informational forms that my and my children’s doctors want me to sign. A majority of the forms, that I am told are merely informational, actually contain language that when signed and consented to would lead a judge to believe that the patient consented to many medical procedures, treatments and exams – even prior to anyone knowing there is a need for those.
            Likewise, many of the consent forms, when signed and consented to, would allow a doctor to completely control your medical care without your consent – no matter how invasive and unnecessary the procedure, treatment or exam is.
            I have never seen a form at a doctor’s office that I did not have to change to maintain my right to informed consent or refuse to sign.
            Anyone who has read this website knows that there are many instances of medical staff misconduct and misinterpretation of the law. However, many patients sign away their right to informed consent by failing to read before signing the papers they are given in their doctor’s office prior to even seeing a doctor or having a known medical condition in need of exam and treatment.
            Many patients don’t know their rights, or know they won’t be able to stand up for their rights under certain conditions, but know that they don’t want the medical staff bullying them into procedures while the patient is in a vulnerable position. In this instance, it is perfectly acceptable to want and to have someone either videotaping the medical staff, or to have and advocate present (or both).
            Keep in mind, everything the doctor makes you sign before a medical procedure is ONLY to cover his/her butt in the event of something going wrong. It is not to help the patient. Lawyers draft nearly every consent form that your doctor makes you sign before a procedure. In spite of that, patients don’t have an attorney explain the consequences and the loss of patient’s rights that flows from signing those consent forms.
            If you want to consider how adversarial the medical system is, consider all the forms you sign absolving the doctor of liability if a normal procedure goes awry. Consider that doctors lobby for tort reform so they don’t have to pay as much when they royally mess up a procedure, and their patient’s life. Consider how nearly every hospital policy is written by a group of lawyers NOT a doctor, in order to reduce malpractice liability. Those policies that the attorneys draft are not based on science, but are based on the statistical probability that a specific procedure will result in a injury that could be foreseen and mitigated. This is the exact reason that VBACs are difficult to get. It is foreseeable that injury will occur at a higher rate than that of mothers without a prior cesarean, a cesarean is considered “standard practice in the community” (that is medical community – evidence that ‘all the other doctors are doing it this way’ can absolve the doctor from much liability), a cesarean can mitigate the risks of a VBAC. You say, but the cesarean has risks of its own. The reason lawyers prefer a doctor to perform a cesarean is that principle above of “all the other doctors are doing it”.
            Doctors are not necessarily evil for not performing some procedures (e.g. a VBAC), but doctors are told what procedures will and won’t be covered under his/her malpractice insurance. That influences the doctor’s decision on what procedures he/she will perform. In other words: the doctor’s own lawyers dictate the medical care you receive.
            Has it occurred to you that this adversarial system is the result of doctors having a posse of lawyers in their corner, and not a result of a patient wanting anything more than his/her rights respected?

          • I don’t understand why adversarial is a bad thing in this context. Attorneys protect the rights of people. If you don’t like your rights protected, that’s your option.
            As an attorney, and as a mommy, I read through a whole lot of consent forms and informational forms that my and my children’s doctors want me to sign. A majority of the forms, that I am told are merely informational, actually contain language that when signed and consented to would lead a judge to believe that the patient consented to many medical procedures, treatments and exams – even prior to anyone knowing there is a need for those.
            Likewise, many of the consent forms, when signed and consented to, would allow a doctor to completely control your medical care without your consent – no matter how invasive and unnecessary the procedure, treatment or exam is.
            I have never seen a form at a doctor’s office that I did not have to change to maintain my right to informed consent or refuse to sign.
            Anyone who has read this website knows that there are many instances of medical staff misconduct and misinterpretation of the law. However, many patients sign away their right to informed consent by failing to read before signing the papers they are given in their doctor’s office prior to even seeing a doctor or having a known medical condition in need of exam and treatment.
            Many patients don’t know their rights, or know they won’t be able to stand up for their rights under certain conditions, but know that they don’t want the medical staff bullying them into procedures while the patient is in a vulnerable position. In this instance, it is perfectly acceptable to want and to have someone either videotaping the medical staff, or to have and advocate present (or both). (cont)

    • It’s awesome that your friend had the gumption to do this! :)

      It’s awesome that the lawyer was willing & able to be there! :)

      It’s not so awesome that this kind of thing can be necessary. :(

    • My friend was told in no uncertain terms by the OB she was more or less stuck with that she was a “C-section waiting to happen” and that she was stupid for wanting anything less because her husband wouldn’t want her after her parts got “Screwed up” by the baby.

      He also told her women CAN’T have a baby without an episiotomy and that he “hated thes euppity type women”

      He REALLY hated her lawyer, who documented everything he said and asked for a “signature confirming this exchange of information” for pretty much anything.

      Oddly, she says her lawyer and the OB who actually delivered her (The first one went off call without telling her OR the mother in the next room, so they both just got a shock when a diffrent OB came in and introduced himself.) got along just fine. They (and my friend) discussed the plotline of a prime time show through transition and the new OB asked her if she wanted to cut the cord herself. (She did)

      She claims her lawyer was tyhe best birth coach she had. He argued with her when she hit the “I can’t do this” stage with “Of course you can! You ARE doing this.”

      Her husband ran away at her first pushing howl.

      And Goldilocks, from some of your posts, I doubt you’d be the type of OB that would need a lawyer sic-ed on them. Her OB was just a very nasty, unpleasant man who knew women were more or less stuck with him if they had Friend’s type of insurance. (No it wasn’t medicaid or anything, its a private insurance through her husband’s job that has really lousy women’s benefits.)

  7. God complex much?
    I’m a person, not a bedpan.

  8. yeah, see i am not under the control of the homebirth midwife either. you don’t get it do you…?

  9. It’s caregivers with this kind of attitude that are responsible for most of the UC births.
    In my opinion.
    I know that some people choose it as their first choice, but I think that for many it is simply self-preservation.

    • No, I’d say that’s a very accurate statement.

      Only when/if doctors recognize that they are the only ones responsible for driving birth into the hands of midwives will we see obstetrics improve.

      In other words… don’t count on it.

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