Adventures of a Student Midwife: June 2010

First, thank you, thank you, thank you to Birthing Beautiful Ideas for transcribing this. The disgust I felt for this practice wouldn't permit all my snarky comments to fit in her comments box (couldn't type it all on my phone either) and I hated to take up her space. Please see her related posts:

Another Doula Ban, Another Bad Birth Plan
and

Here I thought the Kingsdale Anti-doula letter was bad

My personal comments are in turquoise

Kingsdale Birth Plan
The physicians at Kingsdale Gynecologic Associates congratulate you on your pregnancy and the money it brings us and hope that your journey through pregnancy, labor, delivery and beyond is exactly what you we wish for. Our primary goal is to provide you and your baby with the medical ~~expertise, experience and support~~ management you need to have a healthy as determined by what day of the week, how the wind blows, or our own personal biases towards what we consider healthy pregnancy, a safe also up to our definition that day delivery note, it's not a birth, definitely not your birth as a mother or your child's entrance into this world, we are delivering something to you that you ordered and a wonderful experience. again, wonderful to us, your experience and participation matter not.
We recognize that this is a very busy time for you and your family really, all you need to do are pick out the baby shower colors, how many onesies to buy, does your carseat match your stroller, did you get the lastest unnecessary baby gadgets to separate you from your instinctive parenting(I foresee another post) and wish to help minimize the work ahead of you by providing our advice doctor's orders and philosophy in this “birth plan.” ok, so I agree with the parentheses, you can't plan birth (except scheduled C-sections). Call it a wish list, but by all means write down what you hope to do, avoid, experience, make a goal people. Don't just try, do By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary mainly because these books and websites teach, encourage, empower you to think for yourself. DON'T think for yourself! It's very dangerous. If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them. don't bother discussing them with all the doctors who may be present at your birth. the doctor with whom you speak may ok something out of the norm, but don't expect the rest of us to go along with it. Also, please oh, please, read NOTHING from Dr. Marsden Wagner. He's out to ruin obstetrics for the rest of us!

IV’s: Patients often ask us if IV’s are necessary in labor. The answer is “yes.” This is so we can treat you like a bomb waiting to explode. We need to keep you tethered to the pole and preferably the bed so that you don't try anything with which we are uncomfortable. Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished feeling nourished during labor can only be accomplished via IV, not through the digestive tract because we don't want you to listen to your body's signals. We are the only authority on your body. We don't spend 24 hours a day in YOUR body, but through years of book studies we are the experts. through the labor process, the most important part is the “hepwell” itself. If we run into an emergency situation which is why we are now requiring "hepwells" for all people in the event you are in a catastrophic car accident and we cannot access a vein in the ER, we will also be providing IV poles to all humans to tote around so that in the event you need an emergency apendectomy we can do it with no worries about stomach contents where the life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access. This is obviously a rare occurrence actually, due to our constant intervening in the natural process of labor, we often have to rush you and your baby to the OR for our super-safe abdominal delivery, but often an unexpected one. ok, not so unexpected because we pit to distress and expect you and baby to need us to intervene on our interventions.
Nourishment in labor: We usually limit women to ice chips and popsicles during labor. This is not designed as an attempt to starve you no, we aren't trying to starve you, we're torturing you. We enjoy watching you squirm when you need nourishment for the marathon event ahead of you. We are out in the hall betting on maternal exhaustion and flipping coins to see who is scrubbing in for the section we've already planned for 2pm, just for you. Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous forget about Ina May's Law of Sphincters, you know, opening one orifice in the body helps the others to open, we wouldn't want your cervix to dilate. Honestly, our staff doesn't want to deal with the smell and mess of vomit. In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk. Of course, we will give you nourishment and hydration through the IV as necessary again, this is not determined by your body's signals, but based on when it is convenient for us.
Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor. The hospitals have multiple options for pain control including positioning techniques but we are too busy charting and intervening in other labors to show you any of them. Again, do not read books or websites with information regarding the use of these devices and methods. They are an ancient practice which has no place in "modern" medicine. Drugs are GOOD, movement is BAD (birth balls, etc.), IV pain medication, and regional anesthesia. Labor, unfortunately, is a painful process please don't read anything that might indicate that this pain is good, for a purpose. You know things like Birthing from Within, Painless Childbirth, Spiritual Midwifery. It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs. Some labors are quite rapid and tolerable while others require a great deal of patience and intervention. We get really upset when you show up ready to push. We need you here for hours so we can do the maximum amount of intervening to stretch out your labor and make it very difficult. The patience required is on our part because some of you just refuse to go along with our orders and try that new-fangled thinking for yourself. You get the idea that maybe we should just let labor happen on its own--NO!!! Nature can't possibly have designed your body to labor effectively without our drugs and equipment.

Labor without anesthesia you aren't really going to try this, are you?: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class we offer childbirth classes, but of course we're just paying that whole "natural" childbirth crap some lip service. For the love of Pete, don't you dare take an independent childbirth class that might empower you. Don't go anywhere but a class taught by a hospital or doctor's office. The information we offer is archaic and designed to keep you following the rules we have put in place for you so your labor will procede. that teaches you about focal points we'll move these out of sight during your labor and breathing techniques we'll tell you how to hold your breath and push until the capillaries in your face, neck and chest break. The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes except that most of the time they are far too busy staring at a monitor that says your labor is going perfectly even when you are struggling. Because we have banned your use of a doula who provides non-medical emotional, physical and informational support, you're just stuck with someone who instead of supporting you, will start saying, are you sure you don't just want to get the meds? no personal reference to what happened to me or anything. Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary. Of course, we are out in the hall taking bets on how soon you'll take the meds. We're laughing at you because you think you can do this without our magic medications!!

IV pain medication: IV pain medication is available for use during labor. The medication can often make women a little sleepy and is said to “take the edge off.” It will not completely alleviate the discomfort of labor. This is actually a factual statement. We try not to use IV pain medication close to the time of the actual delivery as it depress the baby’s drive to breathe. Also factual, but the way these meds are sold to you during labor will feel like you are on the street being offered illicit drugs--come on, it will give you a little break. Right, that "little break" can wear off within 30 minutes and you can't have another dose for 2-3 hours. If you've gotten it as an in-between while deciding on an epidural, you might have just made your labor a little more difficult. I hallucinated on Staidol, not a pleasant thing to happen during labor.

Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals. There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible. The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby. Again, do not google "effects of epidural on baby", all you will find is information about how it can depress breathing, the sucking reflex (if we let you breastfeed our kick-backs from the formula industry go out the window and we need those to pay for our malpractice insurance because one of these days women are going to start suing us for DOING interventions and unnecessary c-section.) The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement. The nurses will continue to help you with position changes occasionally we'll come in and wedge a pillow under your hip since our epidurals don't always work as well as we make them sound that will facilitate the birthing process. Honestly, we've got you right where we want you at this point--lithotomy position, probable episiotomy (without your knowledge or consent, of course) and we may even pull out the vacuum or forceps, two of our favorite things! And since at least one of our hospitals is a teaching facility, we have to show these interns how to do the procedure! Since you are presumably numb from the waist down, the primary OB will place the forceps, remove them and then let 2-3 students do the same and then the OB will place them the final time and yank your baby into the world. By doing this we've inserted the forceps at least 3 times increasing the risk of infection and that helps your pelvic floor maintain its integrity for later in life.

The choice to use anesthesia or not is ultimately your choice. There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby. Ultimately, we want the birthing process to be one you can enjoy and remember fondly. We want you to tell all of your friends how we "saved"you and or your baby from the situation we created in order to train interns and/or manage your labor.

Fetal monitoring: In order to provide the safest possible delivery, we feel that fetal monitoring is important during labor in order to assure we raise your risk of cesarean as much as possible that your baby is tolerating the process well. Because we are surgeons, we are untrained in checking heart rates with fetoscopes or Pinard horns, so We often accomplish this with continuous external monitors that are placed against your abdomen with tight, uncomfortable elastic belts. We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times. But, honestly, this is just a huge inconvenience for us. It pulls us off our butts so that we can chase you around with a hand-held doppler (often times we lie about having one so we can hook you up to the one next to your bed hoping you'll get as tired of the on-off game as we were to start with). If we are concerned about the adequacy of labor or fetal well-being, we occasionally use internal monitors, which are more precise. We're not even going to mention the risks that go along with the internal monitors. You know, like breaking your water (possible prolapsed cord and emergency cesarean), increased infection risks for you and baby, trapping you in bed, etc. The intrauterine pressure catheter (IUPC) is a device that goes next to the baby inserted between baby's head and the cervical mouth to monitor the strength and frequency of contractions. The fetal scalp electrode is applied superficially to a baby’s scalp we'll tell you it doesn't hurt baby, because we all know babies can't feel anything yet, but would you like to have a screw inserted into your scalp? to get the most accurate fetal heart monitoring. We will not use these internal devices unless we feel they are medically indicated. We're really good at dreaming up reasons to keep you strapped to your bed. If only we could bring back the Twilight Sleep......

Labor support: We do recommend that you have a good support person or two during labor but don't forget that we have banned anyone who has any type of formal training, is certified (or becoming certified) and follows the scope of practice. We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with. We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it as a doula and student midwife, I find it necessary to agree with this statement. Your parents, in-laws, siblings, friends and even partner can actually hinder labor. This isn't to say that doulas have never done the same, but a good doula should know when to back off or NOT do anything. The labor and delivery nurses and doctors together act as “doulas” (if this were true, doulas would not exist in the numbers that they do) in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy for us as possible. Your support person should be there to do just that–give support only physical--none of that educational or emotional support!.
Mode of delivery: Our goal is to provide you and your baby the safest delivery again, this is not a birth, we are delivering a package you ordered some time ago. We do occasionally need to do c-sections for delivery when it is necessary for you or your baby. We never ok, ok, never say never do c-sections for our own convenience. If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in as few details as possible. We'll say there isn't much time, just sign here, oh, wait you signed that paperwork at your first prenatal, we'll play the dead baby card, we'll prey on dad's role as protector, we'll ignore any emotional consequences or upset this may cause. We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time. Actually, we'll just state that this needs to happen without any attempt to try a different pushing position that may hinder our view. Remember, we're trained with our eyes not our hands. We are NOT midwives.

Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing. Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing shhh, cutting an episiotomy can lead to more damage than a tear. We promise to use our medical expertise and experience to make the best and safest decision you are NOT qualified to make any decisions for yourself, goodness gracious, have you really not figured out that you are not capable. for you and your baby. The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice. Unless you call, flat-on-your back with an epidural so you can't move to a better position for you and baby "routine"

After delivery: The birth of your child is truly an amazing event. We want you to be able to bond with your baby as quickly as possible, but only after we have bathed your baby so you can't smell him or her, put ointment in his eyes on the off-chance you have an infection that causes blindness and that interrupts breastfeeding (again with our kick-backs). If the baby does not require immediate resuscitation (seriously, they said this? very, very uncommon), we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord. Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby. This usually occurs in your room at the infant warmer and not on your chest. Remember, you are not capable of taking care of your child. But don't you dare call us 3 days postpartum with issues. We washed our hands of you when we signed the discharge paperwork. If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible as long as it doesn't interfere with all the poking and prodding we want to do to your baby, often transporting both of you to the postpartum floor together. If desired, you may attempt “skin-to-skin” care tip: take off your t-shirt or gown if you fell into that trap and breastfeeding just take the formula, my income increases while you spend yours at this time. With c-sections it is often necessary to take the baby to the nursery prior to your own transport. In these situations, we will try to get you to your room as quickly as possible to reunite you and your baby.
We hope that this clarifies many of the questions about the birthing process that you may have along the way. Do not do any independent research, only listen to frightening birth stories. Remember, birth is NOT normal. You are sick and in need of medical care. You should not hire a doula (the person who can help you sort through all of our mumbo-jumbo) or even worse, don't seek out the care of a midwife! Please feel free to ask questions and obtain clarification if needed from your individual provider. But if you are a good, compliant patient and do exactly as outlined, you won't need to question us. Besides, the 3 minutes we give you in your appointment isn't enough time for us to ask. When you call for a non-physical appointment we're going to tell you that we don't have time. You can ask during your regular appointment.

“Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.” -William MacNeile Dixon
"Ask the woman, she will tell you everything you need to know"--Ina May Gaskin
There is a secret in our culture,
And it's not that childbirth is painful,
It's that women are strong.
-Laurie Stavoe Harm

If it hurts, get off it, move it around, rub it better.
~ Barbara Kott (president of the NCT)
Just as a woman’s heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth.
~ Virginia Di Orio
The same movements that get the baby in, get the baby out
~ From Birthing From Within
You will emerge from uncertainty into great peace and freedom.
~ Unknown

Adventures of a Student Midwife

26 June 2010

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