So MAD about STUPID OB Procedures!

[MegBoz]

I get so mad about stupid maternity care in the US - I CANNOT SHUT UP! I'm sick, I swear, it's an illness! It's awful. I just can't shut my mouth.

A co-worker of mine is going to hit 40W with her first baby this Friday. She told me they'll induce her by 41W. ARGH! Of course, I couldn't help but say, "Average gestational length for healthy 1st time Moms is 41W and 1day!" If NSTs + AFIs are showing reassuring results, studies show that expectant mgmt is better than routine induction up till 43 weeks.

It just makes me so mad to hear about the dumb stuff that goes on, I have such trouble not spouting facts. If people want to get induced for sheer convenience or get an epidural, FINE! That is their choice! I respect that. But they ought to know the facts.

So much for "informed consent." : Of course, it seems most American OBs (ok, and probably some MWs too) don't even know lots of these facts themselves, so it's no surprise they don't share them with their patients. (Because maternity care in the US is, for the most part, NOT "evidence-based" - based on science - as Dr. Marsden Wagner states in his book "Born in the USA.")

It just makes me so mad. Of course, I do want to channel my passion into to ACTION to HELP!!! Which is why I've joined the Coalition for Improving Maternity Services. .

But I'm still, unfortunately, a rabid extremist in favor of "humanizing childbirth," & have such trouble zipping my lip!

Just realized I ought to add... I KNOW that being a "rabid extremist" turns people off & just inhibits communication! Which I why I say it is a problem that I can't calm down & zip my lip! When I do open my mouth, I try to state facts! (I have a great memory for stats.) So that I'm not passing judgement - just letting people know what science has shown. Again though, I don't want to spout facts if people don't want to hear it, - so even nonjudgemental facts can be a turn-off - but I can't help myself!

[AutumnAir]

I have the same problem. It makes me so angry that they do all sorts of ridiculous things without any evidence to back it up - in fact the evidence usually points in the opposite direction.
I find it really hard not to share my hard-earned information with others, and I know that it's not well-received for the most part. I have a colleague and friend who's pregnant and planning to give birth in the same hospital I was birth-raped in, and I had such a hard time biting my tongue and not spewing invective. I tried to gently caution her that they are not at all conducive to either natural childbirth or breastfeeding, and I lent her a book that I hope might give her some things to think about. But I could tell that even that much she thought was a bit OTT.
It's so stupid that they're allowed to get away with it - in no other branch of medicine do doctors get away with antiquated practices that have been shown in extensive studies to be of no use at best, and extremely harmful and dangerous at worst. Imagine if doctors still bled patients with fever?! Or used leeches? People who suffered from migraines or very bad headaches used to have holes drilled in their skulls. Can you imagine what would happen if a doctor did that nowadays? So why on earth are all the old myths and dangerously harmful practices allowed to persist and thrive in obstetrics?

[MegBoz]

Originally Posted by lisabeeprague

It makes me so angry that they do all sorts of ridiculous things without any evidence to back it up - in fact the evidence usually points in the opposite direction.

YES! Exactly!

It's so stupid that they're allowed to get away with it - in no other branch of medicine do doctors get away with antiquated practices that have been shown in extensive studies to be of no use at best, and extremely harmful and dangerous at worst.

Yes, I know! it's just infuriating!!!! I was going to deliver at a, literaly world class hospital - Johns Hopkins Bayview, until I learned they did "nothing by mouth" with IV fluids & continuous EFM. (Thankfully, I had a much better option!) The nurse actually AGREED it would be better for me to switch if I wanted a natural birth. She said - and I quote - "Well, we are a high risk facility. We're not used to healthy patients."

Excuuuuse me?! Can you imagine if you went to the dentist & he drilled an unnecessary hole in a healthy tooth just cuz he is "used to filling cavities"?

So why on earth are all the old myths and dangerously harmful practices allowed to persist and thrive in obstetrics?

Marsden Wagner, MD had lots of insight as to why this is in his book "Born in the USA." I know that I personally want to do all I can to help drive change in American maternity care!

On another note, I read your birth story & am sorry for your loss.

[Sheryl1678]

My SIL, (first time mom) is going in for induction tonight and is 41 weeks tomorrow. She is actually angry that they made her wait this long. She certainly does not want to hear any advice from me. I have been biting my tongue this whole time.

I personally believe that the doctors induce for fear of a fast homebirth that they will not get paid for (or maybe for the realization that they are not needed).

As a survivor of an unnecessary and particularly cruel induction, I find them barbaric.

[azjen43]

Another really well-written book that explains why this stuff happens, and more importantly, how to avoid it, is "Pushed" by Jennifer Block. I think it should be required reading for all women of childbearing age. (Preferably before getting pregnant!)

[Calidris]

Of course, I couldn't help but say, "Average gestational length for healthy 1st time Moms is 41W and 1day!"

Of course, the more they push these procedures the more the average will shift towards the lower end of the scale, and then you won't even have numbers to back you up again.

[lifeguard]

DH was talking to two of his male employees about childbirth earlier this week. Afterwards he said to me in amazement "You know both of them were shocked that a natural, intervention free birth is generally healthier & easier than a medicalized one?!" I thought it was cute he was so clueless as to how non-mainstream we are in our thinking. But it also shows how ingrained the idea that "Doctor knows best" is.

[OceansEve]

I had a friend this week insist to me her next kid will have to be c/s because her first son was in the birth canal too long. This is what her new OB told her....... I said not really, smiled politely and moved on. This is the same girl I told not to induce, there was no reason to induce, and she now says she never will induce again because it was so horrible Also ONE of the people who tried to convince me VBAC was ILLEGAL AHHH!! Cause that is what her OB told her!!

[ChetMC]

Let Me Join this Club

I bite my tongue a lot. I look at DH, and he acknowledges, and then I rant in the car on the way home.

I find it especially hard when I'm within earshot of a mom spreading the misinformation she's been given to another mom or mom-to-be. I know too that being a militant, left wing, statistics spouter doesn't advance any of my causes. It's difficult though when somebody assures you that they, "are physically unable to dilate."

However, when moms share war stories I do tell people with pride that I stood up to my OB and why... so at least they know that it's possible.

[PookieMom]

I usually say "Well....(pause) I guess if your okay with that....(longer pause)..." If they say nothing, I say nothing and go on. If they say, "what do you mean by that?" Then I tell them.

Now, if someone is standing in front of a group of people and spreading misinformation, like say around a lunch table or something, then I try to do a little bit of re-education in as non confrontational manner as possible....but it can be really, really hard. Did I mention it's really hard? But I try.

[PookieMom]

Originally Posted by ChetMC

I bite my tongue a lot. I look at DH, and he acknowledges, and then I rant in the car on the way home.

I am sooooo bad about this. My poor DH, I should bake him cookies.

[MegBoz]

Glad to see it's not just me!

Originally Posted by Calidris

Of course, the more they push these procedures the more the average will shift towards the lower end of the scale

True! But the Mittendorf study reviewed "uncomplicated gestational length" - he removed inductions from his study. The ACTUAL average gestational length in the US is now like 39W or something. But the average length for uncomplicated/ non-intervention pregnancies in primiparas is still the 41W1D.

I agree - the book "Pushed" by Jennifer Block is great as well. My fav though is still "The Thinking Woman's Guide to a better birth" because of the way she organizes all the stats & then bullet-points out the specific tactics for avoiding unnecessary intervention.

PookieMom - Good tactic! I like that.

[SiobhanAoife]

I had an OB tell me on the day I was exactly 39 weeks (last week!) that my best bet for avoiding a c-section was to be induced at 39 weeks, and that I should just not go home (was at the hospital for a test) but rather should admit myself for induction.

When I cited the study showing that healthy white American first-time moms on average go to 41w1d, so why shouldn't I do likewise, he told me that we go that long on average because we're fat He said that evolutionarily speaking we'd've had shorter gestations because we wouldn't on average be so fat.

Calling me fat is like poking a bruise hard, and it made me sad

Note that I'm now 40w and haven't induced, so making me sad didn't lead to induction, but it led to me being sad, which sucks!

Now they want to induce me for having high-ish blood pressure (Note: not PIH, and not Pre-E, we've ruled out both of these, I have pre-existing essential hypertension, and my current BP is 'normal' for me from pre-pregancy, though it is high). I am sufficiently worried about my baby and they keep fussing at me, that I may just throw in the towel t 41w and induce if no progress before then. This makes me very sad.

[MegBoz]

Originally Posted by SiobhanAoife

I had an OB tell me on the day I was exactly 39 weeks (last week!) that my best bet for avoiding a c-section was to be induced at 39 weeks,

Now that is ironic, considering induction increases your risk of CS! My midwife said that instantly when I told her how people at the office were saying, "Oh, you could get induced on your due date if you want!" Like it's some great option.

When I cited the study showing that healthy white American first-time moms on average go to 41w1d, so why shouldn't I do likewise, he told me that we go that long on average because we're fat He said that evolutionarily speaking we'd've had shorter gestations because we wouldn't on average be so fat.

I'd like to know what study HE knows of that says that 40W or less actually IS the normal, average, healthy gestational length for non-obese ladies! #$&%^!!
The 40W was picked almost arbitrarly by a German OB named Naegel in the 1800's!! He decided 10 moons (40 weeks) seemed about average. It was not based on empirical evidence!

I may just throw in the towel t 41w and induce if no progress before then. This makes me very sad.

Well, you might want to try membrane stripping. Studies show it's quite effective - you just have to have it done repeatedly sometimes (and if it doesn't work the first stripping, having it done again does increase the chances that it will be successful. At 41W4D I decided to have it done. When my MW stripped, she said I was already at 3cm & went to 4cm as she went around to stirp. Contractions started 2 hours after the stripping & baby was out just 6 hours after that!

Routine procedure at my hospital was to induce at 42W, of course, LOL, my midwives didn't necessarily agree with this. They didn't say so explicitly, but one MW says, "So are you gonna let us induce on on Monday (42W)?" Before I even answered she says, "I went to 43W with one of my babies & it was fine." haha!

[SiobhanAoife]

Unfortunately I'm not dialated enough to sweep the membranes yet. And my midwife is anti-vaginal-EPO, says that it leads to PROM too often for her to be comfortable with it. I might see whether the OBs (I'm getting parallel care, but hoping for a homebirth) would let me do an outpatient cervidil thingie (where they monitor me for some hours right after application but then let me go home) to see if I can get my cervix to progress some short of leaping onto the entire bring-on-the-pitocin bandwagon. Oh well, acupuncture, sex, and oral EPO is what I'm doing now, wish me a natural labor and birth Real Soon Now. Sorry for derailing the thread, I've just had so many stupid OB interactions in the last two weeks that it sucked me right in

[BetsyS]

Originally Posted by Sheryl1678

I personally believe that the doctors induce for fear of a fast homebirth that they will not get paid for (or maybe for the realization that they are not needed).

I don't think this is really true. If it's a true accidental homebirth, chances are that the woman will go to the hospital and get some sort of "delivery" care--maybe delivery of the placenta or stitches or what-not. Then she'll stay in the hospital for several hours or days. The doc/CNM will still be able to charge the global fee for that birth.

From working in OB, I think a major reason that people get induced is because they beg for it. LIterally. We used to get called names and cussed out because we wouldn't induce before 41 weeks.

[MegBoz]

Originally Posted by BetsyS

From working in OB, I think a major reason that people get induced is because they beg for it. LIterally.

I don't doubt that. However, I think less women would be so eager if they were REALLY informed about the risks. I think the same goes for epidural. The info my hospital gave on it certainly didn't mention the fact that it doubles the risk of CS and quadruples the risk of insturmental delivery!

But there are still lots of ladies pressured into it when they don't want it. My case in point - they said it is "The policy" that they induce at 42 weeks - REGARDLESS of how Mom & baby are doing. In my opinion, most ladies probably just don't know they can refuse, or are too scared to consider refusing because they believe carrying past 42 weeks is always more risky than expectant management (even though it's not.) i.e. they just (blindly) trust the docs.

But finally, I think induction is simply demonstrative of the OB model... they think they are less legally liable if they do something as opposed to expectant management - when it comes to speeding up labor with pitocin / PROM/ Cervidil, or speeding up 2nd stage with directed pushing & insturmental delivery, C/S etc. etc. They just want to act rather than let nature take it's course.

[momm-i-o]

I am right there with you! Nevermind my 4 unnecessarians that led to #5 ercs, every intervention possible has been done to me! They must be called interventions because without them we'd llikely have women who birth just fine. My dad called to tell me that my cousin was going to have her baby on the 17th. I rolled my eyes and said yeah, give or take a few weeks. He said that it was to be a c/s because the baby was already 8 lbs. My cousin is a vet and her mom is a physical therapist and there was no way I could even talk to them about how much no one knows the size of the baby- they just guess. I felt so helpless, I had to get off the phone so I could have a good cry. I cried for days and prayed my cousin would be fine. The baby ended up being 10lb 6oz so of course everyone thinks the doc is a hero for saving her from certain birth issues! AARGH!!! I can't even talk about how my rupture cs traumatized me because I get the look that says I brought it on myself by going AMA. I am really curious about the organization you're a part of.

[BugMacGee]

I dunno, I knew the risks and if I hadn't ROM'ed @ 40+3, I would've begged for induction by 41 weeks. I think it was the lack of sleep and SCREAMIN' sciatic pain that did me in. So much pain prior to birth!

But we genetically gestate ~40 weeks in my family. Both my sister's kids born spontaneously on their due dates. Mine 40+3 and 39+4. But that's beside the point.

I think the being able to control the date of birth is really compelling to people. Some cultures have auspicious days and unlucky days to be born. IIRC, 8/8/08 was a big scheduled C/S, induction day in our hospital because of the date. I guess a lifetime of luck trumps a lifetime of RC/S.

[AmieV]

Siobahn, I just have to say I have never ever heard of vaginal EPO leading to PROM. You should ask her if the same can be said for cervidil, when the idea is the same thing. If you're being pushed into an induction, the vaginal EPO might at least give your cervix a chance to get ready.

"High blood pressure" has become the absolute #1 reason for early inductions at our hospital. They'll do it "prophylactically" at 39 weeks sometimes just to keep marginally high blood pressures from getting higher. Now I haven't extensively researched the benefit/risk factors of these "prophylactic" inductions, but it seems suspicious to me that so many freaking women are being diagnosed with PIH right around the time they're trying to push everyone into inducing anyway. Do your research and listen to your heart, not fear and scare tactics. If YOU feel like the 41w induction is safest for you and baby then great, but don't feel pressured to do it. Only you and your baby have to live with the consequences. ((((hugs))))

I work at the hospital and I swear almost everyone is getting induced. I'm quitting at 35 weeks because I'm afraid if I hit full term and show up to work they'll try to get my baby out!

And yes, unfortunately there are plenty of women out there begging for inductions as soon as their doc/midwife will allow.