Using manual removal of the placenta to check for uterine rupture??????

[harli]

Hi all, Back in 2009 I had a very bad birth experience.  Simply put my doctor first did an AROM without asking (but was recently told this was 'necessary' because babies heart rate was dropping.  I never heard a thing about it when I was actually in labor though.) or telling me he was doing it.  Then he decided to tell me "I have to check for uterine tears" and he said it in such a way that lead me to believe there was a real emergency.  What he really did was a manual removal of the placenta (MRoP) procedure WITHOUT any pain killers about 45 sec's after birth.   He then lied about it on my medical records by saying my placenta was delivered 'spontaneously' and then never mentioning the MRoP procedure. 
 

After hearing about the same thing happening to a few friends and finally a complete stranger I decided I needed to contact the hospital.  I spoke with the vice president of the family birthing suites at the hos.  She said she needed to speak with the OB.  He continued to claim that my placenta was delivered spontaneously but that this procedure is standard procedure at that hospital.  He stated the reason why he did the procedure was for 3 reasons.....

1) to protect me from retained placenta

         My question is how can he be protecting me from retained placenta if he claims my  placenta was already delivered 'spontaneously'(which it WAS NOT I hadn't even had a separation bleed yet).

2) to protect me from hemorrage due to retained pieces of placenta.

         To which I would ask...."if my placenta was already delivered (which it was not) wouldn't you be able to check to make sure it was whole so you wouldn't have to put me through an incredibly painful procedure?"

3) to check to make sure that my uterus hadn't ruptured.

       This is the part that gives me most pause since I haven't been able to find any information on it.  Why in the world would sticking your hand up into a uterus that is still contracting be a good idea if my uterus HAD ruptured???  And wouldn't you be able to watch vitals and other signs to make such a procedure unnecessary? 

So my question is.....Are there any doctors out there who check for uterine rupture like this at all?  Because if there aren't that means that he really did lie to me to get me to okay a procedure. 

BTW I am going to the attorney general about this.  But I want to have all my facts together before I do this.

[LiLStar]

I'm so sorry you were put through that :( It sounds terrible, and not one shred of it sounds necessary. 

[Marissamom]

I'm pretty sure there are signs of uterine rupture that don't require sticking your hand in there, and I've never heard of manually checking as a routine procedure. that sounds seriously messed up.

[soso-lynn]

That`s insane. Also, if there truly was any reason to do that, it would have been written in your file. Since it isn't, I can only assume that this doctor does so many c-sections that he forgot that he did not need to manually remove the placenta after a vaginal birth.

[msmiranda]

I have heard other stories of doctors doing this, and unfortunately, the reason I have heard for manual removal is very simply so the doctor can finish sooner and get out of there.  Now, he *may* have forgotten that you didn't have an epidural, since most women do ... the uterus is incredibly sensitive just after birth, so a manual removal without anesthesia is cruel and unusual.  I have also heard (sadly) of doctors doing manual removal to "punish" a woman -- for choosing natural birth, for not taking his recommendations, etc.  Honestly, this is one of my very worst nightmares about a hospital birth.  I'm so sorry this happened to you, and I hope that you are able to take some action against the doctor -- at least file a complaint if nothing else.  The falsification of your records is also infuriating -- makes you wonder how often this is done to cover up shenanigans like this.

[wombatclay]

I'm so sorry.

I did some reserach on this a few years ago... apparently, in some (older) obstetric books a manual/digital examination of the uterus following a VBAC was considered "standard".  I'm forgetting where I found it (my old laptop died and I lost a lot of my archived files) but I do recall I started my search after reading an older VBAC book (I'm thinking mid-70S?) that warned women to request that a manual examination be done ONLY if other signs of rupture are present (wonky blood pressure for example).  There was a thread about it in the VBAC forum at one point... several women had encountered this.

I'm glad you've taken this to the hospital admin... it most certainly is something they should know about and address!

[harli]

I'm sorry I can't get the quote feature to work properly so I'm going to have to do this the hard way....

"I have heard other stories of doctors doing this, and unfortunately, the reason I have heard for manual removal is very simply so the doctor can finish sooner and get out of there. Now, he *may* have forgotten that you didn't have an epidural, since most women do ... the uterus is incredibly sensitive just after birth, so a manual removal without anesthesia is cruel and unusual. I have also heard (sadly) of doctors doing manual removal to "punish" a woman -- for choosing natural birth, for not taking his recommendations, etc. Honestly, this is one of my very worst nightmares about a hospital birth. I'm so sorry this happened to you, and I hope that you are able to take some action against the doctor -- at least file a complaint if nothing else. The falsification of your records is also infuriating -- makes you wonder how often this is done to cover up shenanigans like this."

I really think my doctor wanted to get out of the room faster too. The nurses were complaining about all the delivery rooms being packed that day. The funny thing is is that because the nurse wouldn't listen to me when I told her it was time to push (dd was born 13 min's later) the doctor only made it in time to pretty much catch dd as she was on her way out. I delivered her head and shoulders by myself. So he got paid thousands of dollars to spend probably 7 min's with me. You would think he could have waited another 5 min's for my placenta to deliver on it's own. He did not forget I didn't have an epi. I was screaming in pain and for help and was trying to kick him off of me during the procedure and the nurses held me down. I've since read that some doctors don't give pain medicine during this procedure so that Mom isn't groggy and 'can better bond with baby' soon afterward. I've been through a lot in my life...I've had a horse fall on top of me, I've broken my back which I never took one pain pill for, and I had a raging kidney infection for over a week that once I finally got surgery for my urologist told me he's amazed I didn't die because I had the most swollen kidney he's ever seen without it rupturing. I can handle pain but the MRoP was by far and away the most pain I have EVER been in. How on Earth some doctor could think it's even remotely possible to bond with a baby after that kind of an experience is beyond me. To make matters worse I DID ask the doctors what their standard procedures were at this hospital. This procedure was never mentioned to me and why on Earth would I ever think of it happening just so a doctor could get me out of a room faster.

"I did some reserach on this a few years ago... apparently, in some (older) obstetric books a manual/digital examination of the uterus following a VBAC was considered "standard". I'm forgetting where I found it (my old laptop died and I lost a lot of my archived files) but I do recall I started my search after reading an older VBAC book (I'm thinking mid-70S?) that warned women to request that a manual examination be done ONLY if other signs of rupture are present (wonky blood pressure for example). There was a thread about it in the VBAC forum at one point... several women had encountered this. I'm glad you've taken this to the hospital admin... it most certainly is something they should know about and address!"

Hmmmm you've given me some food for thought. The only thing is is that I'm not a VBAC. I had one very quick and easy delivery before this one. I'll have to check into this some more. Unfortunately the hospital admin are doing nothing. The doctor(who just so happens to be the Chief of Surgery at this hospital) says he had good reason to do what he did so they are blindly following along. The nurses also haven't admitted anything. This happens at this hospital A LOT. I've heard of several people that it's happened too and more and more are coming out about it. Unfortunately it's the only place to deliver a baby anywhere around here and there are only 3, possibly 2 midwives that I know of that service this area. Also unfortunately I can't pursue anything legally. In my state there is some kind of law that states that if there are two prevailing thoughts (so if one doctor thinks its ridiculous to do this procedure and another does it on a routine basis) then the accused doctor is protected. Another words even if it's negligence/abuse as long as other doctors are neglecting and abusing their patients too then it's okay. The only thing I can really pursue is a complaint of falsification of medical records. Since it's a he/said she/said against the doc and nurses and my husband and I nothing will probably happen with that either. Really IMHO the field of obstetrics has done a lot of damage to womankind over time (admittedly they have done good as well)this procedure is apparently getting more and more common as a routine procedure. It's no different IMO then twilight sleeps, child bed fever etc...

Edited by harli - 1/24/11 at 4:00pm

[wombatclay]

Given how busy it was that day, is it possible that the OB thought you were someone else and is trying to cover up that slip?  I mean, if he was old school in his training (so he would routinely includes a manual extraction/digital examination for rupture in a VBAC) and he was running from room to room... maybe he thought you were a VBAC and so switched into that "pre-set routine"?

I'm certainly not trying to excuse or condone his behavior, just trying to think of reasons why he would have done that in the first place and then give the "reasons" he gave.  I mean, in a VBAC the whole "uterine rupture" scenario is the ultimate boogey man.  It's the reason dr's and hospitals give for not allowing VBAC and it's the complication that gets the most press during a VBAC attempt (the reasoning behind constant monitoring, the complication named when they want to motivate a mom to move to the OR, the reason why certain positions or birth styles are strongly discouraged, etc).  But the thing is, uterine rupture in a woman who does NOT have a prior uterine scar is a very scary and obvious event.  In a uterus with a prior scar, the scar can give way slowly and with relatively few symptoms.  In a "normal" uterus though a rupture is generally catastrophic and not the sort of thing a horspital team would "miss".

I'm really sorry this happened to you, and sorry there doesn't seem to be much you can do about it now... I'd still keep pushing the hospital though.  And maybe let local birth/parenting groups (ICAN, LLL, doulas, MOPS, NINO, SOLACE, etc) know so that they too can push back on this?  Patient satisfaction counts for a lot in the current hospital market and while they certainly wont come out and say "we were wrong", they may start changing their internal policies as a result of patient outcry.

[harli]

Wow sorry my previous post had no paragraph spacing.  I have no idea how that happened I just can't get this new forum to work for me sometimes.

Originally Posted by wombatclay 

Given how busy it was that day, is it possible that the OB thought you were someone else and is trying to cover up that slip?  I mean, if he was old school in his training (so he would routinely includes a manual extraction/digital examination for rupture in a VBAC) and he was running from room to room... maybe he thought you were a VBAC and so switched into that "pre-set routine"?

I'm certainly not trying to excuse or condone his behavior, just trying to think of reasons why he would have done that in the first place and then give the "reasons" he gave.  I mean, in a VBAC the whole "uterine rupture" scenario is the ultimate boogey man.  It's the reason dr's and hospitals give for not allowing VBAC and it's the complication that gets the most press during a VBAC attempt (the reasoning behind constant monitoring, the complication named when they want to motivate a mom to move to the OR, the reason why certain positions or birth styles are strongly discouraged, etc).  But the thing is, uterine rupture in a woman who does NOT have a prior uterine scar is a very scary and obvious event.  In a uterus with a prior scar, the scar can give way slowly and with relatively few symptoms.  In a "normal" uterus though a rupture is generally catastrophic and not the sort of thing a horspital team would "miss".

I'm really sorry this happened to you, and sorry there doesn't seem to be much you can do about it now... I'd still keep pushing the hospital though.  And maybe let local birth/parenting groups (ICAN, LLL, doulas, MOPS, NINO, SOLACE, etc) know so that they too can push back on this?  Patient satisfaction counts for a lot in the current hospital market and while they certainly wont come out and say "we were wrong", they may start changing their internal policies as a result of patient outcry.

I was also thinking that maybe he thought I was a VBAC by accident but in his statements to the Vice President he stated that he did this to ALL patients.  Which I believe because 2 of the 4 that I personally know of that this happened too were first time Mom's so not a chance for a VBAC there.

Unfortunately while they claim to be all into patient satisfaction they really aren't.  The nurses were downright rude including the abuse that was done to me.  In my area satisfaction doesn't matter one little bit since for some they are the only hospital to deliver in in our area for close to an hour (depends on where exactly you live).  Even then all the doctors in our city deliver at this hospital.  So if you want to go elsewhere you need to go to a doctor who is pretty far away.  Of the other two hospitals that are somewhat close one of which was involved with trying to legally force a women into a c-section for a 'too large baby' in a Mom with no prior sections who had already delivered (safely) two babies who were over 11 lbs.  Baby ended up being born around 9 lbs and it was only through luck that she didn't end up with the forced section.  The other hospital I've heard horror stories about as well with the exception that they have some good CNM's but you might not get them when you show up in labor.  Unfortunately there really are no birth choices in this area that the hospital has to compete with.  They can pretty much do whatever they want and like I said before.  If a doctor is abusing his patients, as long as other doctors are too then according to the law that is okay. 
 

[MegBoz]

Originally Posted by wombatclay 

And maybe let local birth/parenting groups (ICAN, LLL, doulas, MOPS, NINO, SOLACE, etc) know so that they too can push back on this?  

Good idea. I'd also say look to inform other "mainstream" parenting groups. Generally members of groups like LLL, NINO & ICAN are already aware of the dangers of 'mainstream,' medicalized birth & are therefore already making attempts to protect themselves from unnecessary intervention. So it might be particularly beneficial to try to inform 'mainstream' Mommy groups who might not even think to be asking about issues like various 3rd-stage active management.

While it may be true that there are very few birthing options in your area, it still might help to change their practices if enough women are standing up saying, "STOP."