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Article: Failure to Progress: What's Wrong with Hospital Obstetrics? - Page 3

post #41 of 60
Quote:
Originally Posted by AllyRae
Ahh, but my risks *shouldn't* have gone up...
Edited to remove much of AllyRae's post due to pending litigation, which I did not think of at the time of quoting so much of her post.


It seems so freaking WRONG that in a country with a 30% c-section rate, with women being sectioned cause it's quitting time, etc etc etc...

That something like this would even happen AT ALL. It is horrifying that they would ignore HOURS of decels without even calling the doctor. We get so used to hearing that docs section mom at the first little blip, real or imagined, then something like this happens.

The hospital I delivered my twin girls in was much like this. They protected their less than 10% section rate like it was SO much more important than, oh, I don't know...actually worrying about the BABIES in question.

It should not be so hard in this day and age, with all the medical knowledge that we possess, to find a hospital that will intervene without hesitation when it is NECESSARY, but will allow nature to do its thing otherwise. Why is this such an elusive thing?

As for the risk with ruptured membranes when you're already on antibiotics for GBS, I really don't know the answer to that one. What you say makes sense, assuming of course that the antibiotics routinely given to GBS+ moms is a broad enough spectrum to cover whatever infections they are afriad of after the membranes are ruptured for more than 24 hours.

I've never thought about it really, but it makes me wonder if this is the case, would it not be possible to give moms an antibiotic after 24 hours of ruptured membranes instead of automatically going to pit? Of course, the antibiotics have risks too, and honestly, around here, you don't make it 24 hours (ruptured membranes or not) without pit if you aren't dilating 'fast enough'. Once you get to 4cm, it's 1cm per hour or out comes the pit.

Nowhere that DH has worked L&D is it typical to NOT have pit during labor. He says usually the only women who DON'T get it are the ones who show up 6cm+ dilated and get to 10cm in less than a couple of hours tops. Otherwise, it's almost as routine as putting in an IV. Sad, isn't it?
post #42 of 60
Quote:
Originally Posted by wifeandmom
I think many KNOW what normal childbirth is like and understand that while one woman may very well follow the textbook outline for what is normal, many will deviate from that and are just fine. However, again, they have to always be aware of their ability to defend their actions (or inactions) should the need arise.
I don't agree with this at all. There is almost nothing normal about giving birth in a hospital, so there is no way for docs to have firsthand knowledge of what that is, and very few have ever even witnessed natural birth, and I don't think for a minute that a textbook outline is sufficient. Experience is the whole thing of it and I don't think practicing using the technologies or one's "skills" fulfills that.
post #43 of 60
Quote:
Originally Posted by annakiss
I don't agree with this at all. There is almost nothing normal about giving birth in a hospital, so there is no way for docs to have firsthand knowledge of what that is, and very few have ever even witnessed natural birth, and I don't think for a minute that a textbook outline is sufficient. Experience is the whole thing of it and I don't think practicing using the technologies or one's "skills" fulfills that.
Well, I can't say I don't agree with you to a certain degree.

Maybe I should have said I think many docs know *in theory* what natural childbirth should look like, but they are taught and trained for all the things that can go wrong, so it's more of just this polly-anna type theory in their head that isn't really put into practice a whole lot, if at all. It's like they could recite off what normal, natural childbirth looks like, but that doesn't really HAPPEN in their world for the most part, so it's more of just a theory or how things were done way back before hospital births became the norm. I just don't think they are totally ignorant to the process of birth itself, even though it's not something that is typically seen in today's hospitals for the most part. Does that even make sense?
post #44 of 60
Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
post #45 of 60
Quote:
Originally Posted by cmd
Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
post #46 of 60
Quote:
Originally Posted by wifeandmom
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
Agreed, but I shudder to think that a doctor's first experience with a natural birth - after how many years of med school & residency - would occur when said doctor is finally a practicing OB/GYN. Yikes.
post #47 of 60
Quote:
Originally Posted by wifeandmom
Turns out they have been giving this baby CARBON DIOXIDE from the pulmonologist's cart the entire time.
post #48 of 60
So heard a story from alegna, I think, maybe she'll chime in...about a doc asking a midwife if he could watch her UA of her twins....he did, in the corner, without interfering. Now that...would be quite the lesson!

I second the "It's very hard to sue, even when you have a case." I won't go into my son's case, but basically we hear from everyone "You have a case, but we wont' take it." Read: they have no idea what kind of money they will make.

And basically, if my son would have died...which he almost did several times due to medical neglect, me yelling, do something now, them saying, nothing is wrong....if he would have died, well then, yeah, you have a case.

Never mind the hours of reconstructive surgery and the brain damage. That's nothing.

I honestly think there should be a no-fault system in place for births where there really is no one at fault...where something bad happened...and someone dies. I remember reading about it in one of the Sears' books.


mv
post #49 of 60
Quote:
Originally Posted by annakiss
I'm confused though about this: Do you mean as in the instance wifeandmom mentioned? I just finished reading The American Way of Birth and from what it says, this just isn't true in general. Some cases are won, sure, but very few. Most don't even go to court. Unless you're talking about the dishonest lawyers defending OBs who may skew what normal and abnormal birth are.
I was imagining a situation like that, where the doctor knows he/she is in the right and goes to court...in that case, the lawyers can get any witness they want to say whatever they want, and the jury has only the conflicting witness testimonies to go on. That, and their preconceived notions...

But as for the rest of those cases that settle rather than go to trial: Think about the reason why most cases don't even go to trial...the doc settles out of court because, as many people have said here, "a jury doesn't like a dead baby." True enough, but if the lawyers were completely trustworthy in court cases, and the actual facts of the situation were provided by both sides, then perhaps juries would make logical decisions at least some of the time. The docs would not need to fear the outcome quite so much.
post #50 of 60
Quote:
Originally Posted by wifeandmom
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
There are plenty of people who define "natural birth" as simply coming through the birth canal, or avoiding drugs or sythetic oxytocics. So you're on your back in a bed under bright lights, surrounded by several strangers, not allowed to eat or drink, with an EFM (or maybe IFM,) told when and how to push, with the baby taken away to be washed, and maybe even an episiotomy, and that's "natural". I'm sure many doctors have seen this kind of natural birth. What the vast majority haven't seen is spontaneous, instinctive physiological birth, because the hospital environment and the care givers ministrations aren't conducive to this happening.
post #51 of 60
I've read most of this thread, but not quite all of it. One thing really stood out to me.

I see the same theme in several places - about "moms believing birth is 100% safe", and "moms who think there should always be a perfect baby", etc. I don't feel sorry for doctors there at all. My doctors have all done the "everything's great - everything's wonderful - the ultrasound is perfect - this baby's doing great", etc., etc. I've also had the "if it were me, I wouldn't..." thing, while we consult some heavy-duty obstetrical text. They're going to make sure that I/you/whoever believe they have all the answers. Whatever their intentions might be, every doctor (whoops- except one) that I've dealt with throughout my pregnancies has done everything they could to make me believe that they could guarantee a good outcome, and that if I just let them call the shots and do what they know is best, my baby and I will be just fine. I think a lot of them get off on acting like demigods. Well - fine - if that's your particular ego trip, so be it. But, acting like a jerk when people are let down later isn't too admirable. Maybe if doctors, specifically OBs, don't want their clients to feel so betrayed when something goes wrong, those same doctors should stop climbing up on pedestals and kicking patients in the face when they try to even the playing field. (And, yes - I realize that not all doctors are like this, but it's a large enough percentage to drastically affect the culture.)

I've had three c-sections. I didn't want any of them, and I still don't believe they were necessary. I didn't sue, for two reasons. One is that I'm just not a suing kind of person. The second...I can't prove damages. A scarred uterus and PPD and PTSD don't stack up against a healthy baby, and all my OB has to say is "look at that infant - he'd have been born dead if I hadn't saved him" and I'm dead in the water. Besides, I'm "healthy" (aside from the damage to my uterus, which the obstetrical community is obsessed with, while still denying it exists).

Edit, to change some phrasing, per the MDC UA.
post #52 of 60
Quote:
Originally Posted by cmd
Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
I personally wonder if the textbooks actually mention things like shifting positions and rather than confining women to bed. That would be part of a normal birth to me.
post #53 of 60
Quote:
Originally Posted by wifeandmom
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
I suppose if natural means without medication and vaginal then I had one,too, however, being tied to the bed with strangers pulling my legs with a spotlight on my crotch getting an episiotomy is not exactly what I call natural. Most unnatural and traumatizing,too.
post #54 of 60
Quote:
Originally Posted by wifeandmom
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
It does happen, but in most cases, the woman has to plan very carefully for it and actively fend off unwanted and unnecessary interventions. It takes a very strong desire to give birth naturally to be offered drugs and interventions that will "help", during the emotionally vulnerable process of labor, and turn them down. I know many women who have planned NCB in a hospital and as the birth draws nearer they often talk about an experience similar to "girding up for battle". Which they really must do (mentally and intellectually) in order to have a chance at succeeding. Even if they have a sympathetic OB or MW, there are the nurses and other hospital staff to contend with.

I studied Hypnobabies, read everything I could get my hands on about childbirth, had a great doula and a husband who was educated about NCB, a brief and pre-approved birth plan to hand out, and a low-intervention hospital with a low C-sec rate (Kaiser). I ended up getting an epidural, although I avoided Pitocin or a C-section. I do not blame the hospital for my choice to get the epidural one bit, they were great at following my birth plan - but I still did not succeed at NCB for all my months (years, really) of preparation. If I had had a different, easier labor I might have, but if I had had a homebirth I almost certainly would have.

And while I am generally pretty pleased with the way my birth was managed and my experience with the hospital was worlds away from the horror stories I have heard, it was definitely not my first choice (we chose the hospital because we did not have $4000 for a homebirth at the time - before I got pregnant I was not sure if I really wanted a homebirth so we didn't make provisions for it, and Kaiser was only a $250 copay for all prenatals and the birth). Next time, as positive as my birth experience was, I will be avoiding the hospital unless there is a specific reason to be there, and will plan a homebirth.
post #55 of 60
Quote:
Originally Posted by mamaverdi
I honestly think there should be a no-fault system in place for births where there really is no one at fault...where something bad happened...and someone dies. I remember reading about it in one of the Sears' books.
I recall reading (I think in Baby Catcher, of all places) about the idea of having a central fund that docs pay into to cover damages, rather than a for-profit malpractice insurance industry. I think that in combination with strong medical boards to handle licensing and peer review, single-payer national insurance for all, and a government fund for families with disabled members would do the trick really much better than the misguided fix of tort reform. Very medical minded to patch a tiny hole like that when the whole roof is leaking. Also, it would be nice in a single-payer insurance system to try to reduce costs and improve outcomes by building upon the midwifery model of care and to cover homebirths. I'm very wary of licensure for direct entry midwives, however, for personal reasons.
post #56 of 60
This is essentially what the US has done for vaccine injury. If too many OB's get out of the biz of delivering babies, my guess is there would be more support for such a system. But as it stands right now, too many '3rd parties' (i.e. malpractice lawyers) stand to make too much money and have too much political influence to see this implemented.
post #57 of 60
Quote:
Originally Posted by hopefulfaith
Oh, and I just wanted to add... this is a great discussion. I don't want to hijack by focusing on one aspect of one post, but I couldn't not respond. It's particularly fascinating looking at it from the physician's point of view, since that isn't often represented on MDC.

Carry on with your regularly scheduled discussion, please!
Emily,

:
post #58 of 60
Quote:
Originally Posted by wifeandmom
Well, I can't say I don't agree with you to a certain degree.

Maybe I should have said I think many docs know *in theory* what natural childbirth should look like, but they are taught and trained for all the things that can go wrong, so it's more of just this polly-anna type theory in their head that isn't really put into practice a whole lot, if at all. It's like they could recite off what normal, natural childbirth looks like, but that doesn't really HAPPEN in their world for the most part, so it's more of just a theory or how things were done way back before hospital births became the norm. I just don't think they are totally ignorant to the process of birth itself, even though it's not something that is typically seen in today's hospitals for the most part. Does that even make sense?
wifeandmom,

post #59 of 60
Quote:
Maybe I should have said I think many docs know *in theory* what natural childbirth should look like
I think they might have a vague idea, based on what they might imagine women in the African bush do or whatever, but they have absolutely no idea what facilitates it. I think they just assume that American women are uptight and/or maybe genetically inferior, rather than that our bodies are just fine and that it is the environment that is causing our bodies to malfunction.

Either that, or they simply don't care what natural birth looks like -- it's irrelevant to them because man's idea of how birth should be is better. Sure, those African bush women might squat to give birth, but so what? Having the woman lie on her back is obviously so much better. So while they may know what natural birth looks like, they don't seem to know why it's important that it be that way.
post #60 of 60
Well, let's think about it this way: If your job training was entirely based on the scrubbing of barnacles from the hulls of sailing ships, and you inadvertently found out that many of the ships actually sail as well or better without the barnacles being scrubbed off, would you tell anyone? Would you stop scrubbing, or only scrub the few ships that need it?

Yeah, most doctors don't either.

(And yes, some days I do feel like a barnacle-clad sailing ship! )
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