Monday, March 11, 2013

Support patient autonomy & breech birth (and win a sling!)

Last week, Hudson Hospital in Hudson, WI (near the Minneapolis/St. Paul metropolitan area) instated a new patient care policy that forbids vaginal breech birth and appears to deny obstetric patients, including home birth transfers, the right to refuse treatment.

Here's the new policy announcement, released March 7:

Hudson Hospital & Clinics is committed to achieving the Triple Aim in our service to patients and families. We are dedicated to providing excellent patient experiences while delivering quality care at an affordable cost.

We have consistently experienced growth in our Birth Center volumes each year and want to ensure on-going safe patient outcomes for both mothers and newborns. It has been decided jointly by medical staff leadership and hospital administration to suspend vaginal breech deliveries immediately and these patients will be delivered by cesarean section.

Medical interventions will be employed, when needed, on all mothers and newborns, including transfers in, to assure the safety of the mother and newborn. This practice is in alignment with national medical standards of care and consistent with other hospitals in the region.

Gail Tully of Spinning Babies has been corresponding with an obstetrician who currently works at Hudson and has been offering vaginal breech births, VBAC, and vaginal twins for many years. She confirmed that the ban on vaginal breech births was an administrative policy decision and occurred despite no bad outcomes and no physician sanctions.

In the meantime, women in the Twin Cities area seeking physiologic breech birth, VBAC, or vaginal twins can work with Dr. Dennis Hartung at Woodwinds Hospital in Woodbury, MN.

If you'd like to express your disappointment with these new policies and your support for patient autonomy, please contact Hudson Hospital. Even if you don't live near the Twin Cities, make your voice heard. Let's get women from all over the country--and all across the world--urging Hudson Hospital to reinstate vaginal breech birth and uphold patient autonomy. This may be a small hospital, but the new policy has a HUGE significance for the rights of childbearing women.

Gail Tully commented: "Robbi Hegelberg (715-531-6012) and the other board members need to hear why we won't be referring hospital birthing parents to Hudson any longer and that refusing informed consent and informed refusal is in violation of a woman's right as a patient and as a human being. Volumes of mail, calls, emails, and social network posts will make a difference."

Who to contact: 

Robbi Hegelberg
Hudson Hospital
405 Stageline Road
Hudson, WI 54016

Talking points:
  • Patients have a right to informed consent, which includes the right to refuse treatment--including cesarean for breech presentation.
  • Refer to Hudson's Patients Rights and Responsibilities (PDF), which states:
  • Except in emergencies, the consent of the patient or of the patient’s legally authorized representative shall be obtained before treatment is given.
    All patients have the right to be informed concerning their continuing health care needs, course of treatment, prognosis for recovery, and alternatives to meet these needs in terms the patient can understand.
    Any patient may refuse treatment to the extent permitted by law and is informed of the medical consequences of the refusal.
  • If you live in the area, let Hudson Hospital know you will be taking your business elsewhere.
  • The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice issued the following recommendation on vaginal breech birth in 2006: "The decision regarding the mode of delivery should depend on the experience of the health care provider...Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management." A blanket ban on vaginal breech birth, especially when there are trained, experienced physicians willing to offer breech birth, goes against this recommendation.
Win a sling!

If you contact Hudson Hospital expressing your concerns about this new policy, you can enter to win this hand-dyed linen ombré sling. Let's make it clear that we care about patient autonomy and access to vaginal breech birth!

Rules of entry:
  • Contact Hudson Hospital by Monday, March 18.
  • Leave a comment letting me know you've contacted Hudson Hospital. Feel free to include details of how the conversation went, copies of your letter, etc. 
  • One additional entry if you share this call to action on Facebook, Twitter, your local birth network, etc. (new comment, please). 
  • Open to anyone, anywhere in the world. (Non-US residents are kindly asked to pay shipping costs.)
  • Winner will be chosen on Tuesday, March 19.


  1. Wow. That is horrifying! Do they really mean that women have no right to refuse or modify the recommendations of their providers? Can they really get away with that???????

    I just sent an email.

  2. I also shared on facebook, and I will continue sharing.

  3. wow!!! i did read the SB update on FB, but I'm still so irritated... so few practitioners are skilled in vaginal breech birth as it is, to limit this more is so sad.

    my letter is in the mail!!

  4. shared on FB & re-blogged too (although i need to clean it up --- darn mobile) ... so burned up about this!

  5. Email sent. Here an excerpt: "Let us as women decide with our doctors what we can and can't do, and not have it decided by some misguided, admin's attempt to "lessen" risk."

  6. Also shared on 2 FB groups (One a Powerful Birth Group and the other a Babywearing group.)

  7. Just curious, for those of you who emailed, what email address did you use? I tried to find one for Robbi Hegelberg, but couldn't.

    1. I sent the email to their "feed back" email address.

  8. I love this part: "to assure the safety of the mother and newborn"

    As if sectioning the mother guarantees the mother and baby won't be harmed!

  9. I copied and pasted their new policy from your blog onto their FB page. I also added "What happened to a family's right to make an informed decision and having options available to the mother and baby? If they've done their research and know the true risks and benefits, we should be empowering them to make good decisions, and TRUST them, not making them powerless!! My midwife thought I might be carrying twins and for three days, until I got my ultrasound to confirm a singleton pregnancy, I cried and cried knowing I would be more likely to be subject to interventions and having to stand up for what I believe in while I was in labor. Please reconsider your policy as I think we have the right to choose. Offering breech births is invaluable in our society as the c-section rate continues to rise. Remember, c-sections aren't without complications themselves!!!"
    I'd love to win a sling because I would give it to a mother of spontaneous triplets. She's the sweetest person I know and she was blessed with 3 babies at once!!!
    I made my own sling from your tutorial, with the help of my crafty, seamstress mother, and it turned out beautifully. Thanks for the instructions.

  10. I also posted your link on Believe Families FB page. Thanks for making us aware of this change in policy.

  11. The letter addressed to local providers, of which I am one, does not say that they have a policy of refusing informed consent and informed refusal. This is totally incorrect Rixa, They may try to strong arm, convince and persuade but they cannot legally perform a procedure on a mother and or baby without her consent.
    By all means write your letters but get the facts straight and don't criticize them for something that they are not doing. Stick to the fact that they are banning breech births with a skilled provider as the main talking point.

    1. This statement implies that interventions will be used regardless of consent: "Medical interventions will be employed, when needed, on all mothers and newborns, including transfers in, to assure the safety of the mother and newborn." If in fact, it doesn't mean that, then Hudson Hospital needs to make that fact clear. Because as it is worded, it says that "all" mothers and babies will receive whatever interventions the staff feel are needed.

    2. Thank you, Emme, for trying to set the record straight. This is my local hospital, many friends and family members have been patients here - both for maternity care as well as for medical conditions.

      I will continue to recommend this hospital because I know firsthand the care provided by the medical and nursing staff is excellent.

      I know it will be an adjustment, but I'm happy to hear that women wanting VBB still have options in the Twin Cities metro area.

    3. For more detailed info (and some updates from Gail in the comments section), visit From recent correspondence with Gail, she says that the hospital's intent isn't to totally deny informed refusal (despite the wording of the statement implying that intent). However, a VBB ban obviously would deny that for all breeches.

    4. midwife Emma wrote that they may try to strong arm, convince & it's ok to bully & coerce women? As a midwife you should be "with woman" & supporting her to make informed decisions. YOu should be standing up against this policy. I hope you are.

  12. Letter sent, call attempted, posted on FB, and an email sent to my fellow midwifery students at Southwest Wisconsin Technical College.

  13. Wow Wow Wow, this makes me sick! I sent an email, hopefully enough of us let them know how truly unacceptable this is and they will think again and reverse those policies.

    wiley 250 at hotmail dot com

  14. I sent them an email. I'm so disgusted with this! I'm in Oregon but I really hope that by doing this and showing the outrage from around the country we will show that this isn't acceptable from any hospital across the U.S.

    spencerashleybarrett AT gmail DOT com

  15. I don't see an email to send to, but I called and got the run around. Also shared on facebook, I can't believe anyone is ever being denied the basic right to choose to do with their body what they like!

  16., ladies, lets fill their inbox! I wrote:

    I recently heard about your new policy change regarding breech births. My first baby was breech when I arrived, pushing and 8 cm dialated, at my local hospital. Their policy, like yours, had recently changed to not allow breech birth. The place I'd come to for information, help, and choices, was giving me none of the above. The nurse seemed mostly concerned that I would violate policy and have the baby "too fast" (her words).

    I told the intake nurse "no" so many times, she finally pulled me away from my mother, made me lie still while in extreme pain, and told me I would be kicked out into the parking lot if I didn't sign the papers for a c-section. I agreed, and every time I get pregnant in the future, I am going to have to deal with the additional risks of that surgery, which, given a few more minutes and a caring expert breech doctor, I almost certainly did not need. My later births have been fast and uncomplicated, but I am still a high risk patient because of that first c-section.

    It seems unfair to put more risks and limitations on the mother when its not needed. Some breech positions can be a perfectly safe way to deliver a healthy term baby. If I show up with a foot problem, wouldn't you find me a good expert doctor to care for my foot? Please reconsider your policy.

    Thank you,


    (insert your own story for the first paragraph is desired)

  17. Since when should hospital administration EVER make decisions about patient medical care?

  18. I contacted them with the following things to say: Hearing of your new policy regarding vaginal breech birth has me very upset. How dare you try to impose some policy that goes against the fundamental rights of patient autonomy. The decision of how a woman gives birth is between her provider and herself. If a provider is trained in the aspect of vaginal breech birth, what is the point in forcing surgical birth? You're violating the very basic ideas of informed consent and right to refusal.

  19. Shared on facebook.

  20. I sent the following email:

    To Whom It May Concern:

    I am saddened to learn of Hudson Hospital's recent ban on breech births. I would like to believe that this decision was made with your patients' best interests in mind, but such a broad and inflexible rule certainly will not yield the best outcome in individual cases. The only appropriate and ethical solution is to allow each woman and her healthcare provider to make a decision together about how her baby is born.

    You must know that Cesarean sections in our country already occur at a far higher rate than recommended by the World Health Organization. Please do not add to the growing number of women and babies who experience unnecessary risk. Please do not deny women the right to choose how their babies are born. Please allow women and their providers the opportunity to assess the risks, evaluate their situation, and decide for themselves.

    Jennifer Benson

  21. I shared on facebook with a babywearing group. Hope our voices are heard!

  22. Emailed and shared on facebook! What a backwards policy!!!

  23. Emailed

    I recently heard about your new policy change regarding breech births.

    My baby was breech and born safely at home in 1981. Surely women's abilities to birth their babies have not changed so dramatically in these years.

    May i suggest instead, that your hospital take the lead and educate its doctors and attending nurses in the art of breech delivery? And prior to that, hire more doctors who are skilled in breech birth. Breech is simply a variation of normal birth but in the hands of a frightened and unskilled doctor, well, yes, c-section may be preferred.

    In summary, reducing the choices available to women is more cumbersome and less productive than educating doctors in the true art of natural birth. I hope your hospital chooses the latter.

  24. This makes me see RED! So sad!
    Emailed them this letter:

    Dear Sir or Madam,

    I am so sad to hear you have quit offering mothers the option of physiological breech birth. As a mother who has taken advantage of this service in your very hospital, I must say I am very disheartened you have chosen to take away this service from future mothers who may need you. I used to refer other mothers to your hospital all the time. Not anymore. Please reconsider the policy change. Cutting birthing mothers open for unwarranted reasons is a BIG deal.


    Kelly Bant

  25. My letter is in the mail. Here is a copy for you, this will also be posted at "from Grief to Geek" and on the Spinning Babies site.

    14 March 2013

    Dear Robbi,

    I am a mother of two beautiful children who were birthed at Hudson Hospital. I chose Hudson because of the willingness of the hospital to accept my family’s adamant demand for fully informed consent and fully informed refusal for care and interventions. The nurses and doctors that cared for my babies and me were wonderful, caring, and skilled in their art. I have since referred many families to your hospital. I will no longer be referring anyone to your hospital with the current policies in place. Let me explain why.

    First, the decision to suspend vaginal breech delivery is heart breaking. My first child was delivered vaginally and breech at your hospital. The most recent studies have shown there is no higher risk for vaginal breech delivery than cesarean section when the baby is presenting in the Frank position. Especially if the practitioners are skilled in physiological breech birth. Hudson has the unique situation of having very skilled practitioners in physiological breech birth. The ACOG recommendation in physiological breech birth in 2006 even states that vaginal breech delivery of a singleton breech should be based on the skill of the practitioner.

    Second, the decision to employ medical interventions on “all mothers and newborns” is a slap in the face to the educated women of this age. We are not ignorant, helpless nymphs that cannot make a decision for ourselves. This policy is a violation to women and their partners to make medical decisions for the good of their family, with what they feel comfortable. The current “national medical standard” is not a good one – the United States has the third highest maternal and infant mortality rates in the developed world. Not impressive. This is the equivalent of saying “Johnny jumped off the bridge, so I am going to do it too.” Hudson’s own Patients Rights and Responsibilities state:

    • “ Except in emergencies the consent of the patient or the patient’s legally authorized representative shall be obtained before treatment is given.”

    • “All patients have the right to be informed concerning their continuing health care needs, course of treatment, prognosis for recovery, and alternatives to meet these needs in terms the patient can understand.”

    • “Any patient may refuse treatment to the extent permitted by law and is informed of the medical consequences of the refusal.”

    It literally made me cry to hear the board’s decision for Hudson to become a surgical birth hospital. I myself have an irrational fear of C-section and was so grateful to find a hospital that would allow physiological breech birth. I went into my birth knowing that at best my baby would have some respiratory difficulty at first, and at worst death for the both of us. But isn’t the worse case scenario for any woman giving birth death? Don’t we all face that when we first discover we are pregnant? Is it so awful to allow women to educate themselves about the risks and delights of birth that now we just say, “Oh, the doctors know best, let them make the decision for you.”? Part of the gift in being able to bring a life into this world is the responsibility of the woman and her family to understand that birth does not always end perfectly. Women hold great responsibility when they become pregnant and taking away the choice of informed consent and refusal is extremely disempowering to all women and their families. I fear for the future of birth and empowering women to be strong, well informed, and allowed to give birth in the manner that is best for them. I ask that the Hudson Administration reconsider their decision and perhaps find a different approach to achieve the Triple Aim.

    Very Sincerely,

    Adrienne C. Caldwell

    Thank for putting together the talking points Rixa. I really appreciate it.

    All the best,

  26. Also shared on facebook

  27. I called Robbi today and she answered her phone. I introducedmy self and said I was very disappointment at their decision to not allow VBAC, Vag Breech,and Vag twins. She said this decision was to suspend these types of birth and not an indefinate decision. I said as a moher who was not given the choice to have a vag Breech and only had the option of ceserean,I was deeply saddened to hear of this decision. She rambled that it was due to reports of saftey and I stated ACOG was now encouraging these births over ceserean.She said that my opinion was noted, but she was not going to discuss this isssue over the phone. She thanked me for my call and hung up!

  28. Legally speaking, a patient who refuses care cannot be operated on, as this would constitute an assault. Refusing to care for an individual by a physician would be ethically wrong. Women should refuse to be operated on if they feel strongly about their decision and should complain to their local College of Physicians and Surgeons if being refused care by a physician.

  29. I emailed them at their "info" email address, and have not heard back. I'm going to wait a few days and follow-up. I specifically asked for a response.


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