Oh, and did you know that hospitals ban herbal remedies like raspberry leaves because it causes uterine contractions and can make you go into labor early. Of course, once you are already in labor it's perfect for speeding things up so that you are not in pain as long. My only question is: if this herb is so potent that even a small amount can launch a pregnant woman into labor immediately, why not use it to induce labor instead of dangerous designer drugs and risky incisions. The drug companies gotta get their kickbacks. One of the reasons that no one can afford healthcare any more, and the nurses are underpaid and pissed off.

My hospital didn't do that. They published a pamphlet saying how progressive and natural birth friendly they were, then conveniently ignored every request I made. They bragged about how they encourage women to walk and labor in different positions, then once they had the monitors hooked up I wasn't allowed to get up because it would take a special mobile monitor that they didn't have access to at the moment. I warned them that I don't react well to certain kinds of pain medications. They reassured me that I wouldn't have a problem with the epidural. They had to try three times to get it in, then it had no effect whatsoever, and I had an allergic reaction. I told them not to use dissolvable cat-gut stitches because I have a family history of them not dissolving, they told me it was impossible and used them anyway. They didn't dissolve and I got an infection. They were so convinced that I was going to labor slowly that I was dilated and ready to go for three hours before they let me push. Then they had to run and get the doctor because the baby was coming out faster then they thought it would. Don't you just love how smart the doctors are? Anyone who disagrees with them must be either crazy or stupid, right? This sounds an awful lot like the nuts or sluts defense from an old court case.

Nice to see someone talk about how the patriarchal structure of medicine is the root of all our problems. Pretty much covers it.

Is it sad that I read that birth plan and think that it sounds great? Around here, it's not so much the doctors but the hospitals. Hep lock is mandatory unless you're a VBAC; then IV is mandatory. Intermittent EFM (20 min/hr) is mandatory unless you're a VBAC; then it must be continuous. And worst of all, they won't give you your baby util he's been "cleaned up"--they take him to the nursery and do heel stick, erythromycin, after you've had less than 10 minutes. With my latest, I had to beg for 3 hours to get my son back because they "had to keep him under the warmer to make sure his body temperature stays up." This, despite me begging for S2S contact which would heat him faster and better. It was also "mandatory" for them to take your baby to the nursery for doctor's rounds (1-3 hours every morning) and nurse's checks (1-3 hours every evening) and to limit laboring women to ice chips only--no water, no popsicles, just ice chips. Frankly, the idea of having a popsicle in labor sounds like a dream!

It makes me very sad to see that these things--many of which I begged my OB for and was denied--are considered unacceptable by many others. And it makes me sad to realize that they do this because most other women allow it.

Great post! I have such strong feelings about this topic! Bottom line is ALL HOSPITALS by design will NOT be able to cater to womens NEEDS and RIGHTS to an unmedicated and un-interfered with birth, birth plan or not. They really are ‘sick houses’, that healthy pregnant women have no business delivering in!

It’s sad because I feel those actively seeking maternity care reform in hospital L & D wings are fighting a losing battle. I believe that women need to to educated and supported so that they are (physically) able and feel confident to give birth in their own homes or in midwife run, free standing and government funded birth centers. Only then, do I believe, that women will be taken seriously when they make carefully considered & researched decisions (aka birth plans) for themselves and the birth of THEIR babies.

Another thing to consider (being a healthcare worker who works on a postpartum floor) is hospital staffing. This doesn't pertain as much to the birth, but the care you receive after baby has been born. There are always enough docs, but the nursing staff are always overworked and understaffed. From personal experience, it's hard to give moms what they want, when they want; and then being blamed when you are unable to do everything for your eight (if you are a nurse) up to twenty (if you are a lowly CNA) patients. I think moms should have the experience they want, but it is so hard to do everything for everyone when the real caregivers- nurses, and especially their aides, are so undervalued.

Also as a by-the-way--
By contrast to WomanCare PC, if any of Gina's readers are in the Chicago area--I delivered twice through this practice of Oak Park midwives, at West Suburban Hospital--they have an "Alternative Birth Center" ("ABC") with birth balls and tub and stools and a normal bed where your partner can sleep next to you...I birthed my second child there, and once I escaped the "We need to monitor you for 15 minutes to ensure you're in labor" triage nurse (I was having 50 second contractions 90 seconds apart by then, DOH!) it was AWESOME. (Things moved quickly--Shirley was filling the tub at that point anyway, and once it was going, I think she came and told that nurse to cut it out and let me get into the birthing room. I KNOW they never got no 15 minutes.) My daughter was a waterbirth.

My son was 5 days premature (i.e. born at 35 weeks and 2 days) so he wasn't allowed to be born in that room, but they were VERY supportive of my desire to have an ABC-like birth in a "normal" hospital room. A few snarky lab techs who were sure I'd opt for the epidural once I felt some REAL pain (bitch), but mostly really good and respectful.

Mary Sarocco caught my first baby, and Shirley Moore my second; I don't know the other midwives currently with the practice, but Shirley's the head of the practice and she's very sharp.

http://www.oakparkmidwife.com/Midwifery_and_Womens...

I highly, HIGHLY recommend these gals. Just wanted to tell one happy story. :-)

I thought I was using a low intervention practice in Columbus, OH with my two previous births because the practice has midwives (CNMs) that do most of the routine vaginal deliveries, and I like the midwifery model. I was totally wrong! The first red flag should have been when a midwife stripped my membranes without asking at my 40 week appointment and then tried to badger me into scheduling an induction for the next day even though I was healthy and less than 1 cm dilated. When I declined, the hospital actually called me to confirm my induction, because she had scheduled it anyway! I had to decline it again at that point and kept waiting for labor. Unfortunately, I stayed with that practice for several more years and had two deliveries with them (an intervention-filled vaginal delivery because they convinced me that my water had been broken for "too long" without progress [probably because membranes were damaged by the non-consensual membrane stripping] and then for a C-section because my second baby was breech post-40 weeks and I got the "dead baby" card pulled about attempting a vaginal breech delivery).

I finally woke up after the first few appointments of my third pregnancy when I started asking pointed questions about VBAC and found out that they had a bunch of restrictions on when VBACs can occur. I knew at that moment that I would be railroaded into a RCS or forced into a major fight if I stayed there.

I don't know why I stayed for 10 years and argued with them and was unhappy and bitter about obstetrics. All I wanted was a low intervention birth and to be given as much time as I needed to labor and deliver, even if that meant 42 weeks and a 24 hour labor. It was a huge relief to make a switch and actually hear a provider say, "I believe in evidence-based medicine and that most deliveries need no intervention at all, so I will not step in unless there is an emergency." I know that many (most?) of my friends ceded control of their births to their providers.

Gina, thanks so much for helping to spread the word about all of this CRAP. Especially for women who go to Kingadale Gynecologic Associates or to WomanCarePC, it's so important for them to see these birth plans, the evidence that contradicts the statements in them, and the comments pointing to the truly condescending and patronizing tone in them. And then it's important for them to TRANSFER their care as soon as possible!

Keep fightin' the power.

wow having doula'd for friends and considering it as a profession, you just made my blood boil...lol. I can't even say anymore about how i feel about this without making my bp go up.

I personally love the birthplan. When I had DB years ago I had a special appointment with Hubman and the nurse and the three of us developed a plan that was followed in the delivery room.

When I had PP 5 years later the midwives did not use one. Their answer was..."We're midwives, we want you to have a natural birth." However I refused to sign the waivers and releases without a birth plan and I have one.

And 1-3 hours to push? It takes some people much less time and some people much more time. Why not say pushing can last anywhere from minutes to several hours.

The birth class I took had us do an abstract drawing and then recommended it be our "birth plan".
At the time I thought that was a great idea, free flow, trusting and all that.
Now I wonder WHAT WAS I THINKING! I should have made a real birth plan if only so I would have addressed all the possibilities for myself.
Sometimes I am still shocked at how naive I was.

You've seen this, yes?!?

http://www.theunnecesarean.com/blog/tag/aspen-wome...

Hey, at least they're being transparent, like pp have said. I started out my first pregnancy with a 2-OB practice who told me I could "swing from the chandelier" if I wanted to - as long as everything looked fine. They said they were conservative, which I thought meant they would be conservative in implementing any interventions. Oh, boy-o, was I wrong! At 5 days postdates, they did an oh-so-innocent-sounding "non-stress test," which is code for EFM (little did I know). They saw what they thought were late decelerations on 3 of 4 pre-labor contractions and were all ready to induce, which threw me for a loop! I thought they were so conservative, they'd be thoughtful about inductions, c-sections, etc.; however, "conservative" to them meant that at the slightest sign of "danger," they were ready to jump on the intervention bandwagon. And of course they didn't seem to understand why I was so hesitant.

It's so insidious, because I think a lot of OBs genuinely believe what they are telling patients - about the IVs and episiotomies, the need for a c-section. My OBs did seem genuine when they were discussing with me the induction they wanted to do. They are so earnest about it all, it's hard to trust your gut. Surely, you think, this honest-sounding guy wouldn't lie to me? I am so thankful that I listened to my gut (and my doula) and switched to a midwife/homebirth. I feel sure that I would have ended up with a c-section because of a failed induction, when there was absolutely NOTHING wrong with my baby.

week in review comment: OMG ARG!!!

My blood boiled so hot this week I was truly moved to tears at moments (seriously).

"with access through the Internet, patients have been able to print one and present it to their physician. "

It's all those women on the interwebs...thinking they know all sorts of things.

HA HA! I love that they said that. My mil is a nurse and she told me that the doctors HATE the web b/c patients come in with all sorts of ideas about what they have and input on treatment options. "Let us do our job" says the docs.

And I say, huh? Our health care system is so disjointed. I have just walked three family members through some major illnesses and if there is one thing that's been made obvious to us is that if you don't advocate for yourself you'll get lost in the system.

I'm sorry if our questions and birth plans are such a pain in the ass, but this is our freakin life, our body and our health. You barely know us.

Otherwise, I agree with a previous poster that this is actually a really good thing. They should be more transparent about these things. If this is how they practice it should be said out loud--hopefully leading to a mass exodus of patients.

I saw something about this a couple months ago, and I picked it apart on the blog I write for our local newspaper.
I was appalled that there are practices out there like this.
Recently the hospital in my state with the highest c-section rate became "baby friendly" when clearly they are not. With a 44.5% c-section rate and a VBAC defacto ban, there is nothing baby friendly about it.

I then learned of a friend who birthed there, and actually had a vaginal delivery. What did she overhear the nurses calling her? A "cesarean bi-pass" DISGUSTING!!

Until more women stand up for themselves and actually FIRE these providers, we will continue to hear these horror stories. It is truly sad.

A. You would think that DOCTORS would have slightly better grammar or at least know how to use Word to proofread.

B. You are preaching to the choir. I would imagine that 99% of us who love your site (and others like yours) would be up in arms if we ever had to sign something like this. I imagine that most of us are pissed off that any woman would have to deal with that crap. Unfortunately, the women who would willingly sign their rights and their bodies away probably aren't reading you. I want to talk to every single woman who is ignorant enough about their bodies to blindly trust their OB without a single question.

I would have thought that my doctor providing a birth plan like that would have been AWESOME with my first. Then I had a normal, uncomplicated delivery and they took my baby away for an hour for routine tests. Between that and the epidural, we never really got the bond that I have with my naturally born second child. Breastfeeding was hard and took months before I finally felt like she was my baby. Sadly, I think it takes something like this during a first birth to make women want something better for the second.

I just used this to add more notes to my birth plan. Every time I see my OB she seems to be in a bit of a rush, honestly, but I intend to discuss this plan with her at the beginning of my third tri (next week) and if it doesn't seem like we're on the same page I WILL switch providers.

These posts couldn't come at a better time for me.

I agree - you need to be comfortable with your provider. If they are creating documents like these, they aren't going to honour your wishes. When push comes to shove, they'll take matters into their own hands because it's 'medically necessary'. There are better care providers out there, I'm sure of it.

This makes me so ANGRY! I hate that women think they're doing the right thing by listening to their physicians, but they're the ones leading them astray.

I am feeling like my ob's office was really great after reading all of this. They were very accepting of my (admittedly too) lengthy list of preferences and each doctor reviewed it and made comments if he had any differences. In general, though, they all were very supportive. I'll never really know what would have happened since I wasn't in labor there long enough for them to do Anything I didn't want other than let me push squatting, and I think that if I had had more time to talk to the nurses they would have been more supportive of that.
I almost wish they hadn't been so nice about it, because then I probably would have gone with a midwife and then I could have just stayed home for the last 20 minutes.

It's lame, and horrific, and condescending, yes....but they (WomanCarePC) are being honest and I actually find that refreshing.

These birth "prescriptions" explicitly inform women of what they will experience should they birth with those care providers in those facilities. No, their clients will not have any autonomy during their birth process and they will receive XYZ interventions, the docs are upfront about that. Women need to know this.

Should we as women accept this miserable standard of care for women who need or choose to birth in the hospital? Of course not. But at least there is *some* transparency here happening between women and care providers.

I talk to women every week who are planning a "natural" hospital birth without unnecessary interventions. Most of them have no idea what they are signing up for.

"these birth plans can be erroneous"
WTF does that mean? Erroneous to whom, for what?
I guess they mean the woman is in error for thinking she had any say. Are thease offices so focused on having complacent paitents they don't realixe how awful it sounds?

I didn't get a birth plan, but it was quite obvious that the OB didn't support any sort of physiological birth. When first finding out I was pregnant, and before I did any research I had my first appointment. I mentioned that "bigger" babies (about 9 lbs) run in my family, and that both my mom and sister (and many of my cousins) went slightly over 41 weeks with their first. This brought the response of, "we don't LET anyone go past 41 weeks..." and some comment about how big babies may need a C-section.

I went home, and started doing research. Thanks to a FIL academic pediatrician I have access to all the medical journals. I easily found what I already suspected; 41 weeks is not dangerous, and big babies are no reason for a C-section. Fired the doctor and wrote a detailed report on a patient review site.

BTW I did confront him with the research. Actually dropped it off a few days before my next appointment, and told the office manager that I would want to discuss it with him. He didn't have any good answers, pulled the "healthy baby" card A LOT.

Now I have a midwife - much better.

When I think about the amazingly respectful, individualized care I received from my midwives (3 different practices for 3 different births), it makes me so sad that the majority of women out there will never experience the type of care I did, and will instead be faced with the type of practices mentioned above, and think that is "normal", and never know the difference. I am by nature very anxious and afraid of pain, but the midwives I worked with always instilled complete confidence in my body and the birth process, so I had confidence, too, and ended up with 3 beautiful, natural, life-changing births. I wonder how differently they would have turned out if I had doctors undermining my confidence and subtly encouraging routine interventions like this.

"There is a solution. Fire them. Take back your body. Refuse to be treated as a wombpod. Let them know that we ARE consumers in this process, and if they won’t treat us with respect, then by golly we’ll get our birth attendants elsewhere, thankyouverymuch. "

The real shame in all this is that two examples are highlighted, but this I'm sure is common practice among many OB's and women accept it without question every day. My guess is that a very small minority of women receiving the "anti-doula letter" will leave the practice, another small minority will be miffed by the doula ban but will stay with the practice and might sneak in a "sister" or "friend" and hope for the best, but the vast majority will NOT fire them, and will have blind trust that their doctors know what's best and will have your standard intervention-filled birth (and roughly 32% of them will have surgery) and think their doctor saved the day and it was all necessary.

These practices do this because they CAN, they are obviously not hurting for clients ("patients"). I don't know what it will take for women to vote with their feet, and their pocketbook- that may be the only way to ever see any difference.

It's great that there is discussion here amongst birth activists, but ultimately, how do we get this message out to the masses? Well, I guess that's what you're doing :) Keep up the good work, Gina. You are awesome. Thanks for telling it like it is, time after time.

I agree, share your birth plan with your care provider early on and if they don't agree with it, then find a new care provider!!!

"Birth plans have become a popular concept for patients over the past several years and with access through the Internet, patients have been able to print one and present it to their physician."

Docs hate the internet. It is a devil that fills the heads of usually sweet compliant mommies-to-be with all manner of craziness. I love how they assume that parents give no thought at all to their own birth plans. They just print off any old thing they find online and start making demands.

You know, this could have been an opportunity to find a middle ground. They could have used this as an interactive exercise to find out what is important to the mom and her partner during labor. It would surely be helpful for everyone going in to know that a mom wants to labor without an epidural, or if she wants one the minute she walks in the door (that's a legitimate plan request too). Instead they tell the patient what the options are, and then inexplicably tell them to sign it. What for? I guess so no one comes up with "crazy" stuff at the last minute. They seem to be saying - These are the options - the only options - end__of__discussion.

Also - the IV issue. I personally believe that it is one of the most dangerous and insidious interventions of all. I mean it makes sense right? You don't want to waist time in a real emergency with something that can be done in advance. It seems logical to submit. But, it makes you a patient in the way few other first tier universal hospital policies do. You could get away with wearing your own t-shirt instead of a hospital gown, and the id bracelet isn't that different from a watch - which you can let yourself ignore. But the IV means you are sick. It tethers you. I makes you theirs. It makes every other intervention that much easier. Laboring while dragging around an IV pole - it sets you distinctly apart from what you were naturally made to do. For many many of us it triggers the fear that makes labor's natural rhythm go awry. IVs are not benign.

holy crap! this is some crazy shiz! but i love your last paragraph. its up to us women to educate ourselves and chose hospitals/birth centers/wherever that agree with our views and beliefs. i drove almost an hour away, passing by at least ten hospitals, for the kind of birth i wanted!

ps. i heart dr marsden wagner!

Wombpods, indeed. This is insanity.

that is just ridiculous! I chose not to make a birth plan, because with my OB (first two births) and MW (3rd birth) I felt respected and listened to. I did have to "make my case" with DS#1 to even get an episiotomy, because my OB thought I was doing just fine and dandy by myself. Once he realized that I was not just a hysterical and tired first time mom and he really wasn't coming out he agreed to perform the episiotomy, and at my request gave me a numbing shot (since the epidural did not take completely, like...everywhere except my vagina)

I feel so lucky, that the hospital calls and asks for a verbal birth plan and to mail in any written birth plan. I got the births I'd wanted (sort of) and got 3 healthy babies out of it! :)

Wow. I had my VBAC in Columbus,OH through Ohio State University Medical Center. I was "allowed" a VBAC but was badgered in active labor and threatened that my baby would die if I didn't agree to an epidural and internal monitoring. So I did and that contributed to my developing an infection in amniotic fluid which required a 1 week NICU stay for my child. Not because anything was wrong with him, but because it was protocol to treat him with antibiotics (even though the blood tests came back negative for infection). Argh. The whole thing makes me livid.