PROVO -- A 14-year-old sign in a doctor's office has lately gotten a lot of reads.
The sign inside Aspen Women's Clinic in Provo states that the health care providers will not participate in a birth contract, a doula-assisted delivery or a Bradley Method delivery out of concern for the welfare and health of the unborn child and quality of patient deliveries.
Obstetrician Dr. Thomas Judd said that sign has been around for years, but only recently did a patient snap a picture of it and post it on the Internet. From there it went viral, and suddenly the office started getting hang-ups from all over the world in what he assumes is a protest against the sign and its perceived sentiment.
"It's not a big deal to us," he said. "The sign is actually accomplishing what we want, and that is getting the word out that that's not our style of practice."
The argument on many of the blogs that picked it up was that this policy limited women's choices and marginalized what is deemed "natural" childbirth -- epidural-free with a focus on breathing, relaxation and working with a woman's body.
"We don't care at all what you want as a parent, or a person in labor," wrote blogger Miriam Zoila Pérez on radicaldoula.com in her translation of the sign. "We want a patient who will sit quiet and do what we say -- no matter what. Oh and if you have a partner you want involved, tough. Your desires don't matter."
Not quite, Judd said. The sign does not decry the methods listed; it simply informs patients of the providers' preferences. He does perform nonmedicated childbirth if a patient wants it, although about 95 percent are happy to get an epidural. They do care what the patient wants, which is why they want to inform patients right away and help them find another provider if the patient and doctor differ.
"I reserve the woman's right to choose," he said. "I also reserve the physician's right to choose."
The local chatter doesn't mirror the anger that the blogosphere has generated. Judd said the angry calls have been from elsewhere, and plenty of women still want their services. Local doulas even said that while they disagreed with the sentiment, the honesty helped the situation.
"I think a lot of people want to be angry about it and say that obviously these obstetricians don't care about women and their choices, but I think it's just a matter of education and understanding," doula Heather Duncan said.
Most of her work is with hospital births, so she works around doctors, but their jobs are different. Duncan said she considers her job to be keeping the mother happy. This could be through massage or other physical comfort measures, providing encouragement and support and being there throughout the whole labor process. She's never had a doctor unhappy with her being there.
That said, she wonders at a doctor who objects to her presence during delivery.
"As a mother it really makes me wonder why they would not want someone there who's going to be continually there with me to support me," she said.
Doula Rebecca Pincock admitted to being grateful for the honesty because that gave women more information in choosing a provider.
"That's really the viewpoint of many care providers in this field, but a lot of them aren't up front about it," she said.
She said she suspected a lack of information was behind the sign and said that women who opt for doulas or a Bradley delivery educate themselves and make the best choice for them. Doulas aren't there for a medical purpose, she said; they are there to help women have the best labor experience possible, which is what doctors and nurses want as well.
"There's some insinuation from their wording that women who do choose these things, who do choose doulas or who do want to have a plan for their birth don't care about the welfare of their child," Pincock said.
Rebecca Allen, who is the manager of the women's center at Orem Community Hospital, said neither Judd nor any hospital intends to deny women the type of childbirth they want. Judd works with nurse midwives at Orem Community, and if a woman wants to have a friend to help her during delivery or give birth without an epidural, that would be fine. The only policy the Intermountain hospitals have is that babies must be monitored during labor, but epidurals, C-sections and the like are not forced on patients.
"Probably all of our doctors have their own opinion on what they prefer in a patient," she said. "It's just that this particular one put a sign in his office so that patients would know right up front his preferences."
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A doula is a professional labor assistant who provides continuous physical, emotional and informational support to the mother during pregnancy and the birth as well as after birth, according to DONA International, an organization that trains and certifies doulas. Women can hire a professional doula or have a friend or family member who unofficially acts as a coach to help during labor.
The Bradley Method of natural childbirth includes 12 weeks of classes that teach a natural childbirth method, meaning no drugs, according to the Web site. The classes focus on working with the body to reduce pain and make labor more efficient, providing coach or doula training, and learning what to expect during natural childbirth and how to make the best of a Caesarean section if necessary.
A birthing contract or birth plan tells the medical staff the woman's wishes, according to the American Pregnancy Association. It can cover pain medication, inducement, C-sections and other issues that may arise during labor. This is not a binding document; if the mother or baby is at risk, the health care provider will talk to the mother about the risks and why a certain action should be taken. Generally the mother agrees with the doctor. In the rare case that she doesn't, there is a line of authority to override the mother's wishes, but again, that's unusual, said Janet Frank, Intermountain Healthcare spokeswoman in Utah County.