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Are you serious? Nobody mentioned risk? - Page 2

post #21 of 116
Quote:
Originally Posted by MsElle07

So no, signing a form does not equal informed consent.
So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.

And then there are the people who are going to blame anyone other than themselves no matter how much of an explanation is given. We know of one OB who was sued for a VBAC rupture related neonatal death. I *know* what the policy is in that particular clinic for addressing the risks of VBAC vs. ERCS because it's the same clinic I used when pg the second time myself, so I went through that entire consent process.

Even though everything was done to inform mom of the risks, to prevent rupture, to deal with rupture when it was detected...well, sometimes the baby is STILL going to die no matter what the doctors in question do. And so it was with this woman, who then tried to come back and say 'Well, they never told me that my baby could die if I tried for a VBAC.'

Which was a load of crap...she wanted to VBAC, so she did, and the results were less than what she wanted, so she wanted to blame someone else. Thankfully she was laughed out of the lawyer's office when it was realized the very extensive consent process that was in place when she consented to this VBAC attempt.

In the end, it was the string of signed forms that protected the OB in question from being sued, despite this woman's desire to blame the doctor for HER choice and its very unfortunate end result.
post #22 of 116
I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section? Therefore, if she consented, it simply MUST be because she was coerced, as sections aren't 'necessary', aren't ever the 'preferable' way to give birth, etc.

When people have the attitude of 'Why would a woman EVER agree to a section?', I can see where this idea of 'informed' consent being impossible to obtain comes from, despite the fact that the entire thought process leading up to this conclusion is bizarre at best.
post #23 of 116
Quote:
Originally Posted by Storm Bride
Well - that was long. To make it short: No. I've never been informed of any risk involved in having a c-section. They've consistently been presented to me as the safe way to have a baby, and I've been consistently assured that a section was necessary for a healthy mom and healthy baby. I wish I'd had the guts to go unassisted (although a homebirth wasn't a really reasonable option with my last two, as I was living at my mom's house), because my desire to have a "care provider" present put me a position where I was too easily bullied and coerced.
That's how I feel it went with my csection too.
post #24 of 116
I'm not sure. I have the feeling that some OBs just think they know best and you don't need all the information, just enough to get you to choose what they think is right.

I was never told how big a deal a c-section was. I was never told how painful it was or how long it would take to recover. I was never told that the hospital would soon revoke the ability to VBAC.

I was utterly and truly uninformed. I thought a c-section was easier and less painful than a natural delivery.
post #25 of 116
Quote:
Originally Posted by wifeandmom
I've yet to read about a woman having surgery that did NOT sign a consent form. I'm reading where women signed forms KNOWING that the information contained therein was NOT accurate. Why is that suddenly the doctor's fault?
How about because women who are harangued, hassled, bullied, and scared are not "consenting" in the legal sense of the word? I was told for months that I could die (with such emphasis that they might as well have said WILL die), that my baby could die (with even more emphasis), the VBA2C just too risky, that all "we" - the doctors - wanted was a healthy baby and a healthy mom. I tried to find another caregiver - couldn't find anybody. Sure - I signed the stinking form. I'd tried to research my rights if I went into labour with no doctor, but I couldn't find anything (I'm not in the US). At the end, I was told I'd have to go it alone if I did anything but what the OB had determined - within the vile standards of "care" - was best for me.

When you're in a mental place where you're just hoping the knife slips and you don't have to face life afterwards, the wording of a document doesn't really matter much.

How is it not the doctor's fault when they deliberately back someone into a corner and make threats in order to get that signature? More to the point, how is it not the doctor's fault when a woman is wheeled into OR saying "no" and trying to sit up to remove her IV? I don't care what I signed when I was admitted to the hospital...I verbally refused consent and was completely ignored.
post #26 of 116
Quote:
Originally Posted by wifeandmom
I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section?
Really? Where have you seen that?
post #27 of 116
Quote:
Originally Posted by wifeandmom
So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.
Consent forms should be read to the mother and father during an office visit before labor begins, for starters, so mothers have a chance to absorb that information before being faced with labor. The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."

Haven't we all consented to treatment at some point without reading every single bit of the fine print? Of course. I am an educated woman, not intimidated by doctors or medical jargon. Two years ago I went to the ER because I had been vomiting up everything I put in my mouth (including water) for four days, with no improvement. I had a nursing baby. When I got there I was so miserable that I gladly consented to anything they wanted to give me to make me feel better. I did not read the three page consent form in its entirety. I did not feel well, my head hurt, I was nauseous, etc. Most people do not read the consent forms they sign.

Because women are seeing their care providers regularly throughout pregnancy (usually), it would make sense that their care providers discuss the risks of the procedure that they are 35% likely to have when their child is born. Unfortunately, part of the problem lies in the fact that many doctors are not up to date on their research and/or are inherently biased toward C-sections, which will alter the advice they give to women.
post #28 of 116
Thread Starter 
Quote:
Originally Posted by MsElle07
I think the larger issue is that often women do not give truly informed consent. Signing a form may give the doctor some legal protection, but it does NOt equal truly informing the mother of the risks of a C-section. Do doctors say to women, "You are three times as likely to die from having this operation, instead of birthing vaginally?" My guess is no.
Mine did; both OBs who performed the sections, and both anesthesiologists told me about the differences involved in spinal vs. epidural anesthesia. In the case of my first section, I was *strongly* advised to take the spinal because it would start working more quickly and time was of the essence, but with the second I was given the choice.
post #29 of 116
Quote:
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.
There is a saying, 'The only c/s a dr has even been sued for is the one he didn't do.' Of course I have read of 2 lawsuits about c/s that weren't needed in the last few years but I am sure there are way more the other way.

I have also read a few news stories of women who were forcibly secitioned (as in lawyers went to court and got a court order to section her). In the one case the women left the hospital, the hospital got the court order in case she returned but she had gone to another hospital where she safely delivered a healthy but very big baby (but apparently not her largest which is what the section would have been for). I would bet money that the only risks they were informed of is what would happen if they didn't have one.

A woman may have all the risks about a c/s but she might not have the correct risks for vaginal birth. In other words she might belive that having a c/s would save her baby because she had been led to belive that a vaginal birth would be much riskier (And I am not talking about actual need here - and I can't belive here on MDC do I have to make such a disclaimer : )

Anyhoo - informed consent if one of those things that probably needs to be discussed long before labor. Of course drs take 5 min in an appt and hospital child birth classes probably don't perpare you properly, so education is difficult. And I'm not talking just c-birth here. Everything pregnancy, labor, and birth related.
post #30 of 116
Quote:
Originally Posted by MsElle07
The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."
Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.

As it is, what's the episiotomy rate in hospitals today? Regardless of the what the rate SHOULD be, we'd have to tell first time moms that they have a 1 in 3 chance of having a episiotomy. We'd have to tell them their baby had a 1 in whatever chance of dying from a whole host of things during vaginal birth...NOT just the stuff suggested thus far, which very convienantly focuses on the real risks of sections.

My point is we'd have to give them the ENTIRE picture, with ALL of the numbers, and if I were a betting woman, I'd say the elective c-section rate would only go UP if we did that.

Quote:
Most people do not read the consent forms they sign.
And that means we can then blame the doctor because????
post #31 of 116
You must have a very low opinion of pregnant women's intelligence. I am so sorry.
post #32 of 116
Quote:
Originally Posted by wifeandmom
Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.
Now you think doctors should provide risk information for a normal process? That doesn't even make sense. Vaginal birth is the natural consequence of getting pregnant. Even if you choose a primary section, you could end up with a vaginal birth (go into labour early - not near a hospital, for example), because a vaginal birth is what will happen if no doctor ever gets involved (I'm not arguing that things can go wrong, and the baby and/or mother could be severely injured and/or die. That's beside the point.) If a vaginal birth is what will happen without a doctor present, why on earth should/would a doctor provide risk analysis for informed consent for a vaginal birth???
post #33 of 116
Thread Starter 
Quote:
Originally Posted by caned & able
You must have a very low opinion of pregnant women's intelligence. I am so sorry.
I'm not sure I get this one.

Storm Bride-- just to play devil's advocate, I'd have to argue that vaginal birth in a hospital, even under the best of circumstances, is not "the natural consequence of pregnancy." Your argument only makes sense (to me) in the context of unassisted birth.
post #34 of 116
If I agreed to a primary elective section for some reason, that doesn't preclude the possibility of my going into premature labour, and possibly delivering my baby with no doctor involved. (I had one friend who had her second baby less that five minutes after getting in an ambulance...the EMTs were there, but they didn't have time to really do anything. A neighbour gave birth in the parking lot at our complex about a month ago - on her way to the hospital.)

Yes - doctors get involved and do all kinds of weird crap to our bodies during a vaginal birth. But, that doesn't make vaginal birth a medical procedure, no matter how hard they try to make it one.

I could maybe see having to provide a risk analysis of the risks of primary c-seciton vs. the risks of medical intervention in a vaginal birth. But, I provided consent to a vaginal birth when I got pregnant.
post #35 of 116
Quote:
Originally Posted by wifeandmom
I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section? Therefore, if she consented, it simply MUST be because she was coerced, as sections aren't 'necessary', aren't ever the 'preferable' way to give birth, etc.

When people have the attitude of 'Why would a woman EVER agree to a section?', I can see where this idea of 'informed' consent being impossible to obtain comes from, despite the fact that the entire thought process leading up to this conclusion is bizarre at best.
I have seen this attitude around here too.

I think the biggest reason that some people have that attitude of "why would you EVER consent to that?" is that their Csection experience was one that wasn't necessary or needed, as opposed to one that saved someone's life.

My c-section saved my daughter's life (and probably mine too, depending on how you look at it) and I am so thankful for it. I was also informed of the risks before he did the c-section. However, I can see how someone who had a completely unneccessary c-section could not understand how anyone would want a c-section. They've just never been in a spot where it was actually necessary.

Just some thoughts.
post #36 of 116
Quote:
Originally Posted by MamaInTheBoonies
The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!" It's all in my medical reports and everything, and, yet, no lawyer would touch my case.
And, that was only the beginning of my horrendous birth experience.
If this is true, that a nurse made you write your name while you told her you didn't want to, then I will find an attorney to take your case. Provided there are no little details you're leaving out.
post #37 of 116
Quote:
Originally Posted by Storm Bride
Now you think doctors should provide risk information for a normal process? That doesn't even make sense. Vaginal birth is the natural consequence of getting pregnant. Even if you choose a primary section, you could end up with a vaginal birth (go into labour early - not near a hospital, for example), because a vaginal birth is what will happen if no doctor ever gets involved (I'm not arguing that things can go wrong, and the baby and/or mother could be severely injured and/or die. That's beside the point.) If a vaginal birth is what will happen without a doctor present, why on earth should/would a doctor provide risk analysis for informed consent for a vaginal birth???
Um, cause if a doctor IS involved, then there is a CHOICE to make. And how can a woman make a CHOICE when she is only given one side of the picture? I'm honestly perplexed here, as I've truly never seen it suggested that it's unreasonable to look at the ENTIRE picture when making medical choices.

It almost seems as if pro-VB folks are AFRAID to look at the real numbers, lest their long-held beliefs be brought into question.
post #38 of 116
Quote:
Originally Posted by caned & able
You must have a very low opinion of pregnant women's intelligence. I am so sorry.
I really don't in general, but dang, then I read some of the stuff people write and I admit I have to wonder sometimes. :
post #39 of 116
Hell, yeah, women ought to be informed what their risk of episiotomy and other intervention in their specific birth setting is. They ought to be informed about the risks and benefits of every intervention proposed - from being encouraged to stay in bed to continuous monitoring, to operative deliveries. I'm quite certain they are not in general receiving such information in general, though.

And I don't know where your dh practices, wifeandmom, and maybe the custom is different their, but around here, and in every hospital I've ever been in, surgery and procedure consents are pretty generic. They say that the person signing has been informed of the risks, benefits and alternatives, and has had the opportunity to ask questions. They say that their may be students involved, and that any pictures or other record taken are the property of the hospital. They don't list the specific risks for specific procedures. Most consents I've seen obtained (not my own, though!) go like midwifetx reports -"Here, sign this so we can do your surgery."

The actual piece of paper that is signed is virtually worthless in a court case, though. Courts actually do engage in a fair amount of "he said, she said." That's why docs are encouraged to write a separate note before doing a procedure that indicates what risks and benefits exactly were communicated to the patient. It is exceedingly rare for a court to grant an order for a cesarean section these days - there have been several cases that went to state supreme courts were women sued and won after a court order was granted. Basically, the rightsof a woman to make decisions for her own body have consistently been upheld, even if it is believed that she is endangering the baby.

Women ought to be presented with all the risks and benefits of any medical intervention not because then they would surely decline a cesarean, or whatever, but because it is their body and they have the right to that information. I've never had a client refuse what I thought was a necessary intervention when she had the risks and benefits explained to her. And if someone did refuse something I thought was necessary, I'd at least feel comfortable that I'd explained it well, although I'd still grieve the outcome if it was poor. Women are not stupid or irrational - in labor or otherwise. Men have been using that argument for years to keep women out of power - in the workplace, in legal matters, and in healthcare relationships with disparate power.

Of course women should understand what the risk of uterine rupture is with a VBAC, and what the risk of 4th degree extension with an episiotomy is, and what the risk of death from a cesarean section is. To argue otherwise is beyond ridiculous.
post #40 of 116
Quote:
Originally Posted by doctorjen
Women are not stupid or irrational - in labor or otherwise. Men have been using that argument for years to keep women out of power - in the workplace, in legal matters, and in healthcare relationships with disparate power.
I don't think women are stupid, however I *do* think they can be irrational while in labor in terms of informed consent when all they want is to be out of pain, and who cares about the potential complications. Does that make sense? It has nothing to do with being a woman, everything to do with being in often the worst pain they've ever experienced.

Quote:
Of course women should understand what the risk of uterine rupture is with a VBAC, and what the risk of 4th degree extension with an episiotomy is, and what the risk of death from a cesarean section is. To argue otherwise is beyond ridiculous.
My thoughts exactly.
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