I have a doula client who when I met her was looking to change care providers.  So I offered her this list of questions to ask.  (I normally don’t concern myself too much with care providers, because most moms are reluctant to change, so unless mom isn’t happy, they are not open to changing)  But since this mom was in process of changing, I thought she might as well make sure she picked a care provider that was actually supportive of what she may want! 

 

My comments on her discussion are italicized.

 

T’s take on her discussion with the OB

 

Clearly he has thought about these things for a long time and has said them to more than just me. But I definitely think he got defensive. He stood there with one hand on one hip and the other waving around.

 

Basically it comes down to – He said if he’s going to be our doctor, then we have to trust him; lots of people are giving lots of advice that have never been in his shoes and don’t have his liability.

 

Really, is this what we are supposed to do, just trust all doctors?  They know best?  Or can we talk to them about things and gather information from them, so we can make the best decision for us? 

 

He basically said consider the source. What are their qualifications? Do they profit off their advice? & What’s their liability? He proudly counted these off to me on his fingers.

 

I agree with this, he definitely is coming from a different place.  Rather than being concerned that a patient has they type of birth she wants, his number one concern is liability.  In today’s litigious society, I don’t blame him. 

 

It went on for a lot longer than that. And I tried to interrupt saying that I believe he’s the expert and that’s why I’m asking him these questions, but got a “Can I finish?”

 

During his lecture, regarding the qualifications of those other people giving advice to pregnant women – he talked about how he’s delivered more than 5,000 babies and how went to an Ivy League school. “They haven’t been in my shoes.” “Why do you think Dr. H. trusted me with all of her deliveries, why do you think Dr. S. trusted me with hers?” (2 doctors I know)

 

OOOO, OOOO I actually did go to an Ivy League School too!  But I guess it doesn’t count since my degree was in Education.  But I am a professional Childbirth Educator, educated at an Ivy League School.  But I have delivered NO babies and thankfully I have never been in his shoes.  I love that I don’t have to worry about the medical aspect of birth, rather focus on the emotional, educational and supportive aspect. 

 

He said “If you hire that doula she will make more at your delivery than I will.”

 

Holy Cow!  If this is true that is really sad.  Any idea how much most OB’s make per birth? 

 

He said if I want to have as natural a labor as possible I should stay at home as long as possible. Because once I get to the hospital then the nurses must follow AORN requirements (when I wrote that acronym down, he’s like, “you don’t have to take notes on that.”).

 

Ok, my L&D nurse followers.  What the heck are AORN requirements and how would they affect birth? 

 

When I asked what his philosophy was on episiotomies (cutting me) He said “If needed.” I said what if I don’t want one. He said, “Why don’t you let me make that call.” He also said, “If I cut you, I have to sew you up, I don’t want to make more work for myself now do I.”

 

Does he…? Dun dun duuun. 😉

 Wouldn’t it be better to explain the times when an episiotomy is a good choice.  What about saying your episiotomy rate for first time moms.  That would be more helpful.

Some other answers (some from him, some from his nurse practitioner) –

– He said an IV is very important because you can’t get one in once (if) the mom has started to hemorrhage because the veins collapse (yikes). I said what if I want to be in the shower in my room, he said, well, a helplock.

 

Why must OBs  try to scare moms into doing what they want?

 

– When it comes to monitoring, he felt that was very important. If I plan to be in the shower then he said I guess it’ll have to be the intermittent one (so I don’t have to be confined to the bed). But I’ll have to work it out with the nurses.

 

It really isn’t up to the nurses.  The nurses seem to say it is up to the OB, or hospital policy.  No one seems to want to take ownership of this!   Nurses do have an effect on this.  I have had OBs say intermittent is fine, but some nurses are not comfortable with this and they really try to keep it on continuously.  So indeed nurses count, but if an OB requires it than for sure the nurse will want it on.  If an OB is ok with intermittent, then mom has more of a chance of actually getting it. 

 

– Philosophy on going beyond 40 weeks – his nurse said he’s fine until 41 weeks then he gets very nervous.

 

His nurse said his goal was to allow all women to tryfor a vaginal delivery. He had said his goal was to make sure you want to come back for your second child “there are 50 other OBs nearby that you could go to.”

 

He said he had to induce a mom this morning who’s got a 10 pound baby.   He thinks he should c-section her, but she wants a vaginal birth, so he’s letting her try for a while.

 

Oh, this one really gets my goat.  I have an issue with Big Baby Bull.  I wonder if this mom got her vaginal birth after “trying for awhile”   I really hope she did.    I also wonder how big her baby really ended up being. 

 

He said don’t eat a cheeseburger before coming to the hospital, because aspiration is the number one cause of death during labor. Then he knocked on the cabinets (because they’re presumably wood).

 

Ahh, this is worthy of its own post.  Death by Cheeseburger

 

How did T. feel about this conversation? 

How would you feel?  Would this be the ideal OB for you? 

 T’s feelings coming in the next post.

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21 Comments

  1. Wow. I would have run for the hills.

    As soon as I read “lots of people are giving lots of advice that have never been in his shoes and don’t have his liability’, I was planning to comment on how, yup, THIS was his bottom line, that magic word. But then Sheridan beat me to it!

    And it drives me insane, this rank-pulling on how he and other OBs are the only ones qualified to talk about childbirth. Doctors who make those arrogant claims haven’t the faintest idea how much training and education midwives have. When it comes to high risk situations and surgeries, absolutely they are the experts.

    But low risk, normal, physiological birth? They are the ONLY ones who grok this? I would go further and say that the majority of them actually DON’T really understand this, in many ways. Certainly they often don’t *respect* it, hence the pandemic of active management that women are starting to question en masse.

    An additional question I would ask him (especially in light of the “pit to distress” scandal, but even before that horrible term entered the birth zeitgeist) how often he uses Pitocin to augment labor.

    I’m very curious to hear T’s feelings! Don’t keep us in suspense too long!

    enjoybirth Reply:

    I think so many OBs only know how to manage birth, not how to watch it and then help if a problem arises. Rather try to run it so a problem doesn’t arise, but then that causes problems. Quite a crazy circle they are caught in.

    Next post is in the works!

    JoyF Reply:

    Wow! The first thing that came to mind was “What a pompous jack***!”

    The conversation reads like something you’d find in “what kind of doctor NOT to see for your prenatal care”!

  2. His attitude is really bothersome, too, not just WHAT he was saying. All a little self-righteous, which makes me nervous in and of itself.

    Oh boy! Can’t wait to hear what “T” thinks.

  3. AORN=Association of Perioperative Registered Nurses (OR nurses.) I’m not sure why the OB nurses would be advised by those guidelines, outside of the OR/doing c-sections. I have my specialty certification from AORN, and there were no L&D questions.

  4. realityrounds

    Ugh! I do not know where to start. You can die from eating a cheeseburger if you go to the Heart Attack Grill in Arizona. They have “sexy” nurses who will wheel you from the restaurant in a wheelchair. OK, I’m digressing.

    This Doc is blaming a lot of his practice philosophy on the staff nurses. He has some passive/aggressive issues.

    “Ok, my L&D nurse followers. What the heck are AORN requirements and how would they affect birth?”
    _I think he meant AWHONN (Association of Women’s Health, Obstetrics and Neonatal Nursing). Which is really ironic because AWHONN supports natural childbirth, no episotomy, breastfeeding, low interventions etc. This Doc is making sh*t up!

    Nurses do not decide how a mom is monitored. That is an MD order. We can make suggestions, etc, but it is up to the MD.

    I wish I had switched Docs with my first baby. She refused all of my requests, like not wanting a resident to examine me, no epidural, freedom of movement, etc. I felt I was too far along to switch providers.

    enjoybirth Reply:

    It is interesting how many moms don’t start asking these questions (if they ever do) until late in their pregnancy and then feel they are too far along to change! But I try to emphasize to my students and clients, if you are not happy, it is never to late to change. It isn’t always easy, but it is worth the hassle.

  5. He was referring to AWHONN or the Association of Women’s Health, Obstetric, and Neonatal Nurses. AWHONN creates guidelines that most hospitals adopt regarding how nurses should manage women in labor. Interestingly enough, its pretty supportive of natural labor but ultimately, the hospital makes the rules for what type of treatment women will receive. Some OBs have the power to break those rules within their hospital and some do not (as in they will lose their privileges if they don’t follow protocol). Bottom line, if you don’t like your provider, switch to someone you do like. You might also want to consider not birthing at a hospital that won’t let you birth the way you want.

    enjoybirth Reply:

    Oh thanks…. that makes more sense than the AORN.

  6. Well, I think the comments on the “AORN” issue illustrate the OB’s arrogance and attempt to B.S. his way through that interview. Of *course* he didn’t want “T” to take notes on that, because he knew he’d just pulled it out of his a**, and would be caught with his pants down if she looked it up (down because he needed to reach into his a** you know…)

    Sorry, OB’s seem to bring out the crass side of my personality.

    As for the doula making more money…he might have read things about doulas who charge $800 or more, and be considering the global fee he gets for a vaginal birth of about $2500–which when you consider how much would go for prenatal care, how much goes to cover his office expenses…yeah, he gets a pretty small slice of that. Of course most doulas don’t charge that much.

    But a doula will easily spend 24 hours with a first time mom between prenatals, misc. support time, labor, and post partum, while the OB will only spend about 4 hours MAX (probably closer to 2 hours) with the mom in prenatals, then only a couple of hours with her during labor–perhaps less than 2 hours if the nurses time things well. My heart is not about to bleed for paycheck issues for a profession that boasts an average salary on salary.com of over $200,000.

    Or he might be considering that doulas tend to help mothers acheive lower intervention births, which means fewer billables for him…which means less income, so he resents doulas for this. In which case, shame on him!

  7. Pingback: Death by Cheeseburger? « Enjoy Birth Blog

  8. I love his hemorrhaging comment. I hemorrhaged, and they still managed to get 7 more IV’s started. Is it more tricky? Yep! But they can do a lot when motivated.

    Personally, I’d run for the hills. Any doctor that won’t let me get a word in edgewise is the wrong doctor for me.

  9. Bottom line is…doesn’t sound like doc and mom “mesh”…and I’m not even talking about on views of a normal birth. There’s got to be a personality match…having a baby is a really special thing; why would you want someone that you don’t get along with really well (not to mention respect and trust) there welcoming your baby into the world with you?

    enjoybirth Reply:

    This is true. Same with doulas. I always say, meet with a few to find one you click with. You want to hire someone you like and trust and don’t mind if they see you naked. Not everyone fits into that category!

  10. Any skilled L&D RN can get an IV started in a PP hemorrhage. Also – did he forget about rectal cytotec or IM methergine/hemabate for PP hemorrhage? You don’t need an IV to manage a hemorrhage!!!

    A doula “might” take home more money per birth than the MD, but she is also much more involved with that one woman than the MD. The MD is seeing probably 5-6 women at one time, so, all in all, he’s making more money by seeing more women.

    But the woman with the doula is undoubtedly receiving better one-on-one care!!

    enjoybirth Reply:

    “A doula “might” take home more money per birth than the MD, but she is also much more involved with that one woman than the MD. The MD is seeing probably 5-6 women at one time, so, all in all, he’s making more money by seeing more women.

    But the woman with the doula is undoubtedly receiving better one-on-one care!!”

    Good point and with a doula you know SHE will be there. With many OB’s in groups, you never know who will show up at the birth.

  11. Pingback: Questions to ask your Care Provider – NOW! « Enjoy Birth Blog

  12. I wanted to add on to this, as I had another thought. It MAY be true (I’m still skeptical, frankly) that a doula “makes more at A birth than a doctor does”. But what does that mean? How is that cost broken down? Point being, think about how much more time a doula actually spends WITH the mother, both during labor itself and at pre- and post-natal appointments.

    Contrast that with the typical amount of time most OBs spend with their patients at their prenatal appointments (after the nurses do all the grunt work). 10 minutes on average? 15? And then, the stereotype at the birth, the doctor coming in for the grand finale, catching the baby, and departing. How long does that segment typically last? sadly, I’d guess that the way to get the MOST time from your doctor is to have a c-section (for which they are paid much more, anyway).

    Add all that up, and I think it’s obvious that the doula spends much, much more one-on-one time with the mother, therefore the doctor makes a significant amount more per actual hour than the doula.

    enjoybirth Reply:

    Good point!

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