Thursday, September 16, 2010


At Alliance for the Imporvement of Maternity Services (AIMS) you can find this great resource to help you with


Prepared by Doris Haire, President

American Foundation for Maternal and Child Health

Below is a wonderful article on how to get what you want, with lists of things to be aware of and to ask for to get the birth you want.
(I have added bold or italics some of the things in the list that I think are really important).

A good childbirth experience should be happy and gratifying, as well as safe. You are much more likely to have a good experience if you establish early a good communication with your physician or midwife. Sometimes it is the expectant parents who must take the lead in establishing a rapport, but don't let that hold you back. It's your childbirth experience. It's up to you to let the doctor or midwife know what you want. If he or she is not in agreement with your wishes, it is far better to find that out while you still have time to shop around for a doctor or midwife who does agree with you.
Most of the common practice patterns employed in the obstetric care of an essentially healthy pregnant woman and her baby have not been shown to be in the best interests of the woman or her baby. Unless there is a medical indication for the procedure there is no scientific support for routinely:
a. confining the mother to bed during labor and birth,
b. placing an IV or saline lock,
c. shaving the mother's pelvic area or administering an enema,
d. chemically "ripening" her cervix or inducing labor,
e. artificially rupturing the amniotic sac,
f. administering analgesia or regional anesthesia (epidural, spinal, pudendal, etc),
g. prohibiting the mother from eating lightly and drinking fluids during labor,
h. placing the mother's legs in stirrups for delivery,
i. performing an episiotomy or proctoepisiotomy,
j. directing the mother to bear down longer than 5-6 seconds,
k. applying fundal pressure,
l. extracting the baby by forceps or vacuum extractor,
m. clamping the umbilical cord before pulsation stops,
n. putting the baby in a baby warmer, rather than putting the baby with the mother, inside a prewarmed blanket, and
o. prohibiting the baby from breast feeding in the delivery room.

Since all of the practices listed above pose a risk to the mother and/or her baby it is important that the mother discuss these risks with her doctor or midwife.
• Ask the office nurse about the fee for vaginal delivery, and also for cesarean section, in case one should become necessary. If you have health insurance, ask if it will fully cover the fee for vaginal delivery or cesarean section.
• To make sure that your doctor or midwife is sympathetic with your wishes ask, "How do you usually conduct labor and delivery?"
• If you are planning a home birth make sure that your provider has sufficient skill and backup to take care of an emergency.
• Ask other mothers who have had that doctor or midwife about their experiences. Find out if he or she honored the mothers' requests they made during their office visits. Did they find their requests denied once they got into labor/delivery? If so, which requests were denied and why?
• If you have any doubt that the doctor or midwife is the right one for you, you may wish to keep your options open to find someone more compatible. Think twice if the doctor or midwife insists that you must pay the full fee early in your prenatal care. This locks you in to an arrangement that you might later regret. After all, you might want to move before your due date. By paying at the end of each visit you preserve your flexibility. This also gives you the freedom to walk out of the office without paying for the visit if you are kept waiting for an hour or more in the office.
• If the doctor or midwife does seem right for you, ask about his or her "call schedule". Ask if it is possible, or likely, that another person will actually attend your delivery. If yes, ask about that person's philosophy regarding labor and delivery. Request a visit with the alternative doctor or midwife on one of your prenatal visits.
• Some doctors and midwives are very sensitive, and some are even annoyed when expectant parents ask questions about obstetric procedures and drugs. Therefore, TACT is very important. For example, to question a procedure you might say, "I realize that you are interested in my welfare, but I'm concerned about................................
TAKE ALONG A "SUPPORT PERSON" FOR YOUR PRENATAL VISITS. It is often very helpful to have a "support person" along on prenatal visits. If the physician or midwife seems defensive about your companion's presence, explain:
"I've brought along my (friend, mother, etc.) because I may not always remember everything you tell me."
If you want to question the safety of a procedure or drug, ask:
• "What is the scientific documentation for using this procedure (or drug)? Please let me read some literature which guarantees that there are no harmful effects to me or my baby from .......... "
If you are questioning the safety of a proposed drug, ask to see the FDA package insert for the drug.
OTHER IMPORTANT QUESTIONS TO ASK YOUR PHYSICIAN OR MIDWIFE INCLUDE:• "What % of your patients ambulate during labor?"
• "I do not want to be fed intravenously during labor since it will interfere with my ambulation and may result in hypoglycemia in my newborn baby. Will I be allowed to drink liquids and eat lightly during labor in order to keep up my stamina?"
• "What % of your patients have no drugs at all during labor and birth?
• "What drugs do you commonly give women during labor?
• "What are the risks of those drugs to me and my baby?
• "Could I read the manufacturers' package inserts (information sheets) of those drugs?"
• "Has the FDA specifically approved of these drugs as safe for my unborn baby?" (Many drugs, including terbutaline, used in obstetric care have not been so approved.)
• "When you listen to the fetal heart rate during pregnancy and labor, do you use a fetoscope or ultrasound?"
• "Since the FDA has acknowleged that no one knows the delayed, long term affects of ultrasound on human development when it is used in obstetric care, I would like to be monitored by a fetoscope. Will you please check with the hospital labor/delivery unit to be sure they have a fetoscope, rather than an ultrasound doppler?"
• "What % of your patients have no episiotomy?"
• "What % of your patients have cesarean sections?"
If you do not want a sonogram, ask the following questions:
• "Why do you consider this procedure necessary? What are you looking for? Is the sonogram being carried out solely to establish fetal age or multiple fetuses?"
• "How would you alter the course of my treatment if the sonogram discloses the condition you are looking for?"
• "If I am sure of the dates of my last menstrual period, what advantage is there in performing the sonogram at this stage in my pregnancy?"
• "Will one sonogram give you the information you need, or do you expect to do additional sonograms later in my pregnancy?"
• Since the FDA has recently acknowledged that no one knows the delayed, long-term effects of diagnostic ultrasound on the subsequent development of the exposed offspring, shouldn't we wait until my baby is bigger?"
• Expressions of concern regarding the safety of ultrasound are often met with assurances such as "Sonograms are not x-rays", or "Sonograms are just bouncing sound waves".
If the doctor or midwife continues to insist on a sonogram then ask:
• "Can you give me information from the company which will guarantee that the ultrasound will have no adverse effects on my child's subsequent physical and neurologic development?"
(The doctor or midwife will be unable to provide you with such a guarantee because there have been no properly controlled, long-term studies to evaluate the effects of diagnostic ultrasound on subsequent human development - but the mental exercise will make him or her stop and think carefully before exposing your baby to ultrasound via a sonogram or electronic fetal monitoring.)

Make a list of your preferences. Begin the list by writing: "If there are no medical contraindications, I would like the following:
1 ........................
2 ............................
3 ........................ , etc."
Make three copies. Keep one for yourself to take with you to the hospital. Give two copies to your doctor or your midwife, one to remain in his/her files. Ask that the second copy of your requests and preferences be attached to the copy of your prenatal records which are sent to the hospital prior to your due date.

During the latter part of your pregnancy write to the hospital's Public Relations Office and ask for a copy of the consent form used for obstetric patients. On admission to the hospital, write in above your signature on the consent form, "Subject to my informed consent at the time." Keep in mind, if you don't give your informed consent, you have not consented.
If you are refused admission unless you sign the consent form "as is", go ahead and sign the form. Once you are in the obstetric unit give your nurse a copy of your previously written instructions which reads:
• "I hereby withdraw my consent to all non-emergency drugs or procedures unless you obtain my informed consent at the time. Neither I nor my baby shall be used as a teaching or research subject without my informed consent at the time..".
• "I realize that you feel I should have the .............. "or "would like to make me more comfortable, but I will wait until my doctor or midwife arrives so I can talk it over with him/her personally. I want to discuss the alternatives with him/her."
• "If you insist on monitoring me, give me some literature from the manufacturer which guarantees that the procedure will not jeopardize my baby."
To make the provider think about what he or she is offering you, ask:
• "Why do you suggest that? Has something gone wrong?"
Remember, directions have legal connotations; requests can be ignored.
• Example: Don't say, "I'd rather not be shaved." Say, "Do not shave me.""Do not put my legs in stirrups."
"Do not send my husband out of the room."
"Do not take my baby out of my room."
"Do not feed my baby water or formula in the nursery"
"Bring my baby to breast feed when he or she is hungry", etc.
If you are being made miserable by a nurse or doctor who insists that
"Hospital rules require that .............",
Tell the caregiver that you will sign a waiver to release the hospital from responsibility for your refusal.
If the caregiver continues to hassel you ask to see a copy of the hospital regulation or protocol that deals with the issue in question. It's doubtful that the regulation actually exists.

Your obstetric records are an important part of both your and your baby's health histories. Well before your due date, during one of your prenatal visits, tell the doctor or midwife that you want a copy of your and your baby's hospital medical records including nursing notes. Nursing notes are important because many notations in your records are made by staff members who are not nurses.
The following statements and questions are examples:
• "I would like a copy of my and my baby's prenatal and hospital medical records, including nursing notes, monitor strip, etc., to keep for my own records. May I have them?"
• "How much will it cost me to obtain a copy of these records?" (Copies should cost approximately 50c a page.) If the cost seems too high, ask what they charge when another authorized physician requests a copy of your records.
• "What do I do now to clear this request with the hospital?"
• "I don't want to wait until the last minute to find out that...."
If you are offered a summary or abstract of your records, rather than the complete records, keep in mind that a summary can OMIT information which you may later find desirable to have. If your doctor or midwife refuses your request for a copy of your and your baby's hospital/medical records you are justified in refusing the hospital's request for your authorization to allow your health insurance company to review your records for payment. To make sure the hospital complies, write in above your signature,
"My and my baby's records may be reviewed by my health insurance company only after my personal inspection of those records and I have received a copy of our records."

We hope that the above suggestions will help to eliminate any misunderstanding that might mar your birth experience. We wish you a happy, healthy birth and baby.
Prepared by Doris Haire, President
American Foundation for Maternal and Child Health

© 2000, Doris Haire

No comments: