Forced Surgery?

[SoonerTexan]

See I don't see this as an issue of her not getting a VBAC. That happens all the time. I see the issue as they are going to make her have a c section and are getting DCFS involved. There's a difference between a VBAC not being offered and a forced c section

[wiva]

Being pro-choice, I can't accept "it's safer for the fetus" as an argument for forcing someone to have a c-section. We allow people to have elective surgeries every day. We allow people to decline recommended treatment every day. I can't see any angle from which forcing someone to have a c-section is acceptable from my way of thinking.

[TulipsAndSunscreen]

Being pro-choice, I can't accept "it's safer for the fetus" as an argument for forcing someone to have a c-section. We allow people to have elective surgeries every day. We allow people to decline recommended treatment every day. I can't see any angle from which forcing someone to have a c-section is acceptable from my way of thinking.

I see what you're saying and I don't want to veer this into an abortion discussion but I don't think it's as simple as, "it's the patients choice". Pregnancy is an incredibly unique medical situation where there are TWO lives at stake. Ignoring that to respect patient preference and say this is the same as declining recommend therapy is not a great analogy. Pregnancy has an end, this isn't an elective situation. And there are two patients.

No matter where you stand on abortion, I think we can all agree that a full term, healthy infant deserves some protection. Or am I wrong?

[wiva]

I see what you're saying and I don't want to veer this into an abortion discussion but I don't think it's as simple as, "it's the patients choice". Pregnancy is an incredibly unique medical situation where there are TWO lives at stake. Ignoring that to respect patient preference and say this is the same as declining recommend therapy is not a great analogy. Pregnancy has an end, this isn't an elective situation. And there are two patients.

No matter where you stand on abortion, I think we can all agree that a full term, healthy infant deserves some protection. Or am I wrong?

I don't think we need to veer into abortion debate too far. I can't agree that women should be forced to do or not do something because they are pregnant. There will always be difficult situations in medicine and, while my heart agrees that a full term baby should be considered, my brain doesn't because the implications are scary.

(I don't mean therapy as in talk therapy, I couldn't tell if that's what you meant. I mean any therapy. A cardiac cath, a medication therapy, radiation for cancer, etc)

[Vanquisher]

I'm at a loss on this one. If my husband was the OB, I'd be worried about his risk. I don't know where this specific woman lives in FL, but at 41 weeks, I would have thought this would have been a thorough discussion with her OB who should know the hospital's take on VBACs. It's hard. I don't agree with forcing a cesarean, but I also don't agree with all of the liability on doctors, especially OBs.

[rainbabies]

I think she should vbac at home with a midwife and deal with her consequences. Weather that means death to herself or her baby...or a healthy happy mom/baby/delivery.

[MrsK]

See I don't see this as an issue of her not getting a VBAC. That happens all the time. I see the issue as they are going to make her have a c section and are getting DCFS involved. There's a difference between a VBAC not being offered and a forced c section

This doesn't make sense to me. What's the alternative? The baby is coming out one way or another. If they "don't offer a VBAC" what do they do? Let her deliver herself unassisted in the hospital?

At 41 weeks, this would have been addressed at numerous prenatal exams. I saw two different OBs when I was pregnant with Lambie and from my very first appointment, a c-section was planned (I'd had 2 already). It was a foregone conclusion. If I had a problem with that, I had at least 6 months to object.

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[Thirteen]

I think she should vbac at home with a midwife and deal with her consequences. Weather that means death to herself or her baby...or a healthy happy mom/baby/delivery.

I gathered that the hospital wants to sue, even if she does this. From my understanding if she tries to labor at home, CPS will be involved.

It's all very strange, and there are many things that just don't add up, on both sides of the story...

[Pollyanna]

We don't have enough of the story. All the articles are so skewed to the, "those evil OBs". With a fourth she is at a higher risk for rupture and then bleeding out and dying. If that were to happen her family would sue the OB and everyone in the same damn building. But you know, she has done soooo much research and considers herself an expert. Those damn hack know nothing, lol.
As dh said, she as a patient has the right to find a physician that practices outside ACOG guidelines. She cannot force an OB to do that though even though her selfishness thinks she can. And make no mistake, when you claim to know more than the experts and are willing to risk you life and your child's life it is selfishness and arrogance. Just because we want something doesn't make it available to us. I'm sorry vaginal birth could not happen for her but that's life for you. I know of no docs that would waste their time with her to the point they have reached. My guess is that she wants what she wants and she is going to stay in that practice because that is where she can get insurance coverage. She wants not only to risk her life and her child's and her entire family's future but also those if the doctors that may be on call the night she delivers. Her solution is to risk a home birth or pay out of pocket for a physician that will practice outside guidelines and pay out of pocket.

[rain_dancer]

I agree with everyone else that we are missing parts to this story. The bias of the "reporter" in this article also makes it hard to get the whole picture.

My guess is that this whole situation and the threats of CPS involvement were instigated by the hospital, NOT the individual doctors/practice. In my experience, hospitals are just big corporations. They are businesses run by non-medical professionals who don't have the same perspective on patients and their care because they weren't trained to think of beneficence and non-maleficence as the top priority. Unfortunately, for hospitals, money is the top priority, and I've seen them go to great lengths to "risk mitigate".

That said, I've always seen the role of a medical professional as being the patient educator. They provide a patient with their expertise and recommendations on an issue, but it is ultimately the patient's choice when it comes to their treatment. However, as pointed out by previous posters, it's not that black and white when there is another life involved who doesn't get a say. I'd think to think that a mother would chose whatever the expert thinks best for her baby, so I'd be really interested to hear this mother's perspective. Does she just want the experience of a vaginal birth because, if so, that sounds selfish to me. And why wasn't this an issue with her previous potential VBAC pregnancies? I'm guessing she thinks this is her last chance to deliver vaginally.

Lastly, here's an update: http://www.charlotteobserver.com/201...l#.U9elSie9KK0

Sounds like all ended well at least.

[alotofyarn]

Thanks for the update - the article linked from that one has a few more details, it seems: http://www.news-press.com/story/news...baby/13276639/

[Thirteen]

We don't have enough of the story. All the articles are so skewed to the, "those evil OBs". With a fourth she is at a higher risk for rupture and then bleeding out and dying. If that were to happen her family would sue the OB and everyone in the same damn building. But you know, she has done soooo much research and considers herself an expert. Those damn hack know nothing, lol.
As dh said, she as a patient has the right to find a physician that practices outside ACOG guidelines. She cannot force an OB to do that though even though her selfishness thinks she can. And make no mistake, when you claim to know more than the experts and are willing to risk you life and your child's life it is selfishness and arrogance. Just because we want something doesn't make it available to us. I'm sorry vaginal birth could not happen for her but that's life for you. I know of no docs that would waste their time with her to the point they have reached. My guess is that she wants what she wants and she is going to stay in that practice because that is where she can get insurance coverage. She wants not only to risk her life and her child's and her entire family's future but also those if the doctors that may be on call the night she delivers. Her solution is to risk a home birth or pay out of pocket for a physician that will practice outside guidelines and pay out of pocket.

I'm glad you posted -- I wanted the perspective of some specialists on here.

I just spoke with my own OB today - she agrees that the whole thing is just terrible )us v. them mentality), and that we just don't know enough.

[diggitydot]

While I agree that "forcing" procedures on pregnant women isn't something most people are 100% comfortable with, medicine isn't always about being able to have your first choice. Medicine is frequently unpredictable, just like the people it is practiced upon. It's not uncommon to have to take the least desirable actions due to various factors in order to have a decent outcome. I think that's what this case highlights.

[MsSassyBaskets]

While I agree that "forcing" procedures on pregnant women isn't something most people are 100% comfortable with, medicine isn't always about being able to have your first choice. Medicine is frequently unpredictable, just like the people it is practiced upon. It's not uncommon to have to take the least desirable actions due to various factors in order to have a decent outcome. I think that's what this case highlights.

I dunno, I don't really think this case is about medicine anymore. I'm sure most of us can totally understand the doctor's reasoning for pushing for a CS. If she had really "done the research" as she claims, she should recognize the difference between a VBAC after one CS and a VBAC after three CS. Where this has gotten hairy is that the mother is not being allowed to decline care and go home and attempt to labor outside of the system--she will likely be arrested if she does so. That gets into the territory of defining when a fetus becomes a legally living entity that can be protected under the law. To me, that is no longer about the doctor or the medical choices involved, it is a question of legal definition of life and extending child protection to fetuses. And I'm sure that we can recognize that talking about a full-term, viable fetus is really not a pro-life/pro-choice situation. It is a whole other debate.

[SoonerTexan]

As dh said, she as a patient has the right to find a physician that practices outside ACOG guidelines.

Is it really out of guidelines, though? I'm not sure. This only specifies after 2 c sections

http://www.acog.org/About-ACOG/News-...BAC-Guidelines

Interesting final paragraph:

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

Seriously, though, it is bad down here. Take a look at states with the highest c-section rates. My OB said he was floored when he moved to Texas and saw the environment. There is a lot less choice here and you really have to do your research in advance.

The Ten States with the Most Cesareans
1. Louisiana 39.7 percent
2. New Jersey 38.4 percent
3. Florida 37.8 percent
4. Mississippi 37.0 percent
5. West Virginia 36.0 percent
6. Kentucky 35.4 percent
7. Alabama 35.3 percent
8. Connecticut 35.1 percent
9. Texas 35.1 percent
10. South Carolina 35.0 percent

(This is just from one website, but it is consistent with what I have seen across a couple)

ETA: One of the frou frou private hospitals here (that caters to a wealthier, relatively healthy area, so we aren't talking about a really high risk population here) has a c-section rate approaching 50%. That's insane