At what point...

[bfoster2000]

Ok, I really hope this makes sense but I'm really tired so it may not. At what point can a doctor "force" intervention on you in a hospital situation? Here's the long sad story that makes me ask:

With my first delivery, I went into labor 5.5 weeks early, no GBS test (was scheduled to have it that afternoon!), water broke, etc. Knowing what I know now, I wish I had not gone to the hospital but it was my first and when I thought my water might have broken, I was excited and scared so I called and they told me to come in right away so they could check. Of course, once they determined that's what it was, it was all downhill from there. The CNM saw me first and she explained that I was 3cm dilated and my water had in fact broken so they were going to start me on pitocin to speed things up. I told her absolutely not...that I was not having pitocin under any circumstances. She told me I didn't have a choice. I knew that wasn't true, but what can you do? So I demanded to see the doctor (the OB was a friend of my boss and I knew her outside of the pregnancy and had discussed my birth plan with her and *thought* that she would be reasonable). I think the CNM thought I was trying to go over her head (I was) so she apparently gave the doc an earful before she got to see me. When the doc walked in, she didn't even say hello, just "Look. You're 6 weeks early (not true), your water's broken, your baby is in danger. The birth plan is out the window...this is my show now. I don't appreciate you giving my nurse a hard time. You WILL do as you're told and this baby will be healthy...is that clear?" Did I mention that this particular OB has always had kind of a motherly attitude toward me? Well, that day, she treated me like a misbehaving 2-year old! I was pretty dumbfounded, as was dh. Like a pleading toddler, I asked her to please check me again and see if I was progressing on my own. I had gone from 3 cm to 6 cm in just over an hour. According to the monitors, I was having strong, regular contractions but I was feeling fine...I've had periods much worse than that. I tried to bargain with her telling her to leave me alone for 4 hours and if I wasn't progressing fast enough then I'd sit back and shut up and let her do what she wanted. No luck. This was her show now. So the doc left again and one of the L&D nurses came in to give me the IV with the pitocin. I stalled by going to the bathroom, talking on the phone, going to the bathroom again, begging and pleading, etc. and managed to put it off for about another hour but then the CNM came back in and "reprimanded" me. So they started the pitocin and I assume the first dose of the antibiotics (which I had no choice about since I had not had a GBS test?) As soon as they started the pitocin, I could tell a difference. I wanted to walk around (I could pull the IV pole with me) but they wouldn't let me. It was painful to lay on my back so I tried to roll on my side but my punishment for that was internal monitors. Again, I told them no but they did it anyway. Within just a few minutes of starting the pitocin, it was like my whole body seized up and I couldn't move, talk, or even breathe. My dh told them that they had to do something so they gave me stadol (at that point I wasn't able to speak for myself so I guess it's ok that he consented?). I do remember him asking what effect the stadol would have on the baby and they told him none because it would be well out of my system before the baby was born. Guess what, I was holding my son about 45 minutes later and he didn't wake up for 3 days!! So a couple of other things happened against my will and I finally gave up and called for an epidural. The nurse said that she would have to "check me" again first so I told her nevermind, that I didn't want the epi...just please don't check me again. She did anyway and told me that I was fully dilated and it was time to push but that I had to wait for the doc to get there. Ummm...yeah! So the doc runs in a few minutes later laughing and sayign that she guessed I was right and didn't need the pitocin after all. I begged her again to please turn it off and let me push on my own but she refused. The whole pushing thing was another mess in itself and even though I had in writing that I didn't want an episiotomy, she nearly cut me. As I was pushing, she picked up something and I started yelling at her not to cut me. She got mad and said that she wasn't going to unless she had to. I told her I'd rather tear and if she cut me I'd sue her (don't know if I had that choice or not but it sounded good at the time! :)) So she let me tear. What happened afterwards was again completely opposite of what she and I had discussed for my birth plan and how DJ was to be cared for as a newborn. While she was sewing me up, I told her and dh that my next birth would be a homebirth.

So anyway I am planning a homebirth this time although dh is not thrilled about it at all. I have been seeing a CNM (different practice!) for my prenatal care and she and I have discussed what I want (in case I have to be transported to the hospital...she doesn't know that I'm planning a homebirth) some but we will discuss it more. The thing is, there is a lot that I want/don't want that she totally does not agree with. She has said that she will work with me if she's the one to attend but that if it's one of the OBs in the practice, she knows they won't go along with a lot of my wishes. Hopefully that won't be an issue anyway. :1praying:

But the thing I'm wondering is, not just with L&D, but with any medical care, we all know that doctors can be bullies (:blush ) but can they really "force" you to do something that is against your will? I know that sometimes you can sign waivers and CYA stuff to refuse treatment and you're supposed to have "informed consent" but in an emergency situation, can they do something you're asking htem not to? Who determines what an emergency situation is? Someone in the GTT thread mentioned doctors forcing or bullying women into having C-sections if they can't prove their GD status and that got me thinking about this. I remember that one case a couple of years ago where they pressed charges against the mother who refused to have a C-section and her baby died...but that was a messed up situation to begin with and they wound up making a deal and dropping the charges. So in my story, did I really have the right to refuse the pitocin? Did they have the right to insist? What about the antibiotics? The internal monitors? The internal exams? The episiotomy? Keep in mind that there were no indications (that I know of) that my baby was in distress at all...everything they did was based on the assumption that GBS *might* have caused my water to break early and since my water was broken, the baby *needed* to be delivered within 12 hours to avoid the risk of infections. And of course the fact that it was Friday afternoon before a holiday weekend had nothing to do with it. :) And honestly, I believe very strongly that because I was handling labor pretty well, they didn't believe that I was really in labor. I couldn't be having productive contractions if I was walking around laughing and joking and talking on the phone. :irked:

Sorry to babble on so...I don't know why I can't seem to post on here without writing a book! :blah Anyway, all of this is to ask what rights do we *really* have as patients when it comes to our own care?

THanks!

Barb

[1stTimeMummytoLore]

Barb- you always have the right to refuse any medical procedure for yourself or your child. Bottom line.

This is of course easier said than done half-naked in the throes of active labor. There are two documents you might be interested in looking at. ICEA has a Pregnant Patient's Rights and Responsibilities paper which addresses these concerns in formal language. There is also federal legislation and case law supporting a woman's right of refusal during labor. Check out this ICAN white paper which specifically addresses acces to VBACs, but also talks about right of refusal in general.

http://www.ican-online.org/resources/white_papers/wp_legalprimer.pdf

Medical staff will use a variety of strong arm tactics to get you to consent to a procedure mid-labor and you are on their turf so it can be hard to refuse, but just remember it is your body and your baby, therefore it is your decision.

I am sorry you had such a rough time with your last birth! I am sure you will have a wonderful, peaceful home birth this time and none of this will even have to be an issue for you!! :love

[turtlemama77]

Wow. I have no advice or answers, but wow. I'm so sorry you had such an awful experience.

I know you were in the middle of labor, but can a hospital/doctor/whoever do anything if you just get up and walk out? In my area, there are at least 4 hospitals that I can think of offhand. If something like this happened, what can anyone do if I just decide to leave?

[Yin Yang]

OMG! Your story makes me SO ANGRY!!! I have aksed the same question myself and people over and over, and I'd also like to know the answer. I hear people telling stories from hospital - they MADE me, I HAD to and such and I just DON'T GET IT!! How can they do that against someone's will?

I am sure your homebirth will go very well and you will never have to set a foot into that nasty institution called HOSPITAL! :irked: :irked:

[Quagmire]

Wow, that story blew me away. SO sorry you went through that. If you haven't already you should write a letter to the hospital admin board letting them know what happened and why you won't be using their services ever again!

No answers here either, just needed to get onboard the outrage train :)

[momsmyjob]

OMGosh! I can't imagine. :hug I don't know what the can and can't force you to do in a hospital. My fear is that they'd call it neglect or child abuse if you refuse something that they think will benefit your DC.

[bugnbean]

As a nurse I'm shocked and saddened by your experience and although I had nothing to do with it, I feel like I owe you an apology. You ALWAYS have rights. And you CAN refuse any medical procedure. I always try to explain to patients why a doctor has suggested something and never push a family to make a decision either way. Simply state facts and let them make an informed choice. Unfortunately you'll find a big portion of physicians and nurses work solely on "standard practice" when we all know there is no such thing as "standard". Further proof that maternal-fetal care has been medicalized to an almost dangerous point (although I'm grateful for some of the advances, we stick our noses and hands where they just don't belong LOL).

Unfortunately in mainstream medicine, there is so much implied consent. Be firm with the staff and let them know that you know what your rights are. They have no rights to force procedures on you except in very few conditions (and yours was certainly not one of those conditions.)

That said...hurray for homebirth (I'm also planning a homebirth)!! I hope you have a wonderful birth experience this time around.

[MsGrizzle]

Wow, I'm speechless and utterly appalled with your treatment.

You CAN refuse! This is from a post on the homebirth thread...perhaps you can find some info there.

-------------

I've been told to reduce the number of words in this thread. Please follow the below links to find out how to protect yourself in the event that you enter into a medical institution to give birth.

For anyone interested in reading more, we've compiled a legal primer on the rights of pregnant women at http://www.birthpolicy.org

To learn more about this important subject, go to
http://www.emtala.com . There you will find frequently asked
questions (FAQ), as well as links to the statue and case law."

[bfoster2000]

I'm definitely going to read through those documents and try to educate myself about what my rights are and I will probably wind up discussing that with the CNM/OB who may deliver if I do wind up being transported to the hospital for some reason. Another plus is that if something goes wrong and i have to be transported, I'll keep the homebirth midwife with me as a doula so hopefully she will be able to help stand up for me (bless his heart, dh meant well but he was more overwhelmed than I was last time!)

If there truly is a life or death situation, I want someone to take action instead of sitting around talking about options and signing consent forms etc. The problem is, I don't necessarily trust the docs and nurses (no offense!) to determine what is a life or death situation or what action is appropriate and warranted. For instance, when my SIL was in labor, her baby's heart stopped so they put her to sleep and did an emergency C-section. She and BIL neither one knew what was going on. They were preparing to give her an epidural and do a "regular" emergency CS (because the baby was in distress...probably due their earlier interventions but they'll never admit that!) and were going to let BIL stay with her and her stay awake, then all of a sudden they grabbed him and drug him out of the room, put a mask on her and started cutting (I wasn't there but that's the way I heard it ;)) A nurse explained to him what was going on WHILE SIL was in surgery. They told SIL what happened when she woke up. I don't like the way that story sounds, but, they probably did the right thing in that case because they were able to get the baby out fast and revive her. But in my situation, the potential threat to the baby was not nearly as immediate. There was time to explain to me what was going on and I was coherent and reasonable (until they drugged me! ;)) enough to make my own informed decisions.

As for the option of leaving the hospital, I don't think there's really anything they can do to you. My mom had pneumonia a while back and her family doctor sent her to the ER in an ambulance. After spending most of the night there, my dad was furious with the care (or lack of) that she was receiving so he told the nurses to unhook her IV and give her clothes back because they were leaving and going to another hospital. They told him he couldn't take her and even threatened to call the police but he told them that he'd be halfway to the next hospital before the police could get there so they could waste time with that or they could go ahead and call the other hospital and let them know they were coming. Apparently a couple of nurses chased them into the parking lot still yelling threats at them but when they got to the other hospital, the ER was expecting them and already had all of her information and all that and admitted her immediately. They got a bill from the first hospital and he sent a nasty letter explaining why he would not be paying it and that he had contacted his insurance company and advised them not to pay it either and they've never heard anything else about it...that was about 2 years ago. Now, if she had died in transit or something, it may have been a different story. Again though, she was really sick but there was not too much risk of her getting much worse in the half an hour it took to get from one hospital to another. I was in labor so I would have had quite a time convincing dh to walk out of the hospital to go sit in traffic.

There is definitely a lot to think about...

Thanks for the links!!
Barb

[vanilla]

wow. Your story is just astonishing. If I were you, I'd be having a homebirth too, and dh would probably actually be in agreement. I've had 3 hospital births with almost no problems (besides being told with my first that I probably wasn't in labor 3 hrs before he was born :lol)

It sounds like you will be having a pretty quick delivery if it goes anything like your last one, you were going pretty quickly all on your own, and I hope it all goes well for you!!

[Kirsten]

Not in your ddc but saw this under new posts. AWFUL story! I think it could have happened to me though - if I hadn't taken Bradley classes. We really learned about our rights as a health care consumer. I had a midwife in a hospital for our first birth (only one of our three kids to be born in a hospital) and I went in pleasant but firm - had our birth plan and stuck to it. They tried to do their normal junk but I sweetly declined and said I'd be happy to sign any AMAs (against medical advice - covers their butt) they needed me to. They were pretty good - I assume because they could tell I knew what my rights were and meant business. If they think they can bully you, they will - it is their hospital and they want to do things their way. During labor is not the time you will find people offering up choices and explanations and such. I had done so much research ahead of time that I knew not only what I wanted to avoid, but what I'd do INSTEAD.

I think a homebirth - or even a birth in a freestanding birth center - would meet your needs much more. Our dd2 was born in a freestanding birth center, and dd3 was born at home with those same midwives. Both of those experiences were SO incredibly respectful! I cannot tell you how different from my first birth - and that actually went really, really well for a hospital birth. (I've been at some of my friends' hospital births and each time was somewhere between sad for them and furious for them - at how they were treated, or mistreated...) My second and third births were just so different from hospital births - so much more calm, joyous, respectful, safe emotionally and physically.

I'd look into Bradley classes in your area. We drove over an hour round trip each week for three months to attend ours - and it was the best decision I ever made. Did it again for pregnancy #2, even though I don't think I forgot any in between - and had to arrange childcare for dd1 each week for it. It is just such a great thing.

Good luck finding people to support you in the birth you want. :)

[ksjhwkr]

Barb - Wow. You had a very traumatic experience the first time. :hug I commend you for planning a homebirth this time. You have EVERY right to deny anything that you don't want to be done. It is YOUR body and YOUR baby. I recommend getting a doula to help to be your advocate during this time. If you're at home, then she's just extra hands to help relax you, if you're at the hospital, she can help you stand up for what you do and do not want.

Just curious - what are some of the things you want that the CNM said you won't be able to have?