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

[Catwoman]

I'm so sorry you have to worry about all of these things, Mergath. I remember worrying about every little thing when I was pg with my ds because I was high risk, too, but at least I had an excellent doctor that I trusted. I would be so scared if I didn't trust my doctor to keep my baby safe, and it sounds like you're in that position. :(

 

Do you know anyone who has used that doctor in the past or have you spoken with other women in the waiting room while you wait for appointments to try to find out if she knows what she's doing? She might be a pain to deal with on a personal level, yet still be an excellent doctor.

 

Personally, my own story is that my ds would not be alive today without my doctor. He took a lot of precautions when I was in the delivery room, but it turned out that they were necessary -- even thought I felt fine and everything seemed perfectly okay... until it wasn't.

 

I understand that you want some control over this process, and what you want to happen seems reasonable to me, but please try to pick your battles and not stress over every detail if you can. It sounds like your doctor is set in her ways, but she can't force you to do things like being induced early -- but I would question her about her reasons for wanting to do it just in case there is a medical scenario where that would make sense for you. (Or maybe she has a vacation planned for the week you're actually due. :glare: You won't know until you ask her.)

 

I'm definitely not dismissing your concerns -- I've been there, too, and I know what it's like to be so worried. It's terrible. Can you make an appointment with the doctor specifically to go over your birth plan with her? Or make sure your dh is with you at your next appointment and say you want to talk to her about it then. But definitely give her your written plan and ask her if it's feasible and reasonable, and let her defend her choices if she refuses any of your requests.

 

I hope you can get this settled soon! :grouphug:

[Guest]

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

 

Here the practice is to be as hands off as possible

It isn't as bad as it sounds and it is only done in rough situations. DS had a tiny scab and a bruise on his melon but he's alive.

[wintermom]

Sorry that the situation is stressful for you. Giving birth is already difficult and stressful, and going into an entire pregnancy as a high-risk patient without the option of the care you would have preferred (mid-wife, I'm assuming), doesn't help.  For some reason, you seem to have some assumptions in place that may or may not be true. Either way, they will not help your stress level. 

 

Assumption 1) Your OB will give drugs for their convenience, rather than the health of their patients

Assumption 2) Your OB is crappy, and you don't feel you're receiving adequate care.

Assumption 3) Your OB isn't working for the best interest of you or your baby

 

If you really believe that these assumptions are truthful, then why are you still with this OB? You should be working with someone you trust your life with and the life of your baby. 

 

 

My OB may not have been the most easy person to deal with, but I had faith in his ability as a doctor. I believed that he would make decisions to the best of his ability to help my baby and me stay alive. My preference in terms of non-essentials for survival were not his primary concern. That kind of perspective was important for me to understand, and when I lost a baby, it put it into even more perspective. Giving birth can boil right down to getting through this alive. If there are opportunities for the "niceties" and choices, then fine. The niceties are NOT the priority, though. 

 

[nixpix5]

I fought it. I argued with my doctor. I refused interventions. I knew better. I now have a daughter who has nerve damage and wears hearing aids because of my choice. If I could go back and undue my choice I would. I just want to let you know that. I am sure everything will be fine and your birthing plan will go beautifully but the interventions are there for a reason. I whole heartedly didn't want them and now I look at my daughter with guilt knowing I have condemned her to her hearing loss, tinnitus, and balance issues. It breaks my heart.

[BusyMom5]

Can you birth on a birth ball at the side of the bed, where the monitors can still reach? This is my preference, and my Dr's in the past have had no issue with it since baby is still being monitored. Last I'm I was on the ball until time to push. As for pitocin after birth, I needed it last time, too. I had a trusted low intervention nurse that assured me I needed it, I only had a he lock placed abut 15 minutes before birth and nothing hooked to it. For a short labor, the Dr's were fine with that. They do need the port for immediate access. I think the key is compromise, think about the things you will really want and need, the try to find workable solutions. It shouldn't be a fight, you are both on the same side. In your case, I think constant monitoring is important bc of the risk of rupture. The port is important bc if there is an emergency, they need to be able to get baby out ASAP. I had one high risk birth, twin with one breech presentation. I'm not going to lie, it was by far my worst birth experience, but in the end it went as well as possible considering all that naturally happened. My Dr insisted on an epidural if u wanted to try to birth them. It was the main thing we disagreed on. In the end, he was right. I needed it. Without it I would have ended up with a natural birth twin and a c Section twin. With it, he was able to get the second twin started down the birth canal. Continuous monitoring wasn't even a question, it was needed to monitor both babies. Toward the end I had a nurse on each side, each in charge of keeping the monitor on each twin as they shifted and one was delivered. I prefer natural childbirth, but there are reasons for monitoring high risk moms and babies.

 

Best of luck with your delivery. I'm pg again, with a different OB, and I totally get the worrying about how labor and delivery will go.

[Lang Syne Boardie]

Sorry that the situation is stressful for you. Giving birth is already difficult and stressful, and going into an entire pregnancy as a high-risk patient without the option of the care you would have preferred (mid-wife, I'm assuming), doesn't help. For some reason, you seem to have some assumptions in place that may or may not be true. Either way, they will not help your stress level.

 

Assumption 1) Your OB will give drugs for their convenience, rather than the health of their patients

Assumption 2) Your OB is crappy, and you don't feel you're receiving adequate care.

Assumption 3) Your OB isn't working for the best interest of you or your baby

 

If you really believe that these assumptions are truthful, then why are you still with this OB? You should be working with someone you trust your life with and the life of your baby.

 

 

My OB may not have been the most easy person to deal with, but I had faith in his ability as a doctor. I believed that he would make decisions to the best of his ability to help my baby and me stay alive. My preference in terms of non-essentials for survival were not his primary concern. That kind of perspective was important for me to understand, and when I lost a baby, it put it into even more perspective. Giving birth can boil right down to getting through this alive. If there are opportunities for the "niceties" and choices, then fine. The niceties are NOT the priority, though.

In the original post, Mergath explained that there are only two OBs in her community, and the other doctor is even worse than her doctor. People can't always just choose a HCP they trust, unless they are able to travel.

[Lang Syne Boardie]

All of this talk about how interventions are there for a reason and about how you don't want to be responsible for hurting your baby...do those of you in that patronizing and fearmongering camp see any difference between

 

A. Interventions and directives decided upon in the moment, or in advance if pertinent to a particular mother's or baby's needs, which parents who trust their HCP would absolutely submit to even if it wasn't their ideal bc it was needed, and

 

B. A laundry list of What This Doctor Does For All Patients no matter what, because she knows best, she's the one delivering the baby not the mother?

[Janeway]

Legally, you have all the say you want. Logistically, the doctor will do whatever she wants once you show up at the hospital. You really have no control over what goes in to the IV as I have discovered in the past, no matter what you write on the consent forms. And most states have tort reform in place to greatly limit doctors from being sued.

 

You may wish to seek out a home birth, or just accidentally finding yourself in a different town when you go in to labor.

[imagine.more]

Your best bet might be to make sure your husband is 100% in the know about what you want and have him stand up for you to them. Hospitals won't exactly listen to him but he can step in and say "wait, listen to my wife! She said no pitocin." He can eye your iv like a hawk because they will sneak stuff in there. They snuck pitocin in without my consent after my first was born (because they didn't want to wait 5 minutes for the dang placenta to come on its own). I found out after when I was billed for it.

 

As for induction, maybe try bargaining. Like, "I will happily consent to an induction if my pre-e flares and my blood pressure goes above X/Y number."

 

I have never heard of internal monitoring for any but the most extreme cases. I was induced (sort of) with number 4 and it was the usual external belt. So maybe you won't even have to fight that?

 

For the cord clamping your husband could 'remind' them as soon as baby is out "remember, she asked for the cord not to be cut right away." Since obviously you'll be occupied :)

[ktgrok]

As for induction, maybe try bargaining. Like, "I will happily consent to an induction if my pre-e flares and my blood pressure goes above X/Y number."

 

 

 

 

This. I recently went to the hospital at 42 weeks for testing. My plan was that if all was well I'd check out and give myself another 24 hours. At first, I got HUGE push back from the midwife at the hospital, lots of "you can't" etc. Once they realized I was not a nutter, and that I was more than willing to run the tests they wanted, and would absolutely be induced if x,y, or z happened, etc they calmed way down and actually told me they hoped I got my homebirth!  They just needed to know I wasn't rigid, and once they knew that they became flexible as well. 

 

SaveSave

[Danestress]

Legally, you have all the say you want. Logistically, the doctor will do whatever she wants once you show up at the hospital. You really have no control over what goes in to the IV as I have discovered in the past, no matter what you write on the consent forms. And most states have tort reform in place to greatly limit doctors from being sued.

 

You may wish to seek out a home birth, or just accidentally finding yourself in a different town when you go in to labor.

 

You would suggest a woman with a history of preeclampsia and previous c-section have a home birth?

[Guest]

You would suggest a woman with a history of preeclampsia and previous c-section have a home birth?

Sure, that is a much better option than a tricksie doctor who is just waiting to slip you piticon.

[Danestress]

Write out your plan, talk through it with you doctor, ask her to explain why she objects to any items, research areas where she raises objections, and ultimately submit a plan. How your OB responds to your questions and to your demands will give you in formation about her. Tell her about your fear she will sneak in medications. Get it all on the table.

 

You have a right to be listened to and to have your decisions respected. She may have a right not to be your care provider if she believes your plan is medically ill advised. A tragic outcome will affect her too, and if either of you can not accept the other's bottom line, now is the time to find out.

[EmseB]

I am kind of in Bluegoat's camp. I smiled and nodded at every appointment. When labor came I stayed at home as long as I could bear it (having my husband learn emotional and physical stages of labor was key so he knew when I should go to the hospital).

 

I knew the hospital was pretty interventionalist. I mostly ignored them during my labor passively. Like I heard one nurse say, "She needs to be in bed; her membranes have ruptured." I just pretended not to hear her. I went to the bathroom a lot as an excuse to be up and around. When they wanted me on my back to push I just stayed on all fours on the bed like I didn't hear them...I was in laborland after all.

 

I didn't make any demands up front because I knew the OB group didn't care and would likely balk just from the discussion. I didn't have a choice as to who I would see or who would be there for the birth from the ob clinic, or what hospital I was going to be at. I just did my own thing when the time came. Luckily I've had four natural births without any huge fights. I was also prepared to acquiese, of course, if there were any complications.

 

My husband's prepared list of questions was, "Why do we need to do this, what else is an option, what if we do nothing?"

Edited June 9, 2017 by EmseB

[prairiewindmomma]

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Edited June 9, 2017 by kbeal

[wintermom]

In the original post, Mergath explained that there are only two OBs in her community, and the other doctor is even worse than her doctor. People can't always just choose a HCP they trust, unless they are able to travel.

 

What are her assessments of these 2 doctors based on, though? How is she measuring their abilities. What outcomes are important to her?  

[busymama7]

While you may not have access to the midwives that delivers at the hospital, depending on the state, you may still have the option of using an out of hospital midwife. And yes, I'm aware of your history. I read the thread. But someone who has had pre e is much more likely to have it not reoccur than to have it reoccur. Some states prevent midwives from attending VBACs out of hospital but not all do. I know many people would think that an unreasonable risk to take and only you can know what is right for your situation. But the situation you describe at the hospital is not without risk either.

[Heather in OK]

I'm so sorry you are having to fight for the informed decisions you want to make. 

You probably are one of the first to tell her no and question her decision making.  ;)

Early induction - But you don't have any PreE symptoms now, correct?  Ask her why she wants to do it a week early.  What evidence?  If she's concerned about PreE, expectant management is fine with the absence of actual PreE symptoms.  Insist that she back up her decision making with evidence. 

Cord clamping - This one is tricky.  It's really not about hospital policy as much as the care provider.  So them telling you it's up to the OB is right.  Not that you don't have a say, but you have to convince the provider to do it.  It's ingrained in an OB to catch, clamp, cut, get the placenta out, etc.  Changing up that sequence and routine throws them off.  Just like if you asked me (I'm a CPM) to follow that sequence, it would throw me off because it's not my routine.  It's possible but it is a hard one to get them to do.  All you can really do is talk to her about it now BUT you will have to remind her at delivery.  Yes, sometimes they do ignore the request...I've seen that happen.  Or the doctor will stand there with the clamp and spin them around anxiously because he/she doesn't know what to do now.  LOL! 

Your husband can help by keeping an eye out, reminding the doctor as delivery is happening, reminding the doctor right after, saying things like, "We do not consent to...." may help. 

How much say you have - Well, you are the consumer.  You can refuse anything.  Again, "I do not consent...."  The problem is, as a laboring woman it's hard to fight for what you want and they know that.  They know women are vulnerable.  Yes, you can say "No".  And yes, they can challenge you and do everything they can to oppose you and make your experience hell.  I've also seen situations where a patient was told "We need to do XYZ..." and later found out the reason for and actual care they said they were doing was not even charted.  I wholeheartedly agree with the suggestion of a doula.  Get another set of eyes in the room. 

 

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.

Some home birth midwives will take a woman who has history of PreE.  I have.  We monitor nutrition, watch the client carefully, and make the appropriate transfer of care if symptoms arise. 

 

Oh, one last thought. There's a movement happening now to try to get old-school hospitals and doctors on board with current mother-baby practices, including delayed clamping/cutting and immediate skin-on-skin and spontaneous nursing. I'm sorry, I don't remember what the initiative is called, but maybe you could track down the bullet points of it and bring that when you discuss your birth plan with your doctor.
 

Baby Friendly Hospital Initiative

 

It ties you to the bed doesn't it?  I refused internal monitoring.  I wanted to be able to move around while in labor and use the restroom. 

 

Not necessarily.  The internal monitor is attached to baby's head and they put a little thing on the mother's leg to attach the cord to.  So it's all in place and the woman can move and change positions.  While invasive, one benefit of internal monitoring is she can move around without the monitor slipping off baby like the external monitors do. 

 

You would suggest a woman with a history of preeclampsia and previous c-section have a home birth?

I would consider a client with this history.  I've had one in the past.  A history of PreE does not equate PreE in the current pregnancy.  And VBAC status does not risk a woman out of the home birth option. 

[Mergath]

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.

 

I'd prefer it to be low intervention if there's no medical indication for the interventions. Believe me, if I end up with pre-e again, or if the baby is in distress, or if something else goes wrong, they can go ahead and do all the interventions they want. I just don't want them for no reason.

[SparklyUnicorn]

I'd prefer it to be low intervention if there's no medical indication for the interventions. Believe me, if I end up with pre-e again, or if the baby is in distress, or if something else goes wrong, they can go ahead and do all the interventions they want. I just don't want them for no reason.

 

Yeah and in my experiences doctors tend mostly to be dismissive.  If they would explain their reasoning for not agreeing to what you want, that would be better than saying flat out no or ignoring you.

[Guest]

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.

But Continuous External Monitoring is another option; it is the one I didn't have but now wish I would have. Because for me it went like this: Interval one: heartbeat. Interval Two: no heartbeat. The only emptier sound than a heart monitor with no swish-swish-swish is a birth with no crying baby.

 

I'm just saying - not all emergencies play out the way you are thinking, Katie. What rings in my ears was my midwife, during orientation saying, "We know normal like the back of our hand, and if anything is not normal, the hospital is five minutes away." Well, what happened in my case was abnormal, but not unheard-of, and five minutes away was four minutes too far away.

 

I (now) give OBGYNs an awful lot of mercy; they have seen it all. They have seen uterine rultures, they have seen placental abruptions, they have seen eclampsia; they have lost mothers, babies, both right on the table. They know the rain falls on both the righteous and the unrighteous; there is no reason to think everything will be fine with this woman, therefore deeming those interventions unnecessary after all. When you've seen it go as badly as it can go, being tied to the bed on a CFM machine, or with IVs or whatever does not seem like a very big deal.

 

I completely understand wanting to have a natural birth without a bunch of medical people rushing around like you could die any minute. I detest all things medical, hate hospitals, and love things that are natural and beautiful and picture-perfect. But a birth is a very tiny part of motherhood and many, many people do not have a wonderful, beautiful, picture-perfect birth. Bad stuff can and does happen during labor; even in a low-risk mom, which Mergath already is not. The most important thing is to get Baby here alive and healthy, with Mom alive and healthy as well.

 

Okay...off my soapbox now. I wish you the best, Mergath, and hope you do have a picture-perfect birth.

[Murphy101]

So you are a previous pre-e Vbac...

 

Well everyone knows my horror stories and less than optimistic view of how maternal care is handled ...

 

But here is my .02.

 

I think continuous EXternal monitoring of baby, and your blood pressure and heart rate is a must. And do not look at this as a bad thing. Look at it as your ability to keep the staff honest. If they come in and say the numbers are concerning, they you can see for yourself if they are.

 

The cord clamping if there's no other problems, should be a non-issue.

 

The hep-lock instead of IV shouldn't be a problem. What matters is there is a line of immediate access if necessary. And there should be someone with you at all times asking as the nurse arrives, what and why she is doing what she is doing. Imnsho, a good nurse tells you anyways. "Hi, how are we doing? I'm here to give you some pit and staydol and check your vitals." Oh I don't want that. "Well I'm supposed to do what the doctor ordered." I do not want that, you will have to tell the dr I refuse. Thanks."

 

But for those who tend to just come in and inject and leave, Dh has a policy of standing next to the IV pump and or on the side of the bed that has my hep lock. They basicly have to ask him to move and he won't (he suddenly becomes oblivious chatty with questions) until they show what they want to inject. It sounds very aggressive, but it is very passive aggressive and super nice unless they make it otherwise. 😉

 

If you want to move around and such, maybe try a compromise. 30 minutes of monitoring with safe result gets 30 minutes of freedom.

 

Even in my backwater, well baby nurseries are gone and all babies room in. Even for c/s. With my Rose 8 months ago, immediately after the c/s, they showed her to me briefly, then Dh with her and the nurse behind a glass wall to do the apgar and such stuff for about.. well it felt like eternity, but was actually less than 10 minutes. I couldn't see them, but I could hear everything and was telling Dh he better take pictures for me and the nurses were laughing about how pretty she was and how much they enjoy first time parents. Apparently too many repeat parents aren't as excited and fun as us newbies.🤣 My OB had to stop sewing me up for a second to giggle about that and yell over to them that this was baby 11. When they were done repairing me with a brief lecture about not having anymore because my uterus is very thin, Dh and nurse and baby all followed me back to my maternity room and set up in there.

 

And lastly, be understanding that if there is really only 2 OBs, time is of some serious factor in their decisions pending how many patients are laboring at the same. From their POV, the faster they deliver you of a baby, the faster they don't have to worry about you and go on to the next patient. Or the less likely you are to have complications at the one moment when they can't leave another patient to help you, this isn't likely why they want so much monitoring too.

 

Above all, remember you can't control everything and all you can do is make the best decision from one moment to the next.

 

And no, not presuming dr knows best doesn't mean we don't value the life of our babies above all else. I wish people would quit with that false dilemma. Not wanting to be subjected to out dated unhelpful medical practices by power tripping doctors doesn't mean a woman is putting her comfort before the very life of her child. Yes, a mom and baby surviving is the most important thing, but no, it is not the only important thing.

 

Congratulations and I hope everything goes wonderfully.

Edited June 9, 2017 by Murphy101

[Mergath]

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.

 

I'm so sorry. :grouphug: :grouphug: :grouphug: 

 

I'm totally fine with intervention if there's a medical reason for it. And if the doctor explains her reasons for something like constant monitoring, for example, I'll be fine with that, too. I'm really just trying to avoid interventions that are for the doctors convenience rather than the well-being of my baby or myself. With the pitocin, for example, some studies are finding that having pitocin during labor might increase the risk of PPD by something like 36%. I had severe PPD and borderline PPP with dd (I was actually hallucinating by the time I went to the ER) so if the doctor wants to give me pitocin simply because I haven't dilated another centimeter in an hour, I'm not okay with that because I think the risk outweighs the benefit. If she wants to give me pitocin because my water broke twenty-four hours before and the risk for infection is sky-high, that I'm fine with.

 

[MercyA]

All of this talk about how interventions are there for a reason and about how you don't want to be responsible for hurting your baby...do those of you in that patronizing and fearmongering camp see any difference between

 

A. Interventions and directives decided upon in the moment, or in advance if pertinent to a particular mother's or baby's needs, which parents who trust their HCP would absolutely submit to even if it wasn't their ideal bc it was needed, and

 

B. A laundry list of What This Doctor Does For All Patients no matter what, because she knows best, she's the one delivering the baby not the mother?

 

I truly believe those sharing personal stories in this thread are all doing so because they genuinely care about Mergath and her baby. People have gone out of their way to say things as tactfully and kindly as possible and have shared things that must be personally painfully for them. I'm sure Mergath is resilient enough not to be bothered by hearing differing opinions and experiences. 

 

I do understand wanting to defend someone's choices. My sister delivers all her babies at home, and it seems that every time I mention it, someone criticizes her decision or pipes up with a negative story. It does make me bristle. But IDK, offhand comments by strangers feel different than well-thought out posts from people who "know" each other here. Just about everyone participating in this thread is trying to help, I think.

Edited June 9, 2017 by MercyA

[Bluegoat]

But Continuous External Monitoring is another option; it is the one I didn't have but now wish I would have. Because for me it went like this: Interval one: heartbeat. Interval Two: no heartbeat. The only emptier sound than a heart monitor with no swish-swish-swish is a birth with no crying baby.

 

I'm just saying - not all emergencies play out the way you are thinking, Katie. What rings in my ears was my midwife, during orientation saying, "We know normal like the back of our hand, and if anything is not normal, the hospital is five minutes away." Well, what happened in my case was abnormal, but not unheard-of, and five minutes away was four minutes too far away.

 

I (now) give OBGYNs an awful lot of mercy; they have seen it all. They have seen uterine rultures, they have seen placental abruptions, they have seen eclampsia; they have lost mothers, babies, both right on the table. They know the rain falls on both the righteous and the unrighteous; there is no reason to think everything will be fine with this woman, therefore deeming those interventions unnecessary after all. When you've seen it go as badly as it can go, being tied to the bed on a CFM machine, or with IVs or whatever does not seem like a very big deal.

 

I completely understand wanting to have a natural birth without a bunch of medical people rushing around like you could die any minute. I detest all things medical, hate hospitals, and love things that are natural and beautiful and picture-perfect. But a birth is a very tiny part of motherhood and many, many people do not have a wonderful, beautiful, picture-perfect birth. Bad stuff can and does happen during labor; even in a low-risk mom, which Mergath already is not. The most important thing is to get Baby here alive and healthy, with Mom alive and healthy as well.

 

Okay...off my soapbox now. I wish you the best, Mergath, and hope you do have a picture-perfect birth.

 

The thing is, there are downsides, medically, to many of these interventions.

 

The fact that they are so focuesed on the possibility of rupture - which is very unlikely - while also wanting a pitocin induction - suggests the hospital/doctors standard way of doing things isn't all that well thought out.   It's difficult to be really trusting when they seem to be following policy mainly for its own sake.

[Mergath]

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.

 

Exactly. I know how bad pre-e can be. I mean, I've been through it once, and I'm not an idiot. ;) But if my blood pressure is completely stable, I have zero swelling, no headache, and my urine is totally normal, I don't see the point in pre-e specific interventions during the actual birth.

 

[Caraway]

A phrase that really helped during my very confrontational birth was "Is this an emergency? Can we have a minute to discuss this?"

 

Find a doula if you can. Around here there are volunteer doulas, maybe there are in your area too?

 

I hope your birth is safe and comfortable.

 

 

Sent from my iPhone using Tapatalk

[Mergath]

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.

 

Believe me, it's not a giant list. ;) It basically says I don't want pitocin without a darn good reason, I'd prefer a heplock to an IV and would like to do intermittent monitoring, and I'd like to delay cord clamping and hold/feed the baby right after the birth if she's healthy. That's it. It's like a quarter of a page long, lol. I'm not one of those women with a birth plan divided into chapters that details the required threadcount of the sheets and how the specific EO mixes my dh puts into my diffuser will be timed to different music that syncs with the stages of labor. :lol: :lol: :lol: 

 

Edited June 9, 2017 by Mergath

[Mergath]

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.  :)

 

Yup! She's a girl. :) I keep meaning to update my sig (and forgetting, lol).

 

[prairiewindmomma]

--

Edited June 9, 2017 by kbeal

[Mergath]

I'm so sorry you are having to fight for the informed decisions you want to make. 

 

You probably are one of the first to tell her no and question her decision making.  ;)

 

Early induction - But you don't have any PreE symptoms now, correct?  Ask her why she wants to do it a week early.  What evidence?  If she's concerned about PreE, expectant management is fine with the absence of actual PreE symptoms.  Insist that she back up her decision making with evidence. 

 

Cord clamping - This one is tricky.  It's really not about hospital policy as much as the care provider.  So them telling you it's up to the OB is right.  Not that you don't have a say, but you have to convince the provider to do it.  It's ingrained in an OB to catch, clamp, cut, get the placenta out, etc.  Changing up that sequence and routine throws them off.  Just like if you asked me (I'm a CPM) to follow that sequence, it would throw me off because it's not my routine.  It's possible but it is a hard one to get them to do.  All you can really do is talk to her about it now BUT you will have to remind her at delivery.  Yes, sometimes they do ignore the request...I've seen that happen.  Or the doctor will stand there with the clamp and spin them around anxiously because he/she doesn't know what to do now.  LOL! 

 

Your husband can help by keeping an eye out, reminding the doctor as delivery is happening, reminding the doctor right after, saying things like, "We do not consent to...." may help. 

 

How much say you have - Well, you are the consumer.  You can refuse anything.  Again, "I do not consent...."  The problem is, as a laboring woman it's hard to fight for what you want and they know that.  They know women are vulnerable.  Yes, you can say "No".  And yes, they can challenge you and do everything they can to oppose you and make your experience hell.  I've also seen situations where a patient was told "We need to do XYZ..." and later found out the reason for and actual care they said they were doing was not even charted.  I wholeheartedly agree with the suggestion of a doula.  Get another set of eyes in the room.

 

From what the receptionist I was chatting with later told me, because there are only two OBs in town this doctor is insanely busy and likes to schedule inductions for everyone to organize her schedule. :glare:  And I feel bad for her having to deal with that. Really, I do. It must be awful to have so many patients whose lives, and children's lives, are in your hands. But I can't agree to compromise my health in favor of her schedule.

 

And with the cord clamping, given that ACOG's guidelines say that all healthy babies should have delayed cord clamping because it has real, tangible benefits for the baby, I can't imagine why any doctor wouldn't do it if the mother and baby are both doing well. I'm sorry, but "I feel stupid standing there for two or three minutes" isn't a valid medical reason. THAT'S the kind of thing I want to avoid.

Edited June 9, 2017 by Mergath

[Saddlemomma]

They cannot refuse you medical treatment.  You have a right to decline any services they advise.  The problem is, they don't like to listen to us mere mortals. Unfortunately, most people just accept whatever they're told, so when someone dares to question, that really puts their panties in a twist...so to speak.

 

We have mediocre medical services where I live.  They are about 40 years behind in knowledge.  We have to be our own advocates here, and while the drs don't like me much because I question everything they want to do with my family and sometimes countermand their recommendations, there's nothing they can do about it.

 

I would suggest having a meeting with your doctor and those who will be assisting in your delivery -- include the hospital administrators if possible.  Have a list of those procedures you DO NOT wish to have unless it is an emergency. Give a copy of this list to your doctor and the administrators.  Read down the list with them and make sure they understand your wishes.  Make sure the administrators understand you will want a detailed, itemized bill after the delivery and that you will be checking that bill against your list. (If they don't list it, they can't charge for it.) This should ensure you are not given anything you don't want or will be misled about it.  Also, make it clear to them that if there is an emergency situation, you and/or your family reserve the right to alter said list if necessary.

 

When you go in to deliver, at check in, reiterate that you will be expecting a detail, itemized bill. Have a copy of that list and present it to your doctor to remind her and the nurses of the meeting you had prior.

 

HTH

[Mergath]

Whoa, wait a minute...why is it patronizing and fearmongering? These are personal experiences. Interventions were developed for a reason. They do save lives. Do some doctors misuse or abuse them, with negative outcomes for their patients? Yes. But that doesn't automatically translate to patronizing fearmongering when others try to lovingly encourage another look at them from a different perspective. Those are hard words.

 

This wasn't directed to me, but I think everyone in this thread who shared their stories did so out of concern, and I appreciate it. It really does help to be reminded that the doctors aren't always trying to get stuff done so they can get back to their golf game or whatever.

 

Sometimes, though (Not here! But on other childbirth forums I've seen) there's sort of an attitude of, "If you refuse any intervention for any reason, you're a horrible mother and you care more about being crunchy than you do about your baby's life." Which is frustrating, because there's no reason we can't try to balance the safety of the mother and baby with having a positive birth experience.

 

And it's hard to figure out where that line is, because childbirth is SO polarizing, and it's hard to find unbiased research. I mean, you've got people saying that if you have a c-section for any reason, you'll be physiologically unable to bond with your baby because chimpanzees or something and your relationship will be forever ruined, so even if you're about to die, don't have a c-section. But then on the other hand, you do have some (not all, of course, but some) doctors who don't seem to care about anything other than getting the baby out as quickly as possible, regardless of how the mother feels about anything. It's ridiculous.

Edited June 9, 2017 by Mergath

[MedicMom]

As far as the pitocin, I would suspect that having been a previous c section they'd want to be careful with that anyway. I don't have the studies to back it up, but after my first c section and discussing a VBAC with my second baby my doctor was adamantly against pitocin Due to the increased chance of rupture with it. We didn't know at that time how thin my uterus was, and my VBAC went bad anyway even without the pitocin.

It may be something worth asking about. It sounds like pitocin is something you need to stay away from for many reasons.

[ktgrok]

FYI it is against their agreed to ethics to drop a patient within 30 days of delivery without giving them another doctor to go to. 

 

and no, the hospital cannot kick you out if you are in active labor, due to EMTALA (regulations about having to stabilize people before transferring them...and in the case of labor stable means baby and placenta have been delivered. Before that, they can get in HUGE trouble for kicking you out or transferring you. There is actually a Quincy episode about this...in regards to trauma patients I think, not women in labor. But same law.)

[ktgrok]

How close is your next nearest hospital? You could go just there once you are in labor, and take whomever is on call, if that hospital is known to be friendlier to what you want. 

 

 

[EmilyGF]

A friend took his daughter in for possibly swallowing a strong magnet. They admitted the girl for "watching" and said they wanted to keep her until she pooped the magnet out. They did NOTHING but have her stay in bed for a few days. 

 

He was incensed and said he would just take her home and have her lay in bed there. 

The doctors told him if he did that they would report him to Family Services for not properly treating his child and refusing the appropriate treatment.

 

Emily

[Heather in OK]

From what the receptionist I was chatting with later told me, because there are only two OBs in town this doctor is insanely busy and likes to schedule inductions for everyone to organize her schedule. :glare:  And I feel bad for her having to deal with that. Really, I do. It must be awful to have so many patients whose lives, and children's lives, are in your hands. But I can't agree to compromise my health in favor of her schedule.

 

And with the cord clamping, given that ACOG's guidelines say that all healthy babies should have delayed cord clamping because it has real, tangible benefits for the baby, I can't imagine why any doctor wouldn't do it if the mother and baby are both doing well. I'm sorry, but "I feel stupid standing there for two or three minutes" isn't a valid medical reason. THAT'S the kind of thing I want to avoid.

 

Oh believe me, I don't have a super busy practice but when I am in a busy season, I completely understand the ease that scheduling births brings.   :lol:  :glare:   And you are correct, just because it makes it easier for her, that doesn't make it right to not listen to a woman, dismiss a woman's informed choices, or refuse to compromise. 

 

So stand your ground.  Let her know that unless she has a documented, medically indicated reason to induce, you do not give your informed consent. 

 

ACOG states that 30-60 seconds of delayed cord clamping is adequate.  You would think the care providers would listen to their organization's practice guidelines.  But they don't.  I completely agree with you...just sharing my experience in watching doctors try to actually wait until the cord is completely done pulsing.  ;)

Edited June 9, 2017 by Heather in OK

[Mergath]

How close is your next nearest hospital? You could go just there once you are in labor, and take whomever is on call, if that hospital is known to be friendlier to what you want. 

 

The nearest one is about sixty miles away, but it's in a fairly bad area with a lot of crime and it's also in the middle of the big measles outbreak we're having here in MN, which makes me nervous. :( After that I'd be looking at driving to Minneapolis, which is more than a two hour drive. Depending on how this next appointment goes, however, it might be worth the drive.

[Heather in OK]

As far as the pitocin, I would suspect that having been a previous c section they'd want to be careful with that anyway. I don't have the studies to back it up, but after my first c section and discussing a VBAC with my second baby my doctor was adamantly against pitocin Due to the increased chance of rupture with it. We didn't know at that time how thin my uterus was, and my VBAC went bad anyway even without the pitocin.

It may be something worth asking about. It sounds like pitocin is something you need to stay away from for many reasons.

Some providers are.  Some are not.  I know one doctor who gives his VBAC oral methergine (Cytotec) to induce.   

[Murphy101]

Some providers are. Some are not. I know one doctor who gives his VBAC oral methergine (Cytotec) to induce.

We are in the same area. I have never had a dr not want to give me pit drip even tho I was VBAC. 6 different DRs wanted to do it as SOP even for VBAC. And my labors tend to go fast as it is without it. I refused as much as possible.

[prairiewindmomma]

Some providers are.  Some are not.  I know one doctor who gives his VBAC oral methergine (Cytotec) to induce.   

 

:scared:  :thumbdown:

[ktgrok]

Some providers are.  Some are not.  I know one doctor who gives his VBAC oral methergine (Cytotec) to induce.   

:scared:

[Heather in OK]

We are in the same area. I have never had a dr not want to give me pit drip even tho I was VBAC. 6 different DRs wanted to do it as SOP even for VBAC. And my labors tend to go fast as it is without it. I refused as much as possible.

 

Oh are we?  :thumbup1:   I wasn't of that many doctors in the Tulsa area who will do VBAC.  Over the years I've only known of three, maybe four as an option for those planning hospital VBAC.  There is the hospitalist option at St John but it's very tricky to get a VBAC there. 

 

 

 

[ktgrok]

I've said before, when my ex was doing his rotation though Labor and Delivery in nursing school he didn't see even one woman get through without pitocin. Every single woman got it in labor. It was standard. 

 

There are crappy hospitals out there. 

[Bluegoat]

As far as the pitocin, I would suspect that having been a previous c section they'd want to be careful with that anyway. I don't have the studies to back it up, but after my first c section and discussing a VBAC with my second baby my doctor was adamantly against pitocin Due to the increased chance of rupture with it. We didn't know at that time how thin my uterus was, and my VBAC went bad anyway even without the pitocin.

It may be something worth asking about. It sounds like pitocin is something you need to stay away from for many reasons.

 

If it were me, what would really worry me about the drip is that labour would start, but stall out because things just are not ready, and I'd end up with a C-section.

[Soror]

 

And with the cord clamping, given that ACOG's guidelines say that all healthy babies should have delayed cord clamping because it has real, tangible benefits for the baby, I can't imagine why any doctor wouldn't do it if the mother and baby are both doing well. I'm sorry, but "I feel stupid standing there for two or three minutes" isn't a valid medical reason. THAT'S the kind of thing I want to avoid.

This is exactly the thing x100. Not every intervention is associated with better outcomes for babies and their mothers. Not all doctors are up to date on what is considered optimal practice based on real science and statistics, so pushing Mergath that she should do whatever intervention the dr. wants just b/c the dr. says so or she is risking her baby does not line up with the actual facts. I had a birth plan with my first and it wasn't b/c I was so "obsessed" with some perfect birth but because I wanted medical care during pregnancy that actually aligned with the latest recommendations, I didn't want something done just because it has always been done.

Edited June 9, 2017 by soror

[displace]

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.

I thought about mentioning that student doulas work for free. But in her case, a low intervention VBAC, with a difficult OB/hospital... imo experience will be highly needed.

 

Another thought. If someone is in labor and not in the hospital being monitored (delaying going to the hospital), that is very risky. They check BP, labs, baby's heartbeat, etc, for signs of pre eclampsia often. Pre-e can quickly become fatal which is why it is so closely monitored. VBACs are also inherently risky. I won't discuss risk likelihood as each person has to decide how much risk they are willing to take on for themselves and their baby.

[Murphy101]

Oh are we? :thumbup1: I wasn't of that many doctors in the Tulsa area who will do VBAC. Over the years I've only known of three, maybe four as an option for those planning hospital VBAC. There is the hospitalist option at St John but it's very tricky to get a VBAC there.

 

 

 

Yes and no. Remember I've been birthing babies for 22 years? Lots of things have changed over the years. My third was my first c/s and I went on to have FIVE completely uneventful didn't even really care I'd had a c/s for frank breech (where they frequently pushed for me to have pit drips & to induce for scheduling sake.) before everyone suddenly started freaking out about liability risks and refusing VBACs. All of the sudden I go in for baby 9 (8 ish years ago) to the same OB who had delivered previous 2 and was told emphaticly that I couldn't have a vag delivery anymore. Even the OB admitted it was purely bc of malpractice liability rules and had nothing to do with my actual health at the time. So I decided I was not going to have an unnecessary major surgery just to appease their liability insurance and found a midwife to deliver baby 9 at home. Baby 10 started at home, but was an emergency c/s for prolapse. So much for the have a baby in the hospital bc they can handle emergencies. Well they did, but without anesthesia, which I don't recommend. Come to find out, I wasn't the first or last with that problem either and likely a contributor of many other problems there as to why they sold to another hospital chain. After two c/s, there was no discussion of a VBAC for baby 11, which was fine by me bc I wanted everything nice and orderly and planned out. If anything I was distraught bc my OB didn't want to do it soon enough imo.

[ktgrok]

 

Another thought. If someone is in labor and not in the hospital being monitored (delaying going to the hospital), that is very risky. They check BP, labs, baby's heartbeat, etc, for signs of pre eclampsia often. Pre-e can quickly become fatal which is why it is so closely monitored. VBACs are also inherently risky. I won't discuss risk likelihood as each person has to decide how much risk they are willing to take on for themselves and their baby.

 

And this is why hospitals need to realize that their one size fits all policy actually endangers babies. So many women do this, they wait to go in until pushing, and that does mean no monitoring during most of labor. Personally, that's why I chose a homebirth, so I could have a trained, licensed midwife there monitoring me the whole time. I felt it was safer than waiting and only going to the hospital late in labor.