3rd Trimester

OB delivery policies - what can you say "no" to?

I have been thinking a little and started wondering about some things. These aren't things I'm worried about for my delivery, just curious.

Last week my OB mentioned that if babies got to 10 lbs. they automatically do a c-section.  It doesn't look like our LO will be that big so I'm not worried, but if she was, I'd still want to try a vaginal delivery and I'm sure a lot of people would. So what happens if you won't consent to a c-section for that, but they won't do vaginal? How much say do you have?

Or, if baby is breech and they don't do breech extractions, but you don't consent to a c/s, what happens? Can they refuse to do the delivery? 

Again I'm not worried about these things, but the 10 lb. c/s situation just got me wondering what happens in any situation where the OB and the patient disagree. These are just the examples I thought of...


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Re: OB delivery policies - what can you say "no" to?

  • I wouldn't consent to a c/s just for a 10lb baby... that would really irritate me, but they can't force you to do it... at least I hope not!

    I know there are some hospitals that will attempt certain breech positions, but not transverse or other breech positions... I would definitely attempt to turn the baby even in labor though or find a hospital or midwife that would try to help rather than just scheduling a c/s...

    however since, I haven't ever had a baby in the hospital, I can't really say what they would do... I'm sure they would make you sign a form that releases them from responsibility of any complications, but other than that I can't really say... they made me sign a release when I checked out AMA to go back to the birth center for my first...

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  • I wouldn't agree to a c/s because of a large baby, but very few people know how to deliver breech babies so it's not like the OB is just trying to be frustrating by saying he must do a c/s for a breech baby.
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  • I really don't understand why they would automatically send a woman for a c section just because baby is estimated at 10lbs. Did you ask why? It is definitely possible to deliver a 10lb baby naturally without complications, I can attest to that... If be giving the OB a serious side eye just for that alone.

    I think you should straight up ask them the questions you just asked us.
     

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  • image peacelove&mama:
    I really don't understand why they would automatically send a woman for a c section just because baby is estimated at 10lbs. Did you ask why? It is definitely possible to deliver a 10lb baby naturally without complications, I can attest to that... If be giving the OB a serious side eye just for that alone. I think you should straight up ask them the questions you just asked us.

    Not sure; I didn't really question it because he estimated my LO will be 8.5 lbs. if I went to my due date, and I'm probably being induced prior to then, so it's not something that should apply to me. He was just talking about GD and said that in some GD cases the baby does get that big.  Same with the breech thing - it's not a situation I'm in (and don't even know their policy on it), but an example I thought of. 


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  • I would only consent if I felt it was in mine or LO's best interest.  
  • I would not consent to a c section if it was just because of an estimated large baby. But for a breech I would, mostly because if a doctor refuses to deliver a breech baby it likely means s/he does not know how to deliver a breech baby safely (that's a skill rarely taught at this point in time).

    I'll be honest and say that if my doctor required a c-section for size I would be worried about refusing because I would be afraid they aren't going to do all they can to avoid a c then tell me it's necessary towards the end of labor when there's not much I can do about it.

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  • That would be a red flag to me. For one thing, there is no way to know a baby is 10 lbs. Also, plenty of women are capable of giving birth to a 10 lb baby anyway.
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  • I think scheduling  c/s based on a weight estimation is pretty ridiculous, personally. In cases of GD, however, the baby's head may not be the largest part of the body, leading to shoulder distocia, and other complications. So, I can understand where the ob is coming from in cases of GD and high baby weight estimates.
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  • For the baby size, the ultrasound can be 1-2lb off. I would attempt a vaginal delivery first and then see where it goes. Lots of providers lack the patience needed for vaginal delivery and would rather schedule a c-section and be done with it. Bottom line is they can't cut you open without written informed consent.

    In terms of breech, they can attempt to do a version, which is basically when 2 providers try and turn the baby from the outside. I've heard they are very uncomfortable and don't always work (about 50% for most breech or 70% chance if the baby is sideways). There are also a few other things you can do on your own to try and get the baby to switch positions. My mom swears she did this successfully with me.

    This webpage has some suggestions for how to do it on your own. http://suite101.com/article/turning-a-breech-baby-a7421 ;

    A lot of times providers try to take the "easy way out." This is mainly due to the high incidence of lawsuits in OB. For a large baby, the safer route is to deliver via c-section since there are less risks of shoulder dystocia or 3rd/4th degree tears, for example. You have to weigh the risks and benefits with your doctor. Hopefully you have been seeing him/her all along and have developed a good channel of communication to discuss these things.

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  • With my first pregnancy, pretty much everything didn't go how I wanted it too, all the way from delivery to going home.  I also had a lot of complications, so I've already talked extensively with my OB about c/s already.

    That said, I don't think I would ever commit or consent to a c/s based upon an estimated weight.  My hospital won't really do breech deliveries though, so pretty much don't have an option there.  (They only do them in absolute emergencies.)

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  • Wow, yeah, that's pretty surprising that not only they have that stance, but are so upfront about it :/

    Anyway, in regard to what you can refuse.  You have the right to refuse anything.  You don't have to consent to any procedure you don't feel comfortable with.  Now, with that said, the doctor also isn't required to treat you.  So, let's say you they thought you were having a 10+lb baby and you said no to a C/S they would have the right to say they won't participate in delivering you vaginally (stupid stance to take, but whatever).  But you could always find another provider or even just deliver with the OB that's on call for the hospital (which I would much rather do that be forced into an unnecessary C/S for sure!).  

    You always have options and you never have to consent to anything you're not comfortable with, but yes, they can refuse to treat you.  

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  • I haven't heard the big thing. But I do know that there can be serious complication for a breech baby. Including the baby dying. I told my OB right off the bat that I didn't want to risk the baby's health to try breech anyway. I don't know why someone would risk a breech unless its too late to do anything about it to be honest.
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  • image AimeeL85:

    image peacelove&mama:
    I really don't understand why they would automatically send a woman for a c section just because baby is estimated at 10lbs. Did you ask why? It is definitely possible to deliver a 10lb baby naturally without complications, I can attest to that... If be giving the OB a serious side eye just for that alone. I think you should straight up ask them the questions you just asked us.

    Not sure; I didn't really question it because he estimated my LO will be 8.5 lbs. if I went to my due date, and I'm probably being induced prior to then, so it's not something that should apply to me. He was just talking about GD and said that in some GD cases the baby does get that big.  Same with the breech thing - it's not a situation I'm in (and don't even know their policy on it), but an example I thought of. 

     

    I have GD and it's more complicated than just "your baby is measuring 10lb, time for c/s" the thing with GD is that it's more about the abdomen to head ratio. with GD babies, the abdomen is often bigger than the head in the case of the big babies, and if that IS the case, then delivering the baby has a chance of hurting it because the baby's head has more leverage on the birth canal and the body should be able to just kinda follow along for the ride, but if the abdomen is bigger than the head then it cant. (all of this was actually explained to me today)


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  • That's actually a really good question!  I think sbevmc09 is probably right though-if you refuse before the delivery the doctor would probably "fire" you and then you would just have to take whatever doctor was on call at the hospital at the time of delivery.  I do know for a fact that a hospital cannot send you away to another hospital while you are in active labor (unless they have a reason, have found another doctor at the other hospital and you agree) so I guess if you show up laboring with a 10 lb baby or a breech baby you just have to deal with the doc that is on.  

    However, it does make me curious as to how that would be handled if you do refuse things.  Say you show up in active labor with a breech baby and the on-call doc recommends a c-section and you refuse.  What happens then?  I'm guessing that you would just get a lot of pressure from several people, have the risks explained and STRESSED to you repeatedly and maybe have to sign something that says you are refusing the treatment offered by the MD at that time.  And of course all of this would be charted like crazy to protect the staff in case something did happen and you tried to sue.  But really I'm not sure what they could do.  Call CPS and try to claim child endangerment?  Seems extreme, but maybe.....?  Now I'm totally curious!   

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  • image NewMom113:
    I haven't heard the big thing. But I do know that there can be serious complication for a breech baby. Including the baby dying. I told my OB right off the bat that I didn't want to risk the baby's health to try breech anyway. I don't know why someone would risk a breech unless its too late to do anything about it to be honest.

    A rare few doctors and midwives ARE trained in how to deliver a breech baby, and can do so just as safely as a head-down baby.  However, those practitioners are SO few and SO far between, that the chances of finding one who's available are VERY slim.  MOST practitioners, however, don't know how to handle it.  (My midwife knows how to handle it, but still transfers for breech.  She delivered one breech baby, and that's because it flipped during transition.)  

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  • image mistresscox:

    However, it does make me curious as to how that would be handled if you do refuse things.  Say you show up in active labor with a breech baby and the on-call doc recommends a c-section and you refuse.  What happens then?  I'm guessing that you would just get a lot of pressure from several people, have the risks explained and STRESSED to you repeatedly and maybe have to sign something that says you are refusing the treatment offered by the MD at that time.  And of course all of this would be charted like crazy to protect the staff in case something did happen and you tried to sue.  But really I'm not sure what they could do.  Call CPS and try to claim child endangerment?  Seems extreme, but maybe.....?  Now I'm totally curious!   

    Yeah, they would probably make it hell for you to try to refuse.  They would pull the dead baby card for sure.  They do have the option to get CPS involved as well and I've read about this happening (in cases that totally don't warrant it!) and it sounds like a nightmare.  Also, hospitals do have ways to get court ordered procedures.  I don't know exactly how that works, but I would imagine that's in very extreme situations.  They could probably threaten you with it, but I don't know how quickly something like that would happen.  I doubt a mom would refuse something to that extreme, you know?  But for a "big" baby or a breech baby?  I could totally see people refusing C/S for those types of things.  

    And yep, as PP said, breech babies can definitely be safely delivered vaginally as long as you're with a trained provider.  The problem is finding a trained provider as most OBs are now trained just to do a C/S.

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  • I've never heard of doing a c/s for a 10lbs baby. My friend delivered her 10lbs 8oz baby vaginally. I wouldnt consent for a c/s if large baby is the case.
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  • I would NOT agree to a c/s just for a 10 Ib baby. My MIL had my DH all natural with no meds and he was 11 ibs. She swears he was the easiest delivery and she has 4 kids. 

    Of course my OB delivers breech babies and we have midwives who do as well and so I probably would not consent to a c/s over breech even! 

    I would ask you OB straight up. I learned the hard way with my son to not just go with whatever a doctor says..its ok to ask questions and make sure you agree. 
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  • Also my old OB swore my son would be over 10 ibs..he was 7 ibs 10 oz. They can't know for sure. 
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  • image nekorayne:
    I would NOT agree to a c/s just for a 10 Ib baby. My MIL had my DH all natural with no meds and he was 11 ibs. She swears he was the easiest delivery and she has 4 kids. 

    Of course my OB delivers breech babies and we have midwives who do as well and so I probably would not consent to a c/s over breech even! 

    I would ask you OB straight up. I learned the hard way with my son to not just go with whatever a doctor says..its ok to ask questions and make sure you agree. 

    I would definitely want to be informed as to exactly why they would be recommending a csec, but as long as it made sense I'd likely go with what they said, OR if I really didn't agree I'd go with another doctor. I don't want a doctor who is uncomfortable with the situation "forced" to do something. And if I was a doctor and was not comfortable with doing something I'd recommend they change doctors too. Malpractice is the highest for OB's because of the nature of their job. Statistically, large babies and attempted vaginal births have more complications, so...depending on their experience with things they might have good reason to recommend a csection.

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  • Google for the Spinning Babies website, it has good info as well on how to flip a breech baby.

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  • image FutureMrsTowns:
    image AimeeL85:

    image peacelove&mama:
    I really don't understand why they would automatically send a woman for a c section just because baby is estimated at 10lbs. Did you ask why? It is definitely possible to deliver a 10lb baby naturally without complications, I can attest to that... If be giving the OB a serious side eye just for that alone. I think you should straight up ask them the questions you just asked us.

    Not sure; I didn't really question it because he estimated my LO will be 8.5 lbs. if I went to my due date, and I'm probably being induced prior to then, so it's not something that should apply to me. He was just talking about GD and said that in some GD cases the baby does get that big.  Same with the breech thing - it's not a situation I'm in (and don't even know their policy on it), but an example I thought of. 

     

    I have GD and it's more complicated than just "your baby is measuring 10lb, time for c/s" the thing with GD is that it's more about the abdomen to head ratio. with GD babies, the abdomen is often bigger than the head in the case of the big babies, and if that IS the case, then delivering the baby has a chance of hurting it because the baby's head has more leverage on the birth canal and the body should be able to just kinda follow along for the ride, but if the abdomen is bigger than the head then it cant. (all of this was actually explained to me today)


    A friend of mine with GD lost her baby because she refused a C/S. She was having an 11lbs baby and wanted a natural birth even though she was advised against it so they let her try, the baby's abdomen got stuck in the birth canal and the baby suffocated. One of the most difficult things for both she and her DR to go through.  Had she taken her OBs advice she would have her baby today. We don't ALWAYS know everything about everything at the same time there's a reason our OB's "practice" medicine.  

  • When I switched to my new OB I made it very clear my GD diagnosis was not going to change my natural childbirth plans. So, the 2nd visit I came with our "birth preferences" and made it clear that as long as baby and I are ok that there's no way in heck she's gonna get my consent to do a C/S or induction. In fact, ACOG does not recommend an induction even if baby is measuring big. And only if you have GD do they recommend a C/S but only if baby is measuring 10lbs or bigger. They don't recommend induction due to the fact that it greatly increases the odds of a C/S and doesn't improve outcomes for mother or baby either way.
    But to more directly answer your question, I can't. I honestly don't know what will happen if we're looking at a 10lb baby (assuming the u/s is accurate, which it usually isn't) and she starts pushing for a C/S. I think it's a case of how stubborn you are, how stubborn the doctor is, being informed with reliable, scientific facts, and coming to some sort of compromise. My doctor knows if she gives me sound reasoning that I'm flexible, but will not do something that is convenient for her or is a CYA type deal.

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  • Google Amber Marlowe

    The doctor and/or hospital could get a court order for a c-section.

     

     http://www.advocatesforpregnantwomen.org/articles/forced_c-section.htm

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  • image adamsabigail14:
    image FutureMrsTowns:
    image AimeeL85:

    image peacelove&mama:
    I really don't understand why they would automatically send a woman for a c section just because baby is estimated at 10lbs. Did you ask why? It is definitely possible to deliver a 10lb baby naturally without complications, I can attest to that... If be giving the OB a serious side eye just for that alone. I think you should straight up ask them the questions you just asked us.

    Not sure; I didn't really question it because he estimated my LO will be 8.5 lbs. if I went to my due date, and I'm probably being induced prior to then, so it's not something that should apply to me. He was just talking about GD and said that in some GD cases the baby does get that big.  Same with the breech thing - it's not a situation I'm in (and don't even know their policy on it), but an example I thought of. 

     

    I have GD and it's more complicated than just "your baby is measuring 10lb, time for c/s" the thing with GD is that it's more about the abdomen to head ratio. with GD babies, the abdomen is often bigger than the head in the case of the big babies, and if that IS the case, then delivering the baby has a chance of hurting it because the baby's head has more leverage on the birth canal and the body should be able to just kinda follow along for the ride, but if the abdomen is bigger than the head then it cant. (all of this was actually explained to me today)


    A friend of mine with GD lost her baby because she refused a C/S. She was having an 11lbs baby and wanted a natural birth even though she was advised against it so they let her try, the baby's abdomen got stuck in the birth canal and the baby suffocated. One of the most difficult things for both she and her DR to go through.  Had she taken her OBs advice she would have her baby today. We don't ALWAYS know everything about everything at the same time there's a reason our OB's "practice" medicine.  

    This makes me so nervous.  The perinatologist had told me he thought she'd be 8.5 lbs. if I went to due date (which it's pretty guaranteed I won't) and about the 10 lb. thing but didn't mention induction.  Then my OB told me that in his report he recommended delivery between 38 and 39 weeks because her abdomen is in the 95th percentile.  They didn't seem concerned or mention c/s for me, since they don't think she's HUGE, but now knowing the 95% thing and that they can get stuck is pretty scary. Guess we have a lot to talk about at my next appointment.


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  • You can refused for a "large" baby. However, ACOG (board cert Ob/Gyn) , say it is only safe to delivery doulble footing breech or buttock breech. It a Dr/CNM still does a NSVD (vag delivery), (not an STAT/emergent one),  they can lose their certification.

    Plus, several Dr's/hospitals are not trained on cephalic version. Or, it against the hospital's policy, even if they WANTED too.

    As a L/D nurse, I have done a double footing breech, and I have done several version. Sometimes they fail, sometimes they work.

    Good luck.

     

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