Thank you to one of my fellow teachers, Rachel Davis, for
suggesting this topic. It is very timely
given the situations our unplanned unassisted birth couple encountered in the
Most people would not expect their baby to be born at 35
weeks. In addition, they had not counted
on dealing with hospital protocols since they had planned a homebirth. The other situation they hadn’t planned on
was having a hospital encounter with any hospital outside of their local
small-town hospital in northern Arizona.
Their situation underscores the importance of having a
well-thought out and written birth plan no matter what kind of birthplace you
have chosen. No matter where you are
planning to give birth, Bruss and I suggest that you think about writing two birth
plans: one for a normal, uncomplicated birth at your chosen birth place, and
one that has your wishes written down in the event of complications and that
factors in hospital care. Once you have
these thought out, write them down and carry them with you at all times.
As our couple found out, you just never know…in the event of
unforeseen circumstances, your birth plan can act as a compass for your
decisions. It can also remind you of the
decisions you made when you took the time to research your options and when you
were not under pressure. You can then
evaluate the current situation with a little less emotion and a little more
For a full Pregnant Patient and Obstetric Patient Bill of
Rights, I am going to refer you to a link on Doris Haire’s Alliance for the
Improvement of Maternity Services (AIMS):
One of the reasons so many of us feel pressured to make choices
against our instinct or desire for as natural experience as possible is that
sometimes information is relayed in such a way that implies that you are a bad
parent if you deny treatment to your child, or they imply that by not choosing
something you could harm your child. How
many parents are strong enough to follow their instinct with pressures like
time, fatigue and shock also factoring into the situation?
Whether you are planning to give birth at home, in a birth
center, or a hospital, I encourage all pregnant mothers and their coaches to
become familiar with the AIMS Pregnant Patient Bill of Rights in the event that
you end up in a hospital for whatever reason.
I suggest that you print out the American Hospital Association's
"Patient's Bill of Rights," (http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm) as well as the AIMS Pregnant Patient Bill
of Rights and bring them both with you in the event of a hospital visit during
your pregnancy and labor.
I will summarize some of the points here and encourage
parents everywhere, that pregnant or not, if you are in a hospital, there is very little that you can be forced to do or take for yourself or your child. You have every right to ask and be told the
benefits and the risk of EVERYTHING they recommend as treatment, and you have
the right to refuse.
These are what I chose to pull our from both of the Bill of Rights documents as your rights as a pregnant and an obstetric patient:
- to considerate and respectful care.
- to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.
- to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care.
- to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action.
- to be informed of
any potential direct or indirect effects, risks or hazards to herself or her
unborn or newborn infant which may result from the use of a drug or procedure
prescribed for or administered to her during pregnancy, labor, birth or
- to be informed,
not only of the benefits, risks and hazards of the proposed therapy but also of
known alternative therapy.
- to be informed about how a drug or
procedure may adversely affect her unborn baby, directly or indirectly, and
that there is no drug or chemical which has been proven safe for the unborn
Cesarean birth is anticipated, to be informed that minimizing her intake of
nonessential pre-operative medicine will benefit her baby.
- to be
informed of the areas of uncertainty if there is NO properly controlled
follow-up research which has established the safety of the drug or procedure
with regard to its effect on the fetus and the later physiological, mental and
neurological development of the child.
- to be
informed of the brand name and generic name of the drug in order that she may
advise the health professional of any past adverse reaction to the drug.
determine for herself, without pressure from her attendant, whether she will or
will not accept the risks inherent in the proposed treatment.
- to know
the name and qualifications of the individual administering a drug or procedure
to her during labor or birth.
- to be
informed whether that procedure is being administered to her because a) it is
medically indicated, b) it is an elective procedure (for convenience, c) or for
teaching purposes or research).
- to have
her baby cared for at her bedside if her baby is normal, and to feed her baby
according to her baby's needs rather than according to the hospital regimen.
- to be
informed if there is any known or indicated aspect of her or her baby's care or
condition which may cause her or her baby later difficulty or problems.
What is informed consent?
According to Doris Haire:
"Most courts consider that the patient is
'informed' if the following information is given:
The processes contemplated by the physician as
treatment, including whether the treatment is new or unusual.
The risks and hazards of the treatment,
The chances for recovery after treatment.
The necessity of the treatment.
The feasibility of alternative methods of treatment.”
You can ascertain this information by asking questions. For a more comprehensive look at positive
communications and informed consent, refer to page 55 of The Bradley Method®
I suggest that you start with questions that establish how
the mother and the baby are doing.
Always use names to remind the care providers that they are making
recommendations for another human being, not an ambiguous test case:
“How is (Mother’s Name) doing? Are her vitals still within an acceptable range?”
“How is (Baby’s Name) doing?
Are his or her vitals still within an acceptable range?”
“Do we have to make a decision right now? How much time do we have?”
If both are well enough and there is time, then you can
continue with questions such as:
“What is the problem?”
“What are the symptoms or test results causing concern?”
“Could this be normal?”
“What is the most likely cause? Are there any other possible causes?”
If the care provider agrees that Mother and Baby are well
enough to let labor proceed and let nature take her course, continue to trust
that Mother and Baby are working together and that you will be meeting your
baby in due course. You can address
other probable causes – is mom hydrated?
Is she emotionally ready and relaxed enough to accept her labor? Are you using the best positions in the
appropriate stage of labor to allow gravity and physiology to move things
If after asking this series of questions Mother and Coach
decide that further action is worth exploring, then you can continue with these
“What exactly are you recommending?” – Paraphrase it
back to ensure you understand what the recommendation is.
“What are the benefits of this procedure or drug?” - You want to listen well, and paraphrase
again. You can also ask if their opinion
is based on fact or observation.
are the risks and known side effects of this procedure or drug?”
to see the insert if it is a drug and there is time to read it – you may be
surprised at what is in the fine print and the care provider fails to mention.
“Is this an established procedure, or drug or is it being
offered as part of a trial?” – This is very important to know, especially
if it is something whose short-term or long-term effects on an unborn child or
a newborn are unknown.
“What are alternatives to this procedure or drug?” –
Again, care providers have routines based on what their protocol is – sometimes
there are other options that they don’t mention, not from malice, it could be
simply because they are not accustomed to being asked for alternatives.
“What are your qualifications for making this
recommendation?” – Who are you talking to?
Nurses come in many varieties: a student nurse, an LPN (one year of
schooling), an ASN nurse (two years of schooling), a BSN (four years of
schooling). Beyond that, how long have
they been working as a nurse? If you are
talking to a doctor: are they a resident (student) doctor, or an attending
(more experienced) physician? How long
have they been a resident or an attending?
“Who would be performing this procedure?” – This is
an especially important question to ask if you are in a teaching hospital. Every family needs to make a decision
regarding their comfort level with students literally practicing on you based
on their individual preferences. On a
personal note, while I am all for medical students learning, when it come to my
body and our child, I want a trained and experienced professional to work on
us. I am okay if a student wants to
observe, however, only someone with extensive experience and knowledge is going
“to do” something or administer something to us.
“What else can we expect to happen, or which other
interventions typically follow as a result of this drug or procedure?” – In
the interest of full disclosure, this is a very important question. 1.) You want to know how they will measure the
efficacy of the intervention. 2.) When
you accept one medical intervention, it is likely that other interventions or
compromises will follow. If there is
time, you want to hear all of the other interventions or protocol they will
have to follow that may be a result of the first intervention you agree to
“What happens if we choose to do nothing at this time?”
– Back to full disclosure – there are ways to phrase things that force you to
make an immediate decision. If you ask
this question, it tells you the other side of the story, or the whole story in
regards to their recommendations.
One of the reasons it is so important to take care when
choosing your care providers and medical facilities is that sometimes there
isn’t time to ask all these questions.
If Mother and Baby are already compromised and there is no time to ask
questions, you must trust that the care providers and the birthplace will do
the best for your family. Do you have
this level of trust with your care provider?
Do you have this level or trust with the birthplace? If you answered “no” to either of these
questions, it’s time to seriously consider making a change. Although true complications are rare, if you
are part of the small percentage, you want to ensure that you have the best chance
for a good outcome despite any complications that may arise.
You have a couple of
options in a hospital setting in the event that you want to choose differently than your care
providers are recommending and/or if you feel like your concerns are not being
heard by your care provider.
1. If you have done your research and you have
heard the benefits and the risks of a procedure or drug, and you are confident
in your decision and want to refuse, hospitals have documents called “Against
Medical Advice” that you can sign. You
accept the risks inherent in your decision and relieve the hospital of
2. You can ask for an
Independent Patient Advocate. This
person acts as a liaison between the patient and the care providers. It puts someone in between you and the care
provider, and it is implied that they would convey information in a neutral
way. Sometimes taking away the
“authority” of the person conveying the information relieves the pressure and
lets a patient make a decision without feeling the pressure of “The Doctor” or
There is no decision, big or small, that you will regret
making as long as you keep in mind Dr. Bradley’s ultimate outcome: Healthy Mom,
Healthy Baby. As long as your decisions
are made with the best results for these two people in mind, then you can find
peace of mind that you are making the right decision for you and your family.
This is rather longer than most of my posts – thanks for
hanging in there and reading it through until the end. If you made it through to the end and you
want to win a copy of Husband-Coached Childbirth by Dr. Robert Bradley, send me
an email (firstname.lastname@example.org) by next Thursday, May 19, with your name and mailing
address and I will enter your name in a drawing. I will pick and announce the winner next Friday’s (May 20).
material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical
advice. The reader should always consult her or his healthcare provider to
determine the appropriateness of the information for their own situation. This blog contains information about our classes available in
Chandler, AZ and Payson, AZ and is not the official website of The Bradley
Method®. The views contained on this blog do not
necessarily reflect those of The Bradley Method® or the American Academy of