Are you serious? Nobody mentioned risk? - Page 6

[MsElle07]

The situation you described is really sad, Vera. But it's not because CNMs are unable to get insurance coverage -- it's about OBs protecting their territory. In my area, we have a plethora of CNMs, and they deliver in hospitals, birth centers, and at home. However, the OBs have successfully lobbied hospitals to disallow family practice doctors OB admitting priveleges, unless they are under the supervision of an OB. My family practice doctor said that obstetrics was the best part of her practice until these regs went into place, and family docs were unwilling to acquiesce to the new demands. That's not about insurance coverage, though...

[member234098]

To: wifeandmom,

Yes, the Mehl Study used low risk women. The point of the Mehl study was to show that women who deliver in the hospital could have better outcomes at home. Each and every one of the women who delivered at the hospital had a counterpart at home matched for age, parity, and other variants; the outcome at home in every situation was better for the mother, proving that women who allow unnecessary intervention into their labors suffer unnecessarily from the cascade of effects of the consequences.

As for women being induced, many women were induced in the 1970s. Most of my contemporaries had inductions. In the 1980s, the ACOG suggested that doctors let up on the number of labor inductions they did; however since we live in an age when everything is scheduled and no one can wait, we are again doing more and more inductions.

In Immaculate Deception, Suzanne Arms had pitocin wafers on her gums to stimulate labor in 1973. If you read her book, little has changed, particularly in the attitude of the medical profession against women.

There is nothing new in medicine. Everything comes and goes as styles and fashions, often with the same basis in fact and science.

[boscopup]

Originally Posted by miriam

As for women being induced, many women were induced in the 1970s. Most of my contemporaries had inductions.

Yeah, my mom was induced in 1972 with my brother. She was a few days past her EDD, and she very firmly believes that her doctor wanted to go on vacation. : Thankfully, the labor/delivery was still quick and easy (2.5 hour labor, no pain meds, normal vaginal delivery). She probably would have spontaneously gone into labor in the next few days anyway, so the induction was quite pointless.

[niki_73]

I was never informed of the risks of a c/s but I knew them of course. I don't remember signing a form, neither does DH, but we did give them verbal permission, I think we said something to the affect "just save our baby" I even told them not to give me an spinal if there was no time just cut me open. But we had a crappy experience and when I was released was not even told how to care for my incision or not lift anything. I'm having a VBAC this time.

[jcchirib]

[QUOTE=doctorjen][...]although I understand that the VBAC rate will no longer be considered as part of the quality measures used to assess hospitals, so probably we won't have to report them much longer. /QUOTE]

Oh my, this is interesting...why would a VBAC rate really not be considered in quality measures? (or am I being naive?) Is this JCAHO?

[jcchirib]

Originally Posted by eilonwy

How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me. :

With my homebirth transfer, no one discussed c/s risks at the hospital. But, even in active labor, I read the "consent" form. And no risks of c/s were addressed. How do I remember? Well, I took umbrage to "consenting" to students participating in my care, amongst other things, so I very clearly recall crossing the offensive language out. There was no c/s-specific language in it. I came awfully close to having a c/s; had I had one, it would not have been with a full discussion of c/s risks. So yes, it is possible that a doctor would not discuss the risks before surgery in an L&D situation. But I think that the problem is not with individual doctors necessarily acting with malice (I'm sure that there are bad apples--there are in every profession!). I think that the problem is systemic--it is a problem with how the medical/hospital system works. The fact is, it is very likely that when you sign the "consent" form at the hospital, there is no doctor present to ensure that you have been "informed".

Seems that the medical profession is so firmly of the (anecdotal) belief that they won't get sued for the unnecessary c/s that they do not have a healthy fear of litigation over the consequences of those unnecessary c/s. Once women start holding them legally accountable for those unnecessary c/s that cause harm, things might start looking up.

[boscopup]

Originally Posted by jcchirib

With my homebirth transfer, no one discussed c/s risks at the hospital. But, even in active labor, I read the "consent" form. And no risks of c/s were addressed.

I still have my consent forms here somewhere. I had a vaginal birth, but upon entering the hospital, I was handed vaginal birth consent form and C-section consent form. I didn't sign either one, because I read the forms and it says that the risks had been explained to me, yadda yadda yadda. Well, no one had explained the risks, so I didn't sign until they explained them. The staff apparently forgot about the forms, so that's why I still have them, unsigned. No one ever did explain risks of either type of birth. I did have a vaginal birth, but never consented to it. And this wasn't even a matter of "there's no time". I was there for 4 days before the birth occurred. There was plenty of time to explain risks and get the consent forms from me.

[Storm Bride]

Originally Posted by jcchirib

Seems that the medical profession is so firmly of the (anecdotal) belief that they won't get sued for the unnecessary c/s that they do not have a healthy fear of litigation over the consequences of those unnecessary c/s. Once women start holding them legally accountable for those unnecessary c/s that cause harm, things might start looking up.

One of the many problems with this is that it's hard to prove damages if you're okay from a medical standpoint. I can't imagine having to prove I was damaged if somebody on the street cut me open, no matter how well I recovered! But, if it's a doctor, it's different.

[caned & able]

Doctors consider themselves priests or gods even of the religion of modern medicine, as the late great medical heretic used to say, so how could they be wrong, ever?

[pampered_mom]

I signed a consent form for my c/s, but it certainly did not list any risks of the procedure. It was a very general surgery type form. It didn't list any of the risks that I now know today.

Originally Posted by wifeandmom

Anyhow, I'm really curious as to why a woman desiring a natural birth with no interventions would WANT an OB to deliver her in the first place. Even the most low intervention doc is going to do things you won't likely see in other settings. If you truly don't want an IV, continous monitoring, blah blah blah....why on earth would you go to the hospital in the first place? That makes no sense to me. Kind of like going to a Mexican restaraunt and demanding spaghetti, then being royally pi$$ed off when they tell you that's not what they serve.

Because it's the only option fiscally available to her? There are lots of women out there that do not have health coverage for midwives (CNM or otherwise) or birth centers AND do not have the resources available to be able to go out of that network. How about the underserved areas of the country where midwife/birth center options are not available? How about in states where DEM licensure has been heavily lobbied against by the AMA or the ACOG?

How about the simple fact that the EVERY WOMAN has the LEGAL RIGHT to refuse any procedure (IV, CEFM, etc) and that the EMTLA states that hospitals have to "treat" her.

Work to change the system...that would be an EXCELLENT plan, however in the meantime, you have to make your birthing choices based on the REALITY of today. And the REALITY is you are not very likely to have a natural, unmedicated, no intervention birth at most hospitals across this country. Right or wrong, it's the way it is, and stomping your feet, demanding instant change to all you disagree with is incredibly unlikely to work, not to mention VERY likely to stress mom out considerably.

It is not the pregnant or laboring woman's job to make the hospitals/nurses/doctors/anesthesiologists job easier. Nor is it her job to "work within the system" or the "reality" of today. Seriously...she is the one paying here, it's her body, and she has the right to demand whatever she wants regardless of a hospital's policy - again, that's her LEGAL RIGHT!

That doesn't mean that women shouldn't be well informed about the birth climate - it certainly will ease any stress she may have when faced with a difficult birthing situation, but she can't wait for the legislature to figure it out or the hospital administration (every doctor's and nurse's favorite scapegoat) to change. She has to work with her particular situation. I for one am not going to say that the only way women can have low-interventive births is by avoiding the hospital - that has got to be the WORST suggestion I have ever seen someone give regarding this issue.

Figure out what kind of birth you want, and do it in a place that is most likely to respect those wishes. Doesn't mean we shouldn't advocate for change within the current system, but don't expect instant results.

Why not expect results in your situation? It's YOUR body, it's YOUR baby, and it's YOUR birth - no one should be able to tell you what to do, plain and simple. As individuals we have got to stand up and say ENOUGH!

(Side note: I take issue with a couple of places where you state that the OB "allowed" a mom to do something. If anything, it's the mom who's allowing the doctor to assist her with the birth of her baby.)

[LadyButler]

Originally Posted by pamered_mom

(Side note: I take issue with a couple of places where you state that the OB "allowed" a mom to do something. If anything, it's the mom who's allowing the doctor to assist her with the birth of her baby.)

Amen to that!!!

[jennkraig]

Why would a low risk woman choose an ob?
Here is my situation.
My husband and I got pregnant by accident, we were not planning on having another kid, mostly because we don't have insurance. I managed to qualify (barely) for medicaid. I would like to pay a midwife to deliver me here in KY but they aren't licensed in this state. We also don't have a free standing birth center in my area. So, I can't afford to pay for a home birth MW, there are no CNM's covered in my state, my only option is an OB in a hospital, or UC at home. I don't feel comfortable with that because all of my 3 previous kids have had pretty tight nuchal cords at birth. I even told my OB that if it was up to me I would be at home with a MW and want to be treated that way. Of course she isn't completely on board with that. I have agreed to sign waivers for all the medical procedures I am refusing.

Informed consent is a joke. I told my previous ob's at all three births not to cut me as they picked up the knife to do the episiotomy. All three did it anyway.

[ericswifey27]

Originally Posted by MsElle07

Right. It will go away when practitioners, patients and/or gov't regulation changes the system as it exists. (Which is not in the best interest of patients, does not provide them with a higher standard of care, and which leads to our abysmal birth outcomes.) The lives of babies and mothers are not expendable -- we cannot just chalk it up to "Well, that's the current climate" and move on, defending medical providers as if they are blameless.

I was so depressed and disheartened by my birthing experience (unwanted unneccessary csection). I am still suffering today. I am enfuriated that my empowerment was stripped from me, that everything that I asked to be done or not done throughout the birth process was ignored. I am not exaggerating when I say my birth plan might as well have been toilet paper.

I think the current birth atmosphere in most hospitals today is absolutely atrocious.

We need OBs who can stand up for what is right.

[FrumDoula]

One change that some hospitals have made is to require women to sign consent forms before her labor begins. This makes sense to me. Another is to have women take an epidural class, which (hopefully, though certainly not always, I'm no fool) can explain the benefits and risks of the epidural procedure. Some hospitals require you to take the class or you don't receive an epidural, which I'm not sure I agree with, but I can understand in theory.

The point is to educate women as much as possible before she's writhing in pain on the bed.

Women have a responsibility to educate themselves, ask questions and figure out what hospital procedure is. Doctors have the responsibility to educate their patients, explain things in plain English and practice according to evidence.

When I work with mothers as a doula, I explain that their parenting responsibilities begin when they find out they're pregnant, NOT when the baby is born. With the Internet and countless books out there, there's a lot of resources available to them, and ignorance is a very poor excuse.

I also agree that our medical culture is not always friendly to informed women and partners, but that's slowly changing. My husband is in med school, and a lot of the students actually LIKE when their patients know what's up. They're genuinely frustrated when their patients don't care, or surrender their power to the physician.

Alison

[caned & able]

Originally Posted by jennkraig

WI would like to pay a midwife to deliver me here in KY but they aren't licensed in this state.

Are you absolutely sure there are no midwives in KY?

That is amazing because Kentucky was the home of the Frontier Nursing Service http://www.midwives.org/whoweare/fnshistory.shtm. They never lost a mother or baby despite the fact that they were serving an impoverished, malnurished segment of society. What a record!

[JamieCatheryn]

I'm in Louisville, there are CNM's here but no liscenced homebirth midwives. There are homebirth midwives, but they operate kind of extralegally.