A physician speaks about doulas and birth plans

This comment just came in from Kingsdale Gynecologic Associates: Doula Ban and Birth Plan.

So I am actually a physician. Doula's may be beneficial in some situations, but you all must remember that the role of a physician is to provide good medical knowledge and advice based on evidence. Where Doula's may be thought of as positive most have zero training and often times may give inaccurate medical advice which is out of their scope of practice. If people want Doula's there should be a government agency licensing those individuals. As you wouldn't want just any person playing your doctor the same gaves for those helping. If they obstruct what we are trying to do they are not beneficial and can ultimately hurt you. Further, they do not have any medical liability. If you want a Doula they should accept medical liability for the 18 years that OB gyns do. In regards to birth plans. They are all nonsense. When it comes to the delivery room most if not all mean nothing. Your in pain you said I don't want drugs you change your mind you get drugs. Happens everywhere all the time. Look the most important thing is not extra personnel in the delivery room. The important thing is a safe and healthy delivery for both the infant and mother. Any mother or father for that matter that thinks anything else is more important should not have children till they get their priorities straight.

Let's discuss this comment from multiple angles--research evidence for/against doulas, personal experience as a doula/birthing woman/nurse/physician/midwife, role and usefulness of birth plans, desirability of licensing and malpractice insurance for doulas, etc.

Here are a few links to get the discussion started:

• Read another doctor's birth plan from WomanCarePC, a Chicagoland OB practice, at The Feminist Breeder (scroll down a bit to get to it).
• A Texas OB's birth plan, mentioned at The Unnecesarean
• At Your Cervix speaks about birth plans from an L&D nurses' point of view
• Navelgazing Midwife's series on birth plans:
• Let's critique a birth plan
• Birth Plan--Lemme Fix It
• Birth Plan--Revised (With OB approval)
• Homebirth birth plan
• Updated birth plan
• What happened to...?

Have at it.

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Kingsdale Gynecologic Associates: Doula Ban and Birth Plan

Remember back when  the Aspen Women's Center banned "doulahs"? There's another obstetrical practice that has not only banned doulas, but also written up a one-size-fits-all birth plan.

Yes, despite the very strong evidence that doulas have significant positive effects on the course of labor, on intervention rates, and on women's experiences, Kingsdale Gynecologic Associates has banned doulas "because of concerns for increased risk to you or your baby." Their "thoughtful, unanimous decision" to ban doulas comes down to this: "It has been our experience that they may serve to create a state of confusion and tension in the delivery room, which may compromise our ability to provide the safest delivery situation possible for you and your baby."

Not only does the pregnant woman no longer have access to a companion of her choice during labor, she has to sign the physicians' birth plan. Among other things, this birth plan notes that IVs are necessary for a safe labor, that you will only be allowed ice chips and popsicles, that you'll probably want drugs, that they will cut episiotomies to avoid bad tears, and that continuous fetal monitoring provides the "safest possible delivery."
Evidence-based medicine has been tossed out the window.

But this one takes the cake:

The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible.

Yes, the physician who arrives when the baby is crowning and the nurses who are tending to several laboring women and spending almost no time doing direct labor support are somehow the equivalent of a doula--a person who knows the woman well, whose entire task is to provide continuous support and information and encouragement, and who never leaves the woman's side.

I'm sure a lot of us could come up with snarky/sarcastic/witty remarks to the doula ban and the birth plan (hey, it rhymes!). But better yet, I'd love to see someone edit the documents purely from an evidence-based medicine point of view, complete with up-to-date references. Perhaps we could create a wiki and work on this together? I'd be more than happy to send the completed documents back to Kingsdate Gynecologic Practice.

You're also free to write directly to the physician group and voice your thoughts:

Kingsdale Gynecologic Associates
1315 West Lane Avenue
Columbus, Ohio 43221
Click here for Directions

Phone: (614) 457-4827
Fax: (614) 326-0250

Still, the best reaction is if pregnant women leave Kingsdale Gynecologic Associates in favor of a provider who respects women's wishes and supports evidence-based care. For example, CNM Emily Neiman wrote that her midwife/physician practice, Women's Contemporary Health Care, would be "happy, thrilled, ecstatic to have these women transfer to our practice. We have no issues with doulas, 'allow' you to write your OWN birth plan, and provide continuous labor support."

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Ghouls and Doulahs

Halloween is just a few hours away. Are you scared yet? If not, here's something to shiver your timbers.

This sign is from a clinic in a town where I went to university. I am SO glad I didn't get pregnant when I was living there. It was before I knew anything about birth and I could easily have gone to such a place and not known any better. Anyway, the internet has been buzzing about this sign. Here's just a few pieces to whet your appetite:

• Dou-la-la in Signs, Signs, everywhere there's signs asks what's next--forbidding women to look at certain websites, books, or movies?
• Radical Doula wrote about Signs you don't want to see at your ob-gyn's office
• Organic Birth asks What's next?
  
• Bellies and Babies commented on this in Posted Refusal and Black Lists, and corresponded with a CNM who uses one of the clinic's doctors for their backup physician. This midwife explained that the sign isn't quite as bad as it seems.

Still, even if there's a back story and the docs aren't really that bad, they certainly could have come up with a better sign! Like actually spell "doula" right for starters..

If you're not already scared by the "no doulah" sign, then read this OB's Birth Plan. It's so bad that I wonder if it could possibly be real. I read through the original thread and it does seem legit--as legit as something can be on the internet! 

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BRAINED (aka Fun With Acronyms)

Pregnancy, birth, and parenting are filled with decisions: some vitally important, some trivial, some heartwrenching, and some enjoyable. When I was working as a doula, I would often show my clients the following acronyms for making decisions about their pregnancy and birth care. I believe that women are smart enough to make their own decisions. There is no need for coercion, manipulation, guilt trips, threats (subtle or otherwise), or appeals to authority (including mine!). They should research their options from a variety of sources and then carefully weigh their options.

BRAINED
Trying to make a decision? Get BRAINED!
Ask yourself, and your caregivers, these questions:

Benefits - How could the recommended course of action help me or my baby?
Risks - How could the recommended course of action harm me or my baby?
Alternatives - Are there any other courses of action I could consider?
Intuition - What are my gut feelings about this?
Nothing - What happens if I do nothing?
Evaluate - Can you give me some time to consider my choices? Then...
Decide - Now that I have the information I need, I'm ready to make a decision.

BRAINS

Benefits- How will this procedure benefit me and my baby?
Risks - What are the risks to me and my baby?
Alternatives - What are some other things we might try instead?
Instinct/Intuition - What is your gut telling you?
Now/Never/Nothing - What if we don't do the procedure right now? What if we never do it? What if we do nothing?
Safety/Satisfaction - Will this procedure increase the safety and satisfaction of the birth for me and my baby?

To give credit where it's due: the BRAINED acronym comes from a handout that someone gave me from "Lucina Birth Services." The BRAINS acronym was passed around on a doula list serve.

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