Alliance for the Improvement of Maternity Services (AIMS)

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GETTING WHAT YOU WANT FOR YOUR
BIRTH EXPERIENCE

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:

  1. confining the mother to bed during labor and birth,

  2. placing an IV or saline lock,

  3. shaving the mother's pelvic area or administering an enema,

  4. chemically "ripening" her cervix or inducing labor,

  5. artificially rupturing the amniotic sac,

  6. administering analgesia or regional anesthesia (epidural, spinal, pudendal, etc),

  7. prohibiting the mother from eating lightly and drinking fluids during labor,

  8. placing the mother's legs in stirrups for delivery,

  9. performing an episiotomy or proctoepisiotomy,

  10. directing the mother to bear down longer than 5-6 seconds,

  11. applying fundal pressure,

  12. extracting the baby by forceps or vacuum extractor,

  13. clamping the umbilical cord before pulsation stops,

  14. putting the baby in a baby warmer, rather than putting the baby with the mother, inside a prewarmed blanket, and

  15. 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.

WHEN YOU GO FOR YOUR FIRST PRENATAL VISIT:

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:

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:

RESISTING THE INSISTENT PROVIDER

If you do not want a sonogram, ask the following questions:

COMMON RESPONSES TO INQUIRIES ABOUT ULTRASOUND

If the doctor or midwife continues to insist on a sonogram then ask:

(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 SURE THE DOCTOR OR MIDWIFE AND THE OBSTETRIC STAFF KNOW WHAT YOU WANT

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.

 

 

HOSPITAL CONSENT FORM

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:

HOW TO REFUSE AN INSISTENT RESIDENT OR NURSE

To make the provider think about what he or she is offering you, ask:

Remember, directions have legal connotations; requests can be ignored.

"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.

THE DOCTOR CALLS THE SHOTS!

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.

 

GETTING YOUR OBSTETRIC RECORDS

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:

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

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