ETA: Update! What happens if you flat out refuse medical intervention during childbirth?

[Mergath]

ETA Update: I had an OB appointment today (I thought it wasn't for two weeks, but apparently I have another one then, too) and I (very nervously) brought up the delayed cord clamping. My OB said that she routinely does delayed cord clamping, and will even try to do it when possible with babies in minor distress because it's so good for them.  Dh came along for moral support and he was looking at me like, "THIS is what you were so worried about?"

 

That'll teach me to unnecessarily worry about stuff ahead of time. :p :lol: :banghead:  

 

 

 

 

I'm starting to get really nervous about having this baby in August. Where I live there are only two OBs for an area of maybe 25k people, and I'm high-risk because I had pre-e with dd so I'm required to have an actual OB and can't have a midwife. My OB is less than ideal, to put it mildly. (The other one in town is even worse.) A couple of appointments ago she told me that she would be scheduling my induction for a week before my due date, and when I basically told her no thank you, as long as everything is going okay I'm going to wait to go into labor naturally, well, she was not happy. She acted like I was the first patient in history to tell her no. :glare: And she's about seventy, so that's a long history of patients. If she had been wearing pearls she would have clutched them while she gaped at me in shock.

 

Today I called the hospital because I wanted to find out what their policy is on delayed cord clamping, and whether they do it routinely or it was something I was going to have to specifically request, and the nurse I talked to said, "Uh, the doctor will decide what SHE wants to do for that." Implying that I have no say and can't even request delayed cord clamping, and the doctor will do whatever the heck she wants, thank you very much.

 

I'm also planning on not having pitocin just so the doctor can be done by dinner, refusing internal monitoring in favor of intermittent external monitoring, and asking for a saline lock rather than an IV so that I'm not trapped under a tangle of wires and tubes. And because, to be honest, I don't trust them not to slip me pitocin without my consent if I'm not progressing fast enough for them. (Obviously, I'm fine with interventions if something is wrong- this is my plan for everything going smoothly.) Based on my experience so far, I'm guessing all this will go over like a lead balloon.

 

What I'm wondering is, how much say do I actually have? If I outright refuse something like internal monitoring, can they force me to have it somehow? Kick me out when I'm in labor? The only other hospital is an hour's drive away, isn't a very good hospital, and is right smack in the middle of the huge measles outbreak we're having here, so not really an option.

 

Can I order them not to clamp the cord immediately? Will they just ignore me and do whatever they want? I want to hold the baby right after she's born, but I'm terrified they're going to ignore me on that too and take her away and I won't get to hold or feed her for an hour. I'm sure the hormones aren't helping, but this stuff is really stressing me out. Dh has already promised to body-slam the doctor if she tries to clamp the cord too early or take the baby, bless him, but I'd prefer to find a way to navigate this that doesn't end with him in jail for assault. ;) I'm already planning on laboring at home for as long as humanly possible.

 

 

Edited June 14, 2017 by Mergath

[DesertBlossom]

I don't know. But that sounds like an awful situation to be in. For my #3 (when we lived in another state) at my very first prenatal appointment they made me sign an agreement consenting to a number of interventions including IVs, CFM, and pitocin after birth. They basically told me to sign or go elsewhere. And I did end up transferring care to a homebirth midwife. I knew I couldn't labor with those interventions and I certaintly couldn't go into the hospital fighting every step of the way. I would have been a wreck.

 

Being high-risk, homebirth isn't going to be an option. Fighting them on everything sounds awful. I am really sorry they are forcing you into a corner like this.

 

ETA: When I had #2 at the same hospital I said I didn't want pitocin after delivery unless I was hemorrhaging or losing a lot of blood. After baby was born the nurse expressed concern about the amount of blood so I consented to the pitocin. Later, when doing an examination she remarked "oh that's not as much blood as I thought." I really felt she had been dishonest about it just to make me consent. Just one more reason I have trust issues with medical professionals.

Edited June 9, 2017 by DesertBlossom

[Jean in Newcastle]

Do you have any friends or family near a good hospital? Someone you could visit around your due date?

 

 

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[bookbard]

Do you have a lawyer friend who can be your birth support person? Because legally, no, they can't do anything. But they might not 'remember' that unless reminded. 

 

On the other hand, you might end up with a great midwife on the day who is supportive. I hope it all goes well. I ended up transferring to hospital after a homebirth for my last child, ended up with a great midwife and the OB who I'd never met before was great too. 

[Mergath]

Do you have any friends or family near a good hospital? Someone you could visit around your due date?

 

 

Sent from my iPhone using Tapatalk

 

I've been thinking about that. Or, if all my vitals and tests are perfect right up until I give birth, just accidentally staying home a little too long and delivering here. :glare: The problem with "accidentally" delivering in a hospital near family is that dh most likely wouldn't be there, since he'd have to stay home to work. And I'm mostly kidding about having an unassisted homebirth. Mostly.

 

[gardenmom5]

do you have anyone out of town near a better hospital you could go stay at and deliver there?

 

I've also had nurses go against my easier going dr. - but those nurses sound like they'd love your ob. . . .

[Mergath]

Do you have a lawyer friend who can be your birth support person? Because legally, no, they can't do anything. But they might not 'remember' that unless reminded. 

 

On the other hand, you might end up with a great midwife on the day who is supportive. I hope it all goes well. I ended up transferring to hospital after a homebirth for my last child, ended up with a great midwife and the OB who I'd never met before was great too. 

 

Not one who lives in the same state. I have no problem advocating for myself once I know all the legalities, but finding hard, definitive info is surprisingly hard. Pretty much every website says something about being open and honest with your provider so you can decide on treatment together, and if that fails switching to a new provider. Yeah, don't I wish. Ugh.

 

They won't let me see a midwife. Not even for a routine exam. I already asked (begged, pleaded) to switch to a midwife and they told me it's absolutely, 100% not allowed for high risk patients. Gee, maybe you guys should get more than two OBs for an entire region of the state then?

 

[bookbard]

Oh sorry - I'm from Australia and midwife is default here. Maybe you'll get a supportive nurse, then?

 

If you want definitive info, can you call a lawyer from your area and ask? I guess that'd be expensive though. 

[bookbard]

Oh sorry - I'm from Australia and midwife is default here. Maybe you'll get a supportive nurse, then?

 

If you want definitive info, can you call a lawyer from your area and ask? I guess that'd be expensive though. 

[katilac]

You're in the states, yes? You need a WRITTEN birth plan on file with the doctor and hospital. It doesn't guarantee anything, but it does make it impossible for them to say they didn't know your wishes. The act of going over the birth plan will also alert you to what the OB considers acceptable, and what she does not. 

 

The way I understand, the courts have pretty much sided with the mother when it comes to mother/fetus conflicts: doctors cannot force intervention because they feel it would be better for the fetus, the woman giving birth retains autonomy. This won't hold true after the baby is born - that's one reason you want to talk to the doctor about the whole plan. You may find out that delayed cord clamping is something she agrees with or doesn't care about, so one less thing to worry about. 

 

I think it's hard to decide what to do in possible scenarios. You really need to discuss a birth plan with the doctor and gauge her reaction, and then take it from there. 

[Mergath]

Oh sorry - I'm from Australia and midwife is default here. Maybe you'll get a supportive nurse, then?

 

If you want definitive info, can you call a lawyer from your area and ask? I guess that'd be expensive though. 

 

Yeah, I doubt they're going to give me legal advice regarding childbirth unless I've actually hired them, sadly. And I definitely don't have enough extra cash to hire a lawyer. Baby gear has gotten expensive since the last time I had a child! Holy cow.

[Mergath]

You're in the states, yes? You need a WRITTEN birth plan on file with the doctor and hospital. It doesn't guarantee anything, but it does make it impossible for them to say they didn't know your wishes. The act of going over the birth plan will also alert you to what the OB considers acceptable, and what she does not. 

 

The way I understand, the courts have pretty much sided with the mother when it comes to mother/fetus conflicts: doctors cannot force intervention because they feel it would be better for the fetus, the woman giving birth retains autonomy. This won't hold true after the baby is born - that's one reason you want to talk to the doctor about the whole plan. You may find out that delayed cord clamping is something she agrees with or doesn't care about, so one less thing to worry about. 

 

I think it's hard to decide what to do in possible scenarios. You really need to discuss a birth plan with the doctor and gauge her reaction, and then take it from there. 

 

Yup, I live in the US. I've got a birth plan written up- a sane, realistic one, not one that dictates the exact room temperature and what volume the music played during transition will be, lol- but I'm terrified that when I give it to my doctor she's going to rip it up and tell me to find someone else. I honestly don't know what I'm going to do if that happens.

[38carrots]

This is terribly stressful. I'm sorry. Can you have a doula with you? As PP said, legally they can't force you, but in reality they are going to, and things are going to be going fast, and it will be difficult (stressful) to be keeping an eye on everything. They'll do things without asking, on autopilot. Because they know best, and "the woman doesn't know". They can be intimidating. Yeah...

 

signed: Unassisted Birther. :leaving: 

[Mergath]

This is terribly stressful. I'm sorry. Can you have a doula with you? As PP said, legally they can't force you, but in reality they are going to, and things are going to be going fast, and it will be difficult (stressful) to be keeping an eye on everything. They'll do things without asking, on autopilot. Because they know best, and "the woman doesn't know". They can be intimidating. Yeah...

 

signed: Unassisted Birther. :leaving: 

 

That's what I'm worried about, that they'll just do things and inject things and cut things without even telling me first. I had to have a c-section with dd because of the pre-e, so I haven't actually gone through labor before and I'm not sure how much of what I'm worried about could actually happen, and how much is me stressing out because I've heard too many horror stories on the internet.

 

I'd love to have a doula, but I doubt I could afford one at the moment. :( Plus I'd think a doula would be more concerned about preserving her working relationship with the hospital than with making sure I don't get pitocin or whatever. I'm feeling kind of cynical tonight.

 

[Desert Strawberry]

Hire a doula. She can't make the doctor behave, but she can advocate for you, and will know the intricacies that you don't.

 

We had to fight the ob with my first, and it was awful. Don't go it alone. There is someone who can help.

[katilac]

Oh sorry - I'm from Australia and midwife is default here. Maybe you'll get a supportive nurse, then?

 

If you want definitive info, can you call a lawyer from your area and ask? I guess that'd be expensive though. 

 

The law is not super-definitive. Precedent definitely falls on the side of no forced intervention for the woman even if the doctor feels it is in the best interest of the fetus, but some of her concerns are for after the baby is born. They have more leeway then, if they can plausibly claim they thought baby was in danger. 

 

Having a written birth plan takes away the we didn't know or understand excuse. It will definitely improve the chances of things going the way you want them, as will having a (hopefully vocal) birth coach in the room with you. 

 

You do have to be prepared for the doctors and nurses to try and strong arm you into certain things at some hospitals. I'd want to be prepared with some set phrases in response, "Research shows that method Y has just as good of an outcome as method Z, and I'm comfortable with my decision." If they persist or say anything outrageous, call them on it, "That's very unprofessional. I told you I am comfortable with my decision; can you respect that or do we need to talk to the doctor?" 

 

Of course, active labor is not a great time to have to be rational, even if you do plan responses ahead of time. That's where the dad and/or birth coach comes in. If they can be firm and supportive from the beginning, perhaps pointing out the written birth plan that you should definitely have in your room, that can be a big help. People push the hardest when they don't expect pushback. 

 

If the doctor and/or hospital freak out at the idea of a birth plan, reach out to the ombudsman at the hospital for mediation. You have to really balance asking for what you are entitled to versus not wanting to piss off the people who will help you give birth, so channel your inner Buddha and stay calm and non-confrontational. You are all smart and awesome people who want the best outcome, and you know that they will all do their jobs and the details will be worked out. Super annoying but the best hope for getting what you want. 

 

OP, no midwives, but what about a doula as a second birth coach? It would be another voice in the room, and another set of eyes. 

[Melissa in Australia]

I have never even heard of internal monitoring . That sounds very invasive. 

 

Here the practice is to be as hands off as possible

[katilac]

Yup, I live in the US. I've got a birth plan written up- a sane, realistic one, not one that dictates the exact room temperature and what volume the music played during transition will be, lol- but I'm terrified that when I give it to my doctor she's going to rip it up and tell me to find someone else. I honestly don't know what I'm going to do if that happens.

 

Don't worry about that until it happens! She won't do that. She might say that she won't work within your plan. If she does, have a reply ready: Doctor Suck, can you tell me what concerns you most in my birth plan?

 

What could her various reactions and objections be? If she thinks the whole idea is stupid, maybe: I know a plan won't replace your expertise in the moment, but I saw that places like the Cleveland Clinic recommend them, and I'd really like to work out a flexible plan with you that covers the basics. 

 

If she is completely hostile to the idea in face of reasonableness, then you are really in a hard place because you don't have many choices. I want to believe that she was flabbergasted at you not wanting to be induced simply because it is so uncommon and many people love the idea of scheduling the birth. It is possible that she will be of like mind with you about other things. 

 

I feel bad for you. I think my o/b was the one who told me about birth plans 20 years ago! 

[IfIOnly]

Yup, I live in the US. I've got a birth plan written up- a sane, realistic one, not one that dictates the exact room temperature and what volume the music played during transition will be, lol- but I'm terrified that when I give it to my doctor she's going to rip it up and tell me to find someone else. I honestly don't know what I'm going to do if that happens.

If she won't go for you reasonable requests, look into getting it drawn up by a lawyer. Not kidding. Some people are forced to do that in situations where the medical providers are being unreasonable. I didn't have to resort to that because my doctor and hospital were totally respectful of my reasonable birth plan. No pit and delayed cord clamping among other things were no problem and were requests they were totally familiar with.

Edited June 9, 2017 by ifIonlyhadabrain

[katilac]

Does your hospital do tours?  

 

This is a good idea. Maybe the tour guide will recommend a birth plan, lol!

[IfIOnly]

If she won't go for you reasonable requests, look into getting it drawn up by a lawyer. Not kidding. Some people are forced to do that in situations where the medical providers are being unreasonable. I didn't have to resort to that because my doctor and hospital were totally respectful of my reasonable birth plan. No pit and delayed cord clamping among other things were no problem and were requests they were totally familiar with.

Oops, meant notarized: http://medical-malpractice.lawyers.com/childbirth-and-obstetrics/can-i-sue-a-hospital-that-vaccinates-my-newborn-against-my-will.html

Edited June 9, 2017 by ifIonlyhadabrain

[happypamama]

I don't know how to handle things with your hospital, but I wanted to say that I understand your frustration and worries. I will also be high risk next time because of preeclampsia last time, and so homebirth is not likely to happen. I would suggest looking into a doula too.

[displace]

You are wanting a low intervention VBAC?

 

If I read that correctly, I'd start researching VBACs and local support groups. You will likely need a doula (a professional person who will intervene for you). Honestly, a lot of people travel a long distance to find a VBAC friendly provider. Go to ICAN website (International caesarean awareness network ?), find a local support group, and start going to meetings. Even if it's not close. You can find doulas, hear about hospitals and obstetricians, learn more about fighting for your rights, etc.

 

If you want a low intervention VBAC? That is unlikely unless your delivery goes super smoothly.

 

I'm not trying to say this to be confrontational, but to be realistic.

 

Eta- most doulas can set up payment plans and are "only" a few hundred dollars. Depending on your DH he can do similar things but he needs to: be able to see and know what's going on, ask questions, tell the doctor/nurse to stop before doing things, etc.

 

In an emergency they will cord clamp, take the baby, etc, no matter what you request. The baby, once born, is treated separately.

Edited June 9, 2017 by displace

[Ausmumof3]

I have never even heard of internal monitoring . That sounds very invasive.

 

Here the practice is to be as hands off as possible

Through the public system that's true but not my experience with my first private ob unfortunately. Part of the reason I went public the last time around.

[Ausmumof3]

If it's at all possible and these things are important Id be looking at scrimping on the baby gear and getting a doula.

[Carrie12345]

Just  :grouphug: .  I haven't had to deal with high risk or VBAC, but I have faced the possibility of being stuck with crappy providers, and it IS incredibly stressful!

 

Technically, they can't do much to you without consent, but it's not unheard of for them to "forget" or to bully until you relent.  The suckyest thing is, that lack of trust between patient and provider means it's hard to know when they really DO need to legitimately intervene.  My 3rd and 4th babies did go outside of my (verbal) birth plan.  I really don't know that I would have believed a provider I didn't trust.  I actually wound up bullying my midwives into an induction for #5, rather than switch providers when their privileges ended at my preferred hospital just days later!  :svengo:

 

I do think a doula is your best bet in the given circumstances.

[Soror]

Even if you can't get afford to hire a doula (although in this instance I would think CC debt would be worth it and I hate debt) I'd talk to one. A doula would be able to tell you what happens during births where you live and what is realistic to expect. I'd expect you are going to have to compromise on some of your wishes, for negotiation you need to think about what is most important and what you are willing to give up and have facts and statistics for each request ready for when you present it to your dr. 

 

I only had one hospital birth and my OB was good but after the stories, I had heard I was nervous that in the end my birth plan would be disregarded. What I ended up doing is waiting very late to go in, the later you can wait for the less chance for intervention. I was in transition by the time I got there, unfortunately, it took me another 4 hours as pushing took FOREVER. In the end I had no interventions, no IV, no drugs, no cut, external monitoring, the nurses were shocked at my hep lock request as it is evidently never done  but when they checked with the OB he approved it.

 

If you do not live near the hospital I'd look for a hotel or a friend's place nearby you could go labor so you could wait until the last minute before checking in. The hospital tour is a great idea too, talking to the nurses will give you an idea of how they are because your birth experience will largely be managed by them. Although, of course you can't meet every single nurse it gives you something to start from.

 

Good luck!

Edited June 9, 2017 by soror

[Roadrunner]

I refused ivy fluids as well as any monitoring other than intermittent one. They weren't happy, but couldn't force me into anything. Of course I also showed up 9 cm dialated to the hospital to avoid dealing with them.

If they manage to pump pitocin into you, I think internal monitoring is a must.

[Guest]

Well, I hope this doesn't come out more awkwardly than I mean it, but as a person whose baby died in labor, I think none of those interventions are a bad thing if you are high risk. Or even if you were not high risk. I think your best bet would be to bring her the birth plan, but remember, the doctor also does not want you or your baby to die or have permanent injuries due to birth emergencies.

 

My subsequent labor after my stillbirth was, obviously, high risk and it was like one continuous intervention. I had a pitocin induction three weeks pre-dates, but actually, it wasn't bad. They did keep offering me drugs/epidural, but I didn't have one and it was fine. My baby arrived alive.

 

I'm not trying to be "that woman" with the horror story, I'm just saying I wish I had not put so much emphasis on having a particular kind of birth when I had my baby #3. Things went wrong; they went wrong rapidly and if I had been in a hospital, instead of a birth center five miles from the hospital, the outcome might have been different-good. Yes, if could also have been different-bad, but it's a hard thing to wonder if my girl would be alive if I had had that monitoring I eschewed. I also ended up wishing people who thought the birth-center birth was a bad idea had told me so beforehand; they kept quiet because they didn't want to be "that woman," much as I don't want to be.

[SKL]

This may come across as sexist, but see if you can bring your husband to the doctor visit when you tell your OB what you want / don't want.  (And as many visits after that as possible.)  Psychologically, many women (and men) will show more respect and deference when a man is on your team.  It isn't right, but if it gets you what you want, it's worth trying.

[EMS83]

:grouphug:  :grouphug:  :grouphug:  Quill.

 

It's a difficult line to find, for sure.

[displace]

I refused ivy fluids as well as any monitoring other than intermittent one. They weren't happy, but couldn't force me into anything. Of course I also showed up 9 cm dialated to the hospital to avoid dealing with them.

If they manage to pump pitocin into you, I think internal monitoring is a must.

Pitocin doesn't mean internal monitoring is required.

[SparklyUnicorn]

The cord thing might be harder to pull off, but the rest of it?  I don't see why they could not honor that.  I would try to find a really outspoken friend to be there with you.

 

Before I had both kids they actually gave me a questionnaire asking what I wanted or didn't want.  I didn't know anything about anything in that realm so I didn't reject anything, but if I were going to have a redo, I would have definitely rejected a few of the things they did.

 

And if you don't show up for the scheduled induction, what are they going to do?  Send a swat team after you?  KWIM?  They aren't. 

 

I hope it goes the way you want.  :grouphug:

 

 

[trulycrabby]

I have a medical background, and normally I would tell you to push for all of the things you are asking to have a good birth experience. The thing is, few things strike fear in an obstetrician and birth team more than preeclampsia, because when things go wrong in a delivery in an eclampsic patient, they often do so very fast and there are few minutes to save baby and mother. I would be shocked if the OB did not insist on internal monitoring and pitocin for this particular birth, and from a medical standpoint, they are correct in doing so. You might be able to negotiate for delayed cord clamping, but that's it.

 

My advice is, if you feel strongly enough about these things, then travel to a large city where medical teams routinely handle a high volume of high risk births.

 

I'm sorry. This sucks, especially if you have not had preeclampsia with this pregnancy. :grouphug:

[Paige]

I was in a similar situation when I had my twins. I was life flighted to a different hospital than I had planned and the policies were very different than we had prepared for and the doctors were much more aggressive and interventionist. 

 

I'm not sure how far I could have gone with refusing things, but it was not a fun situation. I complied with staying in bed, not eating or drinking, and some other things that I felt were rather minor at the time. I refused other things that were more serious. At that point, because I was an emergency situation, they could not refuse to treat me or send me away. Nobody mentioned that. I did have to sign several AMA waivers. They were very mean to me. I was threatened and yelled at. I think everyone on the floor came in to try to scare me with untrue statistics and unlikely scenarios. In the end, however, they did not force upon me what I refused and they cared for my babies. I had a doula who had coincidentally used to work in that unit in that hospital many something like 20 years earlier and she was extremely helpful. 

 

I still think the things I refused were reasonable (like an automatic c-section for twins who were both head down!) but I don't regret giving in on the other more minor hospital policies. I also had a clean medical history with a previous normal birth, was in excellent health, and had no elevated risk for myself- the risk was only because the babies were premature. They weren't extremely premature either, which would have made a difference. 

 

Good luck. I think I would probably drive or look for a different provider rather than put myself in that sort of situation on purpose! FWIW, I've had a couple inductions and they weren't that bad. The twins were induced because my water broke and my last one was induced because labor stalled. You may be able to compromise and get a better relationship if there's no provider choice.

[emmaluv+2more]

I have 4 children, only the 4th was a close call birth. I'm glad I was in the hospital (wanted a birth clinic, but dh protested) and had the continuous external monitoring (it saved her life and I only agreed to it because I was too exhausted to walk anymore anyway).

 

BUT I could have delivered the first 3 completely by myself. They were that easy and uncomplicated.

 

So, I get why Mergath wants no intervention. My suggestions would be birth plan given to doc and hospital (worry about her dropping you if that actually happens as there are always options), research vbac and try to be confident in what to when interventions are truly going to be necessary (so much easier when you actually trust your team), choose your battles (maybe let go of a couple things and focus on the ones that are most important to you), or find a way to hire a doula.

 

I'd be more than happy to come advocate for you, but I doubt we are close enough 😉

Edited June 9, 2017 by emmaluv+2more

[MedicMom]

Well, I hope this doesn't come out more awkwardly than I mean it, but as a person whose baby died in labor, I think none of those interventions are a bad thing if you are high risk. Or even if you were not high risk. I think your best bet would be to bring her the birth plan, but remember, the doctor also does not want you or your baby to die or have permanent injuries due to birth emergencies.

 

My subsequent labor after my stillbirth was, obviously, high risk and it was like one continuous intervention. I had a pitocin induction three weeks pre-dates, but actually, it wasn't bad. They did keep offering me drugs/epidural, but I didn't have one and it was fine. My baby arrived alive.

 

I'm not trying to be "that woman" with the horror story, I'm just saying I wish I had not put so much emphasis on having a particular kind of birth when I had my baby #3. Things went wrong; they went wrong rapidly and if I had been in a hospital, instead of a birth center five miles from the hospital, the outcome might have been different-good. Yes, if could also have been different-bad, but it's a hard thing to wonder if my girl would be alive if I had had that monitoring I eschewed. I also ended up wishing people who thought the birth-center birth was a bad idea had told me so beforehand; they kept quiet because they didn't want to be "that woman," much as I don't want to be.

The ONLY reason my daughter is alive because is because we were being monitored. It was a low risk pregnancy, everything had gone perfectly, VBAC delivery that my OB encouraged. I had a uterine rupture, and the only reason we knew immediately was because her heart rate was being monitored.

 

Being a VBAC with a history of preeclampsia, I think some things are going to be a losing battle for you. Monitoring is probably one of those things.

[athomeontheprairie]

I'm sorry.

Those sound reasonable-given that we made similar requests. They were hundredths doctor agreed. The nurse did not, but obeyed anyway.

 

Will dh be there to advocate for you? Maybe a doula to fight for you?

 

I would write it up, talk to the doctor, and the hospital.

[ktgrok]

But once she is in labor, blood pressure is fine, labs are good, etc, why would she STILL need to be treated as if she has pre-E? I get monitoring blood pressure, checking labs when she gets in, etc...but if all is fine, then there should be no need for induction, pitocin, etc. If things change, yes, then plans change. 

 

OP, I've had low intervention VBACs. You need a doula. Most do payment plans, especially for someone in your situation. DEFINITELY hook up with ICAN. If no local meetings than maybe they have a Facebook group, ours does. 

 

As for working with your OB, my experience is that if you show that you are not "my way no matter what" and are educated they tend to breathe a bit more easily. They need to know that you are saying, "If all is well, I would like to avoid such and such" not "even if baby is crashing and I'm dying, I'm going to insist on avoiding such and such for no good reason". You have to be VERY clear about that, to get their cooperation. Use the phrase "as long as mother and baby are doing well" a lot. Or even more specifically, 'as long as my blood pressure and labs look good....as long as baby is tolerating labor well..."

 

So maybe start with, " I know that you and I both want the same thing, a healthy mom and baby. I know what I'm asking is a bit unusual, but maybe we can work together? If anything changes, if I show signs of pre-e or the baby isn't tolerating labor well of course I'm going to defer to you and do whatever it takes for a good outcome. But as long as things are going well, I'd like to......"

 

As for monitoring, in my opinion you are going to be hard pressed to get them to officially agree to intermittent monitoring. That said, you are right that the evidence shows intermittent monitoring is appropriate. What I would do is just keeping asking to take it off every so often, when it s bothering you. Get up to go to the bathroom and be real slow to have someone put it back on, that kind of thing.

 

Again, a doula or ICAN could help you know more about what will work at your hospital.

 

As for legalities...anything in labor is your call. Period. However....that doesn't mean they will follow the law :(

 

You REALLY need a doula.  

 

 

 

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[ktgrok]

The ONLY reason my daughter is alive because is because we were being monitored. It was a low risk pregnancy, everything had gone perfectly, VBAC delivery that my OB encouraged. I had a uterine rupture, and the only reason we knew immediately was because her heart rate was being monitored.

 

Being a VBAC with a history of preeclampsia, I think some things are going to be a losing battle for you. Monitoring is probably one of those things.

 

I don't think anyone including OP was saying not to monitor. She was saying she wants intermittent external monitoring vs internal. No one says not monitoring is okay. Even at my homebirth the baby's heart rate is monitored. There are specific intervals that are determined to be safe...I want to say every 15-20 minutes in early labor, then once active labor is established it is more frequent, building up to monitoring during every contraction at the end. (sorry, don't remember the exact frequency...I was pretty oblivious when my midwife was doing it.) This has been determined to be safe and will pick up emergencies without causing false alarm. 

[MedicMom]

I don't think anyone including OP was saying not to monitor. She was saying she wants intermittent external monitoring vs internal. No one says not monitoring is okay. Even at my homebirth the baby's heart rate is monitored. There are specific intervals that are determined to be safe...I want to say every 15-20 minutes in early labor, then once active labor is established it is more frequent, building up to monitoring during every contraction at the end. (sorry, don't remember the exact frequency...I was pretty oblivious when my midwife was doing it.) This has been determined to be safe and will pick up emergencies without causing false alarm.

I was talking about constant external monitoring. I suspect that being a VBAC, the hospital won't budge on that. When I was looking for a hospital that would do a VBAC, that was a requirement at all of them.

[ktgrok]

I was talking about constant external monitoring. I suspect that being a VBAC, the hospital won't budge on that. When I was looking for a hospital that would do a VBAC, that was a requirement at all of them.

 

Gotcha. I don't think it is needed or any more safe according to the research I've done, but agree they will push it. 

[Roadrunner]

Pitocin doesn't mean internal monitoring is required.

This was my experience, but then again, this could have been my doc.

The hell I went through with one kid is the reason I was so confrontational the second time.

[Bluegoat]

I've been in a similar situation, and unfortunatly ended up not even with the crappy OB I expected, but the even crappier chief OB.  I had a similar approach to that birth as what you are contemplating.

 

The conclsion I have come to after some years of reflection, and seeing others births, is that that kind of approach may be effective sometimes, but I think it is brittle.  You push, and so they push back.  I'm inclined to think now it would have worked better to have, as much as possible, visibly gone along with their policies, passively resisted in a quiet way, and so on.  So things like, laboring at home (or at least outside the hospital) as long as possible, really making my list of needs as small and simple as possible, framing it in such a way as to get the doctor on side, and diversion and even dishonesty.  So rather than say "no, I won't do that" you say you need to be in the bathroom.  Instead of saying you think internal monitoring is unnecessary, make some other kind of excuse.  Instead of fighting with your doctor/chief of ob, or whomever, tell them you want to talk to the next person up the line (who they are unlikely to wake at 4am.  Heck, tell them you are a Scientoligist and need only approved people in the room for religious reasons.  Co-opt them as much as you can.

 

You also need to know and practice these strategies ahead of time, because you won't be able to think that far ahead in labour.  A doula is ideal to help with this (professional or not) but keep in mind she can be ejected if the hospital staff think she is a problem.

[MercyA]

I'm so sorry you don't have better options available, Mergath. 

 

Others have given good advice here, so I just want to ask--are you having a girl, for sure? I noticed you were using "she" instead of "the baby" in this post.  :)

Edited June 9, 2017 by MercyA

[Bluegoat]

Oh - as far as a doula, there are sometimes volunteer doulas available, or people working for their certification.  But even a friend can be a doula, if you talk about the role and maybe do some reading.

[wapiti]

nm

Edited June 9, 2017 by wapiti

[Guest]

I'll be the black sheep in this conversation

 

After 5 births, I've learned to pick my battles. If you go in with a giant list detailing what you want at every moment, prepared to fight them on everything, you're just adding more stress to the situation. Decide on the few most important things and advocate for them. Stop researching, you're just stressing yourself out especially since you don't have a lot of OB options. None of my births ha e gone 100% the way I wanted but, oh well, we lived to tell the tale.

[Lang Syne Boardie]

This is awful, but I would actually be considering whether our family could live with dh/dad possibly missing the birth, and make plans to be near a better, safer hospital. Maybe if you start thinking down that road, you can also think of ways to get dh there, too, I don't know...

 

As far as safety and protection in over monitoring and over restricting Mom during labor, I don't think that exists. Basically holding you down, stressing you out, and taking away all your peace and power does not make you safer. Frequent external monitoring, constant presence, sane competence, emergency gear at the ready, and mutual trust make you and baby safer, but that's not this doctor's MO. She thinks that giving birth is something that SHE does to (or at) YOU.

[Myra]

With my high-risk pregnancy, I had the regular doctor and the mid-wife from their medical office.  My exams were mostly done by the mid-wife throughout the pregnancy with the doctor just breezing in for a few seconds each visit.   At the actual hospital birth, the mid-wife stayed with me throughout the labor while the actual doctor was on duty in the lounge.  The doctor then stepped in when things went medically downhill, but was assisted by the midwife during necessary interventions.  The midwife was more of an advocate reminding the doctor during the emergency my wishes plus she "interpreted" what was going on for me.