Seriously?  When it comes to maternity care the emotional tie of a baby’s health can be used unscrupulously.  Of course a mother doesn’t want to do anything that would hurt her baby, but is the emotional blackmail of responses such as these really necessary?:

“Well, if you don’t care what happens to the baby…” “If you don’t do this your baby could die.” “You can choose that if you’re going to take all of the responsibility for the risks and sign this waiver.” ~ What Are They REALLY Saying?

Natural or ‘normal’ birth advocates and educators are sometimes labeled as rebellious, extreme, etc. with the opponents claiming in the same breath to also being focused on healthy birth outcomes.  Kathy Petersen, IC member, muses more about the same team issue.

There may not be an “I” in ‘team’, but there certainly is a “me.”  The only ‘team’ that exists is the one you put together and at its center is you.  You are the “me” in team.  You are an active participant in your birth and that actually benefits your practitioner because you get to give informed consent or informed refusal.   Are practitioners so afraid of the legal system that it’s easier to just have women go along with what makes a lawsuit least likely to arise?  The truth is most consumers don’t want to have to deal with a lawsuit either.  It may appear to be easier and simpler to just go along but it isn’t.  If Big Baby Bull doesn’t help you see ‘malpractice’ intertwined with emotional tugs perhaps a mother or a baby dying from the misuse of the drug Cytotec for an induction (for the suspected big baby??) will.

Informed refusal gets dicey because a practitioner must be able to prove that their client/patient was aware of the consequences of not following a specific protocol.  Yet when it comes to maternity care, a system so fraught with the overuse of technology that many in the field admit they’ve never seen a natural birth, can practitioners really convey to a mother what will happen if they refuse technology?  We can hear that conversation now: “Well, if we just sit here and wait you will have to have this baby completely on your own!”

A practitioner’s ability to understand normal birth is greatly undermined by their own failure to appreciate the litigious environment they created themselves.  ACOG recently admitted, for example, that the guidelines for external fetal monitoring are left open to interpretation.  What they are not making clear to the consumer though is that it is the obstetricians who have failed to understand and deploy external fetal monitoring prudently but it is the mothers who are shouldering the consequences, the fear of malpractice:

“Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page,” says Dr. Macones. One of the problems with FHR tracings is the variability in how they’re interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings. ~ ACOG Refines Fetal Heart Rate Monitoring Guidelines, June 2009

Desirre Andrews, IC member and President of ICAN, shares Alexandra Orchard’s experiences spanning six years of trying to achieve a natural birth.   Again, as Alexandra and her family learned, it is not the VBAC itself that is to be feared but rather fear that the practitioner’s judgement, recommending surgical delivery in the first birth, will be called into question is what drives a practitioner’s loathe to attend a VBAC mother.

Last, the public itself is brought into the drama with irresponsible headlines such as this one from the New York Times blog, Refusing a C-Section, Losing Custody of a Baby.

Contrast Alexandra’s letter to her obstetrician (watch the video to the end!) to this scenario ripped from the headlines today over the mother who supposedly lost custody of her daughter solely because she refused a repeat cesarean.

Independent Childbirth supports the natural birth community through the use of quality and self-earned birth knowledge about natural childbirth.  Mothers are the birth experts.  We share normal birth and because we do, more mothers today recognize medical interventions are sometimes needed but they do not justify today’s rate of surgical deliveries, birth injuries and denying mothers of patient rights.  Let calmer heads prevail, that of a thinking mother (who isn’t?) choosing normal birth experienced practitioners who value a mother’s instincts.

**For more on “informed refusal” visit The Risk Management Handbook for Healthcare Professionals.  For more information on the New Jersey case visit Knitted in the Womb and VBAC Facts.
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Keith Roberts is unfazed by the attention given him as the first man to be certified as a doula by DONA.  He has has spent over 30 years in the field of holistic care, specifically focusing on pregnancy massage therapy and birth support for the last fourteen.  The prenatal massage work he does was a segue to following one mother right into labor where he found expert massage therapy was extremely beneficial to her in labor.  She was the first of fifteen more mothers he supported in labor before he determined to pursue certification as a doula.

Keith is perhaps more determined than female doulas to not replace fathers at birth.  The female support presence is invaluable because she is female and yet that bond is one that many a father may meet with trepidation: a club that he can’t be a member of by virtue of his gender.  Keith recalls an image that influences his genuine welcome of the father, an old cover of International Doula.  The cover’s image showed a mother embraced by her doula and the father is in the background.  Many a father today may not care to be present for labor but just as many men know there was a battle fought by Dr. Robert Bradley and the Hathaways to protect a father’s right to be in the labor and delivery rooms.

Those men who do want to be present for their child’s birth are already engaged in a checklist of all that they are expected to be today: he is to know everything about birth because he will be the mother’s advocate allowing her to focus on her labor; this he must accomplish while also providing physical, mental and emotional comfort.  Then after the baby is born he must strike the perfect balance between staying with mother throughout third stage and going with his baby should there be a medical reason to separate mother and baby.  As many a partner has put it, he/she must be everywhere, have eyes in the back of their heads and know how to play football, delivery room football that is.

Keith’s role is primarily for physical comfort.  It is easy for mom to choose between the two males present for her emotional and mental support….dad is her intimate partner.  “(Partners) are a reflection of mother’s state-of-mind; they tend to follow her lead and birth is just as much of an unknown to them as it is for mom.  They (dads) have as much a desire to meet birth at mother’s level of comfortability and she will want dad in front of her, to see him and be held by him.”  Further, for all of the reasons listed above, men appreciate having another male present in the primarily female energy until and unless a male obstetrician walks in for a few minutes of observation, medical speak and then exits.

When asked how he perceived the choice of a woman to invite doulas, let alone a male doula, to their births over their mothers even Keith’s keen observation of relationships is quick to surface.  In his experience few mothers want their own mothers present because they will feel a need to perform or meet parental expectations whether real or imagined.  Having their own mothers present is often an overwhelming thought no matter how comedic, true or polite the response is expressed!

Keith’s own intimate insight into birth as someone who could not experience birth for themselves but supports laboring women gives invaluable advice to partners.  These are his experienced Natural Birth Critical Factors:

  • Once you are in labor you cannot stop the flow of birth care you signed up for.  Choose wisely.
  • Read. Read. Read.  Take a natural childbirth class and read some more! A natural childbirth experienced and focused birth class leaves mothers and their partners with less “unkowns” and less fear of those unknowns.
  • Learn about fetal positioning.  The more you know about baby presentations and how to encourage optimal ones and work with less than optimal ones the more sense prudent changing of positions in labor makes.
  • Your choice of birth care practitioner directly relates to your odds of having a cesarean!
  • Keep the bag of waters intact!  Artificial rupturing of membranes (AROM) or artificially breaking the bag of waters is trivialized.  EVERY practitioner knows that within a short while of breaking the bag of waters labor intensifies in a ratcheted manner (versus a natural progression) and the majority of women will subsequently ask for an epidural.
  • Hire a doula for the purpose you want be it physiological support, birth knowledge, support for dad.  In all cases the doula can alleviate what stresses you most leaving you better able to meet labor’s demands with all of your own energy.
  • It is very hard to buck the system therefore, go back to Critical item number one.
  • Lastly, but more importantly, he reminds mothers that they have their own voice.  A doula will provide his/her opinion if asked but will never make a mother’s choice for her.  Mom must convey her choice directly to her careprovider and partners must be prepared to be be the first line of support echoing mother’s choice and minimize the number of minutes he/she might otherwise spend playing football by putting all that you’ve learned in a natural childbirth class into action.  Learn more about how your doula can best help you.

Through supporting women in labor hands on, so to speak, Keith has gained a whole new appreciation for the courage of women and for the hospital birth experience.  He concurs with Penny Simkin’s address at the DONA conference in Washington D.C. three years ago where stated the doula backlash is very real.  Keith advises new doulas to be mindful of their standards of practice and ethics.  Unless they have an established relationship with local practitioners then their voice, necessary for the support of laboring women, must be viewed as respectful of the practitioner and facility as well.  Birth is a hands on experience for the obstetricians and nurses themselves.  This is an opportunity for them to observe truly natural childbirth and learn.  If the doula is not respectful and professional in conveying her knowledge and experiences then the entire birth community suffers the backlash.

Informed Consent is defined as the act of agreeing to a medical procedure, taking into account the benefits and risks of doing said procedure. It is up to you to KNOW, UNDERSTAND and DISCERN what is in your best interest. Informed consent is a patient’s right to be presented with sufficient information, by either the physician or their representative, to allow the patient to make an informed decision regarding whether or not to consent to a treatment or procedure. Patients generally are recognized as having the right to refuse medical care for any reason. Their reasons may include any personal grounds they choose, even if the physician considers their grounds to be frivolous or in poor judgment. In order to ensure that you are in a position to make an informed decision you should meet four requirements:
  1. your competence and reasonableness (you are not under undue influence)
  2. full disclosure has been given to you (risks, benefits, alternatives)
  3. you comprehended the information given to you (can you explain it in turn?)
  4. you are voluntarily giving consent based on all of the information you have been given
Informed refusal is defined as once a procedure has been explained with all the benefits and risks, consequences for NOT doing said procedure and you understand and accept these risks knowing that an adverse outcome is possible, if not likely, and choosing NOT to have the procedure.
Against medical advice is defined as a person checking themselves out of a hospital early or refusing admittance against the advice of their physician. Such persons are usually asked to sign a form that they are aware that they are leaving or refusing against their physician’s advice. The term AMA is usually noted on the hospital’s report and said person should be aware that their insurance may not cover any subsequent care or charges as a result of their decision. When the issue is about whether you choose to undergo a procedure against your judgement and therefore absolutely put yourself at risk for which the physician will not be held accountable for OR you are not in the economic position to refuse and bear the financial burden you are under duress and should not be engaging in this agreement!
Are these things important to you? They should be!
Understanding the roots of informed consent and recognizing the physician who is paternalistic in the interpreting of informed consent affects your ability to exercise your patient rights to the fullest extent protected by law. Learn about your health and patient rights in order to have dialogue with your careprovider that gives you REAL answers to your questions about birth care options and your ability to identify and bring to fruition those birth choices that are a priority to you.

It seems that birth can be a very contentious battlefield. That birth choices would cause arguing, even among women, of the sort that leaves our society tearing each other down is more alarming than the state of maternity care in America today.  That’s the smoke and mirrors approach: the success of the medical birth model in dividing women and the attempt to remove the focus from health care to hide behind the red fish of ‘women’s choice.

‘Then there’s the either/or argument: the sense of a competition to scare the newly expecting mother with the most scariest birth experience birth mothers can tell or sensing anxiety that if they don’t have a spontaneous, unmedicated, vaginal birth over an intact perineum then they have somehow failed the class or will be ridiculed by friends and family with the “I told you sos…”.

Mothers are looking for a place where everyone is supportive of her desire to not only inform herself but also to have a birth that does not blindly follow the majority of births today which is in a hospital, medicated and with technology to bring the baby from mother’s body.

Mothers share how her pleas to turn off the pitocin were ignored, their desire to birth naturally met with scorn “Why do you want to suffer?” in birth forums, independent birth classes (you can bet most hospital birth educators will be quick to shut that conversation down).

Where is the support for these mother’s choices?  If you really claim to preserve women’s choice then these choices need to be respected and protected as well.  Unless you’ve been to a birth class where the emphasis was on credible information, sources were cited and the information was presented as educational, not a marketing tool for one option over another then you haven’t been to an independent birth class.  In a manner of healthcare speaking, an Independent Childbirth class provides you with the ultimate preservation of personal, individual choice:  the information you need to give informed consent OR informed refusal.  Two options clearly protected by patient rights.

Maternity care should be no different than any other field of health care.  Informed consent should be a given and parents need to know that not every physician is comfortable with their skills in obtaining informed consent.  It doesn’t make them a bad physician.  It makes them human like you or me and like any other field they need practice and they know it.

Exploring birth education shouldn’t be confusing or feared. To quote a birth book “A Good Birth, A Safe Birth“: ‘ ‘if you don’t know your options you don’t have any.’Br/>
Perception is reality.

Take charge. Create your reality! Put the blame for birth outcomes where it belongs: those who let their own agenda overpower yours.