[...] staff at Strollerderby, the “mother of all parenting blogs”. One of my first articles, “Hospital Rejects Birth Plans”, has started a little comments riot over [...]

I’m not at all disturbed by this. This place is being up front about their approach to childbirth–which is a great thing, whether or not you agree with their approach.

yeah, there’s really nothing wrong with this. Aspen is respecting its patients by giving them the tools they need to make informed decisions about care, and making their own informed (by many years of school and experience) decision perfectly clear.

But they aren’t forcing anyone to give birth there – the sign says that they’ll transfer the patient upon request. How is that a cult? I agree with the other commenters – they’re providing information so the patients can make the best choices for themselves. This is the opposite of terrible.

Very often, hospitals make these kinds of policies based on a poor previous experience. For example, maybe there was one particular case where a doula got in the way of the OB, there was a poor outcome, and the OB/hospital got sued. I don’t know for sure that this happened at Aspen, but I have seen cases where patients say they want things done a certain way, things go wrong, and the sue. The idea is that the doctor is the expert and should have stopped them from making the “wrong” decision.

As others have said, I appreciate the hospital being so upfront.

Also, you have a link to a doula website, saying the doula-assisted birth has better outcomes. It may be true that there are better outcomes, but most of the studies looked at things like “C-section rate” or “epidural usage”. From a medical standpoint, thes are not true outcomes, A true outcome would be linked to baby/maternal health. (Two of the studies did look at Apgar scores, which is appropriate.) I’m not saying that doula-assisted births don’t have better outcomes, but by focusing on mid-points instead of end-points, it is difficult for a hospital to accept doulas as a benefit.

Abqmom has it right.

The real problem here is not the hospital choosing to turn these women away. They are a business. It is their right. At least they’re being upfront.

The problem is the illusion of “choice” in our health care system. The hospital is offering the woman a choice that might not exist. Maybe her OB only has privileges at that hospital. Or her insurance only will pay if she delivers at that hospital. Just because we call it a choice doesn’t mean it is one.

What I don’t understand is that a “Bradley Method” birth isn’t really a specific thing– it’s just a set of really normal strategies for handling pain when you don’t have an epidural. There’s not a specific unique thing you do like hypno birthing, you just do what you can with as little intervention as possible. It has more to do with education and practice. Does that mean that the hospital requires epidurals? Or bans other kinds of birth preparation?

Sounds like they have been sued over a prolonged Bradley birth that went wrong or a doula influencing a mother and the outcome was bad. Believe it or not but the majority of women in the world, even in the USA, want medical professionals to assist them during the birth event. The real cultists are the minority who find a sign like this outrageous.

@Laure68 – There is a large body of research about the effectiveness of doulas. One blogging doctor recently compiled a list of studies.
http://hoydenabouttown.com/20091026.6897/obs-denying-doula-access-wheres-the-science1/

@Ali – ” Believe it or not but the majority of women in the world, even in the USA, want medical professionals to assist them during the birth event.”

What kind of support do you think women receive from doctors and nurses during their labor?

“The real cultists are the minority who find a sign like this outrageous.” Well said Ali!

How many people show up with a birth plan while in labor? Almost everyone I know who had a hospital birth had a lot of time to discuss options with their doctor and the birth plans were on file with the hospital for over a month in advance. It helped the hospital to pair the mothers with like minded L&D nurses (I’m pretty sure it was no accident that my nurse was extremely pro-natural, drug free child-birth). What distresses me about this sign is that it seems like they are uninterested in their patients’ desires with regard to childbirth. By saying “no birth plans” they cut off the mother’s opportunity to articulate, in writing, that she refuses the administration of cytotec or a routine episiotomy or that she would like a c-section employed as a last resort, which sounds like a way to avoid lawsuits for when they go against the mother’s wishes and things go wrong.

Alison – the problem is that, medically speaking, most often the doctor does actually know what will produce the best medical outcome. (Not 100% of the time of course, but most of the time.) They are trained to decide these things. What women do know is what will make them more comfortable/happy. However, it is less likely that someone will sue because they did not get the ideal experience even if mom and baby are healthy. If something goes wrong that affects the health of mom/baby, that is where a lawsuit is more likely.

Personally, I would prefer a world where we could make our choices (with the proper information from professional sources) and then take responsibility for them.

ann05 – I can’t agree with the comment that people “check their brains at the door” when they listen to a doctor. We are living in a society where we have little value for education and expertise, and believe anyone who goes to Google University knows just as much as a true professional. Some people don’t like to admit that someone might possibly know more than they do. This idea seems to be most widespread in medicine. People think they are smart for not listening to someone with an MD, but are happy to listen to a random blogger with no medical training.

I’m not saying that you shouldn’t have opinions about how to give birth, but I would advise getting an OB/Midwife you trust and discuss your options with them. (Of course, I understand there are people who do not have the options that some of us have. However, I do know people who do have plenty of options who think they know more about medicine than doctors.)

In any case, could you provide a link to the NY Times article?

Utah sucks…Mormon fascists…honestly! I can’t believe the comments here…sheep.

This doesn’t bother me. Frankly, whether or not you agree with the clinic, it is their right to set their business practices and, frankly, if I wanted to have a doula assisted birth or do the Bradley method, I’d want to know up front that the people providing my care weren’t comfortable with that. I would want to be in a place where my choices were supported.
Also, in what way are people not allowed to have their loved ones? It doesn’t say anything about that, unless your “love one” is your doula.

ann05 – thanks for the response and the link. I have only read the first page so far, but it looks like it argues for reevaluating existing treatments using evidence-based medicine, which I completely agree with. The more that standards are set based on science, the better off medicine will be. (As the article says, new treatments undergo rigorous testing before being implemented, but we should continually evaluate treatments once they are available.)

Sounds like they just don’t want to deal with “uppity women”… that’s Utah for you. I’m a little sad that the Bradley method people got mentioned… What about hypnobirthers? We’re subversive and threatening too, dammit!
FYI — I had a drug-free, midwife and husband-assisted birth (in a hospital birth center, but a good one — UCSD). It doesn’t always work out for everyone, but it’s worth shooting for (and preparing for) — I had no complications, a healthy baby and was up and showered and dressed and recovering happily later the same day. No drugs = an easier recovery! Also the preparation I did gave me more confidence and calmness approaching my due date.

There are a lot of good comments here. I think the thing I found appalling was that they printed this on a sign over their reception desk. It seems like a very aggressive gesture, and a very black-and-white mindset: anything outside the mainstream is de facto a problem.

I have yet to see a doctor or hospital that will honor a birth plan or allow a doula to interfere in an emergency situation. I’ve seen home birth midwives unhesitatingly cut an episiotomy and coach a woman through timed pushes to get a distressed baby out in a hurry. No one wants personal preference to override good medical care.

But for the majority of women who have a normal, healthy-but-agonizing labor and delivery, good labor support can help them avoid a cascade of interventions that come with their own complications.

When I had my second baby, my husband and I drew up a birth plan. I don’t recall if we even gave it to the midwives, but it was a great tool for us to clarify what we did and did not want from that experience, and it helped us communicate better with each other and our midwives.

be wary of any woman who can’t call a vagina a vagina and insists on calling it a “hoo ha” or any other silly, self-loathing name

The Aspen Women’s Center is an OB-GYN practice, not a hospital. Presumably that gives their clients plenty of time to vote with their feet before it comes time to give birth.

(I’m pretty appalled by the commenters here who think that not submitting to the American obstetrics, and its non-evidence-based approach to birth, makes you a radical cultist. You folks clearly have a lot of reading to do. I recommend starting with Henci Goer’s Obstetric Myths Vs. Research Realities, or her slightly more layperson-focused The Thinking Woman’s Guide to a Better Birth.)

check THIS out!

http://www.theunnecesarean.com/blog/2009/11/4/photoshop-contest-the-anti-doula-sign-in-the-utah-obstetrici.html

Gosh, I’d be wary of the quality of a hospital that has so many grammatical and spelling mistakes in one little sign, not to mention the uninformed and controlling, not to say last-minute, aspects of it.

I am going to agree with Sierra that the placement and style seem extremely aggressive. I also think it is very likely in response to a specific incident or incidents, though. It’s too weirdly specific to be otherwise, as Jennifer pointed out.

I am actually in favor of the honesty, and only hope the region is one where people who want to go to another hospital will actually be covered by insurance.

Andrea raises a really good point: a “Bradley method” birth isn’t a uniform procedure, it’s more of an attitude about what kind of approach you’re going to take to your birth. If your partner accompanies you to the birth, and you have agreed in advance not to accept (say) an epidural, pitocin or continuous fetal monitoring, but you just don’t tell the doctors you’re practicing a “Bradley birth”, then they won’t know until you get to the delivery room. It’s sort of like a policy that is designed to make sure that everyone is as ill-prepared as possible.

Comments
I’m just finishing up my training as a Bradley instructor, I’ve had five children without drugs, and this story is just amazing. No wonder the US continues to fall lower and lower among the countries of the world in maternal/infant birth safety. We’re number 30, according to the most recent stats. Bradley is a copyrighted series of 12 classes, always the same, lots of info and empowerment, just trying to make sure moms know that having a baby is like preparing for an Olympic event, they need to practice relaxing, eat very well, and learn enough about this natural process to take responsibility like an adult. You’d think Utahans would love a method that emphasizes family bonds and fathers coaching their wives as a team. What are these folks so afraid of? Sounds like fear of uppity parents to me. I’m emailing the folks at the Bradley Academy to make sure they know about this. They don’t let anyone use their name without their consent…

while I have a set of strong (and adverse) reactions to the sign at this Utah Hospital, what I think this points to is not just about birth but about lack of choice in healthcare in general. Sadly, my experience suggests that this lack of choice is particularly pronounced when it comes to issues having to do with women’s bodies and women’s health.

In any other case, would you–sans medical license—try and dictate every step of what the doctors did? Also, perhaps it is worth mentioning this is Utah, not San Francisco or somewhere else exactly known for their openness.

The sign is clear and makes sense and is probably for the best.

@Lorraine—Giving birth in my own damn bed is exactly what I did. And the things you cite are exactly why. And doulas *do* have certification standards. Sure, anyone can call themselves anything. We’ve heard of people with botched plastic surgeries who were operated on by fakers with no license. However, there is a DONA certification program for doulas, and a smart woman would do well to look into the credentials of whomever she chooses to attend her birth.

Giving birth naturally on ones own terms is a very empowering experience and I believe that many would have women just shut up and do what they’re told, just to get that baby out, and rob them of this experience. And, sadly, many women are willing to give it up.

The difference is that it is illegal to impersonate a surgeon if you are not actually a surgeon. It is perfectly legal to call yourself a doula even if you do not have the certification. Yes, a smart woman would find this out, but many people don’t understand that these kinds of practitioners don’t follow the same rules as MD’s, RN’s, CNM’s, etc.

Again, personally I wish we could all have the choice of birth we want. (That ranges from all-natural homebirth to demanding an epidural. I don’t include C-sections because of the cost, but if someone is willing to pay for it themselves, I won’t get in their way.) For most hospitals, the issue is fear of legal action.

Also, don’t forget that many of these women who are “willing to give it up” don’t care about the actual experience. For some, this experience is important, and they should be able to have the one they want. I know women who had to beg for an epidural, while the nurse tried to convince them to go natural. To me this is just as bad.

I’m really loving all the discussion here. I’m a little surprised by how polarized many of us are between hospital and home birth approaches. I don’t think anyone wants to put the pleasure of the mother ahead of both mother’s and baby’s safety during childbirth.

Jennifer, I’m glad you and your son were able to get the emergency medical care you needed. Doctors and hospitals are one of the greatest blessings of the world when they’re needed. I’d planned to have my first child at home, but did not hesitate at all to go to the hospital when, after 30 hours of labor, the midwife said it was in my baby’s best interest to transport.

The problem I have with medical professionals who take the attitude written up on that sign is that they’re treating women, fundamentally, like wayward children. If something is actually the best thing for me and my baby, I can be educated about it and choose to do it. I don’t need to be blindly led by the Great Wise Doctors.

I transferred hospitals at 36 weeks in order to be at a hospital that respected my preference for natural childbirth. Because I was receiving proper prenatal care, I was relatively certain that I had a low-risk pregnancy and would probably be fine going the natural route. I was actually kind of a show; residents were called in to see what a natural childbirth looks like, since their chances of seeing one were so small!
The hospital I left has one of the finest NICUs and doctors in the country, and I would have gladly stayed there if I’d had a high-risk pregnancy. I just didn’t prefer to medicalize a natural event. If the birth had turned out badly, I would have no one to blame but me, but these are choices we make.
Palliative care and birth care are very similar in that we hopefully get to decide what our values are and act accordingly. I want to birth as naturally and die as naturally as possible. If that effects my infant’s mortality rate or shortens my lifespan, that’s for me to weigh the options. You can’t equate quality-of-life and quality-of-outcomes. We’d all be a lot healthier if we were directed when and how to exercise; when and what to eat; and what medicines and supplements to consume. There are experts for all of these areas. But that doesn’t mean I’m willing to be governed by them.

My initial reaction to this post was one of disbelief. That a hospital would be so upfront basically saying “if you come here we will force certain types of medical care upon you and you will have no say.” After reading through some comments a lot of good points were brought up. At least they are up front about it whereas a lot of other hospitals might in practice work against natural childbirth efforts while claiming they don’t. A good birth plan is to go into childbirth with an open mind. This hospital is admitting that they don’t and that can only be a disservice to laboring mothers.

Claire, You praise your doctor for letting you make your “OWN informed decision” in one sentence, and then excoriate women for wanting just that. Makes no sense.

the reception desk should be designed as good looking as possible’`,