The letter also said that “giving our patients the best of care” may involve such procedures as episiotomies, which are incisions made at the opening of the vagina during childbirth. Research indicates the surgery should be used sparingly, because it may increase the risk of tears and have long-term complications. The American College of Obstetricians and Gynecologists has recommended against its routine use dating back to 2006.
Weill Cornell Medicine spokeswoman Sarah Smith told Crain’s that the letter was originally drafted by a physician in 2014, who was dismissed sometime that year; Smith said specific information was not immediately available Monday because of the holiday.
“Each doctor works individually with their patients to create a personal birth plan,” Smith said in a statement. “This letter does not represent our approach to patient care.”
Smith said the letter was not authored by the physicians whose names were appended to the version posted online. Crain's reached out to all three providers individually with a request for comment; two did not respond before publication.
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One of the three, Dr. Allison Boester said in an emailed statement that she did not write the letter and that it was old and "completely counter to how I care for my patients."
"In general, we review new pieces to add to the information package. It’s expansive, so it wasn’t our process to sort through the entire package," Boester said. "Now we will review the entire set to make sure it’s current and reflects our collaborative approach. I hope we can repair the trust with patients because this letter is not how we practice."
Emilie Rodriguez, who works as a doula with Ashé Birthing Services and posted the letter online, said she helps her clients compile birth plans to help them feel empowered during the process.
Birth plans include preferences for labor, pain management and delivery. Rodriguez said the expectant patient might express a desire to walk around during labor or ask not to get an epidural. Birth plans may also set specific boundaries, which can help a survivor of sexual assault avoid retraumatization.
“People have autonomy, and they want autonomy over their birth experience,” Rodriguez said.
After hearing about the letter from multiple clients over time, Rodriguez said, she decided to share it publicly in the hopes of eliciting change. Historically, obstetricians have not been trained to obtain informed consent from their patients, she said. Birth plans empower patients to start conversations with and ask questions of their providers, but Rodriguez said the culture among physicians has to change too.
“We have to put on this crazy armor every time we go into most hospitals to advocate for our clients, especially those that are Black and brown,” she said.
Dr. Laura Riley, chair of the department of obstetrics and gynecology at Weill Cornell Medicine, said New York-Presbyterian has for months been working on a birth plan template for patients who deliver at any of the system’s hospitals. She expects it will be rolled out within the next six months.
Riley said she had never seen the letter before, because it seemed to be distributed only in the Upper East Side office of the three obstetricians named on it; Weill Cornell Medicine has 29 OB-GYNs across various practices in the city.
“I was disgusted by it,” she said of the letter.
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Riley said physicians need to engage in shared decision-making with patients, recognizing that some have strong preferences for their labor and delivery.
Asked whether the practice has a policy of obtaining informed consent during labor and delivery, Riley said there is always time for providers to tell patients what they are doing and get input.
Riley said the practice’s current initiatives include implicit bias training and the rollout of condition-specific safety bundles, which she characterized as multidisciplinary checklists to standardize clinicians’ response to an emergency such as hemorrhage or sepsis. She also noted research that shows episiotomies are often unnecessary and said her department is working to get its episiotomy rate as low as possible.
Weill Cornell practitioners handled about 960 deliveries last year at New York-Presbyterian/Weill Cornell Medical Center.
Rodriguez framed the moment as an invitation for change, saying that many hospitals in the city perpetuate a culture in which the patients giving birth are not heard or taken seriously.
“We’re saying this should be a conversation,” she said, “and the door should be open.”
This story first appeared in our sister publication, Crain's New York Business.