Forced Surgery?

[SoonerTexan]

Also, I was talking at C-Section rates at a hospital level. They vary quite a bit in this area and it is interesting to look at the hospital policies and reputations.

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.

I agree with you for the most part. You cant force a doctor to do something they don't agree with. What I think is different in this situation is it sounds like her choices were limited. Which is too bad, so sad in general, you still cant force a doctor to practice where they are not comfortable. However the real difference is she apparently wasn't really given the opportunity to do what you described above without the risk of a DFCS investigation. That is what makes this particular story different in my opinion. Her right to do something else was taken away.

[Pollyanna]

Great article Heidi! Hell, my dh will even see his patients that come 2 hours late because he knows if anything goes wrong he is on the hook. The patient bears no responsibility (oh the stories I could tell).

Thanks St, I'm really not concerned about your opinion of my dh. I was not defending him in anyway. Your response of, "but a is that really practicing out of the guidelines" came across as, "clearly they just don't know what they're doing so but I can do the research myself" It's like a pediatrician's wife having to sit at the nonvaxers table

And that mother certainly had the option of seeking the care she desired. This practice sure as hell didn't seek her out. She wanted what she wanted, she likely wanted it covered by insurance and she didn't care who got hurt. Thankfully in the end she is alright and so his her baby. How much stress did she cause, how much money was spent by the hospital to protect itself? There is no excuse for her behavior IMO.

Eta: I'm NOT lumping you in with nonvaxers!!!! I apologize for the connotation!!

[scrub-jay]

Forced Surgery?

Pollyanna, you brought up ACOG guidelines by saying that she'd have to find a physician practicing outside of them. ST was questioning that comment and referenced ACOG publications in her links. I guess I didn't read it the same.

Also, the (biased) article indicated the hospital would not allow her to birth at home (which would've likely resulted in death of mother & baby) and were going to pursue child endangerment charges. There has got to be more to this story.

[mommax3]

Forced Surgery?

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.

ITA with this. DH trained in a program that was militant about keeping their c-section rate low. He can do forceps deliveries, but his newest partner can't (was never trained), and he told me the other day that he thinks his generation of doctors is the last one that will have learned the skill. The truth is, apart from the wackadoodle in the case we're discussing, you don't get sued when you do a section (even if it isn't necessary), but if you *don't* do one, and some slimy lawyer claims later on that if you had, x wouldn't have resulted, you will most definitely get sued. As someone whose spouse went through years of litigation due to a similar scenario (no indication of a problem prior to delivery/baby died) I can tell you that for the provider, the section is the safe option. That said, DH's section rate is still low (10-15% primary section rate, 20-25% repeat section rate) but he makes no apologies for recommending them.

[Chrisada]

Pollyanna is spot on as usual, down to new OBGYN's not being trained on forceps because of lawsuits. And let's not forget, many many women request c-sections, which leads to a higher rate. If you refuse a c-section request and even one little thing goes wrong even if unrelated to the birth, guess whose in deep shit bec. of that refusal to do a c-section. The OBGYN.


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[bokelley]

Pollyanna is spot on as usual, down to new OBGYN's not being trained on forceps because of lawsuits. And let's not forget, many many women request c-sections, which leads to a higher rate. If you refuse a c-section request and even one little thing goes wrong even if unrelated to the birth, guess whose in deep shit bec. of that refusal to do a c-section. The OBGYN.


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This.

[scarlett09]

Forced Surgery?

Damn, based on those c-section rates by state, I'm screwed.

It seems like doctor mistrust is pervasive in fields like OB, peds and FM. Does anyone else find it occurring in other fields?

How does one even find out what the c-section rates are for their doc/obgyn practice? Not that I'm super worried. I trust them to get all three of us to the end safely (and DH too as a byproduct). But I am curious.

Do they even keep separate stats on multiples? If you think about states that have higher rates of multiples and infertility treatment (thus causing higher rates of multiples), it could be one of several explanations for a higher c-section rate.

[Chrisada]

I'm sorry, this whole thing is so ridiculous. A freaking VBAC after three c-sections?? But she did the "research" so she's qualified to make that decision apparently. Eye roll.


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[Thirteen]

Forced Surgery?

Scarlett - most states release c-section data, per Iive births, for different hospital systems.
Obviously, high risk and multiples are factored into the total percentage, but there's no way of isolating how many and the "why". This will of course skew the results, and it must be taken into consideration. No one should be vilified.

If you are worried about it, I'd seek out a doctor that will allow, based on risk profile to mother and babies, a trial of labor for a Primip of multiples.

Disclaimer: ***I am not an OB spouse, and of course defer to those who are.***

[MrsC]

The new hospital DH works at does an annual report breaking down all their c-section rates etc. I checked to see if they do VBAC's and they do some. I was happy to see the c-section rate is less than 25% or something like that. Scarlett, maybe search the website of the one you're delivering at?

[Sheherezade]

Tangentially related: when I was a kid, my dad was involved in a case that called CPS in on a woman that wanted to have a home birth. She had delivered at home twice before and in both cases the babies died in delivery. The third delivery they tried to block by claiming child endangerment. My dad was the ped for her living children. I remember him being turned totally against home births by this experience even though he himself had been born at home.

I think she was very religious and had the idea that the deaths were "God's will". She lived five minutes from the hospital.


Angie

[alotofyarn]

That's awful, Angie!

I live in the highest c-section state, and I'm thankful that I didn't have to have one. I also trust my OB, and had he recommended one, I would have proceeded. I wasn't super excited about having to get pitocin after my water broke and I wasn't contracting, but I never felt like I was forced, they had good reasons with the meconium staining, and they did give me a little bit of time to start on my own.

One of my good friends has a medical condition where she can't push, so she was given the choice of vacuum, forceps, or c-section. It's interesting, because I'm not sure what I would have chosen in her situation.