Posted By on 15 Sep 2011 12:26 PM

Hello Henci,

 

I found you on the Lamaze Int. website and was wondering if I could get your insight.  I am almost 34 weeks pregnant with my first child and have recently been exploring the idea of natural labor and possibly hiring a doula.  After starting this process (embarrassingly only about two weeks ago), I learned that there were some important questions that I first needed to ask my OB.  I wrote my questions down so that I wouldn't forget them and I need your help interpreting what she said. 

Better to get there later than not at all, and you still have time to make changes.

My first question was regarding whether or not she would actually be able to be present at my birth.   Her reply was that she most likely would be because she didn't have any vacations planned around my due date, however if I wanted to be certain that she could be there she could schedule to induce me so that there was no doubt.  This was the first red flag and it scared the hell out of me...I don't want to be INDUCED!  I was a little scared at this point trying to figure out how the rest of my questions would be answered.  I told her that I didn't want to be induced and moved on to the second question.

And you should be scared. Inducing labor roughly doubles the likelihood of labor ending in cesarean surgery. Her offhand comment tells you she is willing to expose you to the harms of a major medical intervention when there are no counterbalancing benefits.

"What do you think about Doulas?"  She replied that she had no problem with doulas as long as they didn't get in the way of her decision making as my caregiver.  I didn't know how to interpret this response, perhaps you can help.

It means she attributes any questioning or resistance on the part of her patients to the bad influence of their doulas. "Get in the way of her decision making" means she does not believe in your bedrock medical right to make informed decisions about your care, which, by definition must include the right to informed refusal as well as informed consent. 

Next I asked her how often do any of her patients have a natural child birth and what her thoughts on the matter were.  She couldn't give me an exact number, but she said that plenty of her patients have had natural childbirth and explained that her only reservation is that if she feels the mother has been laboring too long that she prefers to administer pain meds to ensure that the mother can "make it" through the entire birthing process.  I didn't know how to interpret this response either?  Did that mean that she would insist on giving me pain meds if I appeared to be tired or exhausted?  Could I refuse them?  How often do women who are trying to have a natural childbirth give in and allow their doctors to administer pain meds?

This means she thinks she is entitled to exert complete control over you, including such personal choices as in what manner you wish to cope with labor pain. This one should scare you as well as she may also decide to perform a cesarean if she thinks you are too tired. No joke. Here is a study in which 13% of cesareans during labor were performed because the ob, by self-report, decided the woman was too tired or for other nonmedical reasons. You want someone who practices what the American College of Nurse-Midwives calls "optimal care." "Optimal care" is the least use of medical intervention that produces the best outcomes given the individual woman's situation. 

I followed up this question with one regarding her thoughts on different birthing positions and whether or not she was open to letting women give birth in a non-traditional position like squatting or on all fours.  She said she had no problem with other positions, however when it was time for the baby to come out she needed me to return to a position that was suitable for her to see what was going on and have better control of the situation.  Again, I was unsure how to interpret this...did she mean that I could push in any position as long an I flipped back over onto my back when the baby starts to crown?  Did she mean that she was OK with me moving around during labor but not after the transition phase?

I interpret this as you can push in whatever position you want so long as she isn't there, but for the birth she wants you in the position most comfortable and convenient for her regardless of what works best for you or is optimal for birthing your baby. In actual fact, I would bet nearly all of her patients have epidurals, so it is a non-issue so far as she is concerned. Also, there is that word "control" again. She delivers babies. The care provider you want assists at births.

My last question was about episiotomies and how often she felt that they were necessary.   She didn't have any stats for me on how often she does them, but she did claim that women who don't give birth with drugs usually are at a higher risk of tearing because there are no pain meds to slow the baby's descent and therefore she usually does not have enough time to perform and episiotomy if the baby is coming too quickly.  I felt like this statement was another vote on her part for having a drug assisted birth, but I could have misread her response. 

This is arrant nonsense and further reveals both her beliefs about normal birth and her failure to practice evidence-based care.

I am basically trying to find out if you think that based on the responses what the odds are that my doctor will abide by my wishes and or be resistant to my desire to have a natural child birth.  I value your expertise and would love your insight on the situation.

I think you know without my telling you that your doctor will not abide by your wishes and will resist your desire for an unmedicated birth. What you want--labor starts on its own, freedom of movement, no medical intervention without good reason--is, BTW, your best option for a safe, healthy birth. My recommendation is that you find a practitioner who shares your beliefs and goals. Here are some ways to do that:

• See if there is anyone local reviewed on The Birth Survey website who sounds good. Ask them the same questions, possibly adding these from the Coalition for Improving Maternity Services website.
• Tap into the local doulas, midwives, independent childbirth educators (i.e. not teaching at the hospital or in a clinic), International Cesarean Awareness Network chapter leaders and ask for a recommendation.
• See if there is a birth resource center or birth network in your community.
• Call your local hospital(s), ask to speak to the nurse manager in the intrapartum unit and ask which of the midwives or doctors are comfortable working with a woman with your goals and preferences.

Also,  I wouldn't worry about cost if the provider you want is out of network. The cost of staying with someone like this ob could be much higher than you would ever want to pay.

 

Thank you so much for your help,

Due October 31st.

I would love to hear back from you what you decide to do and how it goes.

~ Henci