We are often saddened when hearing stories from birthing families about negative prenatal or birth experiences because they were not listened to. It should be standard care practice that our providers, be they OB’s, Pediatricians, Internists or Dentists, give the consumer who has hired them respect and service. A provider should never talk down to their patient or make decisions for them based on what “they” think is best.
Rather the provider should be knowledgeable and experienced in evidence-based medicine, while taking a whole body approach to the care they offer their patients. The patient as consumer should be given complete disclosure of their health status and allowed to gather all available information, should treatment be suggested. The doctor is never to think of himself/herself as in control of the consumer’s medical needs, but as a resource of education and service.
Unfortunately many doctors work out of large group practices with practice guidelines and protocols set to the advantage of the office and success determined by bottom line. Because of this trend, many birthing families who choose obstetricians for their medical care are given minimal time and maximum management. Decisions for care are routine and all patients within the practice are treated exactly the same. There is little talk of choice and large expectations for compliance. This should not be the norm.
Shaana and I created the Prenatal Letter of Intent as a tool. We sincerely desire that this document will not be needed! We hope that the simple knowledge that it is the consumer who decides and that there are options and choices in every scenario of pregnancy health. Most importantly, the message taken from the Prenatal Letter of Intent should be that every woman has the legal and ethical right to choose the course of action that is best for herself, her baby, and her family.
It is our desire that the reader take with them the knowledge that their health is indeed in their own hands. No one can force, coerce, or threaten a patient into a certain course of action. The American Medical Association states, “The physician's duty is to provide appropriate information, such that the pregnant woman may make an informed and thoughtful decision, not to dictate the woman's decision.” (H-420.969 Legal Interventions During Pregnancy).
While the Prenatal Letter of Intent is a written document, our heartfelt desire is that reader first takes their concerns about such topics as choice, treatment and options in care to the provider they have chosen. If the provider is not supportive of consumer choice, perhaps finding a provider who better fits the needs and wants of the patient would be best. However, we are aware that in some geographical areas this is not possible.
We have given permission for the letter to be used as a communication device between patient and doctor, better yet, we wish for you as consumer to forge your own document detailing your needs, wants, and desires.
Change happens only when change is expected. To create consumer-based care, the consumer must be the voice for change. We wish you a blissful, wonderful pregnancy filled with feelings of love, support, and empowering growth.
Prenatal Letter of Intent
Presented By : (patient name) To: (providers name)
I am presenting this letter to you, my medical care provider, in hopes of starting a relationship of open communication and respect during our contract period. It is my sincere wish to express how strongly I feel about these important issues, and to establish our working relationship early on.
I have chosen you because I know you will provide myself and my baby with excellent medical care. Throughout our relationship, I will come to you for the purpose of preventing and/or treating any real complications or emergencies that might arise during my pregnancy. I would like honesty and trust to be the foundation of our relationship and it is only through time that this foundation is forged. Because of the newness of our relationship, I will depend on your forthright honesty and willingness to respect my wishes as we get to know one another.
It is my understanding that pregnancy and birth are a natural part of a woman’s childbearing period and that most women complete this cycle under normal and uncomplicated circumstances. To my knowledge every woman has the uncontested right to be given clear and complete information about the benefits and risks that are involved with all tests, medications and procedures that are suggested for the welfare of herself and her unborn child. Included in these rights is the right to refuse treatments, procedures, and medications even if deemed medically necessary by her care provider*. It is my intent to be an informed consumer and it is my wish to be given control to make decisions for my medical care. Please inform me of all of the benefits and risks that are involved with any tests, medication, or procedure that you may suggest or recommend for the health and safety of this pregnancy.
*I have obtained this information from
‘The Rights of Childbearing Women’ written by Maternity Center Association and ‘The Pregnant Patients Bill of Rights’ distributed by American Foundation for Maternal and Child Health.
During the course of my pregnancy, I will be reading and researching the options available to me for my pregnancy, labor, and birth. I will be taking classes on pregnancy, birth, breastfeeding, and baby care and I will be looking to you for input and guidance. However, the decision I make will be based in what I feel is best for my baby, myself and my family. I ask that you respect my choices and give me any information you feel is important in my decision-making process even if you disagree with my decisions.
I will be hiring a professional birth assistant (or Doula) to help me gather information, support me physically and emotionally, and to help me advocate for my wishes, needs, and wants during this time of great change in my life. My Doula does not shoulder any of the medical responsibilities for my health or that of my child, as my Doula is a non-clinical care provider that will be an active support person for my needs, wants, and wishes. It is expected that my Doula will respect and support any and all of my informed decisions. I hope that all members of my birthing team, including yourself (my provider), the birthplace staff, and my Doula, can work together as needed to assist me in obtaining the birth outcome I desire.
I thank you for your time and understanding in this matter. I would love any comments or questions from you or your partners, associates or staff during any future appointments.
Please sign this copy, return it to me, and keep the additional copy to share with the rest of your team. Your signature stands as acknowledgement of receipt and review of this letter.