Forced Surgery?

[Thirteen]

Maybe this should be in debates?
Anyway, this is all over the news, and people are pissed (on both sides):

http://rhrealitycheck.org/article/20...ced-c-section/

(Ignore the bias, sorry).

As a medical community, what do you all think?

[HouseofWool]

I dunno - there isn't enough information in the article to say why the doctors were recommending a c-section. I can think of LOTS of reasons why a VBAC wouldn't be indicated in a 4th pregnancy particularly when there have been 3 previous sections.

I don't like the idea of forcing someone to have surgery (duh), but my guess is there is a damn good reason for it; excessive uterine scaring from the previous surgeries, placement of the placenta, some other comorbidity that was omitted from the article. Who knows.

[MsSassyBaskets]

I dunno - there isn't enough information in the article to say why the doctors were recommending a c-section. I can think of LOTS of reasons why a VBAC wouldn't be indicated in a 4th pregnancy particularly when there have been 3 previous sections.

Right, it's really hard to make a case by case decision without more information. It's likely that there's plenty of good reason and evidence to do a CS in this case.

However, the doctors against patients mindset that seems to be growing in the field of OB hurts EVERYONE, and court cases like this don't help the situation. I do find it really interesting that OB is the only area of medicine that routinely performs procedures without express consent (e.g. episiotomy, though I know this is changing) and that has debates like this arise regularly. Birth rights activists make the following comparison--if a child was injured in an accident or had a terminal illness and the only way to save her was for the parent to undergo an invasive and dangerous procedure, could you medically compel the parent to do so? No. Can you force a conscious patient who is refusing to undergo an invasive procedure to save their own life? So why are women in labor in the unique position of giving up their right to refuse consent? Not a perfect comparison, obviously. I want OBs available (...down the hall) when I'm delivering, but it does scare me that I have consciously put myself in a situation where I know I may lose my right to choose what happens to me. When that's the trade-off we have to make to give birth in a safe and supported environment, something is seriously fucked up.

[MrsC]

I think there must be some compelling evidence against her having a VBAC for them to take it to court. Wouldn't she have gone with a midwife if it was safe to do a VBAC?
Forcing someone to have surgery is extreme but I feel like someone has to protect the full term viable baby if the mother is unwilling to do so. I can't believe she would risk her child's life and her own just to give birth her way.

Having been in a position where continuing with a natural birth would have put baby and I risk, I can't fathom it. I had a few minutes to adjust to the idea of a c-section. I would have done anything to make sure he arrived safely.

[SoonerTexan]

Forced Surgery?

A lot of midwives won't do VBACs. In fact there are only 4 docs known to be VBAC friendly in the Dallas area. FOUR. I don't blame them because the requirements are really rough on OBs too. Mine Stopped doing them because he had so many women coming to him with no other options and couldn't take the caseload anymore. Sad but understandable. I'm gathering this is an area with very few provider options. The South is pretty bad when it comes to c section rates and VBAC options.

I saw this last night and wanted to know the full details too, but I don't like what I'm hearing about it. I gathered the mom didn't necessarily oppose to a c section but wanted a trial of labor

ETA: getting CPS involved is a douchey move. That angers me

[Thirteen]

The whole thing is a cluster.
On one hand, I agree: we don't know medical history bad details, there's liability/malpractice (despite reform here in the state), insurance nightmares, etc.

On the other hand: not even willing to let the woman try, threatening to involve CPS even if she labors at home? That's kind of extreme, isn't it?

*sigh*
Neither side will be happy with the outcome, I know that.
I'm going to ask my OB tomorrow on her thoughts - she's very balanced.

[ides]

Why can't they just have her sign a 'ok no c section if something bad happens we are not liable.' Or just have the baby alone at home then diall 911 when something goes wrong. I can't personally see any dr who would agree to a vbac after three csections.

[MrsC]

I can't find any unbiased articles on this story. I didn't mean to place blame on the Mom. I know how hard it is. I was terrified of having a c-section. I just can't believe they would try to sue unless there was a damn good reason.
DH flipped when I said I'd consider a VBAC. Then he agreed if docs were okay with it and the hospital had a NICU and MFM.
This story won't end well for anyone, that's true.

[MsSassyBaskets]

Why can't they just have her sign a 'ok no c section if something bad happens we are not liable.' Or just have the baby alone at home then diall 911 when something goes wrong. I can't personally see any dr who would agree to a vbac after three csections.

This is how I feel about it too. Force her to take legal responsibility for her own decision. If doctors are going to have to essentially "clean up her mess", they should have no liability. Good or bad, health care is a balance between medical recommendations and patient wishes. Taking away patient rights is not the solution, it forces them outside of the system and into less safe situations.

[diggitydot]

I just can't believe they would try to sue unless there was a damn good reason.

Oh, you'd be surprised at what people sue over, legit or not. And win. Particularly in states like IL.

[MrsC]

Oh, you'd be surprised at what people sue over, legit or not. And win. Particularly in states like IL.

True.
I was under the impression that they could refuse to treat a patient and refer them elsewhere if they weren't adhering to the treatment plan. Maybe I'm wrong but it would have been cheaper for them.

[diggitydot]

There was a case in IL where a kid was deceased prior to arriving at the hospital. Parents sued everyone involved because their kid wasn't miraculously saved. Those parents won their case. IL is losing docs left and right because of shit like this.

[Thirteen]

While there is a high c-section rate statewide, there are hospitals that have a lower rate (around 30%, not ideal, but not 40-50%). People are asking why she didn't consider a different provider or hospital -- the thing is, like a few of you, I suspect any OB would see a patient that is VBA3C as a walking liability.

Could the provider have just said no in the beginning and turned her away, due to risk?

[TulipsAndSunscreen]

You basically cannot sign away your right to sue in these cases. Even if you want to.

As an MD, why do I want to take on a patient who doesn't trust me at all to take my medical advice. Even if they promise not to sue, that seems a very, very sketchy thing to sign on to but if things go sideways, that's a bad relationship. Plus, you can't get a whole practice to do it so it puts all the pressure on one doc to agree to do it.

[bokelley]

Forced Surgery?

Plus the child has 21 year to sue for what happened to them at birth.

Normally the patient is not the one that sues in these cases. To is usually the spouse, child later in life or extended family that believed there was negligence.