Call me old fashioned, but I am not alone. I often believe that patients don't have the capabilities to make proper decisions about their clinical options. When the issue is childbirth, excuse me, patients
are often nuts. Just witness the epidemic of home childbirths!
S.W. McFee, M.D. from Parkville, Missouri goes even further. Read the
following letter from this clinician to the latest American Society of
Anesthesiologists Newsletter:
It is 0230 again. We could have done this case nine
hours ago. The sun was still up, and she'd been stuck at
6 cm longer than the life cycle of some butterflies. We
should have done this case nine hours ago, but the patient
"really wanted" to delivery vaginally. Apparently
becoming a mother just wasn't enough, and the actual
avenue of the child's arrival had some bearing that I, as
a sleep-deprived and callous male, just couldn't grasp.
She had been told that the baby was too big and that
a primary C-section was indicated, not what she wanted
to hear. She doctor-shopped until she found one who
agreed with her diagnosis.
It doesn't always happen this way, but this time we
got a meconium-stained, cone-headed, floppy baby that
required resuscitation. I guess that balances with the
patient's need to labor and attempt an ill-advised vaginal
delivery. Or not.
No other specialty has allowed itself to deteriorate to
the state of patient control that obstetrics has. We are all
concerned about patient rights. We have to be. But come
on. Let's say you have a kidney stone and you present at
the urologist's office wincing with pain but holding in
your hand a seven-page stone-retrieval plan and a list of
dates that are satisfactory to your social calendar (and as
a bonus would make the stone a Libra) – the urologist
would and should inform you that his afternoon was
booked but that his esteemed colleague from across town
would (he's sure) be happy to see you.
Patients don't always know best. I'm not suggesting
that doctors always know best. I am suggesting, however,
that we can make an expensively educated guess
and be right enough of the time to eclipse the records of
Jean Dixon, Nostradamus or the average meteorologist.
Good medicine should not infringe on the patient's
rights. I'm afraid our brethren in OB have let patient's
rights infringe upon their medicine.
You should take some time one night to rent (and watch) "the Business of Being Born" - it's sensationalist and adversarial, and illuminates where some of the apparent childbirth psychosis comes from.
you've never been on a labor/delivery floor huh? can tell. it's a sad, sad place: and it should be happy.
Here's the point you're missing- normal childbirth is not MEDICINE- its a process that doesn't need your direction. God gave women babies long before he gave them anesthesiologists. Look at the mortality and morbidity rates of women and babies who birth at home (low risk women) with a trained midwife and compare them to those of OBs (low risk women) and see who is better off. Studies prove over and over again that birth is not meant to be a medical event- IN MOST CASES. That is where judicial use of medicine and interventions is completely appropriate.
Kidney stones and birth are two different things- I can tell you- I"ve had both- at the same time.
Clearly, you didn't read the letter: The patient in question was not low risk and not a candidate for home delivery. She clearly was going to need a C-section and attempts to let her deliver vaginally were STUPID.
If women don't want to face the truth, they shouldn't become pregnant. What kind of mothers will they be?
Because the baby was "big"? Because there was meconium? I just gave birth LAST WEEK to a 9 pound, 6 ounce baby who was 22 inches long, in water at a free standing birth center. There was meconium staining, and I didn't even tear. Me and my baby were perfectly fine. We still are. He's perfect. So don't even go there with "the baby was too big" crap. THAT IS BULLSHIT that doctors use to scare mothers. I'm a tiny woman. My normal weight is 103 pounds and I'm only 5'3". And I give birth vaginally with no pain meds to large healthy cone headed (at first) beautiful babies.
care to guess what the maternal mortality rate was just a while back?
Interestingly, not all patients make decisions for ridiculous reasons such as astrological sign. Perhaps if you spent more time talking to your patients as if they are intelligent human beings who CAN make rational choices, they might listen to and respect you.
So, did the baby survive and thrive? Sorry it was cone headed, but that goes away.
It is highly insulting for you to compare a kidney stone with childbirth. Men do not understand this process in the least, you can study birth for 10 years or 100 years but that doesn't make you an expert. Birth cannot be quantified, it does not happen on a time schedule, it does not operate by the clock or the calendar or some 'due date.' It is a life process that unfolds as the process of nature unfolds. Doctors try to control the process and it ends up becoming a disaster. It isn't about passing some inanimate object like a kidney stone. This is the birth of a new life, a woman will remember this day for the rest of her life and it has a very significant impact on her psychological health. (postpartum depression rates have sky rocketed, why?) You think it's no big deal for a woman to have to recover from major abdominal surgery AND get up every two hours at night to feed a baby. It's just no big deal to try and care for a newborn after having your abdomen ripped open. I'm sorry but how heartless can you be. Women don't want birth to be a SURGICAL event. Sure if it is an emergency situation it is necessary but a 30% c-section rate in this country is absolutely appalling! 90% of those c-sections are unnecessary, Look at the World Health Organizations recommendations! the U.S. is 27th among industrialized nations in infant morbidity and mortality. The countries with the best outcomes for mothers and babies have 70% of women giving birth with midwives! Hospitals are notorious for degrading women for no medical reason, starving women during childbirth and then blaming the woman's body for failing to progress (HELLO, no body can function properly when starving.) Studies have shown over and over that this is UNNECESSARY. Women have been subjected to enemas, pubic shaving, lithotomy position (the absolute worst position for birth), confinement to a bed, separation from their infant after birth. The list goes on and on.... the obstetric profession should be ashamed at it's treatment of the birth process and the laboring woman. Women have been giving birth since the beginning of time, WITHOUT obstetricians. Are there times when medical intervention is necessary? Yes, but it isn't common. If women werent' being induced, STARVED, given pitocin to speed up labor, epidurals, fetal monitoring and a host of other invasive procedures the rate of fetal distress and other 'complications' would decrease significantly. This is why midwives have much greater safety records than obstetricians with low risk women, because these interventions turn a low risk, natural process into a medical disaster. Birth is a part of the natural cycle of life, it is NOT an illness. Life isn't perfect and problems will inevitably occur but we cannot walk around interfering in every natural part of living to prevent something that may or may not happen. You don't drive your car with an ER doctor following behind you 'just in case.' Birth is a natural process and must be respected, unfortunately doctors think God gave birth to them but he didn't. Birth is the woman's realm and physicians don't have any respect for the miracle of the human body, for the miracle of birth. They want birth to happen on their turf, according to their time frames and when it doesn't they force it and blame the woman and her body for the failure! Pathetic. Your lack of understanding is very aparrent when you compare birth to a kidney stone. How much more insulting can you be? It isn't just about 'becoming a mother.' It isn't about being a 'hero' either. Doctors have this all backwards. When you have the idea of illness imbedded in your brain you do not have the capacity to see the beauty and the miracle of what is unfolding. One of the most life changing, moving experiences is to watch a woman in labor. She intuitively rocks her hips and goes into a 'trance' like state being very connected to the process. She intuitively will assume positions that are the most optimal for birth without any instruction from the midwife. You will see the eb and flow of the birth process, yes, at times it will stall and the woman will rest. If you are patient and allow the mother and baby to rest, it will intensify and progress again. The event is so powerful, the woman's power is so strong, there is such a reverence and peace in the room and is indescribable to anyone who has not experienced it. This is birth, what it was meant to be. Women's bodies know how to give birth. I've seen women who've had c-sections for a 9 lb. baby because the doctor said it was too big, give birth vaginally to an 11 lb. baby at home without a tear. The difference (she wasn't starved and she wasn't laying on her back so the pelvis had more room). I think it should be a requirement for obstetricians to 'observe' NOT control but observe a natural, uninterupted childbirth to gain a greater respect for women. Any man who degrades childbirth to the level of a kidney stone has absolutely no respect for the immense power of creating life that a woman posesses.
So, you're saying that only women who have given birth can possibly understand childbirth?
That lets out most all OB/Gyn residents of both sexes. Many nurses, including nurse-midwives.
And if the patient didn't want a physician attending, why did she go to the hospital in the first place? Clearly delivering an oversized kid is no problem - she should have been able to pop it out at home.
insurance restraints and state law often force women to birth in hospitals...but even if the woman didnt want to birth at home and HAD to birth in a hospital, she still has the right to the birth she chooses...and it is her doctor's JOB to uphold that.
No, only women who have given birth naturally can truly understand natural childbirth. Anyone else can understand medical childbirth; after all, it's just about learning how to perform procedures, right?
I think the fact that this "MD" believes that a cesarean is as safe or safer for the mom than a vaginal delivery is appauling. Studies repeatedly show that this is not so - vaginal births do not bring increased risks of hysterectomies, infections from the incision, longer healing times, increased risks of uterine ruptures, higher incidence of respiratory problems in babies, injury to the baby, and prematurity. Perhaps this mother wasn't so much thinking of her OWN experience as she was the safety of herself and her child. Ultrasounds are consistently +- a pound for guesstimating weight. Maybe her OB brought on the inability to progress, since she already assumed her baby was too big for her body. Pregnancy and birth is a normal, healthy state of being. The ability to make decisions about your care in this state does not make you crazy - it keeps you safe from harmful practices that are not necessary on a healthy person.
The comments above express my and many other womens' point of view. Something small that was not commented on was that your statements are all wrapped around you and what you feel should happen for you own comfort. No regard for moms. You are sleepy at night. Well, the mom in labor who has been dealing with the sensations as well as being drained of energy is sleepy too. Probably exhausted! But you waking up seems to be a major upset for you. You are paid a lot of money. A LOT of money to sometimes to do a 20 min procedure. As much or more than the OB attending the birth. It is a requirement of your job to be on call for the patients. It is not for patients to take into consideration your personal life when deciding issues regarding their health. If you do not like the at night on call feature, then get a 9-5 job that fits your lifestyle and your belief that your needs come first.
Kelly,
As a physician, I feel that if you and others demand perfection from me, I should be getting the same. So, next time I order a taco or go to the dry cleaners or get an oil change, I don't want to see any lettuce spilled over or oil on the floor, and no mechanic better touch the paint on my car. I wonder what your job is and what happens when you screw up, and how much time you put into educating yourself to get there, and how many hours you work a week, and how many of those are being woken up at night - oh, and I'm sure you're paid a lot, A LOT of money.
So, next time you are told to stay overtime for free for a few more hours on a friday night, or get called in on Sunday morning while you're in the park with your kids, I'm sure you'll be joyously dropping everything to take care of whatever your boss forgot to do during the work week.
Anyways, we don't need your advice. If you don't like the service, why don't you drop your 9 - 5 job and become a doctor, and fix your own damn problems.
Wow, that's a terrifying attitude.
I hope to hell YOU'RE not an obstetrician.
Sheesh, and to to think Frank thought The Business of Being Born was "adversarial".
I choose careproviders who are not defensively resistant to my "advice", but who empower me by working with me in a mutually respectful and collaborative way concerning my health, taking my own experience and knowledge into account as we problem-solve together. I of course have hold the power, since I am the consumer. And of course, this approach protects careproviders from being sued, since I am the one who carried the responsibility for my body (and my baby's body) as well as the power.
I have been both the careprovider and the consumer, so I know what it is like to go three nights with no sleep while supporting a birthing woman (baby born safely at home in birth pool after 59 hours of contractions, primip mother had no perineal damage, perfect apgars for the baby; spontaneous third stage). In such scenarios, it's the fatigue of the birthing woman I am focussed upon, not my own.
You don't have to do this job. Trust us, the consumers - we'd prefer you didn't if this is how you feel.
With respect to childbirth, leaving us women to "fix our own problems" would more often that not be exactly 'what the doctor ordered' - and exactly what skilled midwives in fact do.
That's incredibly scary of an attitude. Not everyone works a 9-5 filling up your car. There are a lot of women who give birth (gasp) who have more than or equal to the education that you do and who do work more than 9-5 and have to bear great responsibility and be called away to work on a Sunday afternoon with their kids.
How on EARTH did YOU make it through med school? I'm baffled to see people like you -- CLEARLY anti-social -- becoming doctors, the ones who are supposed to care the most for people seeing as how even the poor guys and gals at Taco Bell are your patients. I'm sorry, would you have this same opinion if your patient was a doctor with higher qualifications than you? I don't suppose you'd tell her she knows nothing of the childbirth process, would you? Do you think she'd even hire you? I think she'd laugh in your face and tell you to go twiddle your thumbs in a corner. You CLEARLY do not belong in your chosen profession, and you are CLEARLY money motivated. I do, however, believe you would be suited to defense law -- you have all the right morals and ethics for such a profession, so you'd feel right at home defending murderers and thieves. And before you so much as think of trying to overcompensate for your biological inability to perform (as I'm certain you must be trying to compensate for something that when placed on you keyboard starts at the "A" key and ends at the "Z" key -- please look down at your QWERTY keyboard and notice that's a span of about an inch or so), perhaps you should notate that I'm an college grad. So before you go making false accusations of all women being merely servers at your local fast food restaurant (and really, what's a doctor doing eating Taco Bell? Don't you know that stuff is full of trans fat and causes hardening of the arteries, obesity, etc.? What kind of doctor ARE you?), perhaps you should stop - think - and use your brain.
really MD (anyways) what were your grades in med school using that kind of english?
Attending women in childbirth isn't for everyone. Being an obstetrician means (or should mean) that you WILL keep odd hours and be frequently exhausted and you WILL lose out on precious time with your own family. Occupational hazard, sorry mac. If you accept any less, if you decide to force your clients (who have hired you in good faith!!) to birth their babies faster so you can make it to your kid's soccer game, then you are a useless doctor indeed. The number one rule of the practice of medicine is "do no harm", and if you put your own well-being before your clients' then you have failed to offer a safe practice and good medicine. If ya don't like, give it up. There are plenty willing to do it with an attitude of service and grace.
You are a ******* douchebag. Perhaps you should have thought about the demands vs. rewards of being a doctor before taking the Hippocratic Oath. Instead you only seem to have thought about half days on Wednesday so you can play golf, and collecting way more money than you deserve. People have many different roles to fill in this world, just because you seem to be a child of privelege who was afforded the opportunity to go to medical school doesn't mean that you should talk down to people not given those same advantages. People like you are the reason that the mediacal industry in this counrty is so ass backwards. You are a doctor, and if that means being awoken from your cute suburban dream home or called away from your family, then that is what your job demands. If you don't like it then start practicing your taco building, car fixing skills and get a new job.
You seem to be forgetting people who are seeking health care are also consumers. Health care, just like any other service performed, is only as good as the person providing the service. We are not talking about going to your local restaurant or getting your oil changed. We are talking about people who are trusting you with our lives as well as the life of our unborn child(ren). You also seem to have forgotten just like the teenager at the restaurant or the guy who does your oil change you work for us, the consumer. You knew what you were signing on for when you went through school to become a doctor. You made the conscious decision to go into a profession where you are expected to be available to your patients 24/7. If you have become so jaded as to not want to do this any longer, perhaps you should quit being a doctor and start asking, "Do you want fries with that?".
Crystal,
You seem to have a double standard for doctors and everyone else. Doctors in your view should be perfect humans who operate without mistake and are not subjected to tiredness or decreased operational capacity from it. They should behave with the predictability of a computer it seems.
I say people who work flipping burgers and don't wash their hands, don't care for the quality of their work, and subject their customers to disease, shouldn't be talking about "trusting you with our lives". And the same goes for car mechanics who better have the brakes done right and the bolts on tires screwed tight, and the engineer should consider placing the fuel tank somewhere where it doesn't blow up during collisions. Should we discuss bridge builders, road construction crews, food manufacturers, electricians, gas line builders, chemical manufacturers, etc, etc, etc?
How about drunk drivers who crash into the tree because of their stupidity, then expect doctors to fix them at 3am on a Saturday? Couldn't they put in some effort to stay sober or have a friend or taxi drive them?
I want perfection from doctors, but I also want perfection from everyone else. And I resent that people DEMAND what they're not willing to offer. And by the way, just like you don't go into the restaurant's kitchen to tell them how to cook your food, I suggest you do more listening to the physician when you're in the office.
Frank, this resentment makes you a flawed professional. You need to get out. I hope you are not surrounded by peers who are enabling this kind of attitude.
As a provider of health services, you must surely know that being an effective professional depends upon your ability to listen - really LISTEN - to your clients - not upon your insistence that they listen to you.
In no field is this more vital than in maternity services, where the emphasis should be upon empowering a state of health and ability, not upon enforcing a state of pathology and dependence.
Actually, you DO tell the resteraunt what you do and do not want, you can choose what you want to eat, where you want to sit, and what you want them to leave off, or put on your plate...
I agree that SOME patients are ridiculous, and willing to jepordize the health of their child, or themselves for an experience. This however is not a typical case. Most women if they are dareing enough to even question their care provider, are well informed, have studied risks and benifits, and know that most providers are just trying to make their own lives easier.
I agree with most of the comments, you know what your position demands when you get the job.
Okay. I just want to say this.
As a woman who had a c section under general because of a real medical reason, I never want to repeat that exeperience next time.
I do not expect my doctor to be perfect. Not at all. I think that it is the other way round. With the OB's I have chatted with, they expect the patients to be perfect little girls who do not understand the big bad world of childbirth. I most certainly do not believe this of ALL OBGYN's, but a great deal of them do. My OBGYN who delivered my daughter had a God complex. He was a hot shot who thought delivering babies gave me magical powers.
This is what I want from an OBGYN. I want an OB to looks me in the eye, generally cares about me, cares about my wants for child birth and understands that even if it doesn't go exactly how I want (and it doesn't a lot of times) that they understand that it can hurt my feelings, it can scare me, and it can effect me for the rest of my life. Lots of woman are left mentally, emotionally and physically scarred from doctors who do not take the time to think of their patients feelings. I could have dealt with my c section and failure of my birth if my OB had told me it was alright to feel that way. That it was alright to be dissapointed and to be scared and to be upset. Instead I was told how I should wean my perfectly happily breastfeeding daughter and go on Paxil. That one day, my 6 week check up threw me into a spiral of PPD and a panic/anxiety/depression disorder that even 3 years out I am still going through.
I am sorry that you have a job that takes you away from your family. I am sure that it is hard on your wife and your children. And I don't know if I could do a job that requires that of me. But the thing is that YOU wanted to be an OBGYN so bad that you went through the years of schooling, the training and the residency to become it. YOU understood what was expected of you when you started your practice. You have NO ONE to blame for the inconvenience of your family but yourself. The laboring woman is NOT to blame when her birth does not end 6 hours prior. YOU are to blame that you get upset that her body is not responding as quickly as you wanted. You almost seem happy that the baby came out with problems because of the insolent woman and her insubordinate behavior with you.
I have never been a patient so I can not really speak about your medical skills personally, but from your attitude here I do not see how you have a practice at all. I would love to see your patients reactions upon reading this. I seriously think you need to re evaluate your job and your love for it. Maybe another area of medicine would be better. Or does it not pay you enough?
You seem to be very misinformed and unbalanced for a professional doctor. Attitudes like yours accounts for the mistrust and violation so many birthing couples feel. No wonder those who research the alternatives flee and seek the Midwifery Model for birth. I would hate to surrender my body, my baby and my psyche unto the power of someone like you with your attitudes. No wonder intervention rates are sky-rocketing, I had three safe homebirths overseen by midwives, Perfect apgars, of course. I've also supported women who needed caesareans in the ned - but their caregivers didn't appear to hold the same dismissive contempt as you. They didn't see birth as a state of pathology like kidney stones either, and they didn't regard childbirth as a field of medicine. Seriously, if this is how you feel, you need to get out of obstetrics because you will be doing more harm than good, but are probabaly unable to see it.
"Midwifery Model"? That's funny!
http://www.acegraphics.com.au/articles/wagner03.html
Fish Can't See Water - The Need to Humanize Birth in Australia by Marsden Wagner, formerly of the WHO.
Seriously, your ignorance and pompousness is staggering.
You should try researching a term before you dismiss it. The midwifery model of birth - used throughout western Europe - results in considerably lower rates of maternal and infant morbidity and mortality as well as lower rates of c-section than the managed care model used in American hospitals.
But of course, knowing this would require that you give a ____.
Given that the "epidemic" of homebirths is less than 2% of the population, you seem to be amazingly threatened by homebirth!
I wonder if the 90% spontaneous vaginal birth rate, the 80% intact perineum rate, the 4% caesarean rate and the excellent infant perinatal statistics of homebirths have anything to do with it?
Maybe it is the price difference that scares doctors. They know the average cost for a midwife is $10,000 less than the average cost of a hospital birth. For every person that goes with homebirth they are losing serious money. They may not be able to keep up with new Jaguars and BMW's if people don't go to them to be robbed, not only of choice, of cash.
I'm not the resentful one here. I perceive your anti-professional medicine crowd as believing that I and other doctors like me are withholding treatment, knowledge, love, and wisdom from you to make a buck. What we're doing is applying science in a professional manner. And sometimes science isn't warm and cuddly, and evidence often suggests things other than what you want to believe in or think as rational and obvious.
So, if you want to go down that route, leave the medical professional and seek herbal therapists and homeopathists for your care, but don't complain about the fundamental nature of our profession.
I show love and compassion to my patients, but I don't take lightly to the disrespect and abuse that people that simply don't understand throw at physicians these days.
Again, we are humans, remember, and we'd like to be treated as such as well. We, just like you, expect both excellence from others and respect towards our work.
Frank.
Frank, with all due respect: I believe that in this situation, we need you to listen to what we're saying. Many of us are the women who have been the recipients of care, usually under a few different OB/GYN's each. We are not uneducated about the model of care that *we* recieved - and this is what we're trying to tell you.
I don't require a physician to be all warm and cuddly with me but what I do expect is compassion, respect for my wishes, and to not be talked "down" at like I'm a child who wouldn't understand what they're trying to tell me. I don't require a physician to be perfect - none of us are! But the things that I do expect - they seem to be a pretty simple matter. And unfortunately, in literally every single instance that I have been attended by an OB/GYN - be it for a routine check up, pre-natals, birth or post-natal check up - I have not once encountered a physician who gave me the respect or the time of day.
For example, with my last pregnancy, I was experiencing debilitating pelvis pain. It was ignored. I couldn't walk up stairs, get dressed, get in or out of cars. I attempted to talk about this with my OB/GYN. It got brushed off as round ligament pain. Every single time I attempted to bring this up at my 5minute long appointments, it was brushed off. This pain lasted through my pregnany, labor & subsequent cesarean, and only started going away in the 2 years after my son was born. I did some research on my own and found out that the symptoms matched perfectly with symphysis pubis dysfunction. I've since been listened to by my current midwives for this pregnancy about this pain, and they were able to assist me with getting the help I needed and into the condition where my pelvis only hurts when its the day before my chiropractor appointment! -- Frank, perhaps you can explain to me why I, and so many others that I know, were so utterly ignored when we brought our concerns to the very people who were supposed to care and help us? (Not specifically about this type of situation, but as a general springing board of the theme of not being listened to.)
I know that science isn't all fuzzy warm feelings, rainbows or unicorns. Sometimes science says things that really quite suck, but is an unavoidable truth. However - that does not mean that we cannot expect things to be presented to us in a better manner than they have been and with full disclosure.
I wasn't always anti-professional medicine. And I'm still really not. I believe that professional, mainstream medicine has its place - as do the "alternative" methods. I'm grateful that the services are there when needed. But the type of attitude that is displayed here by the original blog poster and other physicians such as yourself is disturbing. Anyone who is attending a birth should have more respect for the process, and for the woman undergoing it. If you look at the science you would be able to see the heightened emotions, hormones, etc...and hopefully you would be able to understand why it is so imperitive that you treat that birthing mother with every ounce of respect possible. If you have to do some sort of proceedure, explain it. And if she still says no: Respect it. You would expect nothing else of a physician treating you, would you?
Frank,
I have to wonder where it is you got the idea that anyone commenting here was expecting perfection?
We don't. What we do expect is a bit of a reality check. Yes, it is okay to be tired and comment (even grump a little bit) about a night of lost sleep. But to blame the patient??? Ummm...no. It's the profession you chose. I've chosen to be a labor doula...which more often than not means that I get a call at about 9-11 p.m. saying "can you meet me at the hospital?" and if I'm *lucky* I get to go home by noon the next day. This while being a mother to 4 children and working another full time job. Do I complain about being woken up? NO. I specifically tell my clients pre-natally that they should not hesitate to call me in the middle of the night--if I wasn't willing to accept the disruption I wouldn't be offering the service.
Unfortunately, I've seen way too much in the field of childbirth that is abusive towards women. Women who are forced (sometimes through bullying, sometimes through physical restraint) to allow cervical exams every 2 hours or sometimes more frequently (despite an absence of strong contractions) with no thought that perhaps this woman has an undisclosed prior history of rape. Or heck, just doesn't appreciate having her genitals man-handled by a resident OB that she just met. And heck, on the lack of genital respect issue...can we discuss the whole issue of episiotomy without consent when there is no fetal distress and pushing has barely begun (especially when the woman has expressed prior to the birth--including in writing--that she does not want an episiotomy unless there is fetal distress and would prefer to tear)? On what planet is THAT ethical? Yet it is par for the course in my area. Women are talked down to, their questions aren't answered, and are in general bullied by medical "professionals." Babies taken away from mothers against their protests for routine assessment that could be done with the mother holding the baby, or could be delayed. I know there are some great OB's out there--I had one who attended my first two births. Interestingly...he provided back-up support for the Certified Professional Midwife who attended my next two births--planned home births.
As a doula, I have attended many hospital births. Not as many as an OB certainly, and I'm not there in a medical capacity--I'm there to offer emotional and physical support--"Mothering the Mother." I've seen good births, I've seen bad births, I've seen train wrecks. I've seen necessary cesareans, and I've seen some that seemed more about the Dr's sleep schedule than anything else. I've only seen ONE hospital birth where I came home and said to my husband "that was an awesome birth." Interestingly, the father-to-be was a cardiologist...wonder if that had anything to do with the exceptionally good treatment the couple got from the medical staff?
When I finish school, I will be a midwife. I understand that part of this job is to be woken up at all hours of the night (and day), have no ability to schedule anything in advance, and feel infinitely blessed when I have a weekend off-call. It's not rocket science to figure out that women give birth 24 hours a day.
If you're not happy with your work hours, you need to either get another job or find another situation that will allow you to have the freedom to sleep or do things with your family.
Blaming the patient for making a choice in her own healthcare is preposterous, controlling and arrogant. You can call it what you want, but it's still lipstick on a pig. It's a woman's own choice to make, to give the birth a little more time.
Your tone in discussing this patient is appalling, and that is what the majority of commenters are upset over. You are objectifying this woman, and ridiculing her to boot. She is a person, not a baby incubator, and she does have the right to be a part of the process. Period.
You haven't heard of the midwifery model? Oh my God you really are uneducated aren't you?! Perhaps you should take a look at the medical evidence before forming an opinion on something you clearly know nothing about.
Right, the 'midwifery model' for a patient that clearly needs a c-section.
Or, let the patient strugle to exhaustion, and in the process deliver (without medical attention) a disabled infant or dead fetus.
BRILLIANT!
Maybe if she hadn't been stuck in bed or suffering from EMOTIONAL dystocia, maybe if she had actually felt relaxed enough to give birth in a cold room with machines whirring and making noises, maybe just maybe she would have been able to progress from 6 cm. Who said there was a magical time limit? I was in labor for 36 hours and all was well in my world. Maybe when a woman's waters break y'all shouldn't be sticking your hands in our vaginas to see how much we've progressed. Our bodies were designed to do this and if y'all would just back off and watch instead of jumping to conclusions and intervening you'd see that we are perfectly capable of having a baby with out your assistance.
I wouldn't mind seeing a few compassionate OBs around, but grow up and realize that you aren't the be all and end all in the childbearing community. We've been having our babies with midwives for centuries and that's how it will continue, like it or not.
You really wonder why women tell you no? It's obvious you don't have their best interests in mind. You'd rather cut her open, and leave her to deal with the aftermath, just because YOU'RE tired? Obviously you've never had to care for a newborn and recover from major surgery at the same time.
Let me explain tired to you, so you can really understand (and yes I am being condescending). Recovering from a cesarean, under full narcotics (which in case you forgot from med-school makes you sleepy), anemic from blood loss from the surgery, caring for a newborn that wakes up every 2 hours to be fed. Add in a wound infection that lasts for months and you'll begin to understand the concept of 'tired'.
Top it off with the standard "at least mom and baby are healthy" (where is the healthy in an oozy stinking wound that needs draining?) as well as "it doesn't matter how the baby got here, at least he/she is here" and you can add a whopping dose of PPD to the mix too.
When the realization that the hell you went through was because your doctor was TIRED/BORED/WANTS TO GO PLAY GOLF and you really didn't need that "necessary" cesarean, you can add pissed off to the top of the that list too. And you can bet your bottom dollar that the next time I'll be using the midwifery model you so blatantly know nothing about!
I'd like to pretend that my words will sink in to you and you'd realize how big an impact your actions have on the mothers you "care" for, but my guess is that you'll just brush me off like the mom in your rant.
The "at least mom and baby are healthy" line isn't even true. A woman sent home from the hospital 48 hours after her abdomen has been prised open, her organs rearranged, with a (50/50 shot inadequately sutured) incision in her uterus and another from hipbone to hipbone in an area that is difficult to keep clean, dry and in optimal condition for infection-free healing is not healthy. And her recovery is significantly impaired by the fact that she's not going to be able to go home and relax, eat well, sleep well and give timely, regular attention to self-care as any other post-surgical patient would, because she has a newborn to care for.
So it's a lie, it's a plain lie, and it's completely dismissive of the real toll that c-sections take on women. But doctors don't have to see us at home for those two weeks before our post-partum checkups, how we struggle, how we can't get up to go to the toilet without pain, how we can't pick up our babies without pain, how it impairs our bond and our breastfeeding, sometimes significantly enough to end our breastfeeding relationships. They don't see how it makes it impossible to deal with our toddlers at home who are too heavy for us to pick up without ripping out our stitches or worse.
Out of sight, out of mind. They don't have to live with it and they don't have to care, and they don't.
exactly! Post-birth complications are only recorded as such when they occur within six months after the time of birth. What about my two friends who have adenomyosis, very very likely due to their unecessary cesareans? They will either have to undergo a hysterectomy (in their mid-thirties) or live in pain for the rest of their lives.
Any doctor that would tote that "at least mom and baby are healthy" line have no idea of the physical, emotional and psychological scarring that they are imparting on women and their babies.
It seems like I'm being attacked by a herd of women who, rather than discuss things rationally, are being emotional and attacking me on every front, calling me names, attributing characteristics to me that I don't have. There must me a midwifery online forum linking to this post, and so you folks finally found a doctor to yell at because you experienced pain during birth. Well, I'm sorry for your pain. I feel it and sympathize with it.
But it seems to me that that pain is ignoring facts of the ward: too many patients, too few doctors, hormones raging while strict procedures have to be followed at 3am or I can lose my profession and be sued into poverty. In response all I hear is "if you don't like it, get another job". Well, if I get another job, what will you do if a complication at the midwife's happens?
Actually, I think I'm arguing with midwives who are basically advertising their services, and downgrading the ones of doctors, and I don't see what's the point of continuing. Keep swindling people - I hope you sleep well.
To me, this is how it this message from you is coming across: They (the comments from women) aren't wanted - business wants to continue as usual, with no regard to the fact that everything that is done by the medical professional will have an effect on the person they are attending. An effect which should be taken into consideration.
Perhaps if there is a feeling that there are too many patients and not enough doctors, maybe that is a sign that an embrace to midwifery needs to be made. They would be able to alleviate the normal, low-risk pressures while leaving the physicians to attend those who really and truly need their expertise. If you look at the birth statistics out of nearly every single other industrialized nation that ranks in the top 10 for infant/maternal mortaility, they nearly, to a one, rely heavily on a symbiotic midwife/doctor relationship. The United States has the second worse rate out of every other industrialized nation - should that not say that there is something irretrievably broken with our system? And should that not spur physicians into examining the other countries who are doing vastly better than we are and figuring out how to adopt a system more like theirs?
I'm a little offended at the phrasing of this part of your message, "so you folks finally found a doctor to yell at because you experienced pain during birth." With most of us here, it isn't about the fact that we experienced *pain* during our birth. Its the pain we felt about how we were *treated* during our birth and the continual pain and emotional trauma we feel *after* our births. I, for one, underwent about as unneccessary of a cesarean as you could get. I've had other people look my records over, and they wonder at why I was sectioned in the first place. Was I tired and in pain? Well, sure. But there was no medical reason, none. Even though it was alluded to me that my child was in distress. Which was very, very far from the truth.
I understand that this is an emotional topic for all sides involved, but I strongly feel that one side (the women who feel harmed, of which, yes, I am in this group) is trying to reach out to the other, and explain their experiences and why they find this so offensive, and the other side is reacting in a way that I find pretty gross. I don't see any attempt from OB/GYN's to try and understand why their patients feel or felt the way they did, all I'm seeing is a spurning. And that is sad. I should feel that, above all, physicians should be able to respond effectively to that concern, fully address it, and figure out how to do their best to make sure it doesn't happen again.
I do feel that there is a pretty callous feeling toward women in some of these responses from you, and especially from the original blog poster. I genuinely wonder why you are an OB/GYN. (And not in a snarky way, I am *genuinely* curious. I come from a family of nurses and physicians, and I always wonder what their motives were.) Did you get into med school with idealistic thoughts? Hopes for how you could change things/make things better? If you hoped to make things better, why does it seem as though you are strongly trying to ignore what a few women are trying to explain to you?
A herd of women????
Midwives advertising their services???
Oh dear God - flee!!! Run for the hills!!! The earth is being overturned!!!!!!!!! Women are talking as if they have a right to a say about their birthing bodies and midwives who care for less than 2% of the population are being a THREAT!!!!!!!!!!!!!!! This cannot be allowed!
Yawn. By the way, I'm neither a woman nor a midwife, however I do roundly object to the ego-driven arguments you present here, and the non-evidenced based care praticed upon the wives of men like myself in the field of childbirth - which should be a Midwifery-led specialty, with referral to the Obstetric speciality if needed.
Your attitude is misogynistic, also you show a great ignorance of birth and birth trauma. My wife slept very well thank you, and so did her midwife too, after 24 hours of effort similar to that of an adventure racer. Like any endurance athlete, she experienced pain, effort and intensity, and found this as challenging and fulfilling as anyone who works their body hard and well. She certainly has no desire for revenge or recompense after such a rewarding experience. How strange that you think "women who experience pain in childbirth" should feel this way? However, many women do experience birth trauma, and it's not because of the normal pain fo childbirth, it's because of the interference and unscientific attempts control birth - the the disrespect.
C'mon, consumers are the 'little guys' deserving the extra mile of compassion and generosity here - not the poor wee doctors. Enough with the self-pity and address the issues, they're important: the medical domination of the field of childbirth is wrong and catastrophic, and it needs to change in accordance with WHO recommendations.
I by no means want to have things stay the way they are. I completely understand how during one of the most difficult and emotional times in a person's life they would want personal, close, and warm attention. I understand that women sometimes feel like they're coming through a commercial farming facility. This is not right and indeed needs to change.
The issue, though, is not with the doctors who are trying to provide care within time, space, legal, emotional, and ethical parameters. The problem is the environment the doctors and patients find themselves in. The solution then is not to get rid of the doctors and have women give "natural" births, but to change the system so that births can happen in a wholesome environment while under the care of science based medicine.
But the debate is being positioned by a certain crowd in a different way. Here's the operational quote from one of the ladies above: "... normal childbirth is not MEDICINE- its a process that doesn't need your direction. God gave women babies long before he gave them anesthesiologists." These folks forget that God gave them polio and appendicitis before there was medicine too. And child mortality was awfully high before science based medicine, lets not forget.
So, I say stop blaming the doctors and stop wanting to believe "naturalists", and start bringing the environment you want closer in touch with real medicine.
Believe me, we would love to have our babies in a wholesome environment. However, we have the ACOG telling the world that homebirth is child abuse and dangerous. And we have OB's, ACOG, malpractice insurance companies and other organizations making it impossible for birthing centers to operate. Would women flock to a birthing center that was not attached to or affiliated with a hospital? Yes. Unfortunately the system continues to fight against our right to have that choice.
This comment says everything we need to know about your attitude toward childbirth.
You've just compared childbirth to disease and disorder. Polio and appendicitis.
You couldn't be more off base - or more condescending and frankly misogynistic - if you tried.
God help your patients.
Frank,
You said : "because you experienced pain during birth. Well, I'm sorry for your pain."
I had two painless labors (hardest work of my life? YES). At home.
And I can't wait to do it again.
MereMortal
This mindset is truly appalling, to be honest. As others have stated, we're not looking for someone to just nod their heads agreeing with our every whim, but we DO need respect. I understand that some women walk into your office uneducated but not all do, and some of us really are making well-researched decisions.
At my first prenatal with my assigned FP (navy hospital) the "discussion" was non-existant, I don't think he looked me in the eye once, just staring at my record. The pap/pelvic exam was deplorable. I've never had such a terrible one, either before or after the fact. During the pelvic I was crying, pushing myself away from him across the table with my legs, and he just kept right on poking and prodding following me as I tried to cringe away. Before my next appt I had changed providers because it was obvious I would not be listened to by this FP. I understand uncomfortable things being done in an intense, emergency situation, but it was a flipping PELVIC EXAM and he couldn't just gentle it up, or pause for a moment for me to relax, or even say something assuring? Nope, just kept right on chattering about god knows what with a smile on his face.
Then there's the nursing staff (which we have no control over who's on duty during our labors) and they were really give and take. I would hardly call homebirth an "epidemic", as it's not spreading at great speeds, killing everyone in it's path. If nothing it's a symptom of the problem, which Frank mentioned in his last post. There is a SERIOUS PROBLEM with the entire system and no, individual dr's are not to blame just as individual women are not. Things need to change, ALOT, and the Obstetrical world would do well to address their own issues rather than get into a territorial pissing contest with midwives over a 1% loss in customers. Actually listen to what women are crying out for when they choose a homebirth, rather than sitting on your high horse and piles of non-evidence-based practices. Take us off the assembly line.
Until things change I WILL be taking my business elsewhere.
Oh, dear, Dr Frank. I am afraid that you have natural birthers all wrong, and I think you are somewhat mistaken about your own profession too. Homebirth isn't an epidemic, it's a rational response to being treated like cattle by a system that doesn't respect, or care for women or babies, and certainly doesn't employ "science based medicine" as you call it. I will assume that you doubt me on this point, in which case I would ask if you are familiar with the Cochrane Database, and try to compare and contrast your hospital's policy and ethics with it. I have no doubt whatsoever that you will find that your hospital uses routine interventions that research has found to be either of no benefit, or to be harmful, for example routine induction for post-dates pregnancies.
I am a rational person. I also (shock!) posess both thoughts and feelings, and (shock!) want what is best for my baby. Why would I choose a model of care (obstetrics) that has worse outcomes, nearly regardless of the risk level of women accessing it?
Your patients are deserving of your care and compassion. I do not expect perfection from you, but an understanding that other people have feelings too would be a start. If you cannot muster that, even when you are tired, then perhaps you are in the wrong profession. And if you think you have the market cornered on tired, cranky, and unpaid overtime, try being a mother.
This basic premise of this post -- that home birth moms are nuts and incapable -- really makes me laugh and laugh!
MANY of the home birth moms&dads I know are obstetricians, family practice doctors, college professors, advanced practice nurses, pediatricians, obstetirc RNs, publc healh professionals (holding MPH degrees), psychiatrists, and the list goes on like that.
So pardon me while I do some deep belly laughing, b/c if you're going to assert that doctors and college professors and advanced practice nurses are incapable of directing their own childbirth choices, then I have no other choice but to laugh!
(Did I mention this is hilarious and makes me laugh?)
This attitude in a care provider is disgusting (yes - I suppose as an anesthesiologist you prefer people asleep & unable to express their needs) - maybe it's time to find a new line of work - perhaps in used care sales.
This sort of attitude and god complex is exactly why I found qualified, honest, and caring midwives to attend my safe, uncomplicated homebirth. They would never dream of speaking to a client the way doctors like this do...they actually have respect for their clients. Please, please, please find another line of work immediately. You do not belong in the field of health care.
"If you don't like the service, why don't you drop your 9 - 5 job and become a doctor, and fix your own damn problems." Frank, I'm doing it the right way and becoming a CNM, to provide a real solution for women who don't want to be treated like dirt.
Well, for an at-risk pregnancy and delivery, what does your experience have to do with anything?
"I often believe that patients don’t have the capabilities to make proper decisions about their clinical options."
I’m gonna take a wild guess and say that’s your fault. A lot of doctors practice medicine as if they were priests in a cult, with little effort given to educating or informing their patients. Health crises are intrinsically difficult, of course, but I think that most people can make proper decisions - with a little guidance and patience from their doctors, of course.
Frank,
One difficulty I have with your point of view, is that you do not recognize that the "double-standard" you complain of is, in fact, the very appropriate distinction drawn between technicians and professionals. You are held to a higher standard in many respect because you have been admitted to the practice of a PROFESSION.
To compare yourself to a cook or a mechanic to make your point, is sad indication that you have failed to comprehend the distinction. I wont' belabor this but you might consider that more is appropriately demanded of you.
----------------
I think women get it from both ends, frankly. A bit less than 20 years ago I had my first child. I was overdue, and eventually induction was the best option. I did, however, come into the hospital at the appointed time, already in labor. I asked to wait a bit before having pit and any procedure to rupture the membranes, and a monitor.
I was accomodated for an hour or two, when the physican came into the room, attempting to disguise his impatience, but demaning I submit to the above immediately,
(And monitior and so forth). I readily agreed, because I did not want my physician angry with me or to gum up the works in his schedule.
However, I went further. I said, should there come a time where it's a judgment call between C-section or continuing towards vaginal delivery, "I don't want to wait... I know some women would ask to..."
And here I was interupted with a short and affronted reply that he would "only do a C-section if medically necessary" and expressed indignation that I would have any opinion on the matter at all.
I softly continued, in order to reassure him, and make myself plain, that I understood sometimes women objected to c-cections and would ask for more time, or to wait, and I just meant to say I would prefer not to wait, and to move ahead as he saw best.
And sure enough, when hours of strong contractions ( and a nurse and myself, but not the doctor) noticing meconium in the amniotic fluid that had been collected in a pan and noted but not seen nor believed by the physician) produced a dilation of 2 cm and some deccelerations, I was very gratified when the physician said, I might wait ordinarily, for some progress because it has only been about 6 hours of hard labor. But I think we are headed to the same place no matter what. And he preferred the better option of operating while everything was stable and all were fresh and awake.
I have no idea if fear of litigation or selfish motives encroached on his decision, but I) I am sure in hindsight it really was best. My son was large at well over nine pounds, and also had very broad, linebacker shoulders. I later discovered my SI joint was fused from arthritis, and that I might have had a very difficult time if allowed to proceed, and would have ended up in the same situation or worse.
But i'll never forget my doctor's anger when I suggested I would not like to wait in case of doubt.
I think any participations or opinion from an OB gyn patient is deeply resented and taken in light of fear of litigation. I can't blame a lot of women for turning away from the disrespect and diminishment of their interest in the proceedings.
Plenty has been said regarding the uninformed, uneducated, callous and arrogant attitude of the original poster, so I'll not repeat it here.
The bottom line here though is that this physician, regardless of his level of expertise or education is simply unfit and unqualified to care for women. Period.
Please sir, find a new profession or practice specialty. This is one that you clearly have no business being a part of.
I'm surprised no one's brought up the elephant in the room: fear of being sued. Obstetricians are among the most frequently sued physicians and their malpractice premiums are the highest. Furthermore, the statute of limitations is at least 18 years, so at any moment something can come back and bite them in the butt. Obstetric anesthesiologists no doubt face the same issues. If they seem defensive, put yourself in their shoes. They're often sued for things beyond their control, so can you really blame them for wanting to control as much as possible? I'm a primary care doc, and I admire those who can and want to work in obstetrics.
I respect the fear of being sued. The people in our country have become so litigious (that's, sue-happy) that one can hardly feel comfortable even having a neighbor's child over to play anymore! I think the way people throw lawsuits around is disgusting and disgraceful. And especially in the field of medicine, where the victims of the lawsuit are usually people who were just trying to do their job - they're human, for goodness sake!
However, I think if the members of the Obstetrical community were to take very careful consideration of how they got from the place where women were grateful for their services, to where women want to sue them for everything, they might see that a large part of the problem lies with what they've done.
During the 30's, 40's and 50's as birth moved from home to hospital, obstetricians promised to "take care of everything." I've heard many, many stories of women - from that time period and beyond - who asked, "Should I take a childbirth class? What can I do to make it go better?" And the response was, "Oh, honey, you don't need to worry about a thing. I'll take care of everything." Physicians shut women out of making decisions about their own care, and so when something went wrong, it HAD to be the physician's fault - he was going to take care of everything!
It's interesting to note how infrequently midwives are sued. It's not because they have some hypnotic power over their clients. It's because they build a relationship with their clients, and they involve their clients in decisions about their own care, and inform them - before labor! - about the risks and benefits of various procedures. I think Obstetricians could get to this place too, if they'd take the time to develop relationships with their patients and involve them in decisions about their care, rather than dictating the course of care and leaving the patients feeling helpless and manipulated.
But really, the ideal system would have midwives caring for the bulk of pregnant and birthing women, and obstetricians doing what they are really trained to do - care for high-risk situations and perform gynecological surgeries. If midwives were caring for the majority of birthing women, the demand for Obs would greatly decrease, and then practicing Obs could focus on surgeries, which is what they're really good at!
Mmm... I'll concede the point that some obstetricians have been arrogant, and that this may have contributed to the increase in lawsuits. But society itself bears a lot of the responsibility. Americans today are always looking for someone to blame. If something goes wrong, well, it's gotta be someone (else's) fault! The attorneys have fostered this by implying that all bad outcomes are somehow preventable. They're not.
Here's the truth, if someone feels that you're working with them, and for them, if your relationship with them is team-based, complementary and collegial, then your culpability in a bad outcome is going to be viewed as much lower than in a case when you're taking an authoritarian or parochial role and your relationship with them is more adversarial.
Very few people sue someone who they consider to be a good person who did the best that they could in a bad situation. A whole lot of people will sue someone who hasn't ever been nice to them and acted like a donkey's butt in a bad situation. This is proven in psychological testing and in studies of people who have approached malpractice attorneys to see if they have a case.
OB/GYNs who are so worried about lawsuits ought to think about that.
I'm with the anesthesiologist on this one. Cone headed is not the problem. Floppy and needing resuscitation is. And thank god there was no shoulder dystocia. Just read this post by rural doc about shoulder dystocia to understand why a doc might want a patient with a large baby to deliver by caesarean.
http://www.ruraldoctoring.com/2008/09/birth-story-423.html
Then again, for every patient like this one who refuses a c-section, there are 5 more who want an elective c-section to avoid labor and the consequences of a vaginal delivery.
Medpolitics is right - we have lost control. And that loss of control is a direct result of the fear of litigation. It's not the women who are running the show, and it's not the docs. it's the lawyers.
Trust me, if this patient had had a bad outcome, she would have been the first to sue her doctor for letting her run the show. After all, she is just an ignorant patient, he/she is the doc.
I wonder if the failure here was in communication with the patient. I have had more than one patient come in to see me for a second opinion on surgery, having rejected the recommendations of their doctor. After a discussion of the various options, the risks and benefits of each, the patient very often finds herself choosing the option recommended by the first doc. What is different is that she is given input into the decision. Giving patients input is not giving over control - it's getting buy-in and understanding. The doctor-patient relationship is a team, and the team needs to know how to work together.
Thanks for a provocative post.
Having delivered 6 considerably larger than average babies vaginally, I just don't buy it. The female pelvis can do some pretty amazing things if it is allowed to function as designed. Which doesn't include immobility during labor and lithomy pushing.
Of course ACOG doesn't buy it either, as their own policies state that macrosomia is not an indication for either induction or cesarean.Think on that one for a bit, and then ask - If ACOG doesn't think it's a good idea, why are so many of their fellows doing it anyway?
I do fully agree that it is fear of litigation that is driving many doctors to cut first and ask questions later. However I don't believe that "CYA" is an appropriate justification to perform major surgery on a woman, beyond that I find it ethically and morally repugnant.
There was a study recently about the power of saying "I'm sorry." Admitting error in this study cut the number of lawsuits almost in half. Pretty darn dramatic.
Bottom line is: If you want to be acknowledged as fallible humans, then stop selling yourselves as infallible gods.
Were any of the physicians in that study obstetricians or in obstetric anesthesia? Lawyers love to go for cases involving bad birth outcomes (even if the doctor wasn't at fault); they love to parade the "victims" in front of the jury. Therefore, they aggressively seek out/ambulance chase for patients. I don't think saying "sorry" would work to dissuage anyone.
Sorry would have cut it for me. Our baby died from an unforseen and unpreventable cord accident during delivery at a hospital. The OB was so afraid we would sue that within minutes of delivering one of those "floppy" babies, all he could say to me was, "this wasn't our fault." I understand an OB's fear of being sued. I do. But maybe that could be shelved for a while and the parents of the dead baby be attended to in a compassionate manner. An "I'm sorry this happened" would have gone a long way.
We've since had 2 more children, the most recent at home with a midwife. I did the research, and it's just safer that way!
I'm so sorry to hear that. I don't have any children, but I can imagine that what you went through is a parent's worst nightmare.
Dr. Dredd,
I notice you completely ignore the fact that ACOG - the OB's own trade group says that induction or c/s for macrosomia is not ok, and instead jump straight to the conclusion that the study must be done by lawyers and therefore somehow invalid.
Why is it, do you think, that so many fellows hold up acog as the end all be all when it comes to pro-c/s decisions such as banning vbac (not for safety concerns, but because it is inconvienant to an ob's schedule to labor sit), but completely ignore them when it comes to anti-c/s descisions such as not inducing vbacs, or suspected large babies, or the magic 40 week 2 day deadline... I could go on.
I understand that a c/s is all around easier, more convienant, less boring, and less stressful for the ob, but it certainly isn't in the best interest of the mother or the baby.
And please don't try to tell me that 1 in 3 mother/baby pairs "really needed that c/s".
No, it's not the lawyers that are running the show, at all. It's the malpractice insurance companies. Why is no one discussing that elephant in the room? They are the ones who set these magical protocols that the OB's are adhering to. Why is no one standing up to them? Why are insurance companies - who have even less understanding or concern for PEOPLE than anyone else in this equation - why do they have control over our actions, decisions and ultimately our healthcare?
Even the sleaziest attorney can come to the understanding that no one can predict a positive outcome when it comes to childbirth. That's the reality - no doctor, no midwife, not anyone can promise a healthy mother and baby. The midwives understand this, many of the mothers understand this. Even some of the OB's understand this. But the malpractice insurance companies don't want to take even the slightest chance that their risk of having to make a payout is increased, and... this is where the problem lies.
"careprovider" "symphysis pubis dysfunction " "chiropracter"? Dear me....
If you want to deliver at home , in a hot tub, hanging from a chandelier to the tune of "Canto gregoriano" do so by all means , but :
1. Don't call me to the bedside because you panic when the newborn has an Apgar of 3 after prolonged second stage and then make me run the code.
2. Call me to do a section after you have seen the mec , refused to do a scalp electrode/pH or CTG and now the EFM fixes the heartrate at 60.
3. Call me to the bedside after you have encountered a massive PPH because you refuse to "medicalise" deliveries by giving syntocinon after delivery (reduces PPH by 55 % RRR)
And last but not least , sue ME because I have insurance , but you don't when the feces hits the fan.
I am a DOCTOR , a scientist , a dad and a husband - I am not a careprovider/care assistant , birth facilitator or birthing coordinator and I take care of patients , not "clients"
There is no "midwifery model" , bright sparks - there is evidence based care and B/S based care and either can be performed by anyone- doctors , midwives , RN's.
PS the man's name was Hippocrates , not Hypocrates.
PPS all of the emotional diatribes are appropriate for discussion whether care was empathetic enough , but add NO substance to an intelligent debate - evidence and anecdote do not coexist - if some of you are actually providing PATIENT care , try Googling "the scientific method" , it may be a transformative experience.
PPPS fetal macrosomia as an indication for a C/S is a total non starter and there is little (if any) evidence to support it! If the patient was ''stuck at 6 cm" the indication for the procedure would have been dystocia. To perform a section merely because "the baby was too big" is malpractice in my opinion - the appropriate thing to do is a trial of labour with a low threshold for intervention and active management of labour. The EVIDENCE shows that late ultrasound and clinician weight estimation can be out by up to a kilogramme!
In general, Obstetricians are not scientists, they are clinicians. They don't usually use scientific studies to determine how they will give care, they use clinical studies. And Obs are notorious for trying the new technology first, and finding out how/whether it works later - i.e. Thalidomide, routine episiotomy, EFM, Cytotec. Even after these fun new toys are proven dangerous, they often don't stop their use - i.e. EFM, Cytotec, even episiotomy for some doctors.
Just to clarify - I think this is true of MOST Obs. There are some who don't fit this description. And I understand that some employ these things because they are the "standard of care", and the lawsuit continues to loom. But they are bad, scientifically DISproven practice.
Minor quibble here. Clinical studies are scientific studies. There's plenty of clinical research going on.
Gee...by your analogy...
The overweight smoker with a family history of cardiac problems shouldn't bother going to the ER when she experiences symptoms of a heart attack...because after all...Dr's are only supposed to care for those patients who do EVERYTHING they've been told to do by Dr's. No choosing their own risks.
Lovely. Thank you for that insight!
I am not a doctor, or a woman. Hell, I'm not even married. But I know this - you need the doctors for all complications that may occur anytime in the complicated procedure of childbirth.
Wow what an educated and insightful comment! *head-desk*
In a hospital situation (and at home for that matter) a stall of labor at 6cm is far more likely an indication that the woman's body is rebelling at the notion of birthing in the current circumstances than any particular pathology. It's not a coincidence that this is about the point where doctors start piling on the pressure to see more progress faster, and start giving that "you're so close, but we want to see things get moving" speech.
Animals won't give birth in places where they feel that they or their babies will be vulnerable. Why doctors have yet to see that prostaglandins and synthetic tocins may coerce a reticent cervix but have no effect on the mind, I still don't understand.
Dear Physician,
I would like to point out that the "midwifery model" of care does indeed exist, is recognized as differing significantly from medical and shared care models, and is specifically mentioned in a recent Cochrane Library review as a model of care that is associated with decreased rates of prenatal hospitalization, use of regional anesthesia, instrumental delivery and episiotomy. Also noted was a decreased rate of fetal loss before 24 weeks GA, an increased incidence of NSVD and increased rates of breastfeeding initiation. No adverse effects of midwifery care were identified; indeed, the reviewers concluded that "midwife-led care confers benefits for pregnant women and their babies and is recommended."
I have been the primary midwife for well over 1,000 home births and have never lost a mother or baby at any birth I have attended. The rate of preterm births (< 37 weeks) in my practice is 0.8% (not a typo). I am conservative and highly attentive to the needs of mother and baby and I have a reputation for making appropriate and timely transfers of care. My licensure allows me to provide prenatal, intrapartum, postpartum and newborn care, including diagnostic testing and referral to specialist care. Your assumptions and sweeping generalizations about the kind of care provided by home birth midwives (as evidenced by your post) are not grounded in fact. You consider yourself to be based in the scientific method: then do the research! Or content yourself with this link to the Cochrane review: http://cochrane.org/reviews/en/ab004667.html
Note that the authors concluded that "all women should be offered midwife models of care" and that "women should be encouraged to ask for this option."
I do indeed promise not to call you to the bedside in a panic, because panic is a luxury that I do not allow in a crisis. Because of my experience attending births at home, birth centers and hospitals, I have actually been known to lobby for a cesarean section before the laborist is convinced it is necessary. My patients (clients, whatever!) are happy to accept medication for a hemorrhage--but they rarely need it. (Yes, I do know very well how to estimate blood loss.)
I deeply respect obstetricians an