Forced Surgery?

[diggitydot]

Holy shit, those are ridic stats. My dude's c-section rate is around 15%-20% and he's one of only a handful of docs who do them in this county.

[SoonerTexan]

Never mind, found my own answer:

Data regarding the risk for women undergoing TOLAC with more than two previous cesarean deliveries are limited

http://www.acog.org/~/media/Practice...5.pdf?dmc=1&ts

[Pollyanna]

She had the right all through her pregnancy to change providers, she had the right to start care with a midwife, she had the right to find a provider that would practice outside ACOG guidelines (hell,dh could give her names). She had choices all through her pregnancy. This wasn't her first rodeo, needing a c-section wasn't a shock to her. She wanted to force her physician to practice in a way that puts everyone in jeopardy. Ask yourself if you were married to her physician how you would feel. Ask yourself how you'd feel if her selfishness led to a lawsuit that destroyed his career and your family. What are you willing to sacrifice? Realize that this is not a simple black and white issue. As you saw, she delivered her baby via section because she didn't progress, she probably never progresses thus the sections. This is the kind of woman that sues. This is the kind of woman that hospitals have to threaten because they KNOW she will come after them. I would be willing to bet she sues for pain and suffering.

ETA: She is the type of woman that then refuses vaccines for her child and then blames the pediatrician when her child gets sick.

[Pollyanna]

Lol ST, really? I'll let dh know you have a handle on the guidelines and safety of VBAC after 3 sections

[Vanquisher]

She had the right all through her pregnancy to change providers, she had the right to start care with a midwife, she had the right to find a provider that would practice outside ACOG guidelines (hell,dh could give her names). She had choices all through her pregnancy. This wasn't her first rodeo, needing a c-section wasn't a shock to her. She wanted to force her physician to practice in a way that puts everyone in jeopardy. Ask yourself if you were married to her physician how you would feel. Ask yourself how you'd feel if her selfishness led to a lawsuit that destroyed his career and your family. What are you willing to sacrifice? Realize that this is not a simple black and white issue. As you saw, she delivered her baby via section because she didn't progress, she probably never progresses thus the sections. This is the kind of woman that sues. This is the kind of woman that hospitals have to threaten because they KNOW she will come after them. I would be willing to bet she sues for pain and suffering.

ETA: She is the type of woman that then refuses vaccines for her child and then blames the pediatrician when her child gets sick.

Yes. I am more apt to side with the medical provider in nearly all circumstances. She clearly should have had this figured out before 41 weeks.

I think we can all agree, though, that decreasing rates of Caesarian sections in this country would be a good thing. Maybe if doctors weren't so worried about being sued for everything and got paid to wait with a woman in labor for 36 hours, the rates would go down. Alas, no. We want to blame docs for everything. Sue the shit out of them, and give them less money to do more.

Fuck medicine.

[Thirteen]

It rang a chord with me for many reasons:

1) I am so tired of the doctor hate/mistrust I hear on a daily basis.

2) I don't think CPS should be involved to potentially take a newborn away from the mother, just because she is doing something unconventional. Having said that, I can see why this situation could be a sign of "child endangerment". This is the slippery slope part.

3) C-section rates are super high, but: we are really not a healthy, fit society (greater risk to the mother/child), and physicians must practice CYA medicine because of #1.

[OrionGrad]

I dunno, I don't really think this case is about medicine anymore ...
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.

This is what I'm getting out of it, too.
But according to previous posters, it sounds like the child could one day sue the hospital (up until age 21) if the hospital let the mom go outside the system to give birth and something went wrong. So, suing the woman/threatening with CPS was really about protecting the hospital and the doctor from a lawsuit. It's not about them referring her to a doc who would perform the VBAC.

In light of that, I think the doctor and the hospital are totally in the right. They have to protect themselves.

[Pollyanna]

The discussion on c-sections in the OB community is already taking place and has been taking place for years. Dh is on several committees that just deal with patient safety. The issue is that you cant discuss the numbers in a vacuum. If Suzie Homemaker goes looking for section rates and then decides doc A must be horrific because he has a 50% rate she is missing a ton of data. Some physicians have a low rate because they refer every patient out that isnt a simple case, they don't want to take on the risk. My husband gets those ladies and he also started a special clinic specifically for the super obese woman because he saw a need for that population to have specialized care. Most of them will need sections, that increases his section rate. Does that then mean he is not providing good care? Many training programs no longer teach residents to use forceps for delivery because of the John Edwards type of rabid lawyers looking to sue doctors. All those cases that could have been derived vaginally via forceps now have to be sections because if you've never been taught to properly deliver with forceps you have no business holding them. Dh is one of the few that has been trained in all the different types of forceps that will even use them, he will deliver twins vaginally (many docs won't do that anymore either). It is not a case of docs just want to schedule everything because if they were looking for easy then OB would not have been the career path. Nearly all want their patients to have their desired experience but life doesn't always work out that way. It amazes me how women feel they have enough knowledge to tell the doctor how to practice medicine. If they feel they need to "teach" their physician they need to change care because they don't trust that doctor. Could you imagine if I told my urologist how I wanted her to do the procedure to remove my kidney stone? Sure, I could tell her how I would like things to go down, you know cuz I read Web MD and play around on kidney stone forums, but in the end I as a patient need to trust that I selected a competent surgeon and she will make the right decision for me. Patients have a responsibility to their physicians as physicians have a responsibility to their patients.

[diggitydot]

The discussion on c-sections in the OB community is already taking place and has been taking place for years. Dh is on several committees that just deal with patient safety. The issue is that you cant discuss the numbers in a vacuum. If Suzie Homemaker goes looking for section rates and then decides doc A must be horrific because he has a 50% rate she is missing a ton of data. Some physicians have a low rate because they refer every patient out that isnt a simple case, they don't want to take on the risk. My husband gets those ladies and he also started a special clinic specifically for the super obese woman because he saw a need for that population to have specialized care. Most of them will need sections, that increases his section rate. Does that then mean he is not providing good care? Many training programs no longer teach residents to use forceps for delivery because of the John Edwards type of rabid lawyers looking to sue doctors. All those cases that could have been derived vaginally via forceps now have to be sections because if you've never been taught to properly deliver with forceps you have no business holding them. Dh is one of the few that has been trained in all the different types of forceps that will even use them, he will deliver twins vaginally (many docs won't do that anymore either). It is not a case of docs just want to schedule everything because if they were looking for easy then OB would not have been the career path. Nearly all want their patients to have their desired experience but life doesn't always work out that way. It amazes me how women feel they have enough knowledge to tell the doctor how to practice medicine. If they feel they need to "teach" their physician they need to change care because they don't trust that doctor. Could you imagine if I told my urologist how I wanted her to do the procedure to remove my kidney stone? Sure, I could tell her how I would like things to go down, you know cuz I read Web MD and play around on kidney stone forums, but in the end I as a patient need to trust that I selected a competent surgeon and she will make the right decision for me. Patients have a responsibility to their physicians as physicians have a responsibility to their patients.

So much word. To all of this.

OB's specializing in higher risk pregnancies and patients will ABSOLUTELY have higher section rates. I think that's entirely reasonable and should be expected.

[scrub-jay]

Now I want to compare states with the highest CS rates against rates of obesity. Maybe toss in uninsured & rates of poverty for good measure.

[Vanquisher]

Toss in malpractice costs too.

[TulipsAndSunscreen]

I as a patient need to trust that I selected a competent surgeon and she will make the right decision for me. Patients have a responsibility to their physicians as physicians have a responsibility to their patients.

This is the part that drives me insane in the whole "I hate my doctor" thing. Find a doctor you do trust and work with them. When you damage the trust relationship by consistently questioning the training and expertise of your physician, you're not setting yourself up to receive great care because the relationship is antagonistic. In reality, these patients often know they're being difficult/can't find anyone else to take them either but they just want to complain.

Can you imagine people complaining about other professionals like this? "My architect is totally incompetent, I'm going to tell him how to build the house. I have a right to a good experience and I want it built in a way that violates structural engineering!" or "My lawyer is just in this for the money"...if you don't trust someone, find someone else to work with!!!!

[scrub-jay]

Toss in malpractice costs too.

Absolutely!

[SoonerTexan]

Forced Surgery?

Tara I didn't know and looked it up. That was my point. Clearly there isn't evidence to point that a VBAC after 3 c sections is safe. I thought you would be happy I looked at the actual ACOG position vs Suzy Homemakers blog post.

I was curious if it was really outside or that outside the guidelines. Apparently 2 is within depending on the situation, of course.

My point about rates in the south is a different topic not wholly related to this particular situation. I think it is a different environment than many of you have experienced. Getting a VBAC here after just one c section IS hard. I wonder if this woman got the chance after her first given where she lives and the options available and I feel for her on that level.

I don't doubt your husband is a wonderful provider who is fully competent and more knowledgeable than I am, but I'm also not a complete idiot. I truly wasn't trying to question his ability though.

[Vanquisher]

http://www.kevinmd.com/blog/2010/04/...-lawsuits.html