Standing Firm with the OB

This post gives suggestions of how to deal with the pressure you will feel at the OB's office in your final weeks - from about 36 on. In my case, I began planning a home birth at 36 weeks, but wanted to maintain OB "shadow care". It was important to me to stay with both the OB and midwife, to not burn bridges, so that I could swiftly change my mind if I felt the situation was degrading. This is a very difficult tightrope to walk, especially as the OB was not aware of my new plan due to laws threatening to midwifery in my state.

I feel it's important to be respectful and not too cocky about the subject with your OB. In some ways, he or she is probably constrained by regulations that do not agree with his or her own beliefs and experience.

* Listen respectfully to their advice
* Try to separate out fear and control techniques from good information
* Remain positive and avoid confrontational reactions
* Stand firm on your decisions and know what you want
* Politely ask to read the scary research they cite
* Ask to see written copies of their bans and other rules if they push those
* Realize that in some cases, medical intervention actually is useful and bend as needed
* Remember that it is your body, your baby and you have patient's rights. There is little they can "allow" or "disallow" that can be done without your consent. "Won't Allow" is a red flag.

A sample conversation on the table, about 38 weeks and up. PLEASE - Respond with some of your own experiences in the exam room! These conversations are very very common.

History: Wanting my 2nd VBAC, age 40, gestational diabetes.
This is my 3rd baby, so while the below was stressful, I had had a lot of practice with these questions during my 1st VBAC attempt. I hope this will help you on your very 1st try.

"Why don't we just put you on the surgery schedule, and hopefully you won't need it?"

"No thanks, I'll just wait until the baby is ready. The BPPs are perfect so I'm in no hurry."

"We have a new absolute policy against VBAC induction with pitocin."
"Then I guess I'll just have to wait it out. What will we do if I go to 42 weeks and still refuse a c-section?"
"We won't let you go that long."
"I think that's up to me."

"I'm sorry, but you absolutely have to give birth by 40w3d."
"Is someone going to come to my house and get me if I don't? (said in a friendly way)"

Said in front of my 4 year old: "You know your uterus could rupture and you and the baby could die. There have been two tragic cases in our local hospitals recently." (I was FURIOUS but still chose to bring it back to the point and not fight that battle.)
"I wonder how many of those women with ruptures had been induced or otherwise rushed through labor? I have read up very extensively on the statistics, and I still feel that trying to follow a natural course will be the safest for us for now."

"Your baby could be getting huge because of the GD and could have serious sugar problems and shoulder dystocia."

"I don't feel that my baby is overly large and I have excellent control of my diet. My fasting numbers are within a few points of the required number. There don't seem to be any indications of a problem in my case."

'What are you going to do when you get to 41 weeks? Start hiding out from us?"

"Well if the BPPs are fine and I feel fine, then I guess I'll just keep coming to my appointments and see what happens."

"How about we just stretch your membranes for you and maybe get you going?"

"I'd rather not do anything that might possibly introduce infection or break my water before I'm ready. By the way - I formally forbid you from trying to induce labor during an exam until I ask for it." (I allowed them to stretch me at 41+ weeks but told them in front of a witness to be very careful not to break my water..)

"You know there is new research that the placenta degrades after 41 weeks and you are endangering the baby's life."

"Can I see that research? I had read that there can be a very tiny drop in function around 41 weeks, a little bit more at 42 weeks, and significantly more problems around 43 weeks and greater. I have not read of this leading to severe damage or fatalities except in extreme cases."

"We've had office meetings about your case and we really need to get you in."
"It seems you are the only ones worried. My baby and I seem to be doing OK."

Let's hear from you.