# Are you serious? Nobody mentioned risk?



## eilonwy (Apr 3, 2003)

I've had two c-sections, one emergency (prolapsed cord; no, my membranes were not artificially ruptured and no, I wasn't in the hospital attached to montiors or 'tied to a bed' when it happened, but that's not the point) and one elective. Both times, I was thoroughly informed about the risks involved with the procedure. Two different nurses, at least two doctors, an anesthesia specialist... in each case, I had at least 5 or 6 people explaining risks and procedures. Nobody ever said or even remotely implied that having a c-section would be safer for me or better in any way. In the case of my first (the emergency), I was certainly told that it was safer for the baby, but not in my second; there was risk to be had either way. I was given statistics for both VBAC and repeat c-section, for me and for her.

Everyone kept asking me if I understood, telling me not to sign anything if I didn't know what it meant. With my first, this went very quickly and there was a definite sense of urgency. With the second, I was in labor and they had a nurse reading everything out loud and following along under the words with a pen, talking to me and Mike before giving one of us the pen. In fact, when I decided during my pregnancy that I wanted to VBAC, I was asked to visit an OB, read several sheets of information laying out the risks of VBAC and of repeat c-section to myself and my baby, and sign that form. This was standard procedure for the hospital; there was an OB and a nurse in the room, to go over *everything* on that form. They didn't want me to sign if I didn't understand the risks involved in either choice, for me or my daughter.

How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me.







:


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## wifeandmom (Jun 28, 2005)

I can assure you that any mother in the United States who has had a c-section anytime recently signed a consent form for the procedure. And I can guarantee the consent form listed the risks associated with a c-section.

How the VERBAL exchange goes between patient and doctor can be much fuzzier I am sure.

But the WRITTEN part is cut and dry, and I'd be more likely to believe a woman flew to Mars and back to birth her baby before I'd believe she had a c-section without signing a consent form first.

Of course, if mom is physically unable to sign a consent form, one can be signed on her behalf by whomever is available to make medical decisions for her at the time. And if she arrives unconscious with nobody available to consent for her, docs are able to perform a section based on the assumption that the mother would prefer to have life saving surgery for herself and/or her unborn child.

Otherwise, there is a consent form that every.single.woman. signed. Whether or not she read it, whether or not she understood it, whether or not she was coerced into signing it, whether or not her doctor outright lied to her about the risks, etc....I can guarantee that it was signed.


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## caned & able (Dec 8, 2005)

You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.


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## laohaire (Nov 2, 2005)

I've wondered why there don't seem to be any lawsuits about HAVING a C/S done, as opposed to NOT.

I believe this is because doing a C/S is considered to be the MOST a doctor can do. Thus if a C/S didn't turn out well, there was nothing better that could have been done (kind of like if CPR is administered to someone who drowned and they died anyway, well, what else could you do?). Whereas having NO C/S resulting in death or injury - is a situation that (judges and juries believe) showed a lack of proper response, i.e. a C/S (like having someone drown and NOT performing CPR).

This makes sense given our managed-labor culture. Birth is inherently a dangerous thing (we believe); we need people DOING things about it. A C/S is the ultimate thing to DO about a birth.

I've not had or been offered a C/S but I know many people who have. One friend my age is on Medicare and she believed that she was not given the proper care during her labor and birth (ignored by staff and left alone) and at some point her mom dragged someone in and they said the baby was in distress. My friend does not know any more than this, no-one explained (and she didn't ask). She said she was told they would "need" to take the baby, sign here, and off she went. She was not told any risks or even really much what happened.

I also know another woman, the wife of the doctor my mom works for (doc is NOT an OB). She has had 3 children, all by C/S. I don't know why the primary C/S but I do know that she told my mom that she liked it better this way since it was "easier and safer." She liked being able to schedule the delivery, and that seemed to be her primary motivation, but she also mentioned safety. I don't know if she knows any of the risks; one would hope she would. FWIW they are Indian and I believe they have an even more extreme C/S culture than we do.


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## sapphire_chan (May 2, 2005)

Quote:


Originally Posted by *caned & able*
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.

She didn't say that. She just said there would be a consent form not that it was an indication that the women were properly advised.

Quote:

Whether or not she read it, whether or not she understood it, whether or not she was coerced into signing it, whether or not her doctor outright lied to her about the risks, etc....


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## laohaire (Nov 2, 2005)

Quote:


Originally Posted by *caned & able*
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.

She didn't say that. She said every mother signed a document (which I'm sure VIRTUALLY every mother did - but probably a couple didn't). And admitted the verbal exchange probably varies.

It's up for debate whether signing a document is proper advisory, and I doubt many people here will say that it is enough given many factors (such as: time pressure, feeling intimidated, poor reading skills, low knowledge of medicine and physiology, and even just the routineness of signing contracts with tiny print and not reading it which we do all the time in this culture - for the phone service, mortgage application, release of medical records, etc.).


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## member234098 (Aug 3, 2002)

In my many years as a childbirth educator, I have known many women who were 'promised' a perfect baby if they would 'consent' to a surgical birth. These women were told such stories as the baby would have a nice round head and not be damaged and squeezed from the trip down the birth canal or bruises from forceps or a vacuum extractor; no episiotomy stitches is also sold as a plus.

The fact that the squeezing in the birth canal may help the baby prepare to breathe and that forceps, an extractor, or an episiotomy are not a necessary part of a vaginal birth is not told to expectant mothers.

Initially many women feel the surgery was very necessary. Then they begin to realize it may not have and become angry.

Just "deliver from above", a heavenly experience. Who wants to deliver from below!


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *eilonwy*
How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me.







:

hmm...first section: Flawless pregnancy - no complications. Labour was going well - arrived at the hospital at least 8cm dilated (10 during contractions). It was determined that ds1 was frank breech, and I was told that I was having a section. I said "no" - several times. I was completely ignored, and wheeled into OR. I consented, in that I had preregistered at the hospital, which includes a "blanket" consent. I didn't sue, because...well, I just don't. My financial situation at that time was such that I had $125/month to live on after the rent was paid...a lawyer was out of the question. I just promised myself a VBAC next time, and focussed as much as I could on my baby, not my scar (it helped, but I was still a wreck).

Second section: I'd been trying to conceive for 10 years, with only three miscarriages (all quite close together) to show for it. However, my fifth pregnancy had gone without a hitch, just like my first. My doctors (FP & OB) were both very positive about me having a VBAC. At 39 weeks, my FP determined that my baby had turned breech. I went for an ultrasound to confirm. The next morning, I was woken up by a phone call from the OB's office telling me that my section was scheduled for the following day (39w, 2d). I went ballistic. I had a couple of conversations with each doctor that largely consisted of me crying, freaking out and stating that I wanted to at least wait for labour so that the baby might have time to turn (only partly true - scheduling without labour just felt _wrong_). OB said my baby was too big (u/s had estimated 8lb.15oz.) to turn. I thought that sounded stupid, but neither doctor would listen, and my mental state was not good. (I've had a lot of emotional upheaval and issues over the primary section, the inability to conceive and the miscarriages - I'm not sure I'm totally emotionally stable on the issue of my reproductive life.) I allowed myself to be badgered into the second section, because I couldn't find a single toehold in the medical wall of "this is the only way to go".

I was assured that my baby would be healthy with the section. No risk to me was ever disclosed. I was, of course, told not to eat or drink, but not told why (I did already know, but I wasn't told). And, yes - when I arrived, I signed the stupid form - I didn't even read it. I'm not sure I was capable of reading or comprehending anything at that point, anyway. I was kind of hoping that something would go wrong, and I'd die on the table, instead of having to live with another section, so the risks didn't seem very important. The form only confirmed that my OB had discussed the risks of the surgery, anyway (he hadn't).

_After_ they'd taken dd, my FP got around to telling me that two sections meant an automatic repeat.

Third section: I got pregnant, with hesitation, because I finally decided that another section was better than not having a baby. I didn't like it, but I thought I could handle it. After a month straight of nightmares, I told my FP I wanted a VBAC. She was totally unsupportive, but said we could talk to the OB. He wasn't very supportive, but said that he understood that psychological factors are also important, so we'd go ahead.

I got negativity and pressure from my "care" providers the entire pregnancy. I looked into the local midwives, but they couldn't take me because I'd had more than one section. I couldn't find any other doctor/midwife who was more supportive. (It was during that pregnancy that I found MDC.) There was nobody to switch to. At 41w,4d, my OB told me that if I chose to "continue this course" (ie. wait for my baby instead of having a section the following day), then he'd withdraw from my case. So, I cried for about 24 hours, and went to the hospital and had my section. Once again, I signed the stinking consent form that says I was "informed of the risks". (I'll make it clear that I was _not_ - my section was presented to me as the only safe option, and a guarantee of a "healthy mom and healthy baby".) At first, I tried to be positive - I was recovering well, and I'd at least gone into labour first. My doctors had wanted to schedule for three weeks earlier, so that was a little victory, at least.

Well - that was long. To make it short: No. I've never been informed of any risk involved in having a c-section. They've consistently been presented to me as the safe way to have a baby, and I've been consistently assured that a section was necessary for a healthy mom and healthy baby. I wish I'd had the guts to go unassisted (although a homebirth wasn't a really reasonable option with my last two, as I was living at my mom's house), because my desire to have a "care provider" present put me a position where I was too easily bullied and coerced.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *caned & able*
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.

Please go back and READ what I wrote.

I can guarantee you that every single mother signed a consent form.

That can be vastly different than 'properly informed', something else I clearly addressed in my post.

I am more likely to believe a mother flew to Mars to birth her child before I will believe a doctor performed a section on a woman WITHOUT a consent form signed for the procedure.

I am not above admitting when I am wrong, and if there is a case of a woman being operated on against her wishes WITHOUT a consent form, my advice would be for her to sue the doctor for everything she could, as there is simply NO WAY she would ever lose that lawsuit. Consent forms are required for a reason, and when I see it announced on the nightly news that a woman was sectioned WITHOUT signing a consent form, I'll believe it then.

Oh, and I also addressed the issue of when mom is physically UNABLE to sign and how that works, so if there is any confusion on that matter, please go back and carefully read that portion of my post as well.


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## caned & able (Dec 8, 2005)

It is generally taught to students in medical school that women in labor are temporarily insane. That is clear in the older obstetrical texts, i.e., Williams' Obstetrics. I wonder how it can be justified that any woman in labor can legally consent to any procedure.


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## ~member~ (May 23, 2002)

Quote:


Originally Posted by *wifeandmom*
I am not above admitting when I am wrong, and if there is a case of a woman being operated on against her wishes WITHOUT a consent form, my advice would be for her to sue the doctor for everything she could, as there is simply NO WAY she would ever lose that lawsuit. Consent forms are required for a reason, and when I see it announced on the nightly news that a woman was sectioned WITHOUT signing a consent form, I'll believe it then.

The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!" It's all in my medical reports and everything, and, yet, no lawyer would touch my case.
And, that was only the beginning of my horrendous birth experience.


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## sapphire_chan (May 2, 2005)

Addressing Storm Bride's experiences for a moment, Wifeandmom, would a hospital blanket consent form count as a "permission to section" form?


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## caned & able (Dec 8, 2005)

Quote:


Originally Posted by *MamaInTheBoonies*
The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!"









Is this considered informed consent?

That is sadistic!


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *caned & able*
It is generally taught to students in medical school that women in labor are temporarily insane. That is clear in the older obstetrical texts, i.e., Williams' Obstetrics. I wonder how it can be justified that any woman in labor can legally consent to any procedure.

Valid point, one that DH considers every time he 'consents' a woman for an epidural during labor. How can a woman in agony, demanding pain relief RIGHT NOW, truly even give thought to the risks of an epidural when the alternative, in her mind at least, is simply DYING of pain?

So what is the solution here? Doctors aren't going to operate without a consent form signed. Period. So if mom cannot possibly consent while in labor, who CAN?

And is your argument now that the consent form signed isn't the point, that a woman in labor cannot consent in the first place, therefore the doctor should do what exactly? Refuse to operate cause mom can't consent properly? Doc would get sued for NOT operating if something went wrong, and they know it.

I've yet to read about a woman having surgery that did NOT sign a consent form. I'm reading where women signed forms KNOWING that the information contained therein was NOT accurate. Why is that suddenly the doctor's fault?

If you don't want to sign it, DON'T SIGN IT. But don't whine about signing it later claiming you had no choice BUT to sign it. Nobody is holding a gun to your head, and I'd venture to guess that most docs would refuse to operate on a conscious woman who REFUSED TO SIGN THE CONSENT FORM.

By signing it, you are legally agreeing to whatever is written in that document. If it says 'My doctor has explained the risks.', you read that and know it's not true, but you sign it anyway...whose fault is that? It is so incredibly unrealistic to come back later and say 'Well, he SAID such and such' and expect that to hold more weight than what is actually IN WRITING.

This goes for ALL contracts, consent forms, permission slips, you name it. You sign it, you better know what it is you are agreeing to.


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## caned & able (Dec 8, 2005)

Are you saying your DH is not responsible for the damage that he may do to a woman in labor because she signed for it while in labor?

Have you ever gone to court?

Some people think they have the right to do whatever they can get away with as long as they can cover their butt with paperwork.

To Sapphire-Chan, it is generally agreed in the legal community that as long as the doctor is acting within the standard of care, no malpractice was committed.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *caned & able*
Is this considered informed consent?

That is sadistic!

Ok, now that I'm thinking further into the realities of the situations being presented, the lawsuit thing may or may not be a 'slam dunk' if mom refuses a section.

Here's why...

If the prevailing standard of care is to section for x, y, z condition, and mom REFUSES a section under those conditions, I can see how a lawyer would refuse to take the case regardles of her refusal to consent.

Why?

Well, let's take a breech baby for example. Prevailing standard of care in most hospitals is to automatically section. There is NO research supporting vaginal breech delivery without an experienced provider, and even then, it's questionable as to what is safer.

So, if mom comes in with a breech baby, insisting that they deliver said baby vaginally REGARDLESS of the fact that it is NOT supported by research unless the hospital happens to have someone on staff with experience in delivering this type presentation, how would a lawyer ever win that kind of case? Especially when the bottom line is that if something DOES go wrong during that vaginal breech delivery, mom is going to sue (and probably win) regardless of the fact that SHE is the one who insisted on doing it that way to start with.

If we eliminated the threat of lawsuits, the birth climate would change dramatically. Of course, some lawsuits are worthy, so it would also open up an entirely different set of problems.


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## velcromom (Sep 23, 2003)

sorry

but "informed consent" with or without signatures on yellow papers has been a travesty in both my boy's births


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *caned & able*
Are you saying your DH is not responsible for the damage that he may do to a woman in labor because she signed for it while in labor?

Huh? Where would you get that idea?

What I was saying is that DH considers this concept of a woman in labor not TRULY being able to consent to getting an epidural if she's in such pain that NOT getting the epi, in her mind at least, equates to dying in agony on the spot. How can a woman truly weigh the risks vs. benefits when the only thing she sees at the time is that she thinks she's going to die without some relief right that very instant?

But then that very same woman who was BEGGING for him to just give her the epidural wants to then come back and say 'Well, he never told me I could have this or that go wrong as a result of the epidural or I wouldn't have gotten it.' So they have a consent form that must be signed outlining all of these complications as it's the best system they can come up with.

Anyway, what my own DH would likely never be held responsible for would be the woman who comes back and says 'Well, he never told me I might have x, y, z complication from my epidural.' when said complications are stated in black and white right there on the consent form that mom signed.

As long as he does nothing NEGLIGENT or beyond the scope of his license to practice or outside of what is considered standard of care at the time, then NO, he will not be held responsible for complications.

He's never been sued himself, but we know several who have. One such case WAS lost as a direct result of the anesthetist deviating from the standard of care in that particular case. All of the other cases we've known about personally never made it to court because what the patient was suing over was a known risk factor of whatever procedure they were having, and the complications suffered in each case were NOT the result of negligence, deviation from standard of care, outside the scope of practice, etc.

Quote:

Have you ever gone to court?
For what?

Quote:

Some people think they have the right to do whatever they can get away with as long as they can cover their butt with paperwork.
DH is personally very content to sit on his butt in the call room, never putting in a single epidural while working L&D. He gets paid the same either way, and there's no chance of being sued if he's watching ESPN. He ceratainly doesn't have this attitude of 'getting away with whatever he can' in terms of putting in epis for women in labor.







Unless you count getting away with NOT putting in an epi for anyone, cause like I said, he gets paid the same to sit there watching TV as he does to deal with a dozen women in labor all screaming at him at once.









He doesn't go around the unit weilding his big needle just looking for some unsuspecting woman to stick when she least expects it. He talks to each woman in labor when they are admitted (per hospital policy), introduces himself, gives the woman a run-down of what anesthetics he can use if she so desires, and tells her to let the nurse know if/when to call him should his services be needed. Then he does just that...waits for the nurse to page him if his services are needed.

He detests working L&D because women in labor are NOT known to be rational creatures and lawsuits arising from L&D care are WAY more likely than in other areas of practice, regardless of whether or not said lawsuit has any merit.

Anyhow, DH has the right to practice within the scope of his license as long as he does so competently and with due diligence.

Quote:

To Sapphire-Chan, it is generally agreed in the legal community that as long as the doctor is acting within the standard of care, no malpractice was committed.
This would be my best guess as to why no lawyer would take on whomever's case that was 'forced' to sign the consent form, although I'm not certain cause I can't remember off the top of my head why they said she needed surgery to begin with.


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## midwifetx (Mar 16, 2005)

Here's how it goes around here.

"Ok, here is the paperwork for your c-section. Sign here saying you allow us to do anesthesia and here to allow us to give blood products if you need them, and sign here consenting to the surgery, and initial here saying that we are not responsible for any jewelry or personal items. Have any questions, ok, now lets get you that epidural and get your baby out."

If the mom stops to read the stuff, the nurse stands there tapping her foot and looking at her watch.

Now, this isn't every case, I'm sure, just the ones I've seen.

FWIW, the last anesthetist was the best care provider we saw the entire trip. He even came back in later to sit and chat with the family. I've never had an experience like that.


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## MsElle07 (Jul 14, 2006)

I think the larger issue is that often women do not give *truly* informed consent. Signing a form may give the doctor some legal protection, but it does NOt equal truly informing the mother of the risks of a C-section. Do doctors say to women, "You are three times as likely to die from having this operation, instead of birthing vaginally?" My guess is no.

Is it really possible for a woman to give truly informed consent when she is faced with the choice: either have this operation, or your baby will die? For the vast majority of mothers, they truly believe that their baby will be likely to die. They are not able to carefully weigh the pros and cons when a doctor plays the dead baby card.

Sometimes, a baby IS truly likely to die. The World Health Organization puts that figure at about 10% of the time. And for that 10% of the time, I am thankful that C-sections exist. (This 10% figure does not take into consideration other medical conditions beyond fetal distress which makes vaginal birth too risky for the mother, so saying that 10% of *babies* need to be born via C-section is probably artificially inflated.)

But the other 25% of the time that C-sections are performed are likely for non-emergent situations, and even though a woman is led to believe it's what's best for her and her baby, the statistics show that babies and mothers do better with vaginal deliveries.

So no, signing a form does not equal informed consent.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *MsElle07*

So no, signing a form does not equal informed consent.

So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.

And then there are the people who are going to blame anyone other than themselves no matter how much of an explanation is given. We know of one OB who was sued for a VBAC rupture related neonatal death. I *know* what the policy is in that particular clinic for addressing the risks of VBAC vs. ERCS because it's the same clinic I used when pg the second time myself, so I went through that entire consent process.

Even though everything was done to inform mom of the risks, to prevent rupture, to deal with rupture when it was detected...well, sometimes the baby is STILL going to die no matter what the doctors in question do. And so it was with this woman, who then tried to come back and say 'Well, they never told me that my baby could die if I tried for a VBAC.'

Which was a load of crap...she wanted to VBAC, so she did, and the results were less than what she wanted, so she wanted to blame someone else. Thankfully she was laughed out of the lawyer's office when it was realized the very extensive consent process that was in place when she consented to this VBAC attempt.

In the end, it was the string of signed forms that protected the OB in question from being sued, despite this woman's desire to blame the doctor for HER choice and its very unfortunate end result.


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## wifeandmom (Jun 28, 2005)

I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section? Therefore, if she consented, it simply MUST be because she was coerced, as sections aren't 'necessary', aren't ever the 'preferable' way to give birth, etc.

When people have the attitude of 'Why would a woman EVER agree to a section?', I can see where this idea of 'informed' consent being impossible to obtain comes from, despite the fact that the entire thought process leading up to this conclusion is bizarre at best.


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## ericswifey27 (Feb 12, 2005)

Quote:


Originally Posted by *Storm Bride*
Well - that was long. To make it short: No. I've never been informed of any risk involved in having a c-section. They've consistently been presented to me as the safe way to have a baby, and I've been consistently assured that a section was necessary for a healthy mom and healthy baby. I wish I'd had the guts to go unassisted (although a homebirth wasn't a really reasonable option with my last two, as I was living at my mom's house), because my desire to have a "care provider" present put me a position where I was too easily bullied and coerced.

That's how I feel it went with my csection too.


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## ~Megan~ (Nov 7, 2002)

I'm not sure. I have the feeling that some OBs just think they know best and you don't need all the information, just enough to get you to choose what they think is right.

I was never told how big a deal a c-section was. I was never told how painful it was or how long it would take to recover. I was never told that the hospital would soon revoke the ability to VBAC.

I was utterly and truly uninformed. I thought a c-section was easier and less painful than a natural delivery.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *wifeandmom*
I've yet to read about a woman having surgery that did NOT sign a consent form. I'm reading where women signed forms KNOWING that the information contained therein was NOT accurate. Why is that suddenly the doctor's fault?

How about because women who are harangued, hassled, bullied, and scared are not "consenting" in the legal sense of the word? I was told for months that I could die (with such emphasis that they might as well have said WILL die), that my baby could die (with even more emphasis), the VBA2C just too risky, that all "we" - the doctors - wanted was a healthy baby and a healthy mom. I tried to find another caregiver - couldn't find anybody. Sure - I signed the stinking form. I'd tried to research my rights if I went into labour with no doctor, but I couldn't find anything (I'm not in the US). At the end, I was told I'd have to go it alone if I did anything but what the OB had determined - within the vile standards of "care" - was best for me.

When you're in a mental place where you're just hoping the knife slips and you don't have to face life afterwards, the wording of a document doesn't really matter much.

How is it _not_ the doctor's fault when they deliberately back someone into a corner and make threats in order to get that signature? More to the point, how is it _not_ the doctor's fault when a woman is wheeled into OR saying "no" and trying to sit up to remove her IV? I don't care what I signed when I was admitted to the hospital...I verbally refused consent and was completely ignored.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section?

Really? Where have you seen that?


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.

Consent forms should be read to the mother and father during an office visit before labor begins, for starters, so mothers have a chance to absorb that information before being faced with labor. The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."

Haven't we all consented to treatment at some point without reading every single bit of the fine print? Of course. I am an educated woman, not intimidated by doctors or medical jargon. Two years ago I went to the ER because I had been vomiting up everything I put in my mouth (including water) for four days, with no improvement. I had a nursing baby. When I got there I was so miserable that I gladly consented to anything they wanted to give me to make me feel better. I did not read the three page consent form in its entirety. I did not feel well, my head hurt, I was nauseous, etc. Most people do not read the consent forms they sign.

Because women are seeing their care providers regularly throughout pregnancy (usually), it would make sense that their care providers discuss the risks of the procedure that they are 35% likely to have when their child is born. Unfortunately, part of the problem lies in the fact that many doctors are not up to date on their research and/or are inherently biased toward C-sections, which will alter the advice they give to women.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *MsElle07*
I think the larger issue is that often women do not give *truly* informed consent. Signing a form may give the doctor some legal protection, but it does NOt equal truly informing the mother of the risks of a C-section. Do doctors say to women, "You are three times as likely to die from having this operation, instead of birthing vaginally?" My guess is no.

Mine did; both OBs who performed the sections, and both anesthesiologists told me about the differences involved in spinal vs. epidural anesthesia. In the case of my first section, I was *strongly* advised to take the spinal because it would start working more quickly and time was of the essence, but with the second I was given the choice.


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## Full Heart (Apr 27, 2004)

Quote:

How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me.
There is a saying, 'The only c/s a dr has even been sued for is the one he didn't do.' Of course I have read of 2 lawsuits about c/s that weren't needed in the last few years but I am sure there are way more the other way.

I have also read a few news stories of women who were forcibly secitioned (as in lawyers went to court and got a court order to section her). In the one case the women left the hospital, the hospital got the court order in case she returned but she had gone to another hospital where she safely delivered a healthy but very big baby (but apparently not her largest which is what the section would have been for). I would bet money that the only risks they were informed of is what would happen if they didn't have one.

A woman may have all the risks about a c/s but she might not have the correct risks for vaginal birth. In other words she might belive that having a c/s would save her baby because she had been led to belive that a vaginal birth would be much riskier (And I am not talking about actual need here - and I can't belive here on MDC do I have to make such a disclaimer







: )

Anyhoo - informed consent if one of those things that probably needs to be discussed long before labor. Of course drs take 5 min in an appt and hospital child birth classes probably don't perpare you properly, so education is difficult. And I'm not talking just c-birth here. Everything pregnancy, labor, and birth related.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *MsElle07*
The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."

Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.

As it is, what's the episiotomy rate in hospitals today? Regardless of the what the rate SHOULD be, we'd have to tell first time moms that they have a 1 in 3 chance of having a episiotomy. We'd have to tell them their baby had a 1 in whatever chance of dying from a whole host of things during vaginal birth...NOT just the stuff suggested thus far, which very convienantly focuses on the real risks of sections.

My point is we'd have to give them the ENTIRE picture, with ALL of the numbers, and if I were a betting woman, I'd say the elective c-section rate would only go UP if we did that.

Quote:

Most people do not read the consent forms they sign.
And that means we can then blame the doctor because????


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## caned & able (Dec 8, 2005)

You must have a very low opinion of pregnant women's intelligence. I am so sorry.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *wifeandmom*
Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.

Now you think doctors should provide risk information for a normal process? That doesn't even make sense. Vaginal birth is the natural consequence of getting pregnant. Even if you choose a primary section, you could end up with a vaginal birth (go into labour early - not near a hospital, for example), because a vaginal birth is what will happen _if no doctor ever gets involved_ (I'm not arguing that things can go wrong, and the baby and/or mother could be severely injured and/or die. That's beside the point.) If a vaginal birth is what will happen _without a doctor present_, why on earth should/would a doctor provide risk analysis for informed consent for a vaginal birth???


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *caned & able*
You must have a very low opinion of pregnant women's intelligence. I am so sorry.









I'm not sure I get this one.

Storm Bride-- just to play devil's advocate, I'd have to argue that vaginal birth in a hospital, even under the best of circumstances, is not "the natural consequence of pregnancy." Your argument only makes sense (to me) in the context of unassisted birth.


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## Storm Bride (Mar 2, 2005)

If I agreed to a primary elective section for some reason, that doesn't preclude the possibility of my going into premature labour, and possibly delivering my baby with no doctor involved. (I had one friend who had her second baby less that five minutes after getting in an ambulance...the EMTs were there, but they didn't have time to really do anything. A neighbour gave birth in the parking lot at our complex about a month ago - on her way to the hospital.)

Yes - doctors get involved and do all kinds of weird crap to our bodies during a vaginal birth. But, that doesn't make vaginal birth a medical procedure, no matter how hard they try to make it one.

I could maybe see having to provide a risk analysis of the risks of primary c-seciton vs. the risks of medical intervention in a vaginal birth. But, I provided consent to a vaginal birth when I got pregnant.


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## ksera05 (Apr 14, 2006)

Quote:


Originally Posted by *wifeandmom*
I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section? Therefore, if she consented, it simply MUST be because she was coerced, as sections aren't 'necessary', aren't ever the 'preferable' way to give birth, etc.

When people have the attitude of 'Why would a woman EVER agree to a section?', I can see where this idea of 'informed' consent being impossible to obtain comes from, despite the fact that the entire thought process leading up to this conclusion is bizarre at best.

I have seen this attitude around here too.

I think the biggest reason that some people have that attitude of "why would you EVER consent to that?" is that their Csection experience was one that wasn't necessary or needed, as opposed to one that saved someone's life.

My c-section saved my daughter's life (and probably mine too, depending on how you look at it) and I am so thankful for it. I was also informed of the risks before he did the c-section. However, I can see how someone who had a completely unneccessary c-section could not understand how anyone would want a c-section. They've just never been in a spot where it was actually necessary.

Just some thoughts.


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## jkpmomtoboys (Jun 1, 2004)

Quote:


Originally Posted by *MamaInTheBoonies*
The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!" It's all in my medical reports and everything, and, yet, no lawyer would touch my case.
And, that was only the beginning of my horrendous birth experience.









If this is true, that a nurse made you write your name while you told her you didn't want to, then I will find an attorney to take your case. Provided there are no little details you're leaving out.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *Storm Bride*
Now you think doctors should provide risk information for a normal process? That doesn't even make sense. Vaginal birth is the natural consequence of getting pregnant. Even if you choose a primary section, you could end up with a vaginal birth (go into labour early - not near a hospital, for example), because a vaginal birth is what will happen _if no doctor ever gets involved_ (I'm not arguing that things can go wrong, and the baby and/or mother could be severely injured and/or die. That's beside the point.) If a vaginal birth is what will happen _without a doctor present_, why on earth should/would a doctor provide risk analysis for informed consent for a vaginal birth???

Um, cause if a doctor IS involved, then there is a CHOICE to make. And how can a woman make a CHOICE when she is only given one side of the picture? I'm honestly perplexed here, as I've truly never seen it suggested that it's unreasonable to look at the ENTIRE picture when making medical choices.

It almost seems as if pro-VB folks are AFRAID to look at the real numbers, lest their long-held beliefs be brought into question.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *caned & able*
You must have a very low opinion of pregnant women's intelligence. I am so sorry.

I really don't in general, but dang, then I read some of the stuff people write and I admit I have to wonder sometimes.







:


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## doctorjen (May 29, 2003)

Hell, yeah, women ought to be informed what their risk of episiotomy and other intervention in their specific birth setting is. They ought to be informed about the risks and benefits of every intervention proposed - from being encouraged to stay in bed to continuous monitoring, to operative deliveries. I'm quite certain they are not in general receiving such information in general, though.

And I don't know where your dh practices, wifeandmom, and maybe the custom is different their, but around here, and in every hospital I've ever been in, surgery and procedure consents are pretty generic. They say that the person signing has been informed of the risks, benefits and alternatives, and has had the opportunity to ask questions. They say that their may be students involved, and that any pictures or other record taken are the property of the hospital. They don't list the specific risks for specific procedures. Most consents I've seen obtained (not my own, though!) go like midwifetx reports -"Here, sign this so we can do your surgery."

The actual piece of paper that is signed is virtually worthless in a court case, though. Courts actually do engage in a fair amount of "he said, she said." That's why docs are encouraged to write a separate note before doing a procedure that indicates what risks and benefits exactly were communicated to the patient. It is exceedingly rare for a court to grant an order for a cesarean section these days - there have been several cases that went to state supreme courts were women sued and won after a court order was granted. Basically, the rightsof a woman to make decisions for her own body have consistently been upheld, even if it is believed that she is endangering the baby.

Women ought to be presented with all the risks and benefits of any medical intervention not because then they would surely decline a cesarean, or whatever, but because it is their body and they have the right to that information. I've never had a client refuse what I thought was a necessary intervention when she had the risks and benefits explained to her. And if someone did refuse something I thought was necessary, I'd at least feel comfortable that I'd explained it well, although I'd still grieve the outcome if it was poor. Women are not stupid or irrational - in labor or otherwise. Men have been using that argument for years to keep women out of power - in the workplace, in legal matters, and in healthcare relationships with disparate power.

Of course women should understand what the risk of uterine rupture is with a VBAC, and what the risk of 4th degree extension with an episiotomy is, and what the risk of death from a cesarean section is. To argue otherwise is beyond ridiculous.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *doctorjen*
Women are not stupid or irrational - in labor or otherwise. Men have been using that argument for years to keep women out of power - in the workplace, in legal matters, and in healthcare relationships with disparate power.

I don't think women are stupid, however I *do* think they can be irrational while in labor in terms of informed consent when all they want is to be out of pain, and who cares about the potential complications. Does that make sense? It has nothing to do with being a woman, everything to do with being in often the worst pain they've ever experienced.

Quote:

Of course women should understand what the risk of uterine rupture is with a VBAC, and what the risk of 4th degree extension with an episiotomy is, and what the risk of death from a cesarean section is. To argue otherwise is beyond ridiculous.
My thoughts exactly.


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## doctorjen (May 29, 2003)

I absolutely think it has a lot to do with being a woman. Men in pain are not considered irrational, but women in labor can't be trusted to understand the decisions they are making? So therefore, we don't have to give them the whole picture? I have repeatedly heard this arguement made about episiotomy, or cesarean birth, or especially epidural anesthesia. I think many in healthcare do not acknowledge the power politics that are often present in a doctor-patient relationship. And to be personal, as a physicians' wife you may have a skewed perception of that as your own physicians are likely to make darn sure they are thorough and evidence-based with you because of your own level of education and the fact that you are married to an insider. An 18 yr old poor, black woman may not be accorded the same courtesy - and since I did my medical school and residency in extremely depressed socio-economic areas, I saw that repeatedly. I still see a fair amount of "don't bother your pretty little head about this" from male docs.

An anesthesiologist I worked with a lot (but who has unfortunately recently moved) did great informed consent. He would tell women "I know you are in a lot of pain, and I want to help you, but I need to know you've heard me, so please let me explain some things to you, and you let me know you understand, okay?" I never had a single woman unable to listen to his informed consent discussion, even if they were screaming a minute before. And I saw a few women change their mind after he explained himself, and most not change their minds, but have a true understanding of what they were agreeing to.


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## LadyButler (Sep 16, 2005)

Quote:


Originally Posted by *doctorjen*
An anesthesiologist I worked with a lot (but who has unfortunately recently moved) did great informed consent. He would tell women "I know you are in a lot of pain, and I want to help you, but I need to know you've heard me, so please let me explain some things to you, and you let me know you understand, okay?" I never had a single woman unable to listen to his informed consent discussion, even if they were screaming a minute before. And I saw a few women change their mind after he explained himself, and most not change their minds, but have a true understanding of what they were agreeing to.

He sounds like an anesthesiangel! There should be more like him so folks really know what they're getting into!

I was reading sample birthplans in my m/w's book... and one of them happened to be the plan of a doctor... (who, interestinly enough was doing a homebirth...)... but she put in her "in case I have to transfer and have a section" part of the plan that she wanted general anesthesia rather than a spinal or epidural. I asked my m/w about it and she said that the woman had simply seen too many things go wrong with spinals and epidurals... I found that quite interesting! I don't know that I would have made the same choice even if I knew what she knew... but that's what she wanted. I did find it interesting though.

I suppose when you get down to it... what one person sees as an unacceptable risk or consequence, another would see as perfectly acceptable. Avoiding something going terribly wrong (however likely or otherwise) with her spinal was worth not being conscious for her birth and not being able to bond with her baby until later. Personally, I would never have another child if I had to have another c/s for any other reason than a true true true emergency... any of the risks associated with a VBAC are miniscule in my opinion- even comparing with the emotional trauma of a c/s alone. That said... I have a friend who LOVED her CNMs so much that even when they told her she was automatically going to be sectioned for her second... she stayed with them.

Different strokes for different folks.

(I still know in my heart and from everything I've read that for the VAST majority of women, a VB is much safer than a c/s. PERIOD.)


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *doctorjen*
I think many in healthcare do not acknowledge the power politics that are often present in a doctor-patient relationship.

I totally agree with this. My doctors (both of them, including my _female_ FP) had a very notable "we're the experts - just don't bother yourself with this" attitude about every single step of things. After ds2 was taken, my OB referred to his threat to drop me as "giving [me] a push", because "he never would have come out" the other way. He wasn't giving me a "push" - he was threatening to leave me with no doctor when I was already in labour, which wouldn't have bothered me _at all_, except that I was concerned about the damage the medical profession had already done to my uterus. I'd bet that if he were asked, he still thinks he was doing me some kind of favour...

wifeandmom: The more you talk, the more I know that if I have another baby, I'm not going anywhere near a hospital. Informed consent for vaginal birth? For what? So that I understand that there's a risk that they'll stick a needle in my spine, slice up my vagina the way they have my abdomen and administer god-knows-what into my bloodstream without telling me? I don't need to give anybody informed consent if there's a next time...because there's nothing to consent to.

I guess the real reason you and I won't have a meeting of the minds is summed up right here:

Quote:

I'm honestly perplexed here, as I've truly never seen it suggested that it's unreasonable to look at the ENTIRE picture when making medical choices.
I wasn't making any _medical_ choices, until some stranger cut me open against my will. Before that ...person...got hold of me, it wasn't a medical decision. I was having a baby. That's not a medical procedure. I don't need to give a doctor informed consent for a vaginal birth, because no doctor is coming near me. And, yes - I know that I might die, and my baby might die. I know that the odds of my baby dying, or of me dying, are increased because of my thrice-scarred uterus. What I don't know is why that seems like a good reason to trust my body and my baby to the doctors again.


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## eilonwy (Apr 3, 2003)

Maybe I'm just strange, but I have *never* signed something which I hadn't/was unable to read in it's entirety. Well, that's not true: there have been times when I've signed things quickly without reading thoroughly, but each time they were forms that I had signed before. When I've got a migraine and I'm in the ER begging for a shot of demerol, I don't read the "permission to treat" form again, I just look at the sequence of numbers along the bottom to make sure they haven't changed it since I last signed it.

The idea of forced consent or lack of [informed] consent really really upsets me.







I understand that not every woman has done her research before she consents to a birth intervention of any sort, but when it comes to medical intervention, I believe that it's the doctor's duty to obtain informed consent, and if they haven't... well, why that's why their malpractice premiums are so high.







Take my sister-- she had two very easy births, with very little intervention. (This is why I'm using this as an example; my sister was told by the triage nurse to go home; they actually called a cab for her about half an hour before my niece was born, because they were convinced that she wasn't in labor at all. She had no monitoring at all, and by the time she was wheeled back to the delivery room she could feel the baby crowning and refused to stand up during a contraction because she thought the baby would fall out onto the floor.







) Not only did she not become irrational during labor, she didn't experience any pain. At the age of 18, her second child got stuck; she had a contraction, my niece's head came down and instead of the rest of her body sliding out, her shoulders got caught. The medical folks who were involved turned the baby, and she slid right out on the next contraction. I'm inclined to doubt that anyone asked permission to turn the baby right then. I know that my sister hadn't read anything about shoulder dystocia, and that any risks involved in interventions (natural or otherwise) were probably not explained to her.

The question is, why? It wasn't because she was young, poor, nonwhite, female, or really any of those things; they simply turned the baby because that was what needed to happen. I know that they didn't have consent of any kind, because my sister didn't sign the admission forms until after BizzyBug was born.

As far as uninformed consent, I think that's pretty much the limit. If I felt for one single moment that either of my c-sections was forced, I'd still be looking for a lawyer. There's no way in hell that I'd be able to move on from that until I'd done everything in my power to stop the person who forced that on me from practicing medicine. In my case, the only birth I feel badly about was my first, which was a vaginal delivery. I seriously considered suing in that case, I honestly believe that my doctor was negligent and cruel. I don't believe that my son's birth needed to go down the way it did. But what can I say? A c-section would have been safer for both of us? I know that's true! I didn't consent to a c-section, though, I didn't push the issue (though in retrospect, I wish I had).

Surgical consent is a *HUGE* deal. If women are truly being forced to consent to unnecessary surgical birth, then more of you should be filing lawsuits. There has got to be a way, because that's just entirely unacceptable. I'm still having a hard time wrapping my head around the idea.







I do understand a bit more why so many women feel miserable about their c-sections, though. I'd probably be pissed too if someone had held my hand and forced me to write my name on a consent form.







:


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.


You previously acknowledged that a large percentage of the risk of vaginal birth is from the way the American medical system treats birth. So, yes, they SHOULD have to require informed consent for things like epidurals and other procedures before labor begins.

However, we fundamentally disagree on one thing: vaginal birth is not a medical procedure. It a natural process, not something that is performed on you. To inform someone of the risks of vaginal birth _in and of itself_ -- barring medical intervention -- is akin to informing someone of the risks of coughing. Coughing can break blood vessels in your face! Coughing can lead to irritation and inflamation of the trachea and bronchii! Coughing can lead to heartbeat irregularities! Coughing can cause hernias! But asking someone to become to "consent" to a natural process, something over which they have no control, is silly. The same is true of birth. Are there some inherent risks? Yes, just as there are with coughing and breathing. But the idea of informed consent for something over which the mother has no control is ridiculous. (By no control, I mean that her body WILL go into labor and birth the baby regardless of whether she gives informed consent.)


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
Surgical consent is a *HUGE* deal. If women are truly being forced to consent to unnecessary surgical birth, then more of you should be filing lawsuits. There has got to be a way, because that's just entirely unacceptable. I'm still having a hard time wrapping my head around the idea.







I do understand a bit more why so many women feel miserable about their c-sections, though. I'd probably be pissed too if someone had held my hand and forced me to write my name on a consent form.







:

They don't sue because it costs huge quantities of time and money. And they have to be able to prove that some kind of harm happened to them as a result. It's very difficult to sue for pain and suffering only -- there usually needs to be some sort of expense to recover. For example, if a doctor didn't obtain informed consent and carelessly nicked the bowel of the mother during surgery, and the mother had no insurance, she would likely be able to recover damages from his insurance company for the medical costs, and perhaps punitive damages as well. If the only harm done to her was psychological (which is very real, but hard for juries to understand), she will have a hard time finding a lawyer to take her case, and a hard time convincing a jury that she deserves some kind of award. If the baby is healthy, lawsuits often go nowhere.

Also, many women don't feel that money will take away the trauma they suffered. It's not about the money to some people.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *MsElle07*
To inform someone of the risks of vaginal birth _in and of itself_ -- barring medical intervention -- is akin to informing someone of the risks of coughing.

Not quite, and certainly not in every circumstance. Can you see that there might be reasons to avoid coughing, for certain people? Shouldn't those people be informed of the risks involved?

I was in labor with my son for 4.5 days; my water broke at the begining of it, but nobody believed me and my doctor refused to see me and told me not to come in because she was sure that I'd just peed myself.







: After three days of this, I finally went to the hospital, natural birth plan in hand again. I begged for a c-section; after all that active labor and months of preterm labor, I felt miserable and wanted it all to be over. I was blown off, but you know what? If I had had the section when I asked for it, I think things would have been better and easier for both of us. I wouldn't have had time to develop preeclampsia, for example, or to have a siezure during the delivery. My son wouldn't have had a big welt on his head from the vaccuum extractor they used to pull him out, and he wouldn't have spent a week in NICU for meconium aspiration. My recovery wouldn't have been as long as it was (10 weeks before I could even begin to think about sex with anything other than utter revulsion, as opposed to five days with my first section and one week with my second), and it wouldn't have been as painful. I'd have seen my baby an hour after he was born, instead of having to wait an entire day, and I've have been able to hold him instead of having my sister pull him onto my shoulder because I was so weak from MagSulfate that I couldn't lift his little body.

Don't tell me that vaginal birth is something that comes without risk. Mine would have entailed risk every way I figure it. When I got pregnant, I consented to vaginal birth, yes, but not to preterm labor, or preeclampsia, or 4.5 days of active labor, or meconium aspiration, or any of the other







that happened to us.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *MsElle07*
Also, many women don't feel that money will take away the trauma they suffered. It's not about the money to some people.

I never said that it was about money at all, but noone will learn anything if the women who are being forced to consent to unnecessary surgery don't come forward and put this issue on the public agenda. Nothing will change if everyone remains silent.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
Not quite, and certainly not in every circumstance. Can you see that there might be reasons to avoid coughing, for certain people? Shouldn't those people be informed of the risks involved?

How does someone stop coughing? The point is that there ARE risks to people from nearly everything. You can catch SARS from breathing. Should we obtain informed consent for breathing as well? Vaginal birth is made far riskier by the procedures (even routine ones) women are subjected to in the hospital, but they are usually not informed of those. When my baby was born in the hospital, I was NOT given a choice about whether I wanted an IV and EFM. Yet both of these things can lead to greater complications for moms later on, which I knew of from my own reading. But the nurse who insisted on them did not inform me of the risks.

It sounds like you had a traumatic birth experience. No one on this thread has stated that C-sections are not warranted in some cases; I'm sure yours was one of them. But C-sections are NOT warranted 35+% of the time, which is how often they're performed. No research supports this statistic. We have poor maternal and neonatal outcomes to show for the unwarranted sections that are performed every day. They are performed because doctors are practicing CYA medicine -- as a PP stated, the only section doctors are sued for are the ones they don't perform.

Quote:

Don't tell me that vaginal birth is something that comes without risk.
I did not say this. I said there are inherent risks to nearly every physiologic function, risks that are often made worse by medical intervention.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
I never said that it was about money at all, but noone will learn anything if the women who are being forced to consent to unnecessary surgery don't come forward and put this issue on the public agenda. Nothing will change if everyone remains silent.

The only recourse women have is to sue for money. And to many people, it's not worth it. They can't afford a lawyer or can't find a lawyer to take their case. But suing is not the way to put it on the agenda, IMO. That will not lead to evidence-based care, it will just make doctors more wary of lawsuits.


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## Full Heart (Apr 27, 2004)

Quote:


Originally Posted by *eilonwy*
I never said that it was about money at all, but noone will learn anything if the women who are being forced to consent to unnecessary surgery don't come forward and put this issue on the public agenda. Nothing will change if everyone remains silent.

Yes, but thats how we got to where we are now. Women sued that weren't given a c/s. (the only c/s a dr was ever sued for was the one he didn't do). So I doubt suing would solve the problem, probably would only create more.

The solution then? Well I don't know. I just keep trying to educate women but thats incredibly difficult for a number of reasons.


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## eilonwy (Apr 3, 2003)

You can stop yourself from coughing if you really want to/need to, it's just incredibly difficult. What I'm saying is not that coughing is inherently dangerous, or even that it's inherently risky, only that for some people in some circumstances, it carries a great risk and that those people should be made aware of it. The same is most assuredly true of vaginal birth, except that there are many more women for whom vaginal birth carries great risk than there are people for whom coughing is risky.

You don't have to sue for money, but I think it's probably the fastest way to get press, and the only way this can possibly change (imo) is with a great deal of media attention.


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## georgia (Jan 12, 2003)

Please remember that MDC is _The Natural Family Living Community_, which includes the advocacy of natural birth and a belief in the mother's inherent wisdom.

Please keep posts from personal criticism or to discuss other threads, forums, or members









Above all, please be respectful. If you see a post that concerns you, please report it by clicking on the red triangular button in the lower lefthand corner of the post in question.

Thread reopened


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## caned & able (Dec 8, 2005)

Quote:


Originally Posted by *eilonwy*
The same is most assuredly true of vaginal birth, except that there are many more women for whom vaginal birth carries great risk than there are people for whom coughing is risky.

Thirty years ago Suzanne Arms wrote the book Immaculate Deception, the deception being that birth is dangerous and risky and necessitates a huge amount of medical intervention instead of a normal, natural event in a woman's reproductive life. It is an attitude that distrusts women's bodies that pervades the medical profession.

If a vaginal birth is dangerous for a woman, usually (not always!) that is because of previous medical surgeries and interventions in her life. A woman with a previous cesarian scar may have a normal pregnancy, but need a surgical birth due to the scar put there by a doctor who determined that she should have surgery, further complicating her reproductive life. A DES daughter with an "incompetent" cervix has a complication from a drug given to her mother before she was even born, something she could not have consented to!

If we interfered with digestion as much as we interfere with birth, we would all have a chronic case of indigestion. Eating can be dangerous, after all, how many people choke or die from gastric problems or bowel problems annually? Why don't restuarants post warning signs or offer to feed everyone intravenously for our nutritional needs?


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## snowbird25ca (May 8, 2005)

Quote:


Originally Posted by *eilonwy*
You can stop yourself from coughing if you really want to/need to, it's just incredibly difficult. What I'm saying is not that coughing is inherently dangerous, or even that it's inherently risky, only that for some people in some circumstances, it carries a great risk and that those people should be made aware of it. The same is most assuredly true of vaginal birth, except that there are many more women for whom vaginal birth carries great risk than there are people for whom coughing is risky.

I was just lurking on this thread, but I had to comment on this... if you know of a way to avoid coughing, I bet you could make a million dollars. I could stop peeing for a little while too if I really tried, although I'd get nasty sick from it... and peeing is something I have control over, coughing can be a reflex much of the time.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
You can stop yourself from coughing if you really want to/need to, it's just incredibly difficult. What I'm saying is not that coughing is inherently dangerous, or even that it's inherently risky, only that for some people in some circumstances, it carries a great risk and that those people should be made aware of it.

I disagree about the coughing. I have had bronchitis a number of times, and I have desperately tried to stop coughing because it hurt so much. I was successful in suppressing that reflex for about 10 seconds before my body took over. While my doctor can inform me that coughing carries additional risk because of X, Y, or Z, he or she cannot obtain my "consent to allow coughing".

Quote:

The same is most assuredly true of vaginal birth
Again, I disagree. While some women do have additional risks for vaginal birth (pre-existing medical conditions, for example), vaginal birth, like coughing, is not something that is done TO you. You cannot consent to something your body does naturally. To suggest that women need to consent to vaginal birth is to remove all of their power and to place that power in the hands of care providers, where is usually does not belong.


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## valeria_vi (Nov 19, 2001)

may I butt in here?

Tylenol has a drug information sheet that includes all kinds of potential side effects. But how many people actually take it seriously? Most people I know, think that Tylenol is a completely harmless pill (it's advertised as totally safe and I am sure that's what the majority of docs tell their patients as well) and that all the precautions in the information sheet are just there so that noone could sue the manufacturer for some stupid reason.

So I think the same thing happens with the epidurals and c-sections. Even if someone will see the list of potential problems, I bet that most people will think the same as they think of Tylenol - that in reality the procedure is quite harmless but the warnings are there for "just in case somebody sues".

it is interesting that several people here mentioned that the concent form at their hospital does nto contain a list of issues, but just that the risks have been discussed and understood. It leaves a lot of room for some docs to manipulate the mind of the woman. BUT on the other hand, I'll play a devil's advicate. An example that had been used here was "you are x times more likely to die if you have a c-section". I am not a medical expert, but I would think that if somebody has a placental abruption or a uterine rupture, the risk of death to mom and baby would be different in vaginal birth vs c-section. every situation is unique, so how cab there be one universal consent form with specific numbers?


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## velcromom (Sep 23, 2003)

Quote:


Originally Posted by *valeria_vi*
it is interesting that several people here mentioned that the concent form at their hospital does nto contain a list of issues, but just that the risks have been discussed and understood. It leaves a lot of room for some docs to manipulate the mind of the woman.

That's a good point. The informed consent conversations I've had with my OB sounded a lot like,

OB:
"Here are the risks... but you don't need to worry yourself about it. It's very safe."







:

Me: "Specifically about xyz complication... what are the risks as you see them in my situation?"

OB:
"Not a problem at all. It'll be fine."

same thing any time I brought up a worry about a risk: Don't worry this is very safe, everything will be fine.

So basically, I was told in general there are risks but
then told, "Don't worry, that's just the legal stuff, it'll be fine" as if to discredit the idea that any of the risks were real.

Not once was I given a clear explanation of what the words on the forms meant, never was I told the risk of certain serious complications were greater with c/s than with vb, or what complications I might really encounter or how long it might really take me to recover - every single staff member told me instead how safe the c/s was. If they had been honest with me, my thought process and decision making process would have been different. But if I asked for more details I was simply told to not worry, it was safe.

off into very wishful thinking here... I wish there were some type of educational procedure required before one chooses a c/s. The OBs clearly don't usually have the time to fully inform women, so why not, if she says she wants a c/s, say, ok, and give here the full story somehow... send in someone to talk about the true realities of surgery and not just keep glossing over things like excruciating pain (aka "discomfort"), how it really can affect your ability to take care of baby, instead of saying , "oh, you'll just need a little extra help" make sure they see the reality of it (lying there knowing he has a dirty diaper or is hungry and crying yourself because you cannot get up to change or feed him till someone answers your call.. waiting... waiting...) Sure, you might be one of the lucky moms who sail through it and feel great right away... but see, that's the _only_ picture that was painted for me. No one wanted to tell me what *could* happen. I was encouraged to believe it was all very safe and was not going to be a big deal.


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## valeria_vi (Nov 19, 2001)

velcromom, your post just proves the point I made using the Tylenol analogy. that docs make you believe that it is safe and all the warnings are there for legal "just in case"s.


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## eilonwy (Apr 3, 2003)

A few years ago, my mother had surgery after which she was not permitted to cough for (72?) hours. She managed to stop herself; it was difficult, but she managed. I have also managed to stop myself from coughing during asthma attacks and while I had bronchitis and pneumonia. Please don't tell me that it's impossible; I've seen it done and have done it myself.

Again, please pay attention to what I'm writing: I have not said that vaginal birth is inherently risky, I've simply said that for some people, there is indeed risk and those women should be aware of that risk. No, it is *not* always due to surgical intervention; I had never had an abdominal surgery at all before I got pregnant with BooBah. In fact, I'd never had any surgeries at all. Even so, the risk involved with a vaginal delivery of a child with a prolapsed cord was too much for me. Perhaps I'm just weak minded, I wasn't intent enough on a vaginal delivery to go through with it? Maybe my daughter's life and my own weren't actually in any significant danger? You can argue all you like, but I'm not gonna buy it. That c-section *definately* saved my daughter's life, and it probably saved mine, too. The risk associated with a vaginal delivery was, in my mind, unacceptable.


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## cchrissyy (Apr 22, 2003)

although vaginal birth isn't a medical procedure to be consented to, hiring a doctor to attend it IS! By choosing that providor and that setting, you are choosing a bundle of risks and benefits- medical and otherwise. And making an informed selection ought to include being informed of all the statistically likely outcomes of that bundle.

It makes total sense to me that a doctor would say "here is the package of risks/benefits for cesarean. for a hospital OB delivery. for a hospital midwife. for homebirth midwife. for unassisted" and then you'd have the information you'd need to consent to any of the above. After all, vaginal birth is not equally safe everywhere/with everyone you may do it with!

Allowing a Dr to attend you, or a midwife, may not make birth a "medical porcedure" but it should still be an informed, consenting decision, so I think it's very relevant to the topic at hand.

Besides, how could you informed-consent to a C/S without seeing data on the alternative?


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *eilonwy*
A few years ago, my mother had surgery after which she was not permitted to cough for (72?) hours. She managed to stop herself; it was difficult, but she managed. I have also managed to stop myself from coughing during asthma attacks and while I had bronchitis and pneumonia. Please don't tell me that it's impossible; I've seen it done and have done it myself.

So, that means anybody who _isn't_ able to stop themselves from coughing just isn't trying hard enough? I have, on occasion, been able to stop myself from coughing. On other occasions, I haven't. It's partly how hard I try, but there are other factors involved, too. If it were just a matter of trying hard enough, I'd _never_ have coughed in the first few days post-op from a c-section, yet I've done so twice. And, there was a weird bug going around here a few years ago that made me cough constantly, and I never once managed to stop it.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *cchrissyy*
although vaginal birth isn't a medical procedure to be consented to, hiring a doctor to attend it IS! By choosing that providor and that setting, you are choosing a bundle of risks and benefits- medical and otherwise. And making an informed selection ought to include being informed of all the statistically likely outcomes of that bundle.

It makes total sense to me that a doctor would say "here is the package of risks/benefits for cesarean. for a hospital OB delivery. for a hospital midwife. for homebirth midwife. for unassisted" and then you'd have the information you'd need to consent to any of the above. After all, vaginal birth is not equally safe everywhere/with everyone you may do it with!

Allowing a Dr to attend you, or a midwife, may not make birth a "medical porcedure" but it should still be an informed, consenting decision, so I think it's very relevant to the topic at hand.

Besides, how could you informed-consent to a C/S without seeing data on the alternative?

Apparently because vaginal birth is the way nature intended things, it makes all of the risks commonly associated with the entire process not worthy of mention.

I think it's more about scaring women into NOT having a section than really making an INFORMED decision


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## member234098 (Aug 3, 2002)

Quote:


Originally Posted by *valeria_vi*
Tylenol has a drug information sheet that includes all kinds of potential side effects. But how many people actually take it seriously?

How many people read the side effects for the BCP?

RE: tylenol. How many people have had liver problems or transplants, not knowing years of indiscriminate tylenol use could be a contributing factor to their problem.


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## member234098 (Aug 3, 2002)

Quote:


Originally Posted by *wifeandmom*
I think it's more about scaring women into NOT having a section than really making an INFORMED decision

In my 54 years of life, of birthing, teaching CBP classes, doula-ing, and working with midwives, I have NEVER known this to happen. A cesarian is considered "'delivering' from above", a heavenly experience!

Obstetricians/Gynecologists are trained surgeons who sell the cesarian delivery and never, ever consider there to be any reason not to do a section.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *miriam*
In my 54 years of life, of birthing, teaching CBP classes, doula-ing, and working with midwives, I have NEVER known this to happen. A cesarian is considered "'delivering' from above", a heavenly experience!

Obstetricians/Gynecologists are trained surgeons who sell the cesarian delivery and never, ever consider there to be any reason not to do a section.

I'm sorry that this has been your experience.







That's seriously depressing.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
A few years ago, my mother had surgery after which she was not permitted to cough for (72?) hours. She managed to stop herself; it was difficult, but she managed. I have also managed to stop myself from coughing during asthma attacks and while I had bronchitis and pneumonia. Please don't tell me that it's impossible; I've seen it done and have done it myself.

This is a little like saying, "Please don't tell me vaginal birth is impossible. I've seen it done and have done it myself."







:

Quote:

Again, please pay attention to what I'm writing: I have not said that vaginal birth is inherently risky, I've simply said that for some people, there is indeed risk and those women should be aware of that risk.
Yes, women should be aware of the risks of vaginal birth. They should also be aware of the risks that their choice of practitioner and birth location have on their births. They should be made aware of how those risks can be lowered. That is *not* standard procedure. Again, you cannot consent to something your body does naturally. It is different than having a procedure performed on you. And people should be made aware of the risks of having a procedure performed vs. letting things happen naturally. (If possible. I understand that not everyone in the universe can give birth vaginally.)

Quote:

Even so, the risk involved with a vaginal delivery of a child with a prolapsed cord was too much for me. Perhaps I'm just weak minded, I wasn't intent enough on a vaginal delivery to go through with it? Maybe my daughter's life and my own weren't actually in any significant danger? You can argue all you like, but I'm not gonna buy it. That c-section *definately* saved my daughter's life, and it probably saved mine, too. The risk associated with a vaginal delivery was, in my mind, unacceptable.
I have not seen one person here say that your particular C-section was unnecessary. You started this thread about "informed consent," not about whether your C-section was necessary. You don't need to prove that your particular operation saved your baby's life. I am talking about informed consent as a matter of policy, and not in your particular birth.


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## gentlebirthmothr (Jul 13, 2005)

Rynna,

Well, I haven't read all of the replies, but have to say, I'm sorry, this does happen all the time with medical model of care. Really, don't have anything else to add that isn't there.


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## member234098 (Aug 3, 2002)

Quote:


Originally Posted by *eilonwy*
I'm sorry that this has been your experience.







That's seriously depressing.

I do not know if you are being serious or just mocking one of my previous posts.

An obstetrician/gynecologist is a surgeon, plain and simple. They are trained to do surgery. They like to do surgery. They see surgery as the answer to all of your ills because that is what they do.

Therefore, to paraphrase the late, great medical heretic, Dr. Robert Mendelsohn, if you do not like to get bit, stay away from snakes. If you do not want surgery, stay away from surgeons/obstetricians/gynecologists. If you need surgery, that is who you should see.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *miriam*
I do not know if you are being serious or just mocking one of my previous posts.

An obstetrician/gynecologist is a surgeon, plain and simple. They are trained to do surgery. They like to do surgery. They see surgery as the answer to all of your ills because that is what they do.

Therefore, to paraphrase the late, great medical heretic, Dr. Robert Mendelsohn, if you do not like to get bit, stay away from snakes. If you do not want surgery, stay away from surgeons/obstetricians/gynecologists. If you need surgery, that is who you should see.

If what you say is true, and ALL OB/GYN's are interested solely in operative delivery, can you explain why the national average for surgical delivery is 25-30%? Why on earth are these so-called surgeons 'allowing' 70-75% of their patients to skip surgical delivery if that's ALL they are interested in doing?

If OB/GYN's were *only* interested in doing surgery, seems to me their surgical delivery rates would be much, much higher than what they are.

FTR, the first hospital I delivered in, where NO midwives were allowed to attend deliveries at the time, so we're talking ALL OB/GYNs here had a section rate of just under 10%.

Second hospital allowed midwife attended births, however they were not common at all, thus the vast majority of patients were delivered with an OB/GYN in attendance. Guess what? Their c-section rate was just under 20%.

The OB/GYN I am currently seeing has a primary section rate of 8%. EIGHT PERCENT.

So I dare say that not ALL OB/GYNs, or even MOST, are as you describe.







When an OB/GYNs section rate approaches 80% or more, I might give your statements more weight. Otherwise, the stats simply do not back up what you are suggesting. At all.


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## member234098 (Aug 3, 2002)

May I direct you to a book entitled How to Lie with Statistics, by Darrel Huff, an oldie but a goodie.

The cesarian rate varies from surgeon to surgeon, from hospital to hospital, from city to city, and from region to region. The 25-30% cesarian rate in this country is an average of stats from all of the country; how that number is figured depends on the hospital protocol for reporting. When a hospital reports a cesarian rate, it is usually a primary cesarian rate, that is, a mother having her first cesarian birth. If a woman has a repeat cesarian birth, she is not figured in the final statistics, depending on the department protocol, laws of the local medical society and rules of the hospital.

I think if all of the births were reported, as they should be, the total number would be more like 50% of the total births in this country. So the reporting, IMHO is skewed and dishonest.

The same with neonatal deaths, stillborns, and premature babies. The hospital, being a profitmaking entity, will fudge numbers to attract their customers.

When I visited the largest medical center in my town (Los Angeles) to visit a friend twenty years ago, there were twenty-eight babies in the nursery and only one was delivered vaginally. That baby was eleven pounds. The rest were delivered by cesarian section. I doubt every single one was justifiable, but there it is. I doubt any doctor was sued for doing surgery.

As for doctors doing *only surgery*, as you put it, what do you think an episiotomy is? That is surgery, and it is done by a surgeon, ie, obstetrician, which as I said is their primary training. The cesarian is simply more surgery and puts more people to work and of course, co$t$ the patient and insurance more.


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## DocsNemesis (Dec 10, 2005)

How about this-I was transferred from a birth center hemorrhaging to the local ER. I had not signed a single paper. The nurse proceeded to start shoving cytotec pills up my bum while I was screaming no at the top of my lungs, because cytotec doesnt work for me and it hurt! They kept doing it anyway. Once the OB got there she said she was going to do a D&C, I said ok, I kind of figured that part out, but then she said she may have to do a hysterectomy. I said no, you will not be doing a hysterectomy, I would rather die (seriously, esp at that time, I probably would have commited suicide). She said yes, she would be. Again, I had not signed a single paper, I was still awake and perfectly capable of signing, but no one had me sign a thing-not even my dh signed anything. And they proceeded to do the D&C, they gave me two transfusions, they did all of this without a single paper on file. I have verified this-I have my medical records. Granted it isnt the same as a cesarean, but I am sure it happens. I know that when I refused to sign the consent form for my first to be sectioned, the doctor threatened to do it regardless. He didnt, but he said he would.
As far as cesarean stats go, it varies so much from doctor to doctor. I have yet to meet one with a rate lower than 20%, but most of the docs I have met have a 35-60% rate. I even know a doc that admitted to having close to a 75% rate! He actually said to me that he prefers to do cesareans because he can schedule them and he feels more involved, because, after all, when a woman has a natural delivery, she is doing all the work. My midwives on the other hand, who do take high risk patients, have a 4% cesarean rate. And then look at the midwives at the farm, they have extremely low cesarean rates as well and they routinely do multiples and breech. Its a small miracle that I have been able to have 4 babies without a cesarean. Of course, if my sOB had had his way with my first, I would have probably had 4 cesareans instead.


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## doctorjen (May 29, 2003)

In general, cesarean rates reported by US hospitals are percent totals of all births. As part of our accreditation process, we are required to report cesarean rates and primary vs. repeat rates as well as VBAC rates and number of "failed" VBACs, although I understand that the VBAC rate will no longer be considered as part of the quality measures used to assess hospitals, so probably we won't have to report them much longer. The nationally reported cesarean rates of just under 30% are for all cesareans, not a primary cesarean rate.
Nevertheless, it is hard to argue in favor of such a rate, and there is much individual variation with some hospitals/surgeons having much lower rates and some having much higher rates. In my little community, my hospital hovers around 20%, with a primary rate of less than 10% - but the hospital in the next town is closer to 40%, and no longer offers VBACs, even if the mom in question has already VBACed successfully in the past. My own total cesarean rate has stayed around 11% total, with a primary rate around 4-5%. Of course I'm a family doc, and have to consult for a cesarean, which I think influences my rate.

I think this thread has deteriorated to "Well I've seen this." and "Oh yeah, well I've seen this."
I don't think there is any question that while some docs provide good, thorough, informed consent, many women have experienced poor consent processes, and worse, poor consent processes after poor care in the first place. If even one woman is coerced or mislead into surgery, that is too many in my book.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *miriam*
I do not know if you are being serious or just mocking one of my previous posts.

Why would I mock you? That is depressing.

Quote:

An obstetrician/gynecologist is a surgeon, plain and simple. They are trained to do surgery. They like to do surgery. They see surgery as the answer to all of your ills because that is what they do.
1) I don't believe that's necessarily true.

2) What about all the women who see family practice doctors? Do they also, in your opinion, "like to do surgery" and "see surgery as the answer to all of your ills?" Because that's not (necessarily) what they do.

Quote:


Originally Posted by *miriam*
I think if all of the births were reported, as they should be, the total number would be more like 50% of the total births in this country. So the reporting, IMHO is skewed and dishonest.

I have a really hard time believing this. Do you honestly believe that 50% of total births in this country are c-sections? There's no way. I personally know hundreds, if not thousands of women who have had babies, and I can only think of a handful who had c-sections, primary or otherwise. In fact, I have a hard time believing that 30% of births in this country are c-sections, but I recognize that my sample is quite limited by the fact that the overwhelming majority of women in this area either have homebirths or birth at one of *three* hospitals in the area, one of which has an overall c-section rate of 15% (about 9% for primary sections).

I'm not buying the episiotomy argument, either; I only know two women who've had episiotomies (irl). Everyone else either tore naturally or didn't tear at all. The whole episiotomy-happy doctor thing is a myth in my experience.







In fact, on the "fill-in-the-blanks" birth plan that they gave me, it listed episiotomy as an option, so I asked about it; my doctor told me that they only do an episiotomy if the delivery will require forceps and they're unable to get in without it, but that the overwhelming majority of the time it wasn't necessary and that he could only remember doing one in the 20-odd years he'd been practicing medicine.









Quote:


Originally Posted by *MsElle07*
This is a little like saying, "Please don't tell me vaginal birth is impossible. I've seen it done and have done it myself."

Not quite-- it's more like saying, "I believe that it is possible, if difficult, to keep one's body from delivering vaginally should extenuating circumstances dictate."

Quote:


Originally Posted by *MsElle07*
Yes, women should be aware of the risks of vaginal birth.

Okay. That's all I was saying. If they can be made aware of said risks, then shouldn't it be required that they consent?

Quote:


Originally Posted by *MsElle07*
They should also be aware of the risks that their choice of practitioner and birth location have on their births. They should be made aware of how those risks can be lowered. That is *not* standard procedure.

That really sucks.







I'm having a hard time believing that, though. The statistics are there for anyone to see. Any woman should be able to ask her care provider what their stats are, and should be able to find other women who've seen said provider and ask them about their experiences. Doctors are like anyone else who provides a service-- you really ought to shop around until you get the best one you can.

Quote:


Originally Posted by *MsElle07*
Again, you cannot consent to something your body does naturally. It is different than having a procedure performed on you. And people should be made aware of the risks of having a procedure performed vs. letting things happen naturally. (If possible. I understand that not everyone in the universe can give birth vaginally.)









Of course you can consent (or fail to consent) to something that your body does naturally. It's difficult, but it's not impossible to stop your body from certain things, including birth. The human mind is capable of all sorts of things. The way I see it, if you're going to consent to one, you've got to require consent for all.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
Not quite-- it's more like saying, "I believe that it is possible, if difficult, to keep one's body from delivering vaginally should extenuating circumstances dictate."

Only with medical intervention.

Quote:

Okay. That's all I was saying. If they can be made aware of said risks, then shouldn't it be required that they consent?
I think we have a fundamental disagreement about what consent means. What does it mean to you? Should women then have to consent to become pregnant? Because pregnancy in and of itself carries extreme risk for a small percentage of women. Should women have to go to their doctor and sign a consent form to get pregnant in the first place?

Quote:

I'm having a hard time believing that, though. The statistics are there for anyone to see. Any woman should be able to ask her care provider what their stats are, and should be able to find other women who've seen said provider and ask them about their experiences. Doctors are like anyone else who provides a service-- you really ought to shop around until you get the best one you can.
I disagree; the stats about many routine hospital procedures are NOT available for everyone to see. Women usually have to hunt for them on their own. Also, if the stats are there for everyone to see, why don't you believe them? (For example, the stat that nearly 30% of the women in this country give birth via C-section is not a statistic made up by the women on this board.) http://www.usatoday.com/news/health/...sections_x.htm

Women are NOT told the difference between having a midwife attend their birth vs. a family practice doctor vs. an obstetrician. When you go see your OB, does he/she tell you, "It's nice to meet you, but I need to inform you that if you see a CNM instead of me, your chances of C-section drop dramatically. (The birth center C-section rate is less than 5%.) If you have your baby in a birth center instead of at the hospital, your chances of dying or having a dead baby are significantly smaller? Do OBs give you copies of the National Birth Center Study? http://content.nejm.org/cgi/content/short/321/26/1804

In terms of episiotomy, this study found that private practice doctors perform them up to 67% of the time: http://www.acog.org/from_home/public...nr12-31-03.cfm

Being informed of risk means being informed of alternatives and the risks they carry as well. Most doctors are not doing this.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *MsElle07*
I think we have a fundamental disagreement about what consent means. What does it mean to you? Should women then have to consent to become pregnant? Because pregnancy in and of itself carries extreme risk for a small percentage of women. Should women have to go to their doctor and sign a consent form to get pregnant in the first place?

Yes, women should have to consent to become pregnant, but no, they shouldn't necessarily have to sign a consent form with a doctor. If getting pregnant doesn't involve a care provider, of course they don't need said cp's consent. That's like saying that you're going to see doctor A for all your care, but you should have to sign an informed consent statement for doctor D, who probably won't be anywhere near you.









Quote:

I disagree; the stats about many routine hospital procedures are NOT available for everyone to see. Women usually have to hunt for them on their own. Also, if the stats are there for everyone to see, why don't you believe them?
The 50% stat? I've never seen that anywhere but here, and I can't for the life of me figure out how it could be true; No, I don't believe it.







I didn't say that I don't believe the 30% stat, I said that I have a hard time believing it *but* I recognize that my sample is skewed by the fact that most women I know who have had babies have done so locally, in a hospital with a low percentage of surgical births.

[quot]Women are NOT told the difference between having a midwife attend their birth vs. a family practice doctor vs. an obstetrician. When you go see your OB, does he/she tell you, "It's nice to meet you, but I need to inform you that if you see a CNM instead of me, your chances of C-section drop dramatically. (The birth center C-section rate is less than 5%.)[/quote]

Yes.









Quote:

If you have your baby in a birth center instead of at the hospital, your chances of dying or having a dead baby are significantly smaller? Do OBs give you copies of the National Birth Center Study? http://content.nejm.org/cgi/content/short/321/26/1804
I don't think we have a birth center locally, but if we did I'm sure I'd get that information from my doctor, especially if my insurance gave me that choice.

Quote:

In terms of episiotomy, this study found that private practice doctors perform them up to 67% of the time: http://www.acog.org/from_home/public...nr12-31-03.cfm
That's horrible.







Still, I have to say that I can only think of a handful of women who have had episiotomies.







I didn't think I lived in a particularly progressive area, either.

Quote:

Being informed of risk means being informed of alternatives and the risks they carry as well. Most doctors are not doing this.
That's just not acceptable, and it's difficult for me to fathom.







Doctors are people who provide a service; I can't understand why they wouldn't inform women about the options, particularly in our lawsuit-happy climate. It just doesn't seem logical to me.


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## MommytoTwo (Jun 20, 2004)

I have had 2 unplanned and unwanted c-sections, and neither time was I told _one single risk_. I heard all sorts of risks while planning a vbac of course.


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## MsElle07 (Jul 14, 2006)

Quote:

Women are NOT told the difference between having a midwife attend their birth vs. a family practice doctor vs. an obstetrician. When you go see your OB, does he/she tell you, "It's nice to meet you, but I need to inform you that if you see a CNM instead of me, your chances of C-section drop dramatically. (The birth center C-section rate is less than 5%.)

Quote:

Yes.








If doctors are doing this, what explanation is there for women choosing their care 90% of the time? If women were truly informed of the risks of hospital birth with your average OB vs. the risk of a homebirth of birth center birth, why would 90+% still choose that care route? Frankly, I have a hard time believing that doctors are telling their patients "You could get better care elsewhere" and 90% of those women still go with their doctor anyway.

Quote:

I don't think we have a birth center locally, but if we did I'm sure I'd get that information from my doctor, especially if my insurance gave me that choice.
And did you also get homebirth information? Did they tell you that homebirth was safer for the mom and baby as well?

Quote:

That's just not acceptable, and it's difficult for me to fathom.







Doctors are people who provide a service; I can't understand why they wouldn't inform women about the options, particularly in our lawsuit-happy climate. It just doesn't seem logical to me.








Most doctors do not practice evidence-based medicine, despite the lawsuits. Because women are uninformed, and they are often kept that way by their practitioners. If obstetricians practiced evidence-based medicine, they would say, "I am not the best care provider for your low risk pregnancy. Here is a referral to a midwife."

I'm not sure what else you want from this thread. You asked if doctors informed people of risk, you have four pages worth of evidence that they don't. Is there some piece of information you're still looking for that someone can provide? I'm glad YOUR doctor informed you of the risks and obtained your fully informed consent -- that's the way it should be. I'm glad your C-sections were good experiences. But that is clearly not the universal experience -- quite the opposite, in fact.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *MsElle07*
If doctors are doing this, what explanation is there for women choosing their care 90% of the time? If women were truly informed of the risks of hospital birth with your average OB vs. the risk of a homebirth of birth center birth, why would 90+% still choose that care route? Frankly, I have a hard time believing that doctors are telling their patients "You could get better care elsewhere" and 90% of those women still go with their doctor anyway.

'You could get better care elsewhere' is certainly not factual in the least. Perhaps 'You could get DIFFERENT care elsewhere' might be more appropriate. There are RISKS to homebirth. There are RISKS to midwife/birth center births. There are RISKS to hospital births. NONE of the choices are risk free, and perhaps a great majority of women feel more secure knowing they are delivering in a place where they will have immediate access to surgical intervention vs. being however many minutes away by ambulance or car should transfer become necessary.

Quote:

And did you also get homebirth information? Did they tell you that homebirth was safer for the mom and baby as well?
You left out quite a few qualifiers there.

First, it's research backed to say it's safer for LOW RISK pregnancy. Second, it's research backed to say it's safer when ATTENDED by a licensed midwife.

Two big issues there, don't you think? The second even more so considering the ONLY way research has shown (to my knowledge, please correct me if there is some huge study out there I am missing) that homebirth is safer is when it is attended by an experienced, licensed midwife. Women have to have access to midwives that do homebirths to make this work. And of course, there's the issue of whether or not (usually NOT, which is a shame and a whole different debate) such care would even be covered under the woman in question's insurance.

Quote:

Most doctors do not practice evidence-based medicine, despite the lawsuits.
A great many practices currently used (continuous EFM comes to mind) are NOT based on evidence, rather based on defensive medicine, something any intelligent OB who would like to continue practicing in their chosen profession quickly learns to do well...BECAUSE of the lawsuits.

Think about it. Doc says 'Well, research doesn't support continous EFM, so I'm going to go against the vast majority of my fellow colleagues and forego continuous monitoring.'

That's all well and good...til something goes wrong...and doc can't produce that lovely continuous monitoring strip to 'defend' himself. So the question of course becomes 'Well, if doc HAD done continuous monitoring, would he have known baby was in trouble sooner, therefore been able to intervene earlier?'

There IS NO WAY TO ANSWER THAT QUESTION, and because doc didn't 'do all he possibly could', guess who wins that case? It sure isn't the doctor.


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## DocsNemesis (Dec 10, 2005)

Why would it be that difficult to find a licensed midwife? I know in some areas there are only CNM's/birth centers, but in those states that allow homebirth, it is not at all difficult to find a licensed midwife. In fact, I am on medicaid and had my homebirth covered, no questions asked. And there is no doubt that homebirth with a qualified birth attendant is SAFER than hospital birth.
I saw an OB for my first. I remember mentioning that I would like to homebirth. He never said that was an option and, being that I was 17 and had no clue, I assumed it wasnt. In addition, when I was told I should be induced for being 2 weeks overdue, no one ever said there was a risk involved with Cytotec, nor the Pitocin. Then when I got an epidural, again, no one spoke of any risks. I was horrified when I read up on it later....its no wonder I almost ended up with a cesarean! Good thing I had the foresight to refuse. I am a firm believer that babies come when they are ready and my ds wasnt ready since he had a tight nuchal cord.
As far as cesarean rates go, as a pp said, it really varies by area, hospital, and doctor. Around here it seems that every other woman delivers by cesarean. I know that most of the women I have met outside of my midwives office ended up with a cesarean. Most of the cases were at least partially due to intervention.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *DocsNemesis*
Why would it be that difficult to find a licensed midwife? I know in some areas there are only CNM's/birth centers, but in those states that allow homebirth, it is not at all difficult to find a licensed midwife. In fact, I am on medicaid and had my homebirth covered, no questions asked. And there is no doubt that homebirth with a qualified birth attendant is SAFER than hospital birth.

Safer for low risk women.

Since I was never low risk to begin with, I'm sure my inability to locate a midwife willing to do a homebirth is not all that unusual.

I have also read quite a few stories from women here who say it was not possible for them to convince their insurance carrier to cover a homebirth at all. I don't think that particular issue is uncommon, but again, I was never low risk to begin with, thus homebirth was never the safest option for me and I didn't look into the matter further once I discovered this fact.


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## velcromom (Sep 23, 2003)

Quote:


Originally Posted by *wifeandmom*
.

A great many practices currently used (continuous EFM comes to mind) are NOT based on evidence, rather based on defensive medicine, something any intelligent OB who would like to continue practicing in their chosen profession quickly learns to do well...BECAUSE of the lawsuits.

Think about it. Doc says 'Well, research doesn't support continous EFM, so I'm going to go against the vast majority of my fellow colleagues and forego continuous monitoring.'

That's all well and good...til something goes wrong...and doc can't produce that lovely continuous monitoring strip to 'defend' himself. So the question of course becomes 'Well, if doc HAD done continuous monitoring, would he have known baby was in trouble sooner, therefore been able to intervene earlier?'

There IS NO WAY TO ANSWER THAT QUESTION, and because doc didn't 'do all he possibly could', guess who wins that case? It sure isn't the doctor.


so the doctor who has sworn an oath to do no harm... concludes it is better for his career to use practices not supported by research (even though he knows better) and let women bear the consequences of the harm these practices can cause in order to try to keep his record suit-free... how is this an ethical choice?

Doc practices based on policy and the fear of lawsuits instead of evidence based medicine... guess who wins in that case? It sure isn't mothers and babies. I understand a dr has a lot to lose, a career they have trained for for many years. But guess what. When we don't get the evidence based care we need, we have more than a career at risk.


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## georgia (Jan 12, 2003)

Quote:


Originally Posted by *wifeandmom*
'You could get better care elsewhere' is certainly not factual in the least. Perhaps 'You could get DIFFERENT care elsewhere' might be more appropriate. There are RISKS to homebirth. There are RISKS to midwife/birth center births. There are RISKS to hospital births. NONE of the choices are risk free.....

Cesarean birth was left out of the RISK paragraph above, so I thought I'd add it here, for balance









Quote:

and perhaps a great majority of women feel more secure knowing they are delivering in a place where they will have immediate access to surgical intervention vs. being however many minutes away by ambulance or car should transfer become necessary
And perhaps a great majority of women would feel _more_ secure if they knew that they are *NOT* safer in the hospital (and I'm not speaking about women who for whatever reason need to have their babies by c/s..so that's not what we're discussing







From the Mehl Study (an oldie but interesting anyway, at least to me):

*Neonatal Outcomes:

In the hospital, 3.7 times as many babies required resuscitation.
Infection rates of newborns were 4 times higher in the hospital.
There was 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.
There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.
There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.
The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.
While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.*
_Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." J Repro Med.
19:281-90_

Quote:

First, it's research backed to say it's safer for LOW RISK pregnancy. Second, it's research backed to say it's safer when ATTENDED by a licensed midwife.
Actually, I don't believe the research specifies "licensure," does it?

Quote:

Two big issues there, don't you think? The second even more so considering the ONLY way research has shown (to my knowledge, please correct me if there is some huge study out there I am missing) that homebirth is safer is when it is attended by an experienced, licensed midwife. Women have to have access to midwives that do homebirths to make this work. And of course, there's the issue of whether or not (usually NOT, which is a shame and a whole different debate) such care would even be covered under the woman in question's insurance.
Are you assuming all women to have insurance?







IME, this is not at all the case, at least in the US. Many women I know do not have insurance, and for those who do, if homebirth was covered, even partially, this is a bonus. Off the top of my head, I know the states of Oregon and Florida legally require HB to be covered. Wouldn't that be an wonderful public policy to support in each of our states!

There are many families who value the experience of never needing to worry about signing consent forms by remaining outside of the hospital system altogether. These families, IME, are informed, educated and aware of the risks and benefits, and who do not operate under the assumption that an obstetrical emergency is going to happen. They realize it could, but assume it will not. This does not mean, in the slightest, that families who believe in the birth process to be a normal, physiological event are unaware and need constant reminders of how dangerous vaginal birth is.

Quote:

A great many practices currently used (continuous EFM comes to mind) are NOT based on evidence, rather based on defensive medicine, something any intelligent OB who would like to continue practicing in their chosen profession quickly learns to do well...BECAUSE of the lawsuits.
Just another reason to avoid selecting a surgeon to provide prenatal and labor care, IMO. If one is birthing in a hospital, perhaps utilizing a midwife would be in the mother, babies and family's best interest. Or perhaps if a mw isn't in the cards, a Family Practitioner, if one who does births is available.

Quote:

Think about it. Doc says 'Well, research doesn't support continous EFM, so I'm going to go against the vast majority of my fellow colleagues and forego continuous monitoring.'
What if a cardiologist (or insert medical specialty here) was practicing this way? Well, the research shows that I there is no reason to keep performing xyz procedure, but, heck, everyone else is doing it..and if I don't if/when I get sued, I will sure wish I did.







Why do OBs get the free pass here? Why is obstetrics the seemingly only field of practice where evidence-based practice is a dirty word? The very idea that "Because everyone else is doing it" would be a reason to do something, for a medical practitioner---a trained scientist---is odd.

Quote:

There IS NO WAY TO ANSWER THAT QUESTION, and because doc didn't 'do all he possibly could', guess who wins that case? It sure isn't the doctor
But, in "defensive medicine", in most instances, who is it who loses the normal, intervention and drug-free, empowering, satisfying and rewarding birth experience? Mom _and_baby.

So, you are suggesting that doctors continue to utilize inferior and/or unnecessary procedures/tests because if she didn't---she's going to be sued and lose? This, to me, is a perfect example of why normal, "low risk" births should absolutely not take place within an institutional setting with practitioners who believe that the human body is somehow defective and the miracle of technology and the power of the doctors can somehow save us all from our inherently risky bodies








:


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## georgia (Jan 12, 2003)

Sorry if that got rambly









Saw this Mothering Action Alert and thought it was interesting:

Good News for People Who Love VBAC News

and check out this link for more information about the advantages of vaginal birth for both babies and mothers


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *velcromom*
so the doctor who has sworn an oath to do no harm... concludes it is better for his career to use practices not supported by research (even though he knows better) and let women bear the consequences of the harm these practices can cause in order to try to keep his record suit-free... how is this an ethical choice?

He probably figures somebody has to pay back the $100K+ in student loans, so he'd best do what it takes to avoid losing his ability to practice medicine.

I've said it before, and I'll say it again...

When women stop suing for imperfect outcomes in childbirth, current practices set up to AVOID such outcomes at all costs will likely change as well.

Bottom line is if something goes wrong with mom OR baby, the care provider better darn well be able to show they did EVERYTHING they could to avoid that outcome. Even then, they might lose. But if they DON'T do 'everything' that could have possibly prevented a bad outcome, well, it's their livlihood on the line, and I don't blame them one bit for doing what pretty much everyone else is doing in their field.

To do otherwise is asking to lose a malpractice case.

This sort of thing works in other fields too, but obstetrics and anesthesia are the two biggest fields most likely to be sued, therefore they are the two professions that are most likely to 'go overboard' so to speak, being ultra-conservative in their approach, in order to protect themselves.

If they have to choose between NOT doing a necessary section and DOING one that is likely NOT necessary, they'll choose to do many UNnecessary sections to avoid missing that ONE that really WAS necessary. Like with continuous EFM where it's fairly accepted that out of 4 babies showing distress on the monitor, only ONE of them is really in trouble. So do they NOT section any of the four, thinking 'Well, that's THREE unnecessary sections according to research' or do they section them all thinking 'Well, I'd rather do three unnecessary sections to save that one baby in trouble.'

If the current section rate of 30% should REALLY be more like 10%, then 2 of every 3 sections aren't truly medically indicated. Nobody has a crystal ball to determine which two exactly would have been just fine laboring longer and which one would not. It's only going to get worse, that's my prediction.

I will add this:

The current OB I am seeing is VERY laid back, touted around town as VERY low-intervention, etc. I've been amazed at some of the things he allows, is comfortable with, recommends, etc. And I admit to thinking he is REALLY wide open for a lawsuit, and really that's a shame.

One such example is he encourages women to bring a video tape to any u/s appt (and he is totally cool with NOT doing u/s, makes it a choice with pros/cons which I'd never experienced before). But if you have an u/s, he'll record it and let you take that video home with you.

That is NOT common practice AT ALL anymore. Why? Lawsuits. If something is 'missed', mom then has a record of exactly what doc 'should have' seen. Of course, hindsight is 20/20, so it might very well be that he didn't 'miss' anything at all, but if another expert views the tape, knowing what defect they are looking for, it's not quite the same, kwim?

Anyhow, there are so many decisions that unfortunately are made based on the liklihood of someone suing that it's very sad, but again, it's the way things are. Until that changes dramatically, I don't see obstetrics changing much either.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *georgia*
Cesarean birth was left out of the RISK paragraph above, so I thought I'd add it here, for balance









I dare say not many moms in these parts are going to be choosing a section for no reason whatsoever, but of course, if she DOES want to choose that route to deliver, I have no issue with HER choice. And she ABSOLUTELY should understand the consequences of making that choice, something I've always stressed without reservation.

Before my first section, I could recite every possible thing that could go wrong during a scheduled section, how likely it was to happen, what it meant if it DID happen, what the potential complications were to future pregnancies/deliveries, blah blah blah.

Of course, I could also tell you the risks of the other choices in my particular situation. Really, it only makes sense to me that ANY woman be able to do exactly that before committing to ANY birthing choice. The beauty of modern medical science is we DO have choices.

We can opt for birth at home by ourselves. There are pros to that choice, but there are also cons. We can opt for a homebirth with a friend, a lay midwife, a doula, a licensed midwife. Again, there are pros and cons to each of these choices. It goes on and on. Have a baby at a birth center. Pluses and minuses. Have it at the hospital with a midwife, a family practice doc, an OB. Go straight to the OR for a section. Every one of those choices carry benefits, as well as risks. Who gets to decide which benefits are most important? Which risks are acceptable vs. which ones are too much to bear?

Quote:

From the Mehl Study (an oldie but interesting anyway, at least to me):

*Neonatal Outcomes:

In the hospital, 3.7 times as many babies required resuscitation.
Infection rates of newborns were 4 times higher in the hospital.
There was 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.
There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.
There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.
The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.
While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.*
_Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." J Repro Med.
19:281-90_

Those are interesting stats. Were all of the babies in each group from low risk moms experiencing low risk pg? Back in the 70's, induction and c-section were MUCH MUCH MUCH less common than today, so I'd be interested to see stats from today's birth data comparing low risk homebirth babies to low risk hospital birth babies. Wouldn't surprise me a bit if the hospital numbers were even worse with all the induction going on since that alone is known to cause distress in the baby.

Quote:

Actually, I don't believe the research specifies "licensure," does it?
Hmmm, not sure. I'd venture to say if insurance is going to pay, you'd have to use someone licensed. I'd be personally more concerned with training and experience rather than a piece of paper, although really, I'd prefer all of the above if it were me.

Quote:

Are you assuming all women to have insurance?







IME, this is not at all the case, at least in the US. Many women I know do not have insurance, and for those who do, if homebirth was covered, even partially, this is a bonus. Off the top of my head, I know the states of Oregon and Florida legally require HB to be covered. Wouldn't that be an wonderful public policy to support in each of our states!
Of course not every woman has insurance. Of those that DO have it, it seems to be a common issue with insurance carriers NOT wanting to cover homebirth with a licensed provider. Maybe that issue is simply exaggerated here, but it seems to come up quite often from what I've seen.

That an insurance company would pay for more expensive hospital care but refuse to pay for a midwife/homebirth delivery is completely absurd IMO. I'd support regulations to change that without a doubt, as it can very easily take away a woman's right to choose what birth situation she feels most comfortable with if she is unable to pay out of pocket for something her insurance should be covering to begin with (assuming we're talking licensed professionals and obstetric care is already covered for the woman in question).

Quote:

There are many families who value the experience of never needing to worry about signing consent forms by remaining outside of the hospital system altogether. These families, IME, are informed, educated and aware of the risks and benefits, and who do not operate under the assumption that an obstetrical emergency is going to happen. They realize it could, but assume it will not. This does not mean, in the slightest, that families who believe in the birth process to be a normal, physiological event are unaware and need constant reminders of how dangerous vaginal birth is.
Ok...

Obviously whatever choice is made, there are risks associated with that choice, and I'd certainly HOPE that each woman knows what those risks are as she's the one who will be living with her decision should the worst case scenerio happen to her or her child.

I'd think if one were truly confident in whatever decision they made, it wouldn't be earth shattering to read about potential problems associated with said choice...cause well, they should have ALREADY read and understood what they were choosing. Of course, I'm not a fan of sticking my head in the sand and pretending like my choices don't have potential complications associated with them, so maybe I just don't get the big deal about discussing pros/cons like some other people seem to have such an issue with. (not meant in a snarky way at all) I'm all about learning as much as possible, knowing what to expect, etc etc.

Quote:

Just another reason to avoid selecting a surgeon to provide prenatal and labor care, IMO. If one is birthing in a hospital, perhaps utilizing a midwife would be in the mother, babies and family's best interest. Or perhaps if a mw isn't in the cards, a Family Practitioner, if one who does births is available.
That seems to be a good compromise for those who feel better in a hospital knowing emergency services are 'right down the hall' but without the higher rates of interventions that are likely with an OB at the wheel.

One reason I've seen/heard that such a decision is not more common is when women say they'd prefer to have an established relationship with whomever might end up cutting them open should the need arise rather than having to rely on whomever is on call that day showing up for an emergency section having never laid eyes on mom. I do know that many midwives have specific OBs that do back up for them, so that could be a possibility in calming this particular fear.

Quote:

What if a cardiologist (or insert medical specialty here) was practicing this way? Well, the research shows that I there is no reason to keep performing xyz procedure, but, heck, everyone else is doing it..and if I don't if/when I get sued, I will sure wish I did.







Why do OBs get the free pass here? Why is obstetrics the seemingly only field of practice where evidence-based practice is a dirty word? The very idea that "Because everyone else is doing it" would be a reason to do something, for a medical practitioner---a trained scientist---is odd.
Perhaps you could look at it like this...

They ARE practicing evidence based medicine. Only they are relying more heavily on the evidence that says 'If you DON'T do everything.under.the.sun. to prevent a bad outcome, you CAN expect to face a very serious lawsuit that threatens your ability to support yourself, your family, and continue to practice in your chosen profession.'

Quote:

But, in "defensive medicine", in most instances, who is it who loses the normal, intervention and drug-free, empowering, satisfying and rewarding birth experience? Mom _and_baby.
And if this is the birth mom desires, she'd best stay far away from an OB, preferably far away from a hospital. It's the way things are, and it's not going to change any time soon. People can work to make changes, and they absolutely should do so, however today's choices must be based on today's realities.

Quote:

So, you are suggesting that doctors continue to utilize inferior and/or unnecessary procedures/tests because if she didn't---she's going to be sued and lose?
I'm saying I don't blame them for doing so.

I understand where they are coming from. I know in the field of anesthesia, which is where my husband practices, there are choices to be made that may involve more intervention 'just to be safe' that are common place, and you bet your butt that I fully expect DH to err on the side of safety with his patients.

If he were an OB, I'd fully expect him to section a woman in an instant if he thought baby might be in trouble. It sucks that it's like that, but I would rather a woman have an unnecessary section if the alternative was DH losing his ability to support our family.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
'You could get better care elsewhere' is certainly not factual in the least. Perhaps 'You could get DIFFERENT care elsewhere' might be more appropriate. There are RISKS to homebirth. There are RISKS to midwife/birth center births. There are RISKS to hospital births. NONE of the choices are risk free, and perhaps a great majority of women feel more secure knowing they are delivering in a place where they will have immediate access to surgical intervention vs. being however many minutes away by ambulance or car should transfer become necessary.

Your tone is unnecessarily hostile.

And what I meant was, "You could get better care elsewhere for a low risk pregnancy." Did you read my link above for the national birth center study? 11,000 women. C-section rate of 4.4%. No maternal deaths. That is better care.

Here are some additional statistics:

1. The risk for neonatal mortality was 33% lower for births attended by CNMs.
2. The risk of delivering a low birth weight infant was 31% lower for CNM attended births.
3. The mean birth weight was 37 grams higher for CNM attended births.
4. The infant mortality rate was 19% lower for CNM attended births.

Tell me, why do you think it is the midwives (particularly CNMs practicing in birth centers) don't practice defensive medicine in the same way doctors do, yet they have better birth outcomes?

Doctors do not share these statistics, published in the US Journal of Epidemiology, with patients. They do not say, "As a low risk mother, you will be much less likely to die while in the care of a CNM."


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## captain optimism (Jan 2, 2003)

I hope this won't sound totally irrelevant, as it's a personal experience with medical care that wasn't related to pregnancy.

i was hit by a car as a pedestrian, and had excellent care for my badly broken leg at the hospital nearest the accident. The emergency orthopedist installed an external fixator, which looks kind of like an erector set--metal rods go through the affected limbs. I returned to my home and needed to see another doctor for follow-up care. My HMO assigned me an orthopedic surgeon. The surgeon decided he should remove _some_ of the rods of the external fixator. (He didn't seem to understand how it worked.) I told him I wanted a second opinion. He tried to browbeat me into signing a surgical consent form in his office, weeks before the proposed procedure.

Risks? Schmisks. He didn't even know what he was doing. I found out that he was not board-certified. He saw me as an opportunity to get another surgery under his belt. The fact that the surgery didn't make any sense--well, that wasn't interesting for him.

That was an orthopedist. I wasn't even pregnant! Okay, that guy was a total ringer, but still. i would never assume that surgical consent forms are always done properly.

I don't have a bad feeling about all doctors. i'm just saying, they are another group of people who have power over people because they take care of them. You always have to be wary and careful about people in helping professions.


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## eilonwy (Apr 3, 2003)

Quote:


Originally Posted by *MsElle07*
Here are some additional statistics:

1. The risk for neonatal mortality was 33% lower for births attended by CNMs.
2. The risk of delivering a low birth weight infant was 31% lower for CNM attended births.
3. The mean birth weight was 37 grams higher for CNM attended births.
4. The infant mortality rate was 19% lower for CNM attended births.

I'm curious about the controls for these studies-- were participants matched for age, parity, and other risk factors? Does it take into account that people who choose CNM attended births are not only healthier in general, but more likely to be educated, not only about birth but in general? There are so many factors that would have to be considered in such a study, I'm just curious as to whether or not they were all considered.

Quote:


Originally Posted by *MsElle07*
I'm not sure what else you want from this thread. You asked if doctors informed people of risk, you have four pages worth of evidence that they don't. Is there some piece of information you're still looking for that someone can provide? I'm glad YOUR doctor informed you of the risks and obtained your fully informed consent -- that's the way it should be. I'm glad your C-sections were good experiences. But that is clearly not the universal experience -- quite the opposite, in fact.









Well, I ended my last post by saying that it didn't seem logical or reasonable, for doctors to fail to obtain informed consent or to mention risks involved with surgical birth, not by asking for more from this thread.


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## DocsNemesis (Dec 10, 2005)

Actually, my point was that even with women who are concidered high risk in certain cases-like with twins, breech, preeclampsia, GD, etc-they STILL have better outcomes with homebirth vs hospital birth.
As an example, I had preeclampsia with my 2nd. My current midwives would have continued my care. However, the CNM's I was seeing required me to deliver at the hospital. They sent me in to be induced. I had to fight to keep the CFM away, had to fight to eat, had to fight to move at all, had to fight to get into the water. Its no wonder women in situations like mine end up with epidurals. And then some of them have problems like becomming too numb or having their labor stall, which means more pit, which means baby is at higher risk for getting stressed out, which in turn means cesarean.
As another example, I hemorrhaged with my 3rd, under my midwives care (I was at a birth center). I almost died. However, that did not risk me out of a homebirth and I had one with my 4th with no problems. We were still prepared-I had planned on getting a hep lock just in case, because the time before they had a very hard time getting an IV in. Well, she just came too darn fast for that, but we were still trying to be prepared.
I have never heard of people not being able to take videos of their ultrasounds and take them home. I have been to oh...5 different ultrasound places and all of them have let me have the video to keep. 1 was my OB, 1 was another OB I was visiting, 1 was my CNMs, 1 at the fetal medicine clinic and another 1 at a different fetal medicine clinic. I know several people who also have their ultrasound videos. So maybe it isnt common where you are but then you said most of the women have homebirths so....
I cant remember where it is, but there was recently a study published on licensed midwives and homebirth/birth center birth vs OB/hospital birth. It was adjusted for risk factors and the results were that midwife attended births were much much safer then OB attended births. Also, you have to concider that many of the people doctors in the US put as high risk really shouldnt be high risk anyway. Not ALL, just some. In other countries they would not be concidered high risk and they would not automatically do a cesarean or whatever else. On top of that, doctors in this country seem to have a "big baby" complex. I cannot tell you how many women "had" to have a cesarean because their "baby was too big to fit." I'm sorry but that is soooo BS! In fact, I had this disussion with my OB while I was preggo with my first. In the 20 years he has been practicing, he has literally NEVER had a case where the baby was too big to be born vaginally. He said the only time he was worried was when the dad was samoan and the mom was this tiny little asian. The baby was a nice size but not huge. Anyway, he was talking about how it is just ridiculous that these doctors say oh, you're too small to deliver your baby. He is also a user of the Gaskin maneuver, something that most OBs either save as a last resort or refuse to do at all. It is the first thing he does in the case of shoulder dystocia and he has never had it fail-and never had a baby be born with a broken clavicle or cerebral palsy. Ok, I gotta go!


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *eilonwy*
I'm curious about the controls for these studies-- were participants matched for age, parity, and other risk factors? Does it take into account that people who choose CNM attended births are not only healthier in general, but more likely to be educated, not only about birth but in general? There are so many factors that would have to be considered in such a study, I'm just curious as to whether or not they were all considered.

Here's the abstract:

Quote:

Midwifery care, social and medical risk factors, and birth outcomes in the USA

MF MacDorman and GK Singh
Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.

STUDY OBJECTIVE: To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors. DESIGN: Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors. STUDY SETTING: United States. PATIENTS: The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991. MAIN RESULTS: After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births. CONCLUSIONS: National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women.
So, every birth in the US in the study year was included (born between 35-43 weeks), and social and medical factors were controlled for.

Quote:









Well, I ended my last post by saying that it didn't seem logical or reasonable, for doctors to fail to obtain informed consent or to mention risks involved with surgical birth, not by asking for more from this thread.








What makes you think that doctors, unlike everyone else in the world, act logically at all times?

The evidence is pretty clear that low risk women have better outcomes when cared for by midwives. If doctors ONLY cared about patient outcomes, why wouldn't they adopt a midwifery model of care or refer their patients to midwives?


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## cottonwood (Nov 20, 2001)

Quote:


Originally Posted by *wifeandmom*
Those are interesting stats. Were all of the babies in each group from low risk moms experiencing low risk pg?

Yes.


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## georgia (Jan 12, 2003)

Yes, I think the term is "matched pairs," if I remember correctly.

Quote:

If he were an OB, I'd fully expect him to section a woman in an instant if he thought baby might be in trouble.
His c/s rate would be astronomical! IME, "trouble" is the fact that the baby is still on the inside of the mother and out of the doctor's control. I don't mean this snarky. It's inherent in the OB's POV. Trouble is so subjective, fortunately for the surgeons. Guess safe is subjective, too.

Quote:

It sucks that it's like that, but I would rather a woman have an unnecessary section if the alternative was DH losing his ability to support our family
I know you're not alone. I guess it's all about the "live baby at the end" mentality that discards that what's best for mom is best for baby and vice versa. The mother's experience in birth is just as integral to the birth as the baby's experience.

It's a sad state of affairs that in order to support a practice/family/etc a physician, who has dedicated her/his life to helping others is reduced to minimizing her/his exposure to lawsuits rather than doing what's in the birthing dyad's best interest. But, singing mostly to the choir here


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *georgia*

It's a sad state of affairs that in order to support a practice/family/etc a physician, who has dedicated her/his life to helping others is reduced to minimizing her/his exposure to lawsuits rather than doing what's in the birthing dyad's best interest. But, singing mostly to the choir here









Yep, it sure is, but unfortunately, those are the parameters within which most physicians practice these days.

Like I said earlier, there are things that are done as a matter of routine in anesthetic administration that are likely unnecessary, however, when it's all said and done, should something go wrong, whomever is administering the anesthetic to the patient had darn well better be able to say they followed x, y, z standard of care. It is really beside the point if they happen to agree with it or not, it's the way things are.

One such example is this business of not allowing a woman to even drink water prior to a scheduled section or once the decision to section is made. That comes straight from anesthesia, and it's largely unnecessary to restrict ice chips so long as mom isn't eating pounds of them.

But guess what? It's the conservative approach, it's typical of hospitals across the nation, and a cup of ice can open up a practitioner to a nasty fight should mom end up with pneumonia from aspirating during surgery.

It's miserable being told you can't have ANYTHING by mouth for hours on end, *especially* if your surgery is delayed. But they'd rather you be miserable than take the miniscule risk of aspiration that 'might' have been prevented had they restricted mom to absolutely nothing by mouth.

That one little thing can be enough to raise questions as to whether or not mom received 'adequate' care, and like many other issues, there's no way to go back in time and answer the question of 'Would this have happened regardless?'

There are many such examples in anesthesia, and even more in obstetrics. And when they are paying $100-150K+ PER YEAR for malpractice insurance already, I can hardly blame them for practicing 'defensive' medicine. This didn't happen out of nowhere, and it won't go away on its own.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
I can hardly blame them for practicing 'defensive' medicine. This didn't happen out of nowhere, and it won't go away on its own.

Right. It will go away when practitioners, patients and/or gov't regulation changes the system as it exists. (Which is not in the best interest of patients, does not provide them with a higher standard of care, and which leads to our abysmal birth outcomes.) The lives of babies and mothers are not expendable -- we cannot just chalk it up to "Well, that's the current climate" and move on, defending medical providers as if they are blameless.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *MsElle07*
Right. It will go away when practitioners, patients and/or gov't regulation changes the system as it exists. (Which is not in the best interest of patients, does not provide them with a higher standard of care, and which leads to our abysmal birth outcomes.) The lives of babies and mothers are not expendable -- we cannot just chalk it up to "Well, that's the current climate" and move on, defending medical providers as if they are blameless.

Who ever suggested we should just 'move on' and accept things the way they are?

And who said medical providers are 'blameless'?

The only thing I've stated is that I don't blame them for practicing the way they do given the current climate. Heck, many OBs themselves don't agree with the way things are done, but they are stuck between the proverbial rock and hard place if they buck the system, something goes wrong, and mom decides to blame anyone but herself. It happens, and all you have to do is be around for one of your co-workers to face it to see the reality of what can happen to your entire career in an instant.

As an example, we personally know SEVERAL OB's who completely disagree with their inability to attend VBAC attempts, but there is NOTHING they can do about it. Their malpractice carrier refuses to cover them if they attend VBACs. It's not like they can just up and decide one day to say 'I think VBACs are fine and I'm not going to stop attending them, regardless of insurance coverage.' The hospitals won't allow them to do that, and realistically, do you honestly expect them to attend ANY birth with NO malpractice coverage? It's bad enough when your insurance carrier gets slammed for millions of dollars, but if it's YOU personally....yeah, I hope people aren't waiting for THAT day to come.

Do they share some of the blame for where things are today? You bet they do. In the end, though, it really doesn't matter. They have to practice within the realm of reality, not something that is very pretty unfortunately.

Anyhow, I'm really curious as to why a woman desiring a natural birth with no interventions would WANT an OB to deliver her in the first place. Even the most low intervention doc is going to do things you won't likely see in other settings. If you truly don't want an IV, continous monitoring, blah blah blah....why on earth would you go to the hospital in the first place? That makes no sense to me. Kind of like going to a Mexican restaraunt and demanding spaghetti, then being royally pi$$ed off when they tell you that's not what they serve.

Work to change the system...that would be an EXCELLENT plan, however in the meantime, you have to make your birthing choices based on the REALITY of today. And the REALITY is you are not very likely to have a natural, unmedicated, no intervention birth at most hospitals across this country. Right or wrong, it's the way it is, and stomping your feet, demanding instant change to all you disagree with is incredibly unlikely to work, not to mention VERY likely to stress mom out considerably.

Figure out what kind of birth you want, and do it in a place that is most likely to respect those wishes. Doesn't mean we shouldn't advocate for change within the current system, but don't expect instant results.

Maybe I'm too much of a realist.


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## MsElle07 (Jul 14, 2006)

Quote:


Originally Posted by *wifeandmom*
Work to change the system...that would be an EXCELLENT plan, however in the meantime, you have to make your birthing choices based on the REALITY of today. And the REALITY is you are not very likely to have a natural, unmedicated, no intervention birth at most hospitals across this country. Right or wrong, it's the way it is, and stomping your feet, demanding instant change to all you disagree with is incredibly unlikely to work, not to mention VERY likely to stress mom out considerably.


I concur. Hospitals are not the place to have intervention free births. I posed a question earlier: why are CNMs able to practice evidence-based medicine and retain their insurance coverage? And why can doctors not to the same?

I am completely sympathetic to the RIDICULOUS malpractice insurance system in this country that dictates how doctors practice in many cases. However, that does not change the bottom line -- that they should be providing the highest possible care for the mom and baby, and the stats are clear that that is not happening.


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## georgia (Jan 12, 2003)

Quote:

Anyhow, I'm really curious as to why a woman desiring a natural birth with no interventions would WANT an OB to deliver her in the first place. Even the most low intervention doc is going to do things you won't likely see in other settings. If you truly don't want an IV, continous monitoring, blah blah blah....why on earth would you go to the hospital in the first place? That makes no sense to me.
I have to totally agree with you on this. Perhaps it has something to do with your insurance points above. It's what is "covered" or who is on the plan, or what the system dictates? I know from personal experience--I had NO idea what I was up against until after my tremendously interventive and horrible hospital birth. I honestly had NO idea women in the US gave birth outside of hospitals and birthing centers. Ten years ago was the first time I'd even heard of a midwife. For me, so much of it is cultural. We're taught birth is risky, unsafe, painful, horrible, etc....and who does one trust? Doctors! They'll fix it and make it all better.

For me, I think the consent thing has a lot to do with perceived trust. Ten years ago, I would have trusted that any doctor that I was receiving care for would provide me with any information that I would need. Now, I know this to be the most completely naive and potentially dangerous assumption I could have possibly held.


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## member234098 (Aug 3, 2002)

I have worked for thirty years to change things; something has to change in the medical community. I was part of a community group that helped fund the first ABC in my town, and the hospital never used it. It was window dressing.

We had funding through B of A. The room was decorated with a rocking chair, a breakaway bed bought and paid for, and the hospital locked it up and threw the key away. This hospital is now the only medical center in the area. The others within 20 miles have closed.

It is so sad to work so very hard only to be totally ignored; what a pathetic statement on our birthing society. I am glad I voted with my feet for my four children's births by never placing them in stirrups and staying home.


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## boscopup (Jul 15, 2005)

Quote:


Originally Posted by *MsElle07*
I posed a question earlier: why are CNMs able to practice evidence-based medicine and retain their insurance coverage? And why can doctors not to the same?

In some areas, I think that's starting to change for the worse, causing CNMs to have to stop delivering completely. In my area, we used to have multiple CNMs delivering at hospitals, but then someone (not sure if it's the state or the insurance companies, but it seems to be a widespread thing) decided that CNMs needed an OB standing over them telling them what to do. So the CNMs were having to do more OB-like things, plus insurance companies were having to pay for two attendants instead of one (CNM *and* OB). There is now only one CNM still practicing in a hospital here (between 3 hospitals). One of the other ones was known to be pretty good (a friend of mine used her shortly before having a homebirth with my CPM), but the OBs in her practice said she cost too much, plus that last year before they took her off delivering, she wasn't allowed to really be a midwife anyway... she had to be more of an "OB-lite". Now she's still working with that OB practice, but can't do deliveries at all.







This all happened around the same time that they started actively prosecuting homebirth midwives (for "practicing nurse midwifery without a license").

Oh, and CNMs can't do homebirths here. Having any trained attendant at a homebirth is illegal (for the attendant, not for the mom). We're working hard to change THAT law though. I'm going out of state to have my out-of-hospital birth. And no, my insurance won't be covering my birth, even though I'll be using a licensed midwife.


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## MsElle07 (Jul 14, 2006)

The situation you described is really sad, Vera.














But it's not because CNMs are unable to get insurance coverage -- it's about OBs protecting their territory. In my area, we have a plethora of CNMs, and they deliver in hospitals, birth centers, and at home. However, the OBs have successfully lobbied hospitals to disallow family practice doctors OB admitting priveleges, unless they are under the supervision of an OB. My family practice doctor said that obstetrics was the best part of her practice until these regs went into place, and family docs were unwilling to acquiesce to the new demands. That's not about insurance coverage, though...


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## member234098 (Aug 3, 2002)

To: wifeandmom,

Yes, the Mehl Study used low risk women. The point of the Mehl study was to show that women who deliver in the hospital could have better outcomes at home. Each and every one of the women who delivered at the hospital had a counterpart at home matched for age, parity, and other variants; the outcome at home in every situation was better for the mother, proving that women who allow unnecessary intervention into their labors suffer unnecessarily from the cascade of effects of the consequences.

As for women being induced, many women were induced in the 1970s. Most of my contemporaries had inductions. In the 1980s, the ACOG suggested that doctors let up on the number of labor inductions they did; however since we live in an age when everything is scheduled and no one can wait, we are again doing more and more inductions.

In Immaculate Deception, Suzanne Arms had pitocin wafers on her gums to stimulate labor in 1973. If you read her book, little has changed, particularly in the attitude of the medical profession against women.

There is nothing new in medicine. Everything comes and goes as styles and fashions, often with the same basis in fact and science.


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## boscopup (Jul 15, 2005)

Quote:


Originally Posted by *miriam*
As for women being induced, many women were induced in the 1970s. Most of my contemporaries had inductions.

Yeah, my mom was induced in 1972 with my brother. She was a few days past her EDD, and she very firmly believes that her doctor wanted to go on vacation.







: Thankfully, the labor/delivery was still quick and easy (2.5 hour labor, no pain meds, normal vaginal delivery). She probably would have spontaneously gone into labor in the next few days anyway, so the induction was quite pointless.


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## niki_73 (Oct 6, 2004)

I was never informed of the risks of a c/s but I knew them of course. I don't remember signing a form, neither does DH, but we did give them verbal permission, I think we said something to the affect "just save our baby" I even told them not to give me an spinal if there was no time just cut me open. But we had a crappy experience and when I was released was not even told how to care for my incision or not lift anything. I'm having a VBAC this time.


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## jcchirib (May 21, 2005)

doctorjen said:


> [...]although I understand that the VBAC rate will no longer be considered as part of the quality measures used to assess hospitals, so probably we won't have to report them much longer. /QUOTE]
> 
> Oh my, this is interesting...why would a VBAC rate really not be considered in quality measures? (or am I being naive?) Is this JCAHO?


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## jcchirib (May 21, 2005)

Quote:


Originally Posted by *eilonwy*
How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me.







:

With my homebirth transfer, no one discussed c/s risks at the hospital. But, even in active labor, I read the "consent" form. And no risks of c/s were addressed. How do I remember? Well, I took umbrage to "consenting" to students participating in my care, amongst other things, so I very clearly recall crossing the offensive language out. There was no c/s-specific language in it. I came awfully close to having a c/s; had I had one, it would not have been with a full discussion of c/s risks. So yes, it is possible that a doctor would not discuss the risks before surgery in an L&D situation. But I think that the problem is not with individual doctors necessarily acting with malice (I'm sure that there are bad apples--there are in every profession!). I think that the problem is systemic--it is a problem with how the medical/hospital system works. The fact is, it is very likely that when you sign the "consent" form at the hospital, there is no doctor present to ensure that you have been "informed".

Seems that the medical profession is so firmly of the (anecdotal) belief that they won't get sued for the unnecessary c/s that they do not have a healthy fear of litigation over the consequences of those unnecessary c/s. Once women start holding them legally accountable for those unnecessary c/s that cause harm, things might start looking up.


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## boscopup (Jul 15, 2005)

Quote:


Originally Posted by *jcchirib*
With my homebirth transfer, no one discussed c/s risks at the hospital. But, even in active labor, I read the "consent" form. And no risks of c/s were addressed.

I still have my consent forms here somewhere. I had a vaginal birth, but upon entering the hospital, I was handed vaginal birth consent form and C-section consent form. I didn't sign either one, because I read the forms and it says that the risks had been explained to me, yadda yadda yadda. Well, no one had explained the risks, so I didn't sign until they explained them. The staff apparently forgot about the forms, so that's why I still have them, unsigned. No one ever did explain risks of either type of birth. I did have a vaginal birth, but never consented to it.







And this wasn't even a matter of "there's no time". I was there for 4 days before the birth occurred. There was plenty of time to explain risks and get the consent forms from me.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *jcchirib*
Seems that the medical profession is so firmly of the (anecdotal) belief that they won't get sued for the unnecessary c/s that they do not have a healthy fear of litigation over the consequences of those unnecessary c/s. Once women start holding them legally accountable for those unnecessary c/s that cause harm, things might start looking up.

One of the many problems with this is that it's hard to prove damages if you're okay from a medical standpoint. I can't imagine having to prove I was damaged if somebody on the street cut me open, no matter how well I recovered! But, if it's a doctor, it's different.


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## caned & able (Dec 8, 2005)

Doctors consider themselves priests or gods even of the religion of modern medicine, as the late great medical heretic used to say, so how could they be wrong, ever?


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## pampered_mom (Mar 27, 2006)

I signed a consent form for my c/s, but it certainly did not list any risks of the procedure. It was a very general surgery type form. It didn't list any of the risks that I now know today.

Quote:


Originally Posted by *wifeandmom*
Anyhow, I'm really curious as to why a woman desiring a natural birth with no interventions would WANT an OB to deliver her in the first place. Even the most low intervention doc is going to do things you won't likely see in other settings. If you truly don't want an IV, continous monitoring, blah blah blah....why on earth would you go to the hospital in the first place? That makes no sense to me. Kind of like going to a Mexican restaraunt and demanding spaghetti, then being royally pi$$ed off when they tell you that's not what they serve.

Because it's the only option fiscally available to her? There are lots of women out there that do not have health coverage for midwives (CNM or otherwise) or birth centers AND do not have the resources available to be able to go out of that network. How about the underserved areas of the country where midwife/birth center options are not available? How about in states where DEM licensure has been heavily lobbied against by the AMA or the ACOG?

How about the simple fact that the EVERY WOMAN has the LEGAL RIGHT to refuse any procedure (IV, CEFM, etc) and that the EMTLA states that hospitals have to "treat" her.

Quote:

Work to change the system...that would be an EXCELLENT plan, however in the meantime, you have to make your birthing choices based on the REALITY of today. And the REALITY is you are not very likely to have a natural, unmedicated, no intervention birth at most hospitals across this country. Right or wrong, it's the way it is, and stomping your feet, demanding instant change to all you disagree with is incredibly unlikely to work, not to mention VERY likely to stress mom out considerably.
It is not the pregnant or laboring woman's job to make the hospitals/nurses/doctors/anesthesiologists job easier. Nor is it her job to "work within the system" or the "reality" of today. Seriously...she is the one paying here, it's her body, and she has the right to demand whatever she wants regardless of a hospital's policy - again, that's her LEGAL RIGHT!

That doesn't mean that women shouldn't be well informed about the birth climate - it certainly will ease any stress she may have when faced with a difficult birthing situation, but she can't wait for the legislature to figure it out or the hospital administration (every doctor's and nurse's favorite scapegoat) to change. She has to work with her particular situation. I for one am not going to say that the only way women can have low-interventive births is by avoiding the hospital - that has got to be the WORST suggestion I have ever seen someone give regarding this issue.

Quote:

Figure out what kind of birth you want, and do it in a place that is most likely to respect those wishes. Doesn't mean we shouldn't advocate for change within the current system, but don't expect instant results.
Why not expect results in your situation? It's YOUR body, it's YOUR baby, and it's YOUR birth - no one should be able to tell you what to do, plain and simple. As individuals we have got to stand up and say ENOUGH!

(Side note: I take issue with a couple of places where you state that the OB "allowed" a mom to do something. If anything, it's the mom who's allowing the doctor to assist her with the birth of her baby.)


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## LadyButler (Sep 16, 2005)

Quote:


Originally Posted by *pamered_mom*
(Side note: I take issue with a couple of places where you state that the OB "allowed" a mom to do something. If anything, it's the mom who's allowing the doctor to assist her with the birth of her baby.)

Amen to that!!!


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## jennkraig (Apr 20, 2006)

Why would a low risk woman choose an ob?
Here is my situation.
My husband and I got pregnant by accident, we were not planning on having another kid, mostly because we don't have insurance. I managed to qualify (barely) for medicaid. I would like to pay a midwife to deliver me here in KY but they aren't licensed in this state. We also don't have a free standing birth center in my area. So, I can't afford to pay for a home birth MW, there are no CNM's covered in my state, my only option is an OB in a hospital, or UC at home. I don't feel comfortable with that because all of my 3 previous kids have had pretty tight nuchal cords at birth. I even told my OB that if it was up to me I would be at home with a MW and want to be treated that way. Of course she isn't completely on board with that. I have agreed to sign waivers for all the medical procedures I am refusing.

Informed consent is a joke. I told my previous ob's at all three births not to cut me as they picked up the knife to do the episiotomy. All three did it anyway.


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## ericswifey27 (Feb 12, 2005)

Quote:


Originally Posted by *MsElle07*
Right. It will go away when practitioners, patients and/or gov't regulation changes the system as it exists. (Which is not in the best interest of patients, does not provide them with a higher standard of care, and which leads to our abysmal birth outcomes.) The lives of babies and mothers are not expendable -- we cannot just chalk it up to "Well, that's the current climate" and move on, defending medical providers as if they are blameless.











I was so depressed and disheartened by my birthing experience (unwanted unneccessary csection). I am still suffering today. I am enfuriated that my empowerment was stripped from me, that everything that I asked to be done or not done throughout the birth process was ignored. I am not exaggerating when I say my birth plan might as well have been toilet paper.

*I think the current birth atmosphere in most hospitals today is absolutely atrocious.*

We need OBs who can stand up for what is right.


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## FrumDoula (Jun 10, 2003)

One change that some hospitals have made is to require women to sign consent forms before her labor begins. This makes sense to me. Another is to have women take an epidural class, which (hopefully, though certainly not always, I'm no fool) can explain the benefits and risks of the epidural procedure. Some hospitals require you to take the class or you don't receive an epidural, which I'm not sure I agree with, but I can understand in theory.

The point is to educate women as much as possible before she's writhing in pain on the bed.

Women have a responsibility to educate themselves, ask questions and figure out what hospital procedure is. Doctors have the responsibility to educate their patients, explain things in plain English and practice according to evidence.

When I work with mothers as a doula, I explain that their parenting responsibilities begin when they find out they're pregnant, NOT when the baby is born. With the Internet and countless books out there, there's a lot of resources available to them, and ignorance is a very poor excuse.

I also agree that our medical culture is not always friendly to informed women and partners, but that's slowly changing. My husband is in med school, and a lot of the students actually LIKE when their patients know what's up. They're genuinely frustrated when their patients don't care, or surrender their power to the physician.

Alison


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## caned & able (Dec 8, 2005)

Quote:


Originally Posted by *jennkraig* 
WI would like to pay a midwife to deliver me here in KY but they aren't licensed in this state.

Are you absolutely sure there are no midwives in KY?

That is amazing because Kentucky was the home of the Frontier Nursing Service http://www.midwives.org/whoweare/fnshistory.shtm. They never lost a mother or baby despite the fact that they were serving an impoverished, malnurished segment of society. What a record!


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## JamieCatheryn (Dec 31, 2005)

I'm in Louisville, there are CNM's here but no liscenced homebirth midwives. There are homebirth midwives, but they operate kind of extralegally.


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