When Doctors Lie: Obstetrics and Informed Consent

[danotoyou2]

New(ish) article...

http://www.truebirth.com/2008/01/21/...ormed-consent/

About what informed consent consists of, and how doctors skirt around it.

[Kitten]

link not working

[mytwogirls]

The link is not working, but I have a general question to everyone...why such the backlash against ALL OB/GYNs? I know, I know, I am about to get burned here, but I have such a GREAT one and I know plenty of women who also have such OBs and I work with a lot of OBs who are wonderful and great. Just curious to why so many think of them as horrible? I understand some of them are careless and crude and skirt around issues concerning birth, but some of them DO care about women and the birth process and whole thing. They listen and are passionate about their work and make the birthing experience great. Maybe I am just too "mainstream"............

[wendy1221]

There are always exception to the rule. The OB I had with my first ds was WONDERFUL, but that doesn't mean that I don't agree with the backlash against the ones that aren't.

[mytwogirls]

Oh, I agree with the backlash, but some of the comments I have noticed in general about OBs have been kinda negative in general. Haven't heard all the much about the great ones.

[kltroy]

It's interesting to me... this just reminded me of a conversation I was having yesterday with an OB/GYN friend. I was talking about my upcoming VBAC and saying that I didn't understand what all the hype was about with UR b/c the rate is only like 0.5%, which in my mind, means that 99.5% of all VBACs go great. Her reaction was "yeah but that's actually really HIGH!"

Anyway, we didn't discuss it much more (she and I have vastly differing philosophies on childbirth in general and we just agree to disagree - but we both like talking about it). But then afterwards I was thinking... maybe the problem with things like this is a point-of-view issue. From MY point of view, my odds of having a successful VBAC are vastly in my favor. From HER point of view, she may see 100 births every month and that would mean several URs each year if a large percentage of them were VBACs . I guess I can see, from HER point of view as a healthcare provider, why this would be really high. It doesn't make me agree with her, but it does put it into perspective.

As Ina May Gaskin points out, some OBs and doctors practice a midwifery model of care, just as some MWs practice a medical model of care. I think it's more about finding a provider whose philosophy matches yours than what their credentials are.

[Romana]

I don't think of OBs as horrible or evil or anything silly like that. However, due to education, training, and the various pressures working on OBs in terms of hospital expectations, liability concerns, medical malpractice costs, patient volume, etc. - it's quite rare to find an OB who really is a patient advocate in any sense of the word.

I have a good friend who is currently applying to OB residency programs, and while she considers herself a woman's advocate (has been an abortion provider, has been a rape crisis counselor and volunteer, is very active in womens' activism etc. supporting choice etc.), she's said to me point blank that she decided not to be a midwife because (a) she doesn't have the patience to wait through a natural labor/birth; and (b) she loves performing c/s. She has also talked to me many times about how she's been trained to see birth as an emergency, to control it however possible, and that the patient is always safest when birth is as controlled (i.e., interfered with) as possible. The ultimate in "control" of course being c/s. And even if it isn't statistically safest, the very strong educational/training atmosphere is that it IS safest because the doctor has the highest level of control over the birth.

Most doctors who would have made good patient-advocate patient-choice type OBs quickly drop those plans while doing rotations in med school and instead go into family medicine, where there is a different attitude about how babies are born (for the most part).

That isn't to say that good OBs don't exist - they're just quite rare. And even those who might be good OBs have a real lack of experience with natural birth. It's not unusual for a student to graduate med school without ever having witnessed a natural birth. Many OBs have never seen a natural, uninterfered-with birth. It's not surprising that under the circumstances, an open-minded or natural-birth-minded OB is hard to find.

[mamabadger]

Well said, Romana.

The "backlash" is not against OBs as individuals, it is against obstetrics.

The kind of OB Romana describes, who believes in childbirth being managed and feels that a C-section is the ideal outcome, who mistrusts or is impatient with the process of birth, is one who has fully absorbed what he was taught in medical school. The fact that some OBs go against the flow just highlights how bad, dangerous, and anti-woman standard obstetrics really is by comparison.

Originally Posted by kltroy

As Ina May Gaskin points out, some OBs and doctors practice a midwifery model of care, just as some MWs practice a medical model of care.

What I find interesting here is that a "good" OB is described as following the "midwifery model" of care. In other words, the better an OB is for birthing women, the less he is like an OB.

[georgia]

IMO, it's about birth philosophy. Either one believes that birth is a medical event needing intervention or birth is a normal, natural part of life. Technology is either viewed as a cure-all w/our bodies as disasters waiting to happen or technology is a useful tool when medically indicated but generally, unnecessary to intervene. We can either view birth as something to fear and "survive" and a healthy baby is ALL that matters or we can view birth as a miraculous yet mundane event, something to be celebrated and experienced with our bodies, minds and spirit. What's good for the mama is good for the baby and vice versa.

Allopathic physicians have been trained to detect pathology, and obstetricians are trained surgeons. Normal birth and pregnancy are not medical events, IMO so most mothers do not need a surgeon to attend their birth or monitor their pregnancy. The current climate in which many mothers find themselves ensures that the odds are stacked against a "normal" birth. Interventions are rampant because most OBs have been trained to DO something. Take action. Cover their rears because the only surgery they're going to get sued for and lose is the one they do not perform. Many are practice much that is not evidenced-based. Check out any of Henci Goer's body of work on this topic.

Most negative discussion you'll encounter here is not directed at any one physician. It's the system. Even the most birth-loving, woman/baby-centric OB is still (in almost all instances) part of the institutionalized system of hospitalization. It's wonderful anytime we hear of women who have amazing, empowering births attended by an OB. It's just that more often than not, a wonderful birth is not what women and babies (and families) are experiencing. If, in the US, one in every three women will have a c/s when they set foot into the hospital to give birth...and most doctors will not "allow" a woman to attempt a VBAC, it's pretty much ensuring a birth climate that's not in a mother or baby's best interest, IMO.

It's not personal. It's the paradigm. Just my personal, scattered .02

[danotoyou2]

Sorry for the broken link. Oopsie. It's working now.

http://www.truebirth.com/?p=19

[barefootpoetry]

Originally Posted by mamabadger

The "backlash" is not against OBs as individuals, it is against obstetrics.

:

I won't deny that there are certain OBs (and even CNMs) I've come across that I find less than savory. But overall, I can't hold it against them that this is what they're taught. Just as it is their protocol to treat birth as they do, it is my protocol to not use their services unless necessary, and to warn others that if they are of the same mind that they might choose to forego it also.

[mytwogirls]

Very interesting. I see your points. I guess I am one of the "lucky" ones who has a great OB. I did deliver at a hospital (the one I work at) but my OB was there to listen and did not just man-handle the whole situation. I could not imagine having one who was horrible...yuck!

[georgia]

My mother is a registered nurse, and she's worked in several different hospitals over the past 40+ years. She (and her immediate family) have received stellar care anytime we've been hospitalized. Being part of the system can often work in one's favor. You're not just another patient; you're also a colleague.

[elanorh]

There wouldn't be so many horrific birth stories, and a 30ish % c/s rate in this country, if the "obstetric" model of birth wasn't broken (in terms of what happens to the women and children who experience it).

That said, that doesn't mean that there aren't good OBs (and FPs) out there - I have a great one. He's pro-extended bf, pro-ncb, hands-off, very non-interventionist. I think he pretty much sees his job as supporting the mother however she needs it - if she 'wants' (or needs) a medicalized birth then he's a doctor; if she wants ncb, then he's happy to oblige. He asked me, after our second baby was born, whether I was happy with the birth. Very humble.

OTOH, dh and I have a good friend that we're just flummoxed over. She just finished her OB residency and she told me that if she has a baby, "I'm not going to be one of 'those women' who refuses the epi, I'm going to get it right away." We thought that since she is a very strong, independent, feminist woman that she would be the sort of OB that I have now ... but she is very pro-intervention, birth as a pathological and dangerous, painful experience OB (thus far anyway). It makes me very sad. I need to keep figuring out how to help her see that natural birth makes the most sense - that interventions pile up and create the danger/pathology she expects in births (and at least a portion of the pain, too!). But it is *hard* to tell an OB, who's seen hundreds of births (albeit very few ncbs) that her experience/training is wrong, when my argument is 2 ncbs and no medical training at all.