Dr. Julie Hansen

03/08/2026

Ok, settle in because this is a long one. This discussion is for women currently pregnant, contemplating pregnancy, formerly pregnant or just know someone who is or has been pregnant.

If you follow me on this page, you know I have been working as a laborist for almost two years now. This means that 100% of my time at work is spent taking care of pregnant patients. I’ve seen things…lots of things. I know when things are going well or not. One thing I’ve seen as a dramatic change is the number if patients who seemingly want to reject most medical advice and essentially try to manage their own labor. And these are not people with simple, uncomplicated health histories. They often have risky medical concerns. I find it frustrating and worrisome.

As an OB, this is why I’m there on the unit and by your bedside. To render advice, aid and support. I truly don’t understand when women invest in months of prenatal care, then seem to be willing to put that all on the line to attempt to orchestrate a delivery scenario that is not grounded in the reality of the sitation at hand.

Below is an op-ed written for other doctors, so may be a little technical, but it may not be that foreign to you if you’ve had a baby or been in the room with someone that was going through that process. I wanted to share it because I felt the author very eloquently illustrated what goes on in this situation, for both the patient and doctor.

If you or one or your friends or family are going to be going through this in the future, just know your doctor cares about you and the hopes you have for a picture perfect delivery. Just please let us take care of you in safest way possible.

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A Birth Plan Cannot Dictate Labor
By Vidya Visvabharathy, MD

March 2, 2026 Original article

An original Op-Med essay contributed
by Doximity members

She came to the hospital with a detailed birth plan tucked neatly into her bag. No epidural, minimal monitoring, freedom to walk during labor. She and her partner had envisioned a quiet, unhurried birth — one where medicine stayed in the background and their baby’s arrival felt as natural as possible. However, with newly diagnosed preeclampsia, those plans shifted. Needless to say, this was not how my patient expected her birth story to unfold.

Though she was initially resistant to starting Pitocin, a synthetic form of oxytocin which is used to induce labor, she eventually agreed for the sake of her baby’s safety. For several hours, her labor course was quiet. She received intravenous magnesium for seizure prophylaxis and labored gracefully with Pitocin, swaying with her contractions, her partner’s hand steady in hers. I checked in periodically, watching from the periphery.

Then, slowly, the fetal heart tracing began to change. At first subtle dips, then longer decelerations. I studied the monitor, weighing how much longer we could wait. Many ob/gyns, myself included, acknowledge the limitations of fetal heart tracings in predicting fetal compromise. A large body of evidence also supports that continuous monitoring does not consistently identify which fetuses are truly at risk of acidemia or neurologic injury. But in the context of preeclampsia and fetal growth restriction — conditions already known to compromise fetal well-being — my senses were on high alert. Her baby was at heightened risk of decompensation.

Eventually, I entered her room, sat at her bedside, and explained what I was seeing: fetal distress, necessitating even more interventions. Her face fell and her voice trembled — not from pain, but from disappointment. It was the last thing she wanted to hear.

I recommended she get an epidural, not because she was in severe pain, but just in case she required an emergent C-section, she could be awake for the birth of the baby. If she did not have an epidural and required a C-section, she would have had to have it under general anesthesia, completely asleep when her child was born.

She sobbed, “I never wanted any of this.”

I told her I understood — if I had expected a birth free from IVs, continuous monitoring, and the possibility of surgery, I would be upset too. But I also explained that these tools were not a betrayal of her wishes — they were extensions of our shared goal: to keep her and her baby safe. It’s in moments like these that medicine feels as much about communication as intervention.

We adjusted where we could; we kept the lights low and minimized staff in the room, trying to preserve the calm she had hoped for. Her water broke spontaneously, and her baby’s heart rate continued to show signs of compromise. We initiated an amnioinfusion, instilling saline into the uterus to relieve umbilical cord compression. Thankfully, it worked.

In the end, she delivered vaginally — a victory, in my mind. I exhaled, relieved we had avoided what would have been a difficult surgery.

I expected her to share that relief, but instead, she was devastated. She never wanted magnesium, Pitocin, or an amnioinfusion.

“You didn’t care about what I wanted,” she said. And yet, she wanted a vaginal birth, and we achieved that. Had she declined our recommendations, she may have faced catastrophic consequences, including an emergency C-section under general anesthesia, maternal seizures, or neonatal death.

Many patients hope for a vaginal birth because they see it as the more “natural” way to bring a child into the world. But sometimes, a vaginal delivery simply isn’t possible, usually due to the 3 P’s we are taught in medical school: power (the strength and pattern of contractions), passenger (the size and position of the fetus), and pelvis (the maternal pelvis). Nearly every labor curve — whether it’s fetal intolerance, failure to progress, or cephalopelvic disproportion — can be understood through these physiologic factors.

Yet, the cultural narrative around childbirth often romanticizes it as a process that should unfold on its own, untouched by intervention. Historically, people did give birth without medical support, but those “natural” births came with staggering maternal and neonatal mortality. Modern obstetrics exists because for centuries, pregnancy and childbirth were life-threatening conditions. Today, we have interventions designed to prevent devastating outcomes. These tools are not meant to withhold autonomy from patients, but rather to safeguard their lives and the lives of their babies.

While a birth plan can guide preferences, it cannot dictate labor. Pregnancy and childbirth carry a level of unpredictability that no plan can fully account for. Labor can turn quickly, and bodies don’t always cooperate with expectations or desires.

And yet, many patients still do not trust us. Whether shaped by a long history of medical discrimination against women and racial and ethnic minorities, or by the frightening stories they hear from friends and social media, skepticism toward the medical system runs deep. I find myself wrestling with this often. My responsibility is to honor patient autonomy while also ensuring safety: a balance that can feel delicate and, at times, impossible. Even when I make recommendations to prevent harm, there are moments when patients feel unheard or overruled. Reconciling my intention to do no harm with their perception that their wishes are not honored continues to challenge me.

Ultimately, I have learned that good obstetric care is not only about sound clinical decision-making, but also about communication, humility, and earning trust in moments when patients feel most vulnerable. It requires an acknowledgement of the trauma that comes with a birth story that does not unfold the way a patient hopes.

I may not always be able to give patients the exact birth experience they envisioned, but I can give them honesty, compassion, and partnership. In a setting with vast unpredictability, shared understanding may be the most meaningful thing I can offer.

When have you had to make choices for patient safety that did not align with their initial care plan? Tell us in the comments.

Dr. Vidya Visvabharathy is an ob/gyn in Cleveland, OH. She enjoys dancing, baking, and taking long walks with her husky mix, Lilo. Dr. Visvabharathy is a 2025-2026 Doximity Op-Med Fellow.

Illustration by Jennifer Bogartz

03/08/2026

https://www.facebook.com/share/v/18L6VimY21/?mibextid=wwXIfr

02/23/2026

Great story that emphasizes someone understanding a woman’s worth and not accepting “no”

In 1970, if a woman arrived at an emergency room after being r***d, the staff moved fast. They cut away her clothing. They washed blood from her skin. They cleaned her wounds, combed debris from her hair, sutured, swabbed, stabilized.

They saved her life.

And in the same efficient hour, they destroyed the case.

The clothing that held fibers and semen was bagged with hospital trash. The fingernails that might have carried skin cells were scrubbed clean. The bruises were documented only as injuries, not as patterns of violence. By the time police arrived, there was often nothing left but a shaken woman and a report that would quietly die in a file.

No one intended harm. Nurses were trained to heal, not to think like investigators. Emergency medicine focused on stopping bleeding and preventing infection. Justice was considered someone else’s department.

Except it wasn’t.

It was the survivor’s.

Virginia Lynch was a nurse who noticed what others had normalized. Born in 1941, she grew up in a culture that treated s*xual violence as something shameful, private, better left unexamined. In the ER, she saw the same pattern repeat. A woman would arrive assaulted. Staff would do what they were taught. Hours later, police would ask for evidence that no longer existed.

Prosecutors declined cases. Defense attorneys dismantled what little documentation there was. Survivors were left with a quiet, corrosive message: if it can’t be proven, maybe it didn’t really happen.

Lynch understood something radical for her time — hospitals were not neutral spaces. They were the first crossroads between trauma and accountability. If evidence vanished there, justice rarely followed.

When she began asking why nurses weren’t trained to preserve forensic evidence, the resistance was immediate. Doctors said nursing was about care, not crime. Law enforcement questioned whether nurses could handle chain of custody. Administrators worried about lawsuits and reputation. Beneath all of it was a deeper discomfort: taking s*xual assault seriously would require admitting how common it was.

But Lynch kept pushing.

She began designing protocols that did not force a false choice between healing and documentation. Clothing could be preserved without delaying treatment. Injuries could be photographed respectfully. Swabs could be taken with consent. Detailed notes could be written in language that held up in court. Evidence could be secured without turning a survivor into an object.

She saw nurses differently than others did. They were already there first. They saw injuries before they faded. They heard the story before it hardened into a deposition. They had the trust of patients in moments when uniformed officers might not.

If nurses were trained properly, they could protect both the body and the truth of what happened to it.

Out of that insistence came a new field: forensic nursing. Eventually, the role of the Sexual Assault Nurse Examiner — SANE — was formalized. These nurses learned evidence collection, trauma-informed interviewing, courtroom testimony, and meticulous documentation. They became the bridge between medicine and the legal system.

Hospitals that adopted these programs saw measurable change. Evidence was preserved correctly. Cases were stronger. Convictions increased. Survivors reported feeling believed instead of processed. The difference was not dramatic technology. It was intention, structure, and training.

By the 1990s, forensic nursing was recognized as a legitimate specialty. Courts accepted forensic nurses as expert witnesses. Nursing schools began offering training programs. What had once been dismissed as unnecessary interference became the standard of care.

Virginia Lynch did not become a household name. Her work does not lend itself to headlines. It happens quietly at three in the morning when someone walks into an exam room shaking and ashamed. It happens in careful documentation that may not be used for months, but will matter deeply if it is. It happens when a nurse says, calmly, “You have options,” and means it.

What she changed was subtle but profound. She interrupted a system that unintentionally retraumatized survivors. She refused to accept that good intentions excused bad outcomes. She insisted that healing and accountability were not opposing forces but inseparable ones.

Today, thousands of forensic nurses practice across the United States and beyond. They work not only with s*xual assault survivors but also in cases of child abuse, elder abuse, domestic violence, and human trafficking. The principle remains the same: you can treat injuries and protect evidence at the same time. You can believe someone and document their story with rigor. You can preserve dignity and preserve truth.

12/31/2025

Doing some lite reading oin professional emails I get and noted this article, whuch promotes co-treatment if partners in women diagnosed with bacterial vaginosis (BV). BV is probably the most common diagnosis made for women coming in to see their gynecologist with complaints of a malodorous or itchy vaginal discharge. When I practiced, based upon reading I had done, I had routinely offered antibiotics to patients and their partners with persistent or recurrent BV, generally with good results. Some women had partners or even their pharmacists or PCP’s scoff at my recommendations, so I felt kind of justified when I read about this research article.😉

Study Refines Bacterial Vaginosis As An Issue Affecting Both Men And Women, Says Infection Should Be Treated As An STI. The New York Times (12/30, Gross) reports a study published in The New England Journal of Medicine found that bacterial vaginosis, “the most common vaginal infection worldwide,” can be transmitted via s*x, and therefore “should be treated like a s*xually transmitted infection.” For the study, “researchers followed 150 heteros*xual couples in which the female partner had bacterial vaginosis. They treated the women with first-line antibiotics, and half the men with both oral and topical antibiotics. Within three months, they found, the partner treatment worked so well that they had to disband the study so all participants could be treated.” The study has challenged the traditional view of BV as solely a women’s issue, as well as the “conventional definition of an STI.” Notably, “in October, the American College of Obstetricians and Gynecologists advised its more than 60,000 members to begin offering treatment for male partners of patients with persistent BV.”

12/23/2025

Merry Christmas everyone! I haven’t posted in a minute because I’ve mainly just been delivering babies on the job, but I did have something, on a personal note, that I did want to share.

Something I was not sure was actually possible, but on my own recent bone density scan I learned I had actually reversed my bone density from osteopenia (bone thinning) to normal!! I turned 63 in November and figured I was just drifting down the pathway toward full on osteoporosis (Swiss cheese for bones!) like the majority of my female family members. Bone fractures of the hips or spine due to osteoporosis is a known contributor to disability and death in older women.

What was the difference for me? I started weightlifting just a couple of times a week starting in 2022. I’ve always taken some calcium and Vitamin D, because I’m not a milk drinker, but it’s pretty well known in medical research that supplements alone won’t fix your bones.

While this is probably not what you’d consider world changing news, anytime we can share stories of how we flip the script on important measures of health, let’s share those little victories!

Shout out to my personal trainer, Issac McCay at Lion Fitness in Edmond! He’s kept me motivated and coming back each week for consistently longer than any other work out program I’ve ever done!

Here’s to a great 2026 🥂ya’ll and get to lifting💪!

06/18/2025

https://www.facebook.com/share/r/1AtbT9DThz/?mibextid=wwXIfr

So much misinformation being spewed by HHS. I stand by Gardasil and other vaccines.

06/18/2025

https://www.facebook.com/share/r/15UGbwCbBT/?mibextid=wwXIfr #

06/16/2025

https://www.facebook.com/share/r/18jZbgdaue/?mibextid=wwXIfr #

02/05/2025

The American College of Obstetrics and Gynecology is still an open source of factual information for patients and professionals alike.

Docs who fear losing access to vital information say this move is vital

06/22/2024

So, an update for anyone that’s been still checking on me….
I’ve been at OU since end of April in my position as a hospital laborist. I oversee the resident physicians management of high risk OB patients while I’m on duty. When I was in private practice, I always preferred to send my patients requiring care for high risk obstetrical needs to OU, because I thought they practiced the most evidence based medicine and provided quality NICU care. I would occasionally get patients complaining about the care they received, which we would all strike that up to the “usual University hospital” setting perhaps lending to subpar customer service.

In my time back at OU, I can tell you the residents are much better educated and trained than we were “back in the day”, and the quality of care they give their patients is top notch. The MFM (Maternal Fetal Medicine/high risk obstetrician) attendings, MFM fellows and all the generalist OB attendings I have witnessed first hand in labor and delivery are caring, empathetic and at the top of their game as well. I can’t really understand where the level of disregard comes from in our community, but it most likely stems from old racial and class prejudices that had sadly been perpetuated in the medical community for years. I’m proud to be a part of this team. Even if I still bleed orange on certain fall Saturdays during football season.

I started my healthcare career as a clinical dietetic student at the OUHSC in 1985, so it’s exciting for me that I will one day complete my career here. Full circle, as they say.

Anyway, just a check in for now. Hope you are all enjoying the summer!

04/12/2024

This is it. Officially retired as a private practice on/gyn. I could not worked with a better group of women. Very proud to been able to play a part in building this practice from the ground up. Love my girls. Love Edmond INTEGRIS. On to my next adventure at OU!

Thank you to all the women who chose me to care for them through out these many years. It was always my privilege to be a part of your life.

02/05/2024

This article was shared with me by my husband’s partner, Dr Blake Evans. A big problem is when politicians dabble in medicine by writing laws for which they do not understand the full ramifications of said law. This is one of those cases. By designating that embryos in a Petri dish have the same rights as any fully born human, it makes the practice of in vitro fertilization suddenly fall on the wrong side of the law. For couples who are unable to conceive, we turn the clock back about 50 years.

If you’ve ever been the beneficiary of in vitro fertilization, please contact this rep and make sure that he understands that he is legislating against people who just want to have their own family. There is nothing amoral about that.