Reviewed Birth Plan with OB today. My how things changed....

beckpreg · October 2012

I am seeing an OB practice and my plan is to birth at home with my mother (midwife) for as long as possible then transition to hospital. All along, my OB office has known my desire for a med free, natural birth. Today, at my 34 week appt. I brought my birth plan for them to review and place in my file. My OB read through and said "ok I have only one concern" I said "what's that?" she said "I need you to be more open to pitocin"....what?!?!?!?! My birth plan says PLEASE DO NOT OFFER PITOCIN. She then goes on to say "all the women who come into the hospital knowing exactly what they want and they refuse this and this, they end up with C sections"

wow. I cant believe we had this conversation.

sschwege · October 2012

So you feel like she responded well to everything else? If you don't mind me asking, what else is in your birth plan?

It worries me a bit that she obviously views birth plans so negatively. I mean to say that women who refuse things end up with c-sections sounds like at best a warning, and a threat at worst. But I wasn't there for the conversation, so I'm not sure the tone, etc.

Well, her pitocin comment should really reaffirm your decision to labor at home as long as possible. If you arrive late in the game they are far less likely to push it. Sorry, don't know what else to say...

NoeliaV · October 2012

sschwege:
So you feel like she responded well to everything else? If you don't mind me asking, what else is in your birth plan?
It worries me a bit that she obviously views birth plans so negatively. I mean to say that women who refuse things end up with c-sections sounds like at best a warning, and a threat at worst. But I wasn't there for the conversation, so I'm not sure the tone, etc.
Well, her pitocin comment should really reaffirm your decision to labor at home as long as possible. If you arrive late in the game they are far less likely to push it. Sorry, don't know what else to say...

This. Especially the last comment about laboring at home as long as you possibly can.

Honestly, though? I'd accept pitocin (on the lowest dose, if I could negotiate it) before other augmentation methods, like AROM.

beckpreg · October 2012

Yes she didnt mention any other concerns and my plan includes the following:

no pitocin, no epidural or pain meds offered please

delay cord clamping, delay hep b vaccine

to release the plancenta to me (b/c I am encapsulating)

no stripping membranes or breaking bag of fluids

to let me use various positions and music if I desire, etc.

Hep lock instead of iv

most of it is the basic, natural birth requests. I was just really surprised by her saying what she said about the pitocin and like you said, it almost sounded threatening.

alanap · October 2012

RED FLAG!!

However, while her comment about pitocin and her disdain for birth plans are annoying, you are planning to labor at home with your midwife mom (awesome!) for as long as possible, so I woudn't really worry about that.

Although I would worry about this doctor trying to pressure you to induce early. YOU CAN ALWAYS SAY NO

sbevmc09 · October 2012

Yikes... yeah.

I'm curious, did you specifically ask her at all about what happens if you don't follow a certain pattern in labor (i.e. progressing 1cm per hour or they're going to start talking failure to progress)? I know this should be a moot point anyway considering you're planning to labor at home as long as possible with great support. Because... I can't see why she would want you to be open to Pitocin usage as you're planning for a normal, unmedicated birth. Obviously your plans would change if circumstances changed from the norm.

amandaleigh1 · October 2012

sbevmc09:
Yikes... yeah.I'm curious, did you specifically ask her at all about what happens if you don't follow a certain pattern in labor i.e. progressing 1cm per hour or they're going to start talking failure to progress?nbsp; I know this should be a moot point anyway considering you're planning to labor at home as long as possible with great support.nbsp; Because... I can't see why she would want you to be open to Pitocin usage as you're planning for a normal, unmedicated birth.nbsp; Obviously your plans would change if circumstances changed from the norm.

Yeah, I specifically spoke to my OB about following a clock or a schedule, whether I was induced it not. I was very adamant that I be allowed to go at my own pace. That is a pretty important piece.

Could your ob be thinking about pitocin being used to help deliver the placenta? This is pretty standard practice to avoid hemmorrage and a lot of natural birth people accept pitocin for this purpose.

Celyn · October 2012

It could be she's talking about the routine use of Pit after the placenta delivers. It makes her comment about birth plans all the more disparaging, since if you've already delivered, you won't need a section.

You could say you're open to Pit in the case of hemorrhage, if and when it's needed, but not before. And you're prefer nipple stimulation before resorting to Pit in case of a stall. Chances are you'd be at home with your mom through any stalls, so that's a non-issue for the most part.

Why aren't you delivering at home with your mom?

hailyf · October 2012

Red flag. Sometimes Pit is needed (especially to expel placenta, like PPs said) but I would have a conversation to clarify. And maybe switch providers if you are not comfortable.

thetwistedwillow · October 2012

Hmmm, I'm a little confused. Why not just give birth at home with your midwife momma? You'll be in your own comfort zone, no bumpy car ride while in transition.

Most OBs (not all) hate birth plans. They don't like being told what they can and cannot do when they went to medical school. It's just an unfortunate fact. I would be seeking other medical care. In fact I DID seek other med care in my third pregnancy, at 37 weeks. It's never too late. If you don't want to give birth at home then at least find a birth center or a more natural-birth-friendly doctor or you'll be pressured into things you originally didn't want when you're in that vulnerable transitional stage of labor.

ILoveRunning · October 2012

Maybe it is how you worded the "no pitocin" request. I think that birth plans are great, and that whether or not a care provider encourages you to have one can be very telling. That being said, birth plans that draw a line in the sand can come across as off-putting. Maybe rephrase it to "Please do not augment labor with pitocin without my consent".

nosoup4u · October 2012

hailyf:
Red flag. Sometimes Pit is needed (especially to expel placenta, like PPs said) but I would have a conversation to clarify. And maybe switch providers if you are not comfortable.

This. Can you use a CNM instead of an OB? It's not too late to switch.

SSAguirre · October 2012

Well, I tend to be moderate to a fault and this is your experience, but my OB made a similar comment regarding absolutes in a birth plan = problems when we first discussed a natural delivery. I, too, am vehemently adverse to pitocin. He made it VERY clear that his intention was to counsel flexibility in the face of unpredictable circumstances, not undermine my wishes in any way. He said "I absolutely promise to respect your wishes and I support you 100%, but I cannot promise that you won't need interventions at some point and I won't promise not to offer what I feel is medically imperative."

He also said that, in his 20 years of experience, women who came in with inflexible birth plans and myopic statements, refusing to even discuss possible interventions under any circumstances, often were setting themselves up to be dissatisfied and even traumatized by the birthing experience when things went awry naturally and interventions were absolutely required.

All of this makes perfect sense to me.

Like any relationship, I would suggest you voice your concerns, and feelings of being threatened, to your OB and ask her to clarify her statement, rather than simply treating her like the enemy, especially since the vast majority of your list was accepted out of hand.

honkytonk_kid · October 2012

I think you need to have a conversation with your OB about whether that statement means:

"I absolutely promise to respect your wishes and I support you 100%, but I cannot promise that you won't need interventions at some point and I won't promise not to offer what I feel is medically imperative." (as pp said)

or

"I like pitocin, you will be expected to make X progress per Y time, and the vast majority of my patients are induced or augmented."

Huge difference. One is reasonable and should be comforting, one is a red flag. I don't think it's fair to assume your OB is anti-natural birth based off one statement, especially if otherwise supportive throughout your pregnancy.

beckpreg · October 2012

Thanks ladies, all very valid points and things to ponder. I failed to mention to you that my birth plan does say that I will accept pit after the baby has arrived and if needed for bleeding or placental reasons.

To answer another question, yes there is a huge chance, if all goes well and there is no need to transition to the hospital that we will just stay home. I havent told my OB this so it kind of feels secretive but if that happens I guess we just call and say WHOOPS we just had a baby at home......lol.

Hyaline · October 2012

OK, just wondering...what was the tone of the comment? I've spoken to LD nurses who have a "Oh god, not another birth plan!" outlooks because of a Murphy's Law sort of thing--the more detailed a mom's birth plan is, the more likely something will go wrong. It's not scientific or anything, but this seems to be a pretty common "ism" in the OB world. If her comment was more flippant than serious, I wouldn't be as worried. And--speaking as someone 100% pro-natural-birth--did she mean "you need to be open" in a general, be aware that situations arise kind of way? Because I do think that's fair. Or was it a "I use pitocin a lot and you should be aware of that" kind of way? If so...red flag.

jinnymb · October 2012

I would get clarification. Of course she is going to tell you to be open to anything that comes up, that is why she is there. I don't understand why they get so annoyed at birth plans. Of course you know anything can happen that is why you research and know what you would want in each situation given a choice. I would want women who are educated and taking part in their own care cause they would tend to have healthier pregnancies. I think OB's should take the extra step of informing you of all these options anyway.

I had a similar conversation with my OB about all of those things. She said in reference to pit, that she highly recommends for after birth for bleeding and delivering the placenta, which we don't have a problem with. I would see if that is what she meant, because otherwise you should be able to go at your own pace.

They can't force anything on you regardless. My OB also didn't know anyone who had taken their placenta home before, lol. So she is suppose to check into if I need to sign anything. I am switching practices mainly because she and another OB as informed by her are the only ones out of 9, that support med-free birth. I had the other one last time, but I don't think the odds look good of me getting one of them again.

Good luck getting everything figured out!!

ILoveRunning · October 2012

honkytonk_kid:
I think you need to have a conversation with your OB about whether that statement means:
"I absolutely promise to respect your wishes and I support you 100%, but I cannot promise that you won't need interventions at some point and I won't promise not to offer what I feel is medically imperative." (as pp said)
or
"I like pitocin, you will be expected to make X progress per Y time, and the vast majority of my patients are induced or augmented."
Huge difference. One is reasonable and should be comforting, one is a red flag. I don't think it's fair to assume your OB is anti-natural birth based off one statement, especially if otherwise supportive throughout your pregnancy.

Very well said.

shutupanddance07 · October 2012

My midwife actually said something similar to me at a recent appointment. Not about the c section, but that I needed to be open to pitocin because sometimes it's a very helpful birthing tool. I'm planning an out of hospital birth center birth, and would need to be transferred to hospital to have the pitocin, but she said sometimes she sees girls who really do need a little bit, and that I might do myelf more harm than good by refusing to entertain the possibility if they think it's something i need. I don't want it for convenience, or to help speed up the process, but if my body is struggling to do what it needs to do on its own, and some pitocin will help to kick start my system... I guess I can be open to that...

MrsSandro · November 2012

shutupanddance07:
My midwife actually said something similar to me at a recent appointment. Not about the c section, but that I needed to be open to pitocin because sometimes it's a very helpful birthing tool. I'm planning an out of hospital birth center birth, and would need to be transferred to hospital to have the pitocin, but she said sometimes she sees girls who really do need a little bit, and that I might do myelf more harm than good by refusing to entertain the possibility if they think it's something i need. I don't want it for convenience, or to help speed up the process, but if my body is struggling to do what it needs to do on its own, and some pitocin will help to kick start my system... I guess I can be open to that...

I agree with this with.

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