Class 4 Summary Sheet
Communications - Make sure to attend LLL meeting and arrange birthplace tour.
Praise and encouragement in public are important, so make sure you can do it in private. Stand and face each other and praise your partner for something they have done this week. Encourage your partner for something they could work on.
Share one positive aspect of the pregnancy and one negative aspect of the pregnancy. How can you be more helpful to your partner?
Vocabulary - Go through vocab in back of student workbook
Mental Relaxation - Think about a place that is relaxing for both of you. What do you see? What do you smell? What do you feel? What do you hear? What do you taste? Write these things down, so coach can help mom create a relaxing mental image in labor.
Nutrition - Coaches review protein counts from the week, and make sure mom is getting enough.
The Coach Needs to Be:
Enthusiastic - Enthusiastically encourage mom to do daily exercises and eat well.
Committed - Understand advantages of natural childbirth, advantages of breastfeeding, effects of medication (Mother: allergic reactions, slow labor, cascade of interventions, longer recovery time, interfere with milk production, blood loss, lifetime back problems, may interfere with breathing, serious health problems, immobility, etc.) (Baby - allergic reactions, longer labor, interfere with reflexes and responses, interfere with sucking reflex, possible decrease in development, serious health problems or death)
A Relaxation Expert
What Coaches Often Say:
- limp 2. one 3. relax 4. great 5. closer 6. let go 7. great
8. opening/flower 9. down 10. through/pelvis 11. great 12.wonderful
13. you 14.stream 15. go/in 16. comfortable 17. comfort
18. fantastic 19. great 20. baby 21. it 22. relax/contractions
23. proud 24. did 25.love
Handouts to Print
ACOG article on refusing medical care (excerpt below)
On the basis of the principles outlined in this Committee Opinion, the American College of Obstetricians and Gynecologists (the College) makes the following recommendations:
- Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a decisionally capable pregnant woman’s decision to refuse recommended medical or surgical interventions should be respected.
- The use of coercion is not only ethically impermissible but also medically inadvisable because of the realities of prognostic uncertainty and the limitations of medical knowledge. As such, it is never acceptable for obstetrician–gynecologists to attempt to influence patients toward a clinical decision using coercion. Obstetrician–gynecologists are discouraged in the strongest possible terms from the use of duress, manipulation, coercion, physical force, or threats, including threats to involve the courts or child protective services, to motivate women toward a specific clinical decision.
- Eliciting the patient’s reasoning, lived experience, and values is critically important when engaging with a pregnant woman who refuses an intervention that the obstetrician–gynecologist judges to be medically indicated for her well-being, her fetus’s well-being, or both. Medical expertise is best applied when the physician strives to understand the context within which the patient is making her decision.
- When working to reach a resolution with a patient who has refused medically recommended treatment, consideration should be given to the following factors: the reliability and validity of the evidence base, the severity of the prospective outcome, the degree of burden or risk placed on the patient, the extent to which the pregnant woman understands the potential gravity of the situation or the risk involved, and the degree of urgency that the case presents. Ultimately, however, the patient should be reassured that her wishes will be respected when treatment recommendations are refused.
- Obstetrician–gynecologists are encouraged to resolve differences by using a team approach that recognizes the patient in the context of her life and beliefs and to consider seeking advice from ethics consultants when the clinician or the patient feels that this would help in conflict resolution.
- The College opposes the use of coerced medical interventions for pregnant women, including the use of the courts to mandate medical interventions for unwilling patients. Principles of medical ethics support obstetrician–gynecologists’ refusal to participate in court-ordered interventions that violate their professional norms or their consciences. However, obstetrician–gynecologists should consider the potential legal or employment-related consequences of their refusal. Although in most cases such court orders give legal permission for but do not require obstetrician–gynecologists’ participation in forced medical interventions, obstetrician–gynecologists who find themselves in this situation should familiarize themselves with the specific circumstances of the case.
- It is not ethically defensible to evoke conscience as a justification to attempt to coerce a patient into accepting care that she does not desire.
- The College strongly discourages medical institutions from pursuing court-ordered interventions or taking action against obstetrician–gynecologists who refuse to perform them.
- Resources and counseling should be made available to patients who experience an adverse outcome after refusing recommended treatment. Resources also should be established to support debriefing and counseling for health care professionals when adverse outcomes occur after a pregnant patient’s refusal of treatment.
Awesome coach videos below.
A Bradley Birth