Is it just my doc or are they all like this? - Mothering Forums
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#1 of 40 Old 11-09-2007, 07:28 PM - Thread Starter
 
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Ok, so my estimated due date was Wednesday. They're already freaking out and telling me I'm on the clock and my placenta is getting old. I got sent directly over to the hospital for a NST that day. The woman doing the monitoring was really confused as to why I was there since I have no risk factors other than having had a c/s and it was only just my due date. As I already knew, everything was fine, including the levels of amniotic fluid. I get to go back on Monday... Joy. So, since I got them to lay off on the big baby thing, now it's my aging placenta. I even got brushed off when I mentioned that due date was an estimate and that up to 42 weeks was still considered on time. : Do we really live in such a control freak, litigious society that our HCPs loose their ever loving minds when a patient doesn't fit the average? And does anyone else have any idea what they might throw at me next?

Anna
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#2 of 40 Old 11-09-2007, 07:31 PM
 
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Oh, Mama, sorry to say they ARE all like that. Hold your ground, but they will be freaking out. I would stop taking their phone calls.
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#3 of 40 Old 11-09-2007, 07:32 PM
 
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I would be thinking at this point that your HCP is drooling to induce and cut you again...watching the dollar signs ring before their eyes....JMHO

I would stay far away until active labor or better yet transition

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#4 of 40 Old 11-09-2007, 08:00 PM
 
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I am trying to prepare myself for the same type of battle ahead. I don't know of any premature babies in my family and those who weren't sectioned came well after EDD... my own daughter was one week past EDD. I have already had one nurse practioner tell me that it wasn't my decision as to whether or not I get induced...?... ended up changing practices... but, yes from what I have heard and read they are all like that.

Hold your ground.

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#5 of 40 Old 11-09-2007, 08:37 PM
 
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Nah, we're not quite all like that
Unfortunately, the docs that are like that and scare their clients into all these inductions and what not and making it hard on me. All these folks tell my clients that their doc (me) must be incompetent if she doesn't know that the uterus explodes and the baby dies if you don't get it out before the due date. I have to spend a lot of time convincing my clients that an induction at 40 wks 1 day is not in their best interest. My favorite are the clients who say "Well, how long are you going to make me be pregnant?" Honey, I did not make you pregnant even on day!
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#6 of 40 Old 11-10-2007, 03:58 AM
 
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About 99% of them are like that That's why we shouldn't hire them as primary carers when we have nothing wrong with us, isn't it?
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#7 of 40 Old 11-10-2007, 04:28 AM
 
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My favorite are the clients who say "Well, how long are you going to make me be pregnant?"
As much as I rip on doctors, this is what really gets on my nerves. Women who treat their pregnancies and births with so little respect. And those that CHOOSE to ignore the facts or do any research regarding their lives.

It's all craziness. :

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#8 of 40 Old 11-10-2007, 04:40 AM
 
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I'm surprised they didn't start pushing for repeat or induction at 38 weeks with a VBAC.

Honestly, I'd never consider having a VBAC in a hospital unless one of our lives was in imminent danger.

Mom of a 7 yr old, 4 yr old, and 1 yr old. Wow. How did that happen?
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#9 of 40 Old 11-10-2007, 01:21 PM - Thread Starter
 
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Nah, we're not quite all like that
Unfortunately, the docs that are like that and scare their clients into all these inductions and what not and making it hard on me. All these folks tell my clients that their doc (me) must be incompetent if she doesn't know that the uterus explodes and the baby dies if you don't get it out before the due date. I have to spend a lot of time convincing my clients that an induction at 40 wks 1 day is not in their best interest. My favorite are the clients who say "Well, how long are you going to make me be pregnant?" Honey, I did not make you pregnant even on day!
Jen, I wish I had you local. I'm getting tired of looking at them like they have three heads and doing the "Oh, really, because, that's not what I've read on the topic. Tell me how I'm the exception." routine. I think they've given up on the hard scare tactics though since I've called them on lawyerisms. I'm not scared of being pregnant past my due date, but it is getting wearing that everyone else seems to be terrified of it.

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I'm surprised they didn't start pushing for repeat or induction at 38 weeks with a VBAC.

Honestly, I'd never consider having a VBAC in a hospital unless one of our lives was in imminent danger.
They started pushing for scheduling a repeat c/s at 40 weeks when I was 3 months and have not let up that much. I keep coming back with my stats and asking for evidence based reasons why I'd need to schedule a c/s. I keep getting the ACOG bs policy. Now that I've been able to review that, I'm going to call them on it too. I haven't quite gone so far as to ask my doc if she's not confident in her own handiwork since she delivered DD.

I would love to HBAC, but I have zero support for even entertaining the concept and I'm not confident enough to attempt UC without DH here for sure. He's 5 states away for work right now. I tried contacting the local midwife practice between 25 and 30 weeks and nobody returned my phone calls. Probably had something to do with the word VBAC... My mom was an OB nurse for 15+ years and I was hoping she would be more supportive, but our birth philosophies are radically different. She believes in the interventions as a routine and I don't see the point if they aren't medically necessary. She thinks I'm just being difficult to be difficult and make everyone's job harder than it has to be for even wanting a VBAC. She tries to make me feel like a teenager bucking "the man" instead of being happy I'm an informed patient.

So, to the hospital I go, if nothing more than so that I have an excuse for someone to watch the kids while I labor and have someone there above the age of 5 to catch in case I'm too out of it. Everyone knows I'm not going to consent to a repeat c/s unless we're playing pizza delivery and it's gotta be here in 30 minutes or less. I have it all in writing what I will consent to when and under what circumstances. The doc sent it over with my medical record already to the hospital and she didn't object to anything I put down when I asked. Said there was nothing out of the ordinary in there and there seemed to be no problems. So here's hoping...

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#10 of 40 Old 11-10-2007, 02:07 PM
 
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I'm not seeing an OB, and didn't last time, but it's a hospital midwife practice. When I went in for my 40th week appointment, they scheduled me for my week 41 appointment with nothing more than a "And if you give birth before then, we'll cancel it for you, don't worry about calling."

They don't start NSTs until after 41 there, and don't start talking about induction until week 42 in the absence of anything else weird going on.
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#11 of 40 Old 11-10-2007, 02:18 PM
 
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I would be thinking at this point that your HCP is drooling to induce and cut you again...watching the dollar signs ring before their eyes....JMHO

They *are* likely seeing dollar signs, but I'd venture to guess it's got a lot less to do with what *you* are suggesting and a lot more to do with malpractice lawsuits.

Unfortunately, a post-dates VBAC that goes bad...heck, a VBAC that goes bad period....yeah, the dollar signs of a potential lawsuit surely do weigh on the docs mind. And for good reason.

As for actual dollar signs for reimbursement based upon delivery method, what I've found is this whole whoopla about docs wanting to do sections cause they make SSSSOOOO much more money just hasn't been true at all IME. Our insurance reimbursement rates are VERY similar for the doc no matter how the baby is born, and a c-section takes a whole lot more time on the doc's part than 'catching' a baby at the last minute during vaginal birth.

IIRC, I think my doc ended up getting paid about $200 more for the fact that I had a section vs. if I'd had a vaginal birth. $200 isn't a lot when you consider he was at the hospital dealing strictly with me and my surgery for 1.5 hours total, whereas if he'd just run in and delivered my baby vaginally, it *might* have taken him 20 minutes tops.

I've been in his office for regular appointments, watched him go out headed to the hospital for a delivery, and he's back through the door again in under 20 minutes. These days, docs really do just show up at the very end of pushing for vaginal births, so why on earth would he want to be at the hospital for an hour or more doing a section to make a whopping $200 extra?
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#12 of 40 Old 11-10-2007, 04:49 PM
 
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As for actual dollar signs for reimbursement based upon delivery method, what I've found is this whole whoopla about docs wanting to do sections cause they make SSSSOOOO much more money just hasn't been true at all IME.
I'm interested... What do you believe the reason is for the high c/s rate in the country?

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#13 of 40 Old 11-10-2007, 05:18 PM
 
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Anna. I'm afraid a great many of them out there really are just like that. It really : me that epidemiological evidence has so little weight when it comes to how the powers that be decide they'll manage pregnancies and determine the "standard of care".

Dh and I just had one of those jaw-dropping moments when we realized that if we were to have gone with the OB who did the unnecessary c/s with my ds we would really only have another 4-5 weeks left before they'd be wanting to schedule it.

Hang in there mama!
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#14 of 40 Old 11-10-2007, 06:00 PM
 
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i do not think that they are all like that, but there are some doctors who try to promote the birth in order to register it for their shift. Can you try to find a doctor that you can trust?
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#15 of 40 Old 11-10-2007, 10:41 PM
 
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Next time it is brought up ask the doc how old she is and reply with, "Yeah, your getting pretty old too!" Maybe that will make her shut up. I wasn't aware my placenta had a use by date much less that it was readable through my cervix.

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#16 of 40 Old 11-10-2007, 10:55 PM
 
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Originally Posted by Da WIC Lady View Post
...I haven't quite gone so far as to ask my doc if she's not confident in her own handiwork since she delivered DD.
That would be ballsie, but funny as all get out!

W/my 1st 2, the medwives were very much like that. They kept trying to induce w/the 1st and schedule a section w/the 2nd. I keep expecting my MW now to turn on me, but I don't think she's going to.

You sound strong & solid & you know your stuff (sadly, more then some of your OB care).

You're on Nov DDC, too aren't you?

Rachel~wife to Keith since 5/01~mother to Georgia since 4/04~Bishop since 1/06~Zoe since 11/07 (my HBA2C!)~EDD 2/14/10 w/Baby surprise #4
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#17 of 40 Old 11-11-2007, 01:09 AM
 
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About 99% of them are like that That's why we shouldn't hire them as primary carers when we have nothing wrong with us, isn't it?

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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#18 of 40 Old 11-11-2007, 01:48 AM
 
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I'm interested... What do you believe the reason is for the high c/s rate in the country?
'The reason', as in, you believe there is ONE reason?

There are actually a lot of reasons. I can list a few, though the list is certainly not complete, nor is it in any particular order.

1. Women waiting until they are older to have babies. Older moms have more complications statistically, and more complications translates into more c-sections.

2. Multiple birth rate is higher, almost assuredly because of increase in use of fertility treatments, though older moms tend to have more spontaneous multiples as well. Multiples are more likely to be born prematurely, experience complications, etc, and are more likely to be born by c-section.

3. Women are heavier than in the past. Overweight and obese women have more pg complications statistically.

4. Induction insanity. *Some* docs want to practice '9-5' medicine and not deal with being called in the middle of the night, so it's easier to induce at or near the due date. *Some* women pressure docs to induce (I actually see/hear of this more than the docs doing the pressuring.)

I have little patience for women OR docs inducing much before 42 weeks without a COMPELLING reason or medical necessity *unless* the woman has a favorable Bishop score AND understands the risks of induction. I think in the end, if mom truly wants to be induced DESPITE the risks with a poor Bishop score, it should be her choice, but I really think a lot of women would opt to wait a few more days if they looked at the numbers.

5. Malpractice/litigation fear. If the least little thing goes wrong during delivery, here comes a lawsuit. I see this even on MDC where someone posts about a delivery with complications, and within the first few replies, people are saying the parents should sue. This is quite often without even the very basic informatin about the complications being posted. People just start shouting for a lawyer. It's the American way it seems.

6. *Some* docs want to get home, get to the golf game, get to the holiday party, get to their kids' baseball game...and all of that can be accomplished if the mom in labor would just have the baby already.

7. Lots of repeats now that the VBAC climate is so hostile in so many places. IIRC, if you eliminate repeats from the national average and look strictly at primary section rates, they aren't nearly as bad (certainly way less than the 30%+ overall national average). Primary rates are still too high, but if that number was lowered, the overall number would be lowered as well since the whole VBAC issue wouldn't come up as often.

8. All the monitoring that is 'standard' in most places has done little to improve overall outcomes, but leads to more sections. This is well known, but as long as most docs are still doing it, the fear becomes 'What if?' It's obviously impossible to go back and PROVE that a particular bad outcome would have still been bad even if continuous monitoring had been used.

In a malpractice case, if there's no fetal monitoring strip to look at, the question becomes 'Well, doc, COULD this baby have been saved if you'd MONITORED him/her during labor...like the vast majority of your peers do? Come up with a good answer for THAT one.

I could go on, but hopefully you see that there are a whole lot of reasons for our current c-section rate.

I *do* think that a lot of c-sections are done as a CYA pre-emptive move on the doc's part. If something goes wrong and doc practiced even slightly outside of the most conservative guidelines, they are wide open for a lawsuit and they know it.
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#19 of 40 Old 11-11-2007, 11:29 AM
 
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That is why I had an HBA2C. But, they will probably want to do a biophysical profile on the baby to check things out in there. That placenta aging thing is so premature if you just hit your DD this week. And since you are a VBAC, you want to stay as far away from induction as you can. Just don't give in to what your intuition tells you. They can't MAKE you do anything you don't want to, as long as the baby is doing fine. By the way I went 10 days past my EDD with my HBA2C. And the baby showed not one sign of being post-date. Everybody is different. Good luck mama!
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#20 of 40 Old 11-11-2007, 05:03 PM
 
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Originally Posted by Da WIC Lady View Post
Do we really live in such a control freak, litigious society that our HCPs loose their ever loving minds when a patient doesn't fit the average? And does anyone else have any idea what they might throw at me next?

Anna
Yes, we live in a litigious society. Yes, most doctors (not doctor {{{JEN}}} will opt to cover their butts instead of doing what is the "right" thing for a VBAC mom. There is a lot of peer pressure from other docs as well as malpractice concerns.

And, if I were to take a guess, they will use the dead baby card next. They see that you are competent and educated about VBAC, so the usual "soft" coercion techniques don't seem to be working. I'm guessing they'll take out the big guns next. Just an educated hunch
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#21 of 40 Old 11-12-2007, 03:10 AM
 
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IIRC, I think my doc ended up getting paid about $200 more for the fact that I had a section vs. if I'd had a vaginal birth. $200 isn't a lot when you consider he was at the hospital dealing strictly with me and my surgery for 1.5 hours total, whereas if he'd just run in and delivered my baby vaginally, it *might* have taken him 20 minutes tops.
Don't know what it is for my current insurance, but my previous was $3000 for an uncomplicated vaginal delivery, $5000 for an uncomplicated c-section. That's *just* the practitioner's fee.

Now, the nice thing about the MW practice is, the surgeon gets the extra $2000, so there's no monetary incentive for them to recommend a c-section. ;-)

The anesthesiologist, hospital stay, etc. are all separate charges, but were also reimbursed at negotiated rates.
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#22 of 40 Old 11-12-2007, 03:34 AM
 
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Don't know what it is for my current insurance, but my previous was $3000 for an uncomplicated vaginal delivery, $5000 for an uncomplicated c-section. That's *just* the practitioner's fee.

Now, the nice thing about the MW practice is, the surgeon gets the extra $2000, so there's no monetary incentive for them to recommend a c-section. ;-)

The anesthesiologist, hospital stay, etc. are all separate charges, but were also reimbursed at negotiated rates.
Wow. Amazing how different insurance companies can be.

My entire pregnancy, start to finish, including my 6 week follow up appt was right at $5500. That is of course not what the insurance company was CHARGED, but that's what they actually PAID.

That included *everything*: all prenatal visits, two shots of Rhogam (those actually cost more than what they paid for my spinal), several u/s, several NST, c-section, 36 hour hospital stay (2 nights), OB, 2nd surgeon, spinal, all of it.

It would have been $200 cheaper for the doc's fee if I'd had a VBAC. I'm not sure what the negotiated rate difference was for the hospital for vaginal vs. c-section, though I can't imagine it would have been that much different.
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#23 of 40 Old 11-12-2007, 05:17 AM
 
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My hospital bill was $15,000 and we paid about $1000 OOP, I don't remember how much the Dr bill was.

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#24 of 40 Old 11-12-2007, 06:12 AM
 
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Wow. Amazing how different insurance companies can be.

My entire pregnancy, start to finish, including my 6 week follow up appt was right at $5500. That is of course not what the insurance company was CHARGED, but that's what they actually PAID.
I should try digging out the paperwork and figuring out how it all ended up, now that I'm not still trying to do their f!@#$ing math for them... I know that one bill we saw (which didn't include anesthesia, for sure; dunno what else was on there) was for $32k and change. That got negotiated to $5000. But there's lots of other stuff that was separate from that.

I'm pretty sure we hit the OOP maximum of $1000 all told.
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#25 of 40 Old 11-12-2007, 12:13 PM
 
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Still... better to send you for a non-stress test than schedule the c/s, right? Nonetheless, I'm surprised they are so nervous when it's not even 41 weeks.

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#26 of 40 Old 11-12-2007, 12:41 PM
 
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My hospital bill was $15,000 and we paid about $1000 OOP, I don't remember how much the Dr bill was.
See, the thing is, the hospital will charge all sorts of outrageous amounts. But they don't actually get PAID that amount.

The actual difference in cost for vaginal birth vs. c-section in terms of insurance payout is usually not all that different. A section will cost more, but not tons more. This is assuming of course that we're comparing a standard hospital vaginal delivery to a standard hospital c-section, neither with complications.

If you think about it, that's a sad testament to how medicalized vaginal birth has become with all the monitoring, pitocin, epidural for almost everyone, etc.
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#27 of 40 Old 11-12-2007, 12:44 PM
 
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I know that one bill we saw (which didn't include anesthesia, for sure; dunno what else was on there) was for $32k and change. That got negotiated to $5000. But there's lots of other stuff that was separate from that.
IIRC, the hospital portion of my bill was somewhere between $9-12K. That was for an uncomplicated scheduled ERCS with 36 hour stay from the time I walked through the door til the time I left again. No complications for either of us. What the hospital actually got PAID for that $9-12K bill was substantially less, maybe a couple thousand tops. I'd have to go back and look at our claim stuff to be sure, but it wasn't even in the ballpark of what was billed.

Anesthesia billed $800ish, but got paid maybe $150-200 IIRC. It was way less than the actual cost of paying the anesthesiologist, I do know that.
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#28 of 40 Old 11-12-2007, 12:48 PM
 
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Do we really live in such a control freak, litigious society that our HCPs loose their ever loving minds when a patient doesn't fit the average? And does anyone else have any idea what they might throw at me next?
Ummm, yes.

And watch for the Low amniotic fluid ploy. They do an ultrasound and claim that "OMG! You have almost no amniotic fliud left! Baby needs to come out RIGHT NOW!!! And, since you've had a section, we can't induce, so off to the OR with you!"

Drink LOTS to keep fluid up, and if they claim a low fluid measurement, ask for a second scan, done by a senior sono tech with lots of experience. I had a client go from 4 to 13 with a second opinion. BIG difference.

Good Luck!
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#29 of 40 Old 11-12-2007, 12:48 PM
 
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Wifeandmom: If every woman who has had some messed up $h!t done to her by an OB (and by messed up $h!t I mean outmoded, non-evidence based medicine) sued, we wouldn't have any OBs left.

I am tired of hearing that we can't have decent evidence based Obstetrics because we might sue. I would sign any waiver there was, just so I could have something other than BS CYA care. The problem is NOT too many mamas suing. Actually for every mama that has 3 or 4 years to devote to a lawsuit, 10 more don't! What we need is a mechanism for cesure that DOES NOT involve hiring an expensive lawyer and giving up 1/2 a decade of your life. If every OB who did stuff that was not evidence based was subject to censure, then maybe things would start to chage.

As it is, when something wrong happens, as long as the baby is relatively fine, most moms DON'T sue or even report the malpractice. And so it continues . . .
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#30 of 40 Old 11-12-2007, 12:53 PM
 
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Oh, and Anna, I'll be in your neck of VA for Thanksgiving next week. I'll be happy to help you UC if DH isn't back!

HUGS!

Sweetpea
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