Get it in writing

Women -- this is your body, your baby, and your baby's birth. You have rights and options. Become a partner with your caregiver. Get it in writing.

From Amy Tuteur, MD:

Kelly: "having a doula there to advocate for me seems like a good compromise"

Another thing that you might ask your doctor to do is to label the front of your chart with your requests. For example, he could write that no one should rupture your membranes without your explicit consent, and no one should even ask to do so unless there is a defined problem that will be solved by rupturing them.

Safe Baby Partners:

In "Hey! Who's Having This Baby Anyway?", Breck Hawk, RN in NICU (neonatal intensive care), midwife, doula, and childbirth educator suggests,

There’s an important secret about birth plans that will make them effective: During the last couple of visits with your provider review the birth plan with him and then have him sign it. Make a couple of copies and take one to the hospital when you go into labor. Your provider’s signature changes your birth plan from your "desires" to his orders and the chances are very good that you’ll get (if medically possible) everything that you requested.

Order the book at www.heyanyway.com

A woman can take charge of her baby's birth and her body. She can require her doctor to sign her birth plan AND make the appropriate notes on her chart. The entire birth plan can be negotiated so that during labor and birth, in the event a woman changes her mind, or the medical need arises, her caregivers can adjust accordingly (without further fear of liability).

It is important to clarify her Doula's role and authority with medical staff. Acceptance of a Doula by medical staff still widely varies. A Doula is trained to not intervene with medical caregivers and must often just watch the overpowering of a woman when staff want, for example, to "break the membrane and get things going faster." One of the things a woman can specify in her plan is that the medical staff rely on her Doula's participation and authority to speak for her during the labor, or allow her time with her Doula to discuss options, etc. Many times Doulas are ignored by medical caregivers even though it is the Doula may know -- even more than the woman's partner and family -- why and what she really wants. Many woman are afraid to do this type of negotiation with their physician because of the power differential.

Aside from that, as per Kelly's statement above, why does SHE have to compromise what SHE wants for her and her baby, particularly when obstetrics is widely known to be non-scientifically based? And, importantly, when it is ignored by medicine that the experience of laboring and birthing in the hospital has a profound emotional and physiological impact to the baby's developing brain and systems (the pituitary-stress axis that Dr. Nathanielsz's research shows is established in utero). When a pregnant woman is engaged in preparing to go again to labor and give birth (be open and vulnerable) in a place where she has experienced fear and violation, how could this not affect the developing brain and the birth? Are we not creating little warriors, people who are vigilant and reactive, and who must worry about their safety and boundaries, rather than people who are empowered, respectful of others, and able to self-regulate? The literature abounds for decades about how the birth experience affects one for life. Brain research in the nineties confirms it. The last to "know" will be those who have the most to gain from the current practices -- Dr. Amy herself says it is a business.

Regardless of the type of experience (birth, rape, loss, accident, etc), one does not typically do well when they must return to the place of a previous violation --- especially if the experience has not been resolved in the body-mind connection. One does not need to have a full-blown medically documented case of PTSD to experience the effects of being in a frightening, overwhelming, painful, or violating situation. The denial of the experience leads to depression. The experience of birth in the hospital is not openly acknowledged in medicine and psychology as detrimental to mother and baby psychologically and physiologically so that the appropriate help is not available. It is not to the advantage of those in position of power and income to admit to what they do as creating trauma for others to live out. Neither is there a social, political, or legal "checks and balance" that would insist the the inappropriate situations and behaviors be mediate; therefore, obstetric caregivers are allowed to blunder along freely, justifying their actions when the science tells us otherwise.

It is up to women to be informed and educated and prepared when the accessibility of out-of-hospital care is so minimal, when insurance companies favor hospitals, and when doctors are held liable for a woman's baby's birth.