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Re: [nbnprofessionals] Required newborn exams???

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  • Rashell Rice
    Honestly, I would tell your client to get a different OB. Nothing is required by law in the state of TN and there are exemptions your client can sign for any
    Message 1 of 7 , Mar 1, 2011
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      Honestly, I would tell your client to get a different OB.  Nothing is required by law in the state of TN and there are exemptions your client can sign for any procedures she doesn't want.  If the OB is already this headstrong and you aren't even in the delivery room yet, I have a good feeling she is going to be even more stubborn when it comes to interventions like pitocin.  Good luck!

      On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <sweetheartbirths@...> wrote:
       

      I am a doula in Murfreesboro. I am currently completing my certification with DONA. My current client and I worked on a birth plan, and she just reviewed it with her OB this week.

      She had decided the following things:
      - wait to cut the cord until it had stopped pulsing
      - wait to do eye ointment until after breastfeeding and/or one hour
      - no hep B shot
      - no vitamin K shot
      - natural delivery of placenta
      - one hour with baby undisturbed after birth

      However, her OB told her that:
      - she requires the cord be cut immediately
      - eye ointment is "REQUIRED"
      - hep B shot is "REQUIRED"
      - vitamin K shot is "REQUIRED"
      - she will only allow assisted delivery of placenta
      - and that it is "required by law" that baby be taken to the nursery at one hour after birth

      I know that the first five items may be "required" by the hospital or this particular OB, but doesn't the mother still have rights? How do you be an advocate for her without offending anybody or how do you encourage her to stand up for what she wants without getting into it with her OB? Also, is it really required by law that the baby be taken to the nursery at one hour of life? What law is that?

      Moreover, the OB requires continuous external monitoring and possible internal monitoring and also listed episiotomy as an option if the OB deems it "necessary", when my client specifically said that it was NOT an option whatsoever because she DOES NOT want to be cut.

      I feel like my hands are tied. What do I do?




      --
      Rashell Rice
      615*425*9998
      BringingOutBaby.net
    • Jessica Broddrick
      I agree completely with Rashell. If your client isn t willing to switch, she is going to be such between a rock and a hard place. Everything is the mother s
      Message 2 of 7 , Mar 1, 2011
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        I agree completely with Rashell.  If your client isn't willing to switch, she is going to be such between a rock and a hard place.  Everything is the mother's decision, ultimately, but in an unfriendly environment it will be difficult for her, you, and her partner to advocate for her without lots of resistance.

        Jessica Broddrick

        On Mar 1, 2011 9:18 AM, "Rashell Rice" <rashell@...> wrote:

         

        Honestly, I would tell your client to get a different OB.  Nothing is required by law in the state of TN and there are exemptions your client can sign for any procedures she doesn't want.  If the OB is already this headstrong and you aren't even in the delivery room yet, I have a good feeling she is going to be even more stubborn when it comes to interventions like pitocin.  Good luck!



        On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <sweetheartbirths@...> wrote:
        >
        >  
        >...

        --
        Rashell Rice
        615*425*9998
        BringingOutBaby.net
      • Kimberly Spencer, CPM
        Eye ointment, newborn metabolic screening, and newborn hearing screening are required by law. So are maternal HIV, hepatitis B, syphilis, and rubella testing,
        Message 3 of 7 , Mar 1, 2011
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          Eye ointment, newborn metabolic screening, and newborn hearing screening are required by law. So are maternal HIV, hepatitis B, syphilis, and rubella testing, and also by extension GBS testing.

          Kimberly

          Kimberly

          On Mar 1, 2011 9:18 AM, "Rashell Rice" <rashell@...> wrote:
          >
          >  
          >
          > Honestly, I would tell your client to get a different OB.  Nothing is required by law in the state of TN and there are exemptions your client can sign for any procedures she doesn't want.  If the OB is already this headstrong and you aren't even in the delivery room yet, I have a good feeling she is going to be even more stubborn when it comes to interventions like pitocin.  Good luck!
          >
          >
          > On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <sweetheartbirths@...> wrote:
          >>
          >>  
          >>
          >> I am a doula in Murfreesboro. I am currently completing my certification with DONA. My current client and I worked on a birth plan, and she just reviewed it with her OB this week.
          >>
          >> She had decided the following things:
          >> - wait to cut the cord until it had stopped pulsing
          >> - wait to do eye ointment until after breastfeeding and/or one hour
          >> - no hep B shot
          >> - no vitamin K shot
          >> - natural delivery of placenta
          >> - one hour with baby undisturbed after birth
          >>
          >> However, her OB told her that:
          >> - she requires the cord be cut immediately
          >> - eye ointment is "REQUIRED"
          >> - hep B shot is "REQUIRED"
          >> - vitamin K shot is "REQUIRED"
          >> - she will only allow assisted delivery of placenta
          >> - and that it is "required by law" that baby be taken to the nursery at one hour after birth
          >>
          >> I know that the first five items may be "required" by the hospital or this particular OB, but doesn't the mother still have rights? How do you be an advocate for her without offending anybody or how do you encourage her to stand up for what she wants without getting into it with her OB? Also, is it really required by law that the baby be taken to the nursery at one hour of life? What law is that?
          >>
          >> Moreover, the OB requires continuous external monitoring and possible internal monitoring and also listed episiotomy as an option if the OB deems it "necessary", when my client specifically said that it was NOT an option whatsoever because she DOES NOT want to be cut.
          >>
          >> I feel like my hands are tied. What do I do?
          >>
          >
          >
          >
          > --
          > Rashell Rice
          > 615*425*9998
          > BringingOutBaby.net
          >
          >

        • mamamicky2002
          It is required that the Care provider Administer the eye ointment, newborn metabolic screening and newborn hearing screening. The other testing done in
          Message 4 of 7 , Mar 1, 2011
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            It is required that the Care provider Administer the eye ointment, newborn metabolic screening and newborn hearing screening. The other testing done in pregnancy are requirements that the care provider fulfill. the MOTHER can waive ALL of these procedures by filling out waivers stating that it is against her beliefs and she understands the risks. I have known many mothers who have said no and signed waivers with absolutely NO problems whatsoever.

            The only test that waiving can get a mother in trouble is the blood test given to the baby to detect metabolic (genetic) issues. The waiver says: I have been informed state law requires these tests and that violation of the blood test is a misdemeanor. ONLY for the metabolic screening. None of the others carry a penalty. Maybe they do for the care provider, but not the parents.

            I have never known anyone to decline the metabolic screening.

            As far as the timing of procedures, clamping the cord immediately, active management of the third stage, continuous monitoring, episiotomy etc. - these are ALL physician and/or hospital requirements, not state laws and not even sound medical practice. Unfortunately, I doubt that these are negotiable with her OB.

            You should present her with her options so she can make the choice right for her. 1. Stay with her current ob/practice. If she does that and truly wants all the things in her birth plan she will need to show up in time to push out a baby and that is all. This is very difficult to time just right and rarely works out that way. 2. She can show up in labor at the hospital of her choice and just hope for a better doc than the one she has. 3. She can change care providers to someone who on the first interview, agrees with the things she is proposing (which are in no way radical or strange.)

            She needs to understand that there is only so much you can do as her doula. You are not her buffer or shield. By agreeing to medical care by that physician/surgeon, with those policies, she will most likely have a highly medicalized birth. It is probably just the way they do things in that practice.

            She can spend her entire birth saying no but a woman's birthing time is no time to fight. Birth should be about surrender, safety, peace and vulnerability. It's difficult to be vulnerable and let your body open when you have to be on guard.

            Talk to her about her options, leave the door open for conversation and help her do research. Hopefully she will find the power and strength to advocate for what she wants.

            Micky
            9 Months & Beyond, LLC
            @nashvillebirth on Twitter

            --- In nbnprofessionals@yahoogroups.com, "Kimberly Spencer, CPM" <nashvillemidwife@...> wrote:
            >
            > Eye ointment, newborn metabolic screening, and newborn hearing screening are
            > required by law. So are maternal HIV, hepatitis B, syphilis, and rubella
            > testing, and also by extension GBS testing.
            >
            > Kimberly
            >
            > Kimberly
            > On Mar 1, 2011 9:18 AM, "Rashell Rice" <rashell@...> wrote:
            > >
            > >
            > >
            > > Honestly, I would tell your client to get a different OB. Nothing is
            > required by law in the state of TN and there are exemptions your client can
            > sign for any procedures she doesn't want. If the OB is already this
            > headstrong and you aren't even in the delivery room yet, I have a good
            > feeling she is going to be even more stubborn when it comes to interventions
            > like pitocin. Good luck!
            > >
            > >
            > > On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <
            > sweetheartbirths@...> wrote:
            > >>
            > >>
            > >>
            > >> I am a doula in Murfreesboro. I am currently completing my certification
            > with DONA. My current client and I worked on a birth plan, and she just
            > reviewed it with her OB this week.
            > >>
            > >> She had decided the following things:
            > >> - wait to cut the cord until it had stopped pulsing
            > >> - wait to do eye ointment until after breastfeeding and/or one hour
            > >> - no hep B shot
            > >> - no vitamin K shot
            > >> - natural delivery of placenta
            > >> - one hour with baby undisturbed after birth
            > >>
            > >> However, her OB told her that:
            > >> - she requires the cord be cut immediately
            > >> - eye ointment is "REQUIRED"
            > >> - hep B shot is "REQUIRED"
            > >> - vitamin K shot is "REQUIRED"
            > >> - she will only allow assisted delivery of placenta
            > >> - and that it is "required by law" that baby be taken to the nursery at
            > one hour after birth
            > >>
            > >> I know that the first five items may be "required" by the hospital or
            > this particular OB, but doesn't the mother still have rights? How do you be
            > an advocate for her without offending anybody or how do you encourage her to
            > stand up for what she wants without getting into it with her OB? Also, is it
            > really required by law that the baby be taken to the nursery at one hour of
            > life? What law is that?
            > >>
            > >> Moreover, the OB requires continuous external monitoring and possible
            > internal monitoring and also listed episiotomy as an option if the OB deems
            > it "necessary", when my client specifically said that it was NOT an option
            > whatsoever because she DOES NOT want to be cut.
            > >>
            > >> I feel like my hands are tied. What do I do?
            > >>
            > >
            > >
            > >
            > > --
            > > Rashell Rice
            > > 615*425*9998
            > > BringingOutBaby.net
            > >
            > >
            >
          • gaylea@mcdoula.com
            The eye antibiotics and hearing screening are state mandated but my clients sign exemption waivers for those all the time. the hep B series can be started at
            Message 5 of 7 , Mar 1, 2011
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              The eye antibiotics and hearing screening are state mandated but my clients sign exemption waivers for those all the time. the hep B series can be started at the 2 week well baby visit (IF mom plans to vaccinate). Like with many state laws or mandated orders, there are EXCEPTIONS (seat belts, emmisions testing, taxes, immunizations, school attendance, etc) and if she feels she should be exempt from putting a vaccination or antibiotic into her childs body because he/she doesn't fit into the risk category for which it was designed then she has the right to sign the waiver and refuse. No one can force her to purchase a product she doesn't want/need. Period. Refusing the metabolic screening will get her a class C misdemeanor in the state of TN. I recently had a client who works for the state attorney generals office. She was told the same thing by a nurse about the eye goop and she was happy to clear that up and educate them on the matter. The nurse found the waiver pretty quickly after their conversation ;)

              But Rashell is correct, if he's already being this aggressive then these things may end up being the least of her worries. End of the day though, its her choice. You can point her in the direction for obtaining evidence-based information and provide her with options and encouragement if she wants to make a change, but if she doesn't, all you can do is support her through the decisions she has made.
              Gaylea

              mcdoula.com ¤ Sent from my Verizon Wireless BlackBerry


              From: "Kimberly Spencer, CPM" <nashvillemidwife@...>
              Sender: nbnprofessionals@yahoogroups.com
              Date: Tue, 1 Mar 2011 09:24:56 -0600
              To: <nbnprofessionals@yahoogroups.com>
              ReplyTo: nbnprofessionals@yahoogroups.com
              Subject: Re: [nbnprofessionals] Required newborn exams???

               

              Eye ointment, newborn metabolic screening, and newborn hearing screening are required by law. So are maternal HIV, hepatitis B, syphilis, and rubella testing, and also by extension GBS testing.

              Kimberly

              Kimberly

              On Mar 1, 2011 9:18 AM, "Rashell Rice" <rashell@...> wrote:
              >
              >  
              >
              > Honestly, I would tell your client to get a different OB.  Nothing is required by law in the state of TN and there are exemptions your client can sign for any procedures she doesn't want.  If the OB is already this headstrong and you aren't even in the delivery room yet, I have a good feeling she is going to be even more stubborn when it comes to interventions like pitocin.  Good luck!
              >
              >
              > On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <sweetheartbirths@...> wrote:
              >>
              >>  
              >>
              >> I am a doula in Murfreesboro. I am currently completing my certification with DONA. My current client and I worked on a birth plan, and she just reviewed it with her OB this week.
              >>
              >> She had decided the following things:
              >> - wait to cut the cord until it had stopped pulsing
              >> - wait to do eye ointment until after breastfeeding and/or one hour
              >> - no hep B shot
              >> - no vitamin K shot
              >> - natural delivery of placenta
              >> - one hour with baby undisturbed after birth
              >>
              >> However, her OB told her that:
              >> - she requires the cord be cut immediately
              >> - eye ointment is "REQUIRED"
              >> - hep B shot is "REQUIRED"
              >> - vitamin K shot is "REQUIRED"
              >> - she will only allow assisted delivery of placenta
              >> - and that it is "required by law" that baby be taken to the nursery at one hour after birth
              >>
              >> I know that the first five items may be "required" by the hospital or this particular OB, but doesn't the mother still have rights? How do you be an advocate for her without offending anybody or how do you encourage her to stand up for what she wants without getting into it with her OB? Also, is it really required by law that the baby be taken to the nursery at one hour of life? What law is that?
              >>
              >> Moreover, the OB requires continuous external monitoring and possible internal monitoring and also listed episiotomy as an option if the OB deems it "necessary", when my client specifically said that it was NOT an option whatsoever because she DOES NOT want to be cut.
              >>
              >> I feel like my hands are tied. What do I do?
              >>
              >
              >
              >
              > --
              > Rashell Rice
              > 615*425*9998
              > BringingOutBaby.net
              >
              >

            • Heather Crandall
              I agree with Micky 100%. The test are required by law for the Dr to do them. But the mother has every right to refuse them and as long as the Dr has her sign
              Message 6 of 7 , Mar 1, 2011
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                I agree with Micky 100%. The test are required by law for the Dr to do them. But the mother has every right to refuse them and as long as the Dr has her sign the proper papers he is protected. As far as efm, episiotomy, etc. If she is not willing to change providers, I Do Not Consent may have to become her mantra.  Good luck to her. I hope all works out and she can have the birth she deserves. 

                Heather Crandall, CD(DONA), HCHD

                On Mar 1, 2011, at 10:10 AM, "mamamicky2002" <micky@...> wrote:

                 

                It is required that the Care provider Administer the eye ointment, newborn metabolic screening and newborn hearing screening. The other testing done in pregnancy are requirements that the care provider fulfill. the MOTHER can waive ALL of these procedures by filling out waivers stating that it is against her beliefs and she understands the risks. I have known many mothers who have said no and signed waivers with absolutely NO problems whatsoever.

                The only test that waiving can get a mother in trouble is the blood test given to the baby to detect metabolic (genetic) issues. The waiver says: I have been informed state law requires these tests and that violation of the blood test is a misdemeanor. ONLY for the metabolic screening. None of the others carry a penalty. Maybe they do for the care provider, but not the parents.

                I have never known anyone to decline the metabolic screening.

                As far as the timing of procedures, clamping the cord immediately, active management of the third stage, continuous monitoring, episiotomy etc. - these are ALL physician and/or hospital requirements, not state laws and not even sound medical practice. Unfortunately, I doubt that these are negotiable with her OB.

                You should present her with her options so she can make the choice right for her. 1. Stay with her current ob/practice. If she does that and truly wants all the things in her birth plan she will need to show up in time to push out a baby and that is all. This is very difficult to time just right and rarely works out that way. 2. She can show up in labor at the hospital of her choice and just hope for a better doc than the one she has. 3. She can change care providers to someone who on the first interview, agrees with the things she is proposing (which are in no way radical or strange.)

                She needs to understand that there is only so much you can do as her doula. You are not her buffer or shield. By agreeing to medical care by that physician/surgeon, with those policies, she will most likely have a highly medicalized birth. It is probably just the way they do things in that practice.

                She can spend her entire birth saying no but a woman's birthing time is no time to fight. Birth should be about surrender, safety, peace and vulnerability. It's difficult to be vulnerable and let your body open when you have to be on guard.

                Talk to her about her options, leave the door open for conversation and help her do research. Hopefully she will find the power and strength to advocate for what she wants.

                Micky
                9 Months & Beyond, LLC
                @nashvillebirth on Twitter

                --- In nbnprofessionals@yahoogroups.com, "Kimberly Spencer, CPM" <nashvillemidwife@...> wrote:
                >
                > Eye ointment, newborn metabolic screening, and newborn hearing screening are
                > required by law. So are maternal HIV, hepatitis B, syphilis, and rubella
                > testing, and also by extension GBS testing.
                >
                > Kimberly
                >
                > Kimberly
                > On Mar 1, 2011 9:18 AM, "Rashell Rice" <rashell@...> wrote:
                > >
                > >
                > >
                > > Honestly, I would tell your client to get a different OB. Nothing is
                > required by law in the state of TN and there are exemptions your client can
                > sign for any procedures she doesn't want. If the OB is already this
                > headstrong and you aren't even in the delivery room yet, I have a good
                > feeling she is going to be even more stubborn when it comes to interventions
                > like pitocin. Good luck!
                > >
                > >
                > > On Tue, Mar 1, 2011 at 1:17 AM, courtney_polivka_doula <
                > sweetheartbirths@...> wrote:
                > >>
                > >>
                > >>
                > >> I am a doula in Murfreesboro. I am currently completing my certification
                > with DONA. My current client and I worked on a birth plan, and she just
                > reviewed it with her OB this week.
                > >>
                > >> She had decided the following things:
                > >> - wait to cut the cord until it had stopped pulsing
                > >> - wait to do eye ointment until after breastfeeding and/or one hour
                > >> - no hep B shot
                > >> - no vitamin K shot
                > >> - natural delivery of placenta
                > >> - one hour with baby undisturbed after birth
                > >>
                > >> However, her OB told her that:
                > >> - she requires the cord be cut immediately
                > >> - eye ointment is "REQUIRED"
                > >> - hep B shot is "REQUIRED"
                > >> - vitamin K shot is "REQUIRED"
                > >> - she will only allow assisted delivery of placenta
                > >> - and that it is "required by law" that baby be taken to the nursery at
                > one hour after birth
                > >>
                > >> I know that the first five items may be "required" by the hospital or
                > this particular OB, but doesn't the mother still have rights? How do you be
                > an advocate for her without offending anybody or how do you encourage her to
                > stand up for what she wants without getting into it with her OB? Also, is it
                > really required by law that the baby be taken to the nursery at one hour of
                > life? What law is that?
                > >>
                > >> Moreover, the OB requires continuous external monitoring and possible
                > internal monitoring and also listed episiotomy as an option if the OB deems
                > it "necessary", when my client specifically said that it was NOT an option
                > whatsoever because she DOES NOT want to be cut.
                > >>
                > >> I feel like my hands are tied. What do I do?
                > >>
                > >
                > >
                > >
                > > --
                > > Rashell Rice
                > > 615*425*9998
                > > BringingOutBaby.net
                > >
                > >
                >

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