Article: "Clinic's sign about choice"

[Belle]

I had to share this article about how a particular hospital is stomping on birthing mother's choices in childbirth.
http://heraldextra.com/news/local/ce...bdb8baadf.html


Here is the very last (and most telling) line of the article. Bolding mine.

Generally the mother agrees with the doctor. In the rare case that she doesn't, there is a line of authority to override the mother's wishes, but again, that's unusual, said Janet Frank, Intermountain Healthcare spokeswoman in Utah County.

This is beyond horrific. I'm sure they have a copy of patient's rights posted somewhere in their maternity wing and hospital policy blatently violates that.

[Turquesa]

"I reserve the woman's right to choose," he said. "I also reserve the physician's right to choose."

Please . . .

[kltroy]

Well to be perfectly honest, I wish MORE doctors were willing to lay it all out for women like this. At least you know what you're getting into when you choose this practice! This is a more honest approach than saying you're supportive of womens' choices, but then not actually supporting them when it comes down to it.

[dachshundqueen]

Well

As a small business person, they are allowed to state what they will and will not do, no? Is that not their right? You are also free, as a pregnant woman or a woman seeking gyno services not to use them.

Personally, I would not choose to use them, but that's beside the point.

Liz

[LiLStar]

How I see it is, as a business and as a dr, they have a right to refuse to perform procedures/prescribe drugs that they believe will cause more harm than good, or even if they simply don't agree to it on a personal level. So a dr, imo, has the right to refuse to induce a mom because she's "sick of being pregnant" or refuse to perform a ECS without medical indication. They can refuse to do extra ultrasounds just because the parents want to see their baby, or refuse to hand out abx for something they don't think abx will help. So yes, I support a dr's "right" to refuse to perform elective procedures. But thats kinda where it ends. I don't believe a dr has the right to refuse to not do a given intervention. If the dr comes in and says, time for some pit and I say NO.. their right to state what they WILL do does not override my right to state what they WON'T. Sign or no sign.

[Belle]

But its not just the doctors of this particular clinic. If it were just that particular practice that said "sit down, shut up, and do what I tell you or we'll find you someone else" it wouldn't be so terrible. The mother could just find another practice.

Its the whole hospital. Many times a mother's insurance will only cover one hospital. For my first I had to drive by 2 other hospitals that were closer to get to the one my insurance company picked out for me.

They have procedures for forcing a mom to do things against her will. And if she doesn't agree with the doctor, the mysterious "line of authority" will come out and make her. The article specifically mentions EFM that is forced on mothers and (big surprise) 95% of mothers "opt" for epidurals. It doesn't say anything about VBACs, Breeches, IVs, Big Babies, or a number of things that a mother could disagree with her doctor over. Likely that the threat of action will be enough to get a mother to "agree" with her doctor and sign her name on the consent form.

[*MamaJen*]

I find it kind of amusing reading stories dealing with birth, just because I've done so much research in recent years about birth, and I can often see in these news stories that the journalist doesn't quite get it.

[Plummeting]

Originally Posted by Belle

But its not just the doctors of this particular clinic. .....
Its the whole hospital.

No, it IS just the doctors of this particular clinic. This was posted on the FB page of the Big Push for Midwives a week or two (or more) ago, so I checked it out then. It's an OB practice, not a hospital. In fact, the hospital system with which this OB practice is associated specifically encourages patients to create birth plans. Additionally, Orem Community Hospital, the one mentioned in the article, has a CNM clinic, so Dr. Judd is definitely not the only choice for prenatal care in that area, and if a woman's insurance covers that hospital, it's unlikely they wouldn't cover the midwives who work there.

I think the doctor's a...UAV...for wording his sign in such a way as to imply that women who have birth plans and use the Bradley method don't care about the health or well-being of their babies. I also think that any OB who refuses to participate in developing birth plans or Bradley deliveries should probably find a new job. However, this is an issue with a particular OB practice, not a hospital. Women have other choices. Thank god!

[mntnmom]

I for one, wish every practice that felt this way would put up a sign. At your first appt. you could walk, and walk right out. Instead women frequently spend months feeling out their provider and making very stressful choices to transfer care later. Or worse, giving birth with one of these OB, under the false illusion that they support natural birth and will honor your birth plan!
The sign is clearly written out of an ignorant, maybe self serving worldview. But so many providers, and hospital administrators think and act this way without having the guts to make it common knowledge.

[kitkatkaddoodle]

A sign like that would have saved me several frustrating appointments with my OB that I transferred to when I had to move states mid-pregnancy. If he'd had that sign up, I'd have been able to walk away before engaging him, but I finally did clue in, walk away, and sign up for my homebirth CNM. Better have their philosophy up front instead of saying what I want to hear in the prenatal clinic and then fighting me the whole time at the hospital.

[SeattleRain]

This sign makes me so angry because I think it just adds to the negative mentality many people have about OBGYNs and hospital births. There are so many caring and natural minded OBGYNs, as well as OBGYNs who are open to birthing naturally even though it might not be something they see every day, but they get totally underminded when d-bags like this doctor make the news. It makes women afraid to deliver with OBGYNs, and it makes them all looks like insensitive control freaks and doesn't give them enough credit.

It is totally possible to find an OBGYN who will work with and be open with you, and its an embarassment that people like this are still able to practice medicine. It would never be acceptable in any other kind of medicine.

[Belle]

Originally Posted by Plummeting

No, it IS just the doctors of this particular clinic. This was posted on the FB page of the Big Push for Midwives a week or two (or more) ago, so I checked it out then.

I wasn't refering to the sign at all. I saw that around a month ago on facebook. The only reason I mentioned the sign was it was the title of the article.

Yes, its just this particular practice of three doctors who have this sign. But when the hospital spokeswoman comes out and says that there is a "line of authority to override the mother's wishes" it does not mean that it is just this clinic. I looked up on Intermountain Healthcare's website. They own 22 hospitals. I'm not saying that all 22 hospitals have this draconian policy, but its sounds like there's a system in place in case they feel they need it.

[SeattleRain]

Originally Posted by Belle

I wasn't refering to the sign at all. I saw that around a month ago on facebook. The only reason I mentioned the sign was it was the title of the article.

Yes, its just this particular practice of three doctors who have this sign. But when the hospital spokeswoman comes out and says that there is a "line of authority to override the mother's wishes" it does not mean that it is just this clinic. I looked up on Intermountain Healthcare's website. They own 22 hospitals. I'm not saying that all 22 hospitals have this draconian policy, but its sounds like there's a system in place in case they feel they need it.

I actually think that might be universal, as in, all hospitals have a line of authority or protocol that they follow when a patient wishes to do something that they deem dangerous. For example, lets say you need surgery but are refusing surgery for wahtever reason, they can admit you for psychological counselling sometimes against your will (compelled by court or by law) to see if you are mentally fit to make a decision that means you will die. If you are found mentally unstable, they can actually compel you to take the surgery. In the case of a birthing mother, there's always a protocol if you want to do something against the wishes of your doctor and usually it involves you signing a waiver that says that if you deny the procedure, you won't hold the hospital accountable for the outcome. In really severe cases, there is leeway for hospitals to get a court order to compel you to do something if they feel it is really dangerous but I've never heard that applied to a mother in labor, only a baby once its been born with complications needing treatment that a mother refuses to do for whatever reasons.

I think the biggest issue here is not that hospitals have this policy (because they have to for insurance and malpractice reasons), but the guidelines they're using to say you're making a dangerous decision. I would be HIGHLY doubtful if a hospital could make a case to go against a mothers wishes simply because she wants to use the Bradley Method for example. A more likely situation would be if a mother refused a C-section for something like a breech baby and insisted on trying to deliver naturally, even if the hospital has a policy against such deliveries. Even then, its not like they can just wheel you into surgery without your permission unless they have a court order, which would be pretty difficult to get as in most states fetuses don't have a right to life. More likely is that they could refuse care and you'd have to check yourself out AMA, or get a C-section.

[claddaghmom]

I wish they were all legally required to state their preferences and practices in writing.

[SeattleRain]

Originally Posted by claddaghmom

I wish they were all legally required to state their preferences and practices in writing.

Are you sure they don't? Take a look at all those release forms, there's probably some stuff in there.

Its just not usually as closed minded as no birth plans and no Bradley Method.

[Turquesa]

Originally Posted by SeattleRain

Even then, its not like they can just wheel you into surgery without your permission unless they have a court order, which would be pretty difficult to get as in most states fetuses don't have a right to life.

Actually, judges are supposedly evoking Roe v. Wade for the court orders. The Supreme Court decision mentions intervention when there's a "compelling state interest in the fetus." The inconsistency is a little ludicrous (the companion case, Doe v. Bolton, is what legalized the late-term abortions), but doctors and judges exploit it all the time. It makes no sense to most childbirth reform advocates (pro-life and pro-choice alike) how in one breath the courts say "woman's right to choose," but when a doctor wants to order major abdominal surgery they suddenly "care" about a woman's offspring.

Like the OP said, it is quite scary how that clinic speaks of "over-riding" a woman's wishes.

[Belle]

Could we please keep off the topic of abortions? I don't want my thread getting closed.

In the case of a birthing mother, there's always a protocol if you want to do something against the wishes of your doctor and usually it involves you signing a waiver that says that if you deny the procedure, you won't hold the hospital accountable for the outcome. In really severe cases, there is leeway for hospitals to get a court order to compel you to do something if they feel it is really dangerous but I've never heard that applied to a mother in labor,

There are several cases where this has happened to a mother. Even one just last year in Florida where a mother was kidnapped by her hospital and held on forced bed rest for three days. She wanted a second opinion but they refused her this and got a court order to keep her there. They did a forced cesarean three days after her arrival and she had a still born baby.

Signing AMA is all fine and good. I've done it myself. But my wishes were respected. There was not someone waiting in the wings to force me to see the doctor's perspective on it. They were really pushy too. And this was for something as simple as not having an hep-lock in an uncomplicated labor.

It doesn't sound like a simple AMA would be sufficient for them here. They want to override what the mother wishes. What if the mother wishes to have a VBAC but the hospital has banned them? Should she submit to forced surgery in this case? What if she doesn't want or need continous monitoring. They have stated outright that they "require" that even though AGOG is okay with intermittant monitoring. I can think of numerous examples where a mother may disagree with her care provider but most of the time it shouldn't involve a "line of authority"

[SeattleRain]

Originally Posted by Belle

Could we please keep off the topic of abortions? I don't want my thread getting closed.

There are several cases where this has happened to a mother. Even one just last year in Florida where a mother was kidnapped by her hospital and held on forced bed rest for three days. She wanted a second opinion but they refused her this and got a court order to keep her there. They did a forced cesarean three days after her arrival and she had a still born baby.

Signing AMA is all fine and good. I've done it myself. But my wishes were respected. There was not someone waiting in the wings to force me to see the doctor's perspective on it. They were really pushy too. And this was for something as simple as not having an hep-lock in an uncomplicated labor.

It doesn't sound like a simple AMA would be sufficient for them here. They want to override what the mother wishes. What if the mother wishes to have a VBAC but the hospital has banned them? Should she submit to forced surgery in this case? What if she doesn't want or need continous monitoring. They have stated outright that they "require" that even though AGOG is okay with intermittant monitoring. I can think of numerous examples where a mother may disagree with her care provider but most of the time it shouldn't involve a "line of authority"

I should revise my statement to say that its not that I've NEVER heard it applied to a laboring woman, I've just very rarely heard it applied. Usually its on the news too, which implies its rarity. For the most part, doctors are not going around ordering women to birth exactly the way they want by court order.

In the example you gave about VBACs, I think that hospitals and doctors DO make their wishes and policies clear. You have to read the small print on all those forms they give you when you pre-register/register. Also, I think at a certain point its the responsibility of the woman to let the doctor know that she wants a VBAC before actual delivery (which I'm sure most do). At that point, most doctors (if not all) would let the woman know at that time what their policy is. Frankly, if a woman knows her doctor is not going to perform a VBAC because they CANT for malpractice reasons, if she goes ahead with this doctor she's ALREADY essentially consented for a C-section.

We can't bury our heads in the sands and say that everything we want in birth is totally without risk. VBACs have the potential to be dangerous, especially unexpectedly, and obstetrics has the highest rate of malpractice insurance. When we ask providers to do a VBAC we're asking them to do something that could be potentially more risky for their liability, espeically if they're not properly trained or experienced in such a birth because there aren't as many women who request that kind of birth. While some providers may take on that risk, some won't, and I'd bet they DO make it clear. Just like there are midwives who are willing to take on riskier homebirths and midwives who will risk out mams whose conditions are beyond what they're comfortable with. What the hospitals are doing is no different than a midwife stating that there are certain conditions that they won't deliver under.

I think you're right in saying that when a mother and doctor disagree they don't usually need to go through litigation to find common ground. But I don't think that changes the fact that most hospitals usually DO have such policies in place for their own protection. I think many women just don't read the paperwork or inquire about the policies or ask the right questions to get to those policies until its too late.

[Belle]

Originally Posted by SeattleRain

In the example you gave about VBACs, I think that hospitals and doctors DO make their wishes and policies clear. You have to read the small print on all those forms they give you when you pre-register/register. Also, I think at a certain point its the responsibility of the woman to let the doctor know that she wants a VBAC before actual delivery (which I'm sure most do). At that point, most doctors (if not all) would let the woman know at that time what their policy is. Frankly, if a woman knows her doctor is not going to perform a VBAC because they CANT for malpractice reasons, if she goes ahead with this doctor she's ALREADY essentially consented for a C-section.

We can't bury our heads in the sands and say that everything we want in birth is totally without risk. VBACs have the potential to be dangerous, especially unexpectedly, and obstetrics has the highest rate of malpractice insurance. When we ask providers to do a VBAC we're asking them to do something that could be potentially more risky for their liability, espeically if they're not properly trained or experienced in such a birth because there aren't as many women who request that kind of birth. While some providers may take on that risk, some won't, and I'd bet they DO make it clear. Just like there are midwives who are willing to take on riskier homebirths and midwives who will risk out mams whose conditions are beyond what they're comfortable with. What the hospitals are doing is no different than a midwife stating that there are certain conditions that they won't deliver under.

I didn't mean to get on a VBAC rant but this is why the VBAC rate in this country is plummeting and RCs are on the rise. Many hospitals have de-facto bans on VBACs and mothers have no options but homebirth. Some areas even homebirth is restricted and mothers have to find underground midwives to get a vaginal birth.

I completely agree with you that the malpractice issues are getting out of hand. I've heard (though not through a quoteable source) that the average malpractice premiums for OBs are around $250,000/yr. This is outrageous. I can see why many doctors are leaving Obstetrics altogether for a less risky profession. But forcing women into unwanted and unneeded surgery for no reason than insurance issues is very unethical.

There is a small hospital in Oregon that has an "official" ban on VBACs. I wish I could remember the name of that hospital so I could get quotes and statistics for it. But dispite the offical ban they have VBACs there all the time. If a mother wishes a VBAC all she has to do is let her midwife know and the midwife will plan a back-up surgical team for the birth per ACOG guidelines. Most of the time it is not used. Again, I'll have to look up stats.

[SeattleRain]

Originally Posted by Belle

I didn't mean to get on a VBAC rant but this is why the VBAC rate in this country is plummeting and RCs are on the rise. Many hospitals have de-facto bans on VBACs and mothers have no options but homebirth. Some areas even homebirth is restricted and mothers have to find underground midwives to get a vaginal birth.

I completely agree with you that the malpractice issues are getting out of hand. I've heard (though not through a quoteable source) that the average malpractice premiums for OBs are around $250,000/yr. This is outrageous. I can see why many doctors are leaving Obstetrics altogether for a less risky profession. But forcing women into unwanted and unneeded surgery for no reason than insurance issues is very unethical.

There is a small hospital in Oregon that has an "official" ban on VBACs. I wish I could remember the name of that hospital so I could get quotes and statistics for it. But dispite the offical ban they have VBACs there all the time. If a mother wishes a VBAC all she has to do is let her midwife know and the midwife will plan a back-up surgical team for the birth per ACOG guidelines. Most of the time it is not used. Again, I'll have to look up stats.

This is why I think the REAL people we should be writing letters to and getting upset over are the insurance companies who in essence, tie the hands of sometimes willing doctors and hospitals. When doctors are told that doing a particular procedure will double their malpractice insurance, sometimes they just can't afford it, even if ideologically they totally agree its unnecessary.