Article: Failure to Progress: What's Wrong with Hospital Obstetrics? - Page 2 - Mothering Forums

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Old 06-05-2006, 12:41 AM
 
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Originally Posted by AndiB
"Obviously the baby died because of the doctor's action/inaction, because he is in control of the situation, so if it goes wrong, it can't be anyone else's fault or just bad luck!" (Unless of course he did do surgery, which is seen as The Big Baby-Saver...sheesh...) Maybe docs should start discouraging pedastal-placement for their own good...
I think this is a very important point. It scares me when my own clients see me as "in charge" and look to me to make the decisions all along the way. When someone is not willing to take any personal responsibility, I definitely tend to gravitate toward more standard medical obstetrics, because I know I could defend that if I had to.

Also, I always wonder with all the large-settlement VBAC rupture cases why no one ever goes after the doc that did the initial cesarean, especially since with the climbing cesarean rate in the US, many primary cesareans are likely unnecessary.

I recently attended a failed VBAC, where the mama's water broke, and then she stop and start labored for 28 hours, uncomfortable enough to not be able to rest, but never settling into a real labor pattern. At that point, exhausted and discouraged, she decided on a non-emergent repeat cesarean rather than continue to wait or take a chance with pitocin. In talking with her in detail after, she felt good about the decision to have the repeat - but she felt she would never feel good about her primary cesarean which was for failed induction at 38 weeks because of "suspected macrosomia." That babe was just 6 lbs 9 oz, and she never progressed past 3 cms. Since her identical twin easily birthed a 7 lb 14 oz baby at 40 1/2 weeks, she feels certain that if she hadn't been scared into an induction, she never would have had the primary cesarean, and then her second pregnancy likely would have been different, too. If she'd ruptured during her VBAC attempt, it would have been me who was liable, not the doc who did her first unnecessary cesarean, and that doesn't seem fair.
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Old 06-05-2006, 12:55 AM
 
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My understanding is that though many claims are filed (the average OB these days has 3 filed against them, up from 1 20 years ago), few get settlements, even fewer go to court, and most cases file in favor of the defendant. The whole "litigous society" argument has a very limited play in this, I believe. What is happening is that insurance companies are hyping the fear of the litigous society to openly steal money, hand over fist. Doing a damn fine job, I might add since here we are hearing this one case that got some kind of settlement and it's used over and over as a demonstration of how much insuring doctors costs. We're supposed to feel sorry for insurance companies. Meanwhile women are being raped and abused by docs (willingly, I might add) trying to cover their asses or to streamline a natural process. It's almost like when the U.S. Forest Service hypes logging as a means of protecting forests from wildfire. Thanks corporate lobby!
That is very true...and it's near impossible to get a lawsuit in. Yes, I am one of those people who is currently having records reviewed by a legal team because yes, there were some things that happened that most likely lead to my son's death. But, it's not like you can just hop in a lawyer's office and walk out with a check--I'm looking at a *1-2 year* battle before it even gets into court. And that's if the lawyers think there's an absolute definate win--they won't even take the case if there's any doubt at all that I could win. My records have to go through several months of review by 3 different experts before a decision is even made to investigate and file a lawsuit. So, the "sue-happy nation" is not really what people think...it's not easy to file a lawsuit. It's darn near impossible and I've been told to be prepared that even if the hospital staff was neglectful, unless it's proven without a doubt, the hospital will get away with it. It's not a matter of being sue-happy. I'm the last person in the world that would sue, but sometimes, what you see as being sue-happy is really deeper than that. Sometimes there is more to a case than you see or hear. My demand for a c-section...conveniently left out of my records. So, even though I was denied a life-saving procedure, it's not even documented.

I don't think it's that doctors should be MORE intervention happy. I do think however that if they push those interventions they need to be responsible for the repurcussions of it. If they want to push those interventions, they need to be prepared for the consequences of that to the baby instead of passing out pitocin like it's tic tacs. If OBs knew how labor was really supposed to go, they probably wouldn't be so fast to push a woman's body to labor faster. You pressure a woman into laboring faster and you tell them that their bodies are defective and require an intervention, you then must be willing to own up to the fact that the intervention has the potential to kill the baby. Instead of telling a woman "oh, this drug is safe...we use it all the time" (like I was told when I was in labor arguing with the staff because I did not want pitocin just because my water had been broken for 24 hours), they need to be honest and say "this drug can be dangerous...and as a result, you need to be the one to make that choice". Instead they say "we are making this choice now...you're in our care" and then they don't pay attention to the repercussions of that...I don't know, maybe they've been brainwashed into thinking all of it's safe.

What they don't tell you is that yeah, you can labor in the hospital med free...but then you hit the 24 hour mark and they basically hold you hostage there--you NEED their interventions because they will not let you go without them. Yes, you can walk out, but after 24 hours of labor, they pull out the scare tactics (if we don't get the baby out right now, he'll die). What they don't tell you is that the interventions are far worse.

Maybe it's not that people are sue-happy. Maybe it's the "cram 20 people into the maternity ward, treat them and street them so we can get 20 more people in". Or maybe it's that doctors are trained to ignore what a woman's body is supposed to do. Maybe they aren't educated in real labor. Maybe they are so used to managed births that they forgot what labor's like. But, when you start playing with interventions, you have to be prepared for those consequences... And if you convince a woman that her baby will die without you, you have to be prepared for the consequences of that too. If you force a woman to believe she can't do it without you, and then your very actions or inactions result in the death of her child, you need to own up to that and finally realize that screwing with nature is very dangerous and that what you believe is safe is not the case.

~Brandon Michael (11/23/03), Jocelyn Lily Nữ (2/4/07, adopted 5/28/07 from Vietnam), Amelia Rylie (1/14/09), & Ryland Josef William (9/7/05-9/7/05 @ 41 wks). 
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Old 06-05-2006, 01:05 AM
 
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I found this article really interesting and depressing. It made me regret my epidural, which I got out of desperation when I had stalled for 8 hours - it was that or Pitocin with *no* epi, so I chose the lesser of two evils. But it is hard to read this article and think about my little dd's brain receiving the drugs in the epi . I am even more determined to have a homebirth next time. I hope that research WILL be conducted on the effects of Pitocin, epidurals etc. on babies and children's neurological development. I won't be holding my breath, though.

Wifeandmom, I just wanted to ask you, if you don't think people should take out $100K+ loans if they are not going to make a large salary, what you would advise people who would like to be public defenders, or emergency room docs, or who would like to go into other areas of law or medicine (etc.) that do not have high income potential? IMO the issue is not whether some individual "should" or "should not" take out loans - it's that one has to either be rich or go into major debt in order to enter certain professions which are necessary to society, and maybe that's not such a good thing. We have to have public defenders and the like, after all - and not all docs and lawyers can make an "adequate" salary to justify their loans by your reckoning. Sorry to make another comment on this since it's OT.
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Old 06-05-2006, 01:15 AM
 
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Originally Posted by fourlittlebirds



A woman can rupture even if she hasn't had a previous cesarean. So what now, are they going to ban *all* births? Of course not. Yes, I know that rupture is statistically more likely to occur after a VBAC (especially when induced.).
What is the purpose of delivering in a hospital if they can't give an emergency c-section?
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Old 06-05-2006, 02:13 AM
 
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Originally Posted by annakiss
My understanding is that though many claims are filed (the average OB these days has 3 filed against them, up from 1 20 years ago), few get settlements, even fewer go to court, and most cases file in favor of the defendant. The whole "litigous society" argument has a very limited play in this, I believe. What is happening is that insurance companies are hyping the fear of the litigous society to openly steal money, hand over fist. Doing a damn fine job, I might add since here we are hearing this one case that got some kind of settlement and it's used over and over as a demonstration of how much insuring doctors costs. We're supposed to feel sorry for insurance companies. Meanwhile women are being raped and abused by docs (willingly, I might add) trying to cover their asses or to streamline a natural process. It's almost like when the U.S. Forest Service hypes logging as a means of protecting forests from wildfire. Thanks corporate lobby!

All it takes is ONE case gone wrong and the potential for disaster is very real. I personally know of one girl that sued the doc over something that I totally disagreed with. I won't go into lengthy details here, but in the end, the lawsuit was settled for close to $100K, and it was one of those 'pain and suffering' type suits with absolutely NO long term damage whatsoever to either mom OR baby. I was shocked that the malpractice carrier settled, but at the end of the day, they likely would have spent more than $100K defending the case with no guarantee that a jury wouldn't have awarded a much larger amount of money.

It doesn't seem to matter on iota that there isn't a SHRED of evidence to support some of the interventions docs are routinely sued over NOT using if something goes wrong. Look at continuous EFM. Can ANYONE find a reputable study showing it improves outcomes? I don't think such a study exists.

But you better believe if a case goes before an arbitration board, or heaven forbid a jury, they are going to ask 'why wasn't this baby being monitored?' and the next 'logical' question is 'Would this baby still be alive if he/she HAD been monitored?'

So there's one example of how things get totally out of hand because the expectation is there that every baby will be born healthy no matter what. And if there was any stone left unturned, any intervention that wasn't fully utilized, the question that can NEVER be answered is 'Would it have saved this baby?'

That is why malpractice carriers want to settle out of court. It's way cheaper in the long run, regardless of whether or not the doc was at fault or not.

As for feeling sorry for malpractice carriers, that is something I've never felt sad about. I figure they are in business and they know how much they must charge the people they insure to make a profit at the end of the year. They are no different than a car insurance company or a health insurance company. They must take in more than they pay out each year. It's a very mathematical process, and they obviously are still making a nice profit at the end of each year or they wouldn't still be in business.
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Old 06-05-2006, 02:28 AM
 
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Originally Posted by annakiss
wifeandmom, do you think that tort reform is the answer? The article seems to scoff at that solution.

also, I find this really odd: What exactly is the kind of medicine they were trained to do? Because what OB sees natural birth in med school?
I actually don't have a problem with capping of 'pain and suffering' damages to a reasonable amount. I do NOT think there should be a cap on ACTUAL damages though, so I'm not sure how much help it would be if the system were set up like this.

For example, there was a baby born by scheduled c-section at one of the hospitals DH worked at. (Thank goodness he wasn't even in the country when all this went down.) Baby was born just fine, I have no idea what the section was originally scheduled for, could have been for breech or repeat or something entirely different.

One minute apgar was an 8, by five minutes apgar was a 9, but they decided to give baby a bit of blow-by-blow oxygen. Not terribly unusual even in vaginal deliveries at a hospital, certainly not unusual for a scheduled section with no labor.

Well, next thing you know, baby is going downhill. FAST. Nothing they do is helping, they cannot figure out what is wrong. FORTY THREE MINUTES elapse. Baby is intubated during this time, but goes into cardiac arrest and cannot be resuscitated.

Then someone says 'Hey, I think we need to switch over to the wall oxygen supply cause this tank is going to run out soon.'

Turns out they have been giving this baby CARBON DIOXIDE from the pulmonologist's cart the entire time.

Once they realized their screw up and started the baby on OXYGEN, from the wall source where it should ALWAYS come from in the first place, they were able to revive the baby. However, he had gone FORTY THREE MINUTES not only without oxygen, but with carbon dioxide, being pumped into his lungs.

He will never recover and was in a vegetative state from that point til the last I heard of the case. The family will receive an ENORMOUS settlement, as well they should, as they are now looking at long term care for a newborn, and that is NOT cheap. I figure it's completely reasonable for the family to be compensated for the medical bills they will incur over this child's lifetime.

That money will come from several sources in the civilian world (this particular case was in a military hospital, so the funds will come from the government). One source is the hospital's malpractice policy. The rest will come from the individual doctors who were present, from the OB to the anesthesia provider to the pediatrician, all of them will be named and all of them will LOSE the case and be assigned a certain % of 'blame' for not noticing sooner that standard protocol had not been followed.

The initial mistake in putting the baby on carbon dioxide was actually made by the OR tech, but the docs in the room are the ones who go down for not realizing it right away.

There were two other OB cases at this particular hospital that ended up being total disasters in the 3 years DH worked there. One I know resulted in a $70 MILLION dollar award (again, it was based on actual damages and costs to care for the patient who was injured). I've no doubt these other two will also result in gigantic awards as well.
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Old 06-05-2006, 02:38 AM
 
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OMG, that poor poor sweet baby. My gosh, that is one of the single most awful things I've ever heard. How even the simplest "routine interventions" can lead to horrible outcomes. That poor family.

~Brandon Michael (11/23/03), Jocelyn Lily Nữ (2/4/07, adopted 5/28/07 from Vietnam), Amelia Rylie (1/14/09), & Ryland Josef William (9/7/05-9/7/05 @ 41 wks). 
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Old 06-05-2006, 02:49 AM
 
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Originally Posted by AllyRae
Edited out due to pending litigation
First and foremost, I am so sorry that you lost your son.

Second, I would not REST until I found a lawyer willing to take my case in your situation. It might take years to work through the court system, but it is cases like yours that make me think it would be a disgrace if we DID limit jury awards for pain and suffering.

Because your son died, the actual monetary damages aren't all that high. You don't have to take care of a brain damaged child for the next 50 years. But that doesn't mean that hospital shouldn't GO DOWN for his death. I hesitate on how much responsibility the doc has if he wasn't called for 2 hours by the nursing staff though. That's more of a hospital liability and nursing liability issue IMO. This is assuming the doc intervened RIGHT AWAY upon finally being notified however. Otherwise, he'd have to go down with the rest of them.

I cannot even imagine the horror you must have felt and are still dealing with and will continue to deal with for the rest of your life.

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If OBs knew how labor was really supposed to go, they probably wouldn't be so fast to push a woman's body to labor faster. You pressure a woman into laboring faster and you tell them that their bodies are defective and require an intervention,
One thing I'd point out here is that research says risks go up once your membranes have been ruptured for more than 24 hours. So at that point, it's either speed things up with Pit, section you, or take the chance that if something DOES go wrong, they'll have a hard time explaining why they didn't DO something when that magical 24 hour mark came and went.

I'd much prefer to see a doc say to the mom 'Well, at 24 hours, the risk of x,y,z goes up since the protective barrier is now compromised. If we start Pitocin, here are the risks. If we do a section, here are the risks. If we do nothing, here are the risks. Here is what *I* think as a physician should happen. What do YOU feel most comfortable with?'

The thing is though, if they are going to put the ball in mom's court so to speak, she has to be willing to take some responsibility for that choice. If she chooses the Pit, it carries risks. If she chooses to do nothing and see what happens, that carries risks as well. If she chooses the section, that carries risks.

But from the doc's standpoint, he/she can only possibly defend what is CURRENTLY accepted as the medical norm for standard of care in a particular situation. And allowing a woman to continue laboring with ruptured membranes past 24 hours is not the generally accepted norm in obstetrical care. So if doc has any inkling that mom is the type to sue should they collaboratively make a bad choice, I see where they push the medically accepted norm as the only real choice. Does that make sense? I mean, I know it sucks, but does it make sense what I am saying?



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Maybe they are so used to managed births that they forgot what labor's like.
I think many KNOW what normal childbirth is like and understand that while one woman may very well follow the textbook outline for what is normal, many will deviate from that and are just fine. However, again, they have to always be aware of their ability to defend their actions (or inactions) should the need arise.
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Old 06-05-2006, 02:59 AM
 
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Ahh, but my risks *shouldn't* have gone up...after all, they had me on antibiotics every few hours for GBS+...shouldn't my risk of infection have been pretty small? They denied that though--they played the dead baby card. They play that a lot. But, they will not admit that their interventions can lead to it as well. I really wish they would not play the dead baby card--no mother would do anything that would risk their baby's life. Which is why I feel that they wouldn't choose the interventions if they knew the risk outweighed the benefits. In my case, the risks of the pitocin/epi far outweighed the risk of an infection when I was already on antibiotics. But they didn't tell me that--I knew that, but they went with the "if we don't do this, your baby will die". Except they DID do it and that's why he died (while they won't admit that, I am reasonably sure that's the truth...I have a copy of all of my fetal monitor strips--his heart started going abnormal within an hour of receiving the medications. My blood pressure also plummeted and they shot me full of epinepheran during that time. Prior to that, neither of us had a single bad reading on the strips)

I can't even believe that this is informed consent (I remember back to Brandon's birth. I was arguing and saying I didn't want misoprostle and they stuck it in anyhow saying "this is what we use on almost every woman and we've never had one problem with it. It's perfectly safe". Which is a lie.) I wonder if their chance of lawsuit would be lower if they honestly stated the risks and had the women put in writing that they understand the risks of all of the possible actions and they choose and take responsibility within reason for the action taken.

~Brandon Michael (11/23/03), Jocelyn Lily Nữ (2/4/07, adopted 5/28/07 from Vietnam), Amelia Rylie (1/14/09), & Ryland Josef William (9/7/05-9/7/05 @ 41 wks). 
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Old 06-05-2006, 03:04 AM
 
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Originally Posted by Nora'sMama

Wifeandmom, I just wanted to ask you, if you don't think people should take out $100K+ loans if they are not going to make a large salary, what you would advise people who would like to be public defenders, or emergency room docs, or who would like to go into other areas of law or medicine (etc.) that do not have high income potential? IMO the issue is not whether some individual "should" or "should not" take out loans - it's that one has to either be rich or go into major debt in order to enter certain professions which are necessary to society, and maybe that's not such a good thing. We have to have public defenders and the like, after all - and not all docs and lawyers can make an "adequate" salary to justify their loans by your reckoning. Sorry to make another comment on this since it's OT.

I don't have an easy answer for your question. I can only answer for US, and that answer is that there is no way we would have been comfortable taking on the student loan debt that we have if we knew the income potential was not adequate for US to feel comfortable paying it all back.

I can only think of one example that I'll share quickly. A friend of ours desperately wanted to go to vet school and work in an animal shelter. She knew she wanted to be home with her children when she had them someday, so she was really thinking more like part time only at an animal shelter. Certainly NOT a very lucrative salary potential there.

Anyhow, she finally decided to go to vet school, take out the $70K in loans, and then took a job at one of the ritzy vet clinics where her and her new DH lived at the time. She worked there for about a year and a half, using her salary for two things. Ten percent went to tithing and the rest went to pay her student loans off.

THEN she went to work at the animal shelter full time til she had her first child and now part time after becoming a mother. It took that year and a half of doing something OTHER than what she desperately wanted to do, but that's what it took to come out from under that amount of debt.

I can't answer for anyone but us as far as what someone should or shouldn't do with their life, what career they should or shouldn't pursue, or how much money they should be willing to borrow to achieve their goals. Everyone's comfort level is different. But we all have to work within the current system when making our choices for today.
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Old 06-05-2006, 03:15 AM
 
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Originally Posted by AllyRae
Ahh, but my risks *shouldn't* have gone up...
Edited to remove much of AllyRae's post due to pending litigation, which I did not think of at the time of quoting so much of her post.


It seems so freaking WRONG that in a country with a 30% c-section rate, with women being sectioned cause it's quitting time, etc etc etc...

That something like this would even happen AT ALL. It is horrifying that they would ignore HOURS of decels without even calling the doctor. We get so used to hearing that docs section mom at the first little blip, real or imagined, then something like this happens.

The hospital I delivered my twin girls in was much like this. They protected their less than 10% section rate like it was SO much more important than, oh, I don't know...actually worrying about the BABIES in question.

It should not be so hard in this day and age, with all the medical knowledge that we possess, to find a hospital that will intervene without hesitation when it is NECESSARY, but will allow nature to do its thing otherwise. Why is this such an elusive thing?

As for the risk with ruptured membranes when you're already on antibiotics for GBS, I really don't know the answer to that one. What you say makes sense, assuming of course that the antibiotics routinely given to GBS+ moms is a broad enough spectrum to cover whatever infections they are afriad of after the membranes are ruptured for more than 24 hours.

I've never thought about it really, but it makes me wonder if this is the case, would it not be possible to give moms an antibiotic after 24 hours of ruptured membranes instead of automatically going to pit? Of course, the antibiotics have risks too, and honestly, around here, you don't make it 24 hours (ruptured membranes or not) without pit if you aren't dilating 'fast enough'. Once you get to 4cm, it's 1cm per hour or out comes the pit.

Nowhere that DH has worked L&D is it typical to NOT have pit during labor. He says usually the only women who DON'T get it are the ones who show up 6cm+ dilated and get to 10cm in less than a couple of hours tops. Otherwise, it's almost as routine as putting in an IV. Sad, isn't it?
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Old 06-05-2006, 03:16 AM
 
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Originally Posted by wifeandmom
I think many KNOW what normal childbirth is like and understand that while one woman may very well follow the textbook outline for what is normal, many will deviate from that and are just fine. However, again, they have to always be aware of their ability to defend their actions (or inactions) should the need arise.
I don't agree with this at all. There is almost nothing normal about giving birth in a hospital, so there is no way for docs to have firsthand knowledge of what that is, and very few have ever even witnessed natural birth, and I don't think for a minute that a textbook outline is sufficient. Experience is the whole thing of it and I don't think practicing using the technologies or one's "skills" fulfills that.

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Old 06-05-2006, 03:24 AM
 
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Originally Posted by annakiss
I don't agree with this at all. There is almost nothing normal about giving birth in a hospital, so there is no way for docs to have firsthand knowledge of what that is, and very few have ever even witnessed natural birth, and I don't think for a minute that a textbook outline is sufficient. Experience is the whole thing of it and I don't think practicing using the technologies or one's "skills" fulfills that.
Well, I can't say I don't agree with you to a certain degree.

Maybe I should have said I think many docs know *in theory* what natural childbirth should look like, but they are taught and trained for all the things that can go wrong, so it's more of just this polly-anna type theory in their head that isn't really put into practice a whole lot, if at all. It's like they could recite off what normal, natural childbirth looks like, but that doesn't really HAPPEN in their world for the most part, so it's more of just a theory or how things were done way back before hospital births became the norm. I just don't think they are totally ignorant to the process of birth itself, even though it's not something that is typically seen in today's hospitals for the most part. Does that even make sense?
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Old 06-05-2006, 03:27 AM
 
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Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
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Old 06-05-2006, 03:44 AM
 
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Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
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Old 06-05-2006, 03:50 AM
 
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Originally Posted by wifeandmom
I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
Agreed, but I shudder to think that a doctor's first experience with a natural birth - after how many years of med school & residency - would occur when said doctor is finally a practicing OB/GYN. Yikes.
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Old 06-05-2006, 05:04 AM
 
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Turns out they have been giving this baby CARBON DIOXIDE from the pulmonologist's cart the entire time.
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Old 06-05-2006, 05:16 AM
 
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So heard a story from alegna, I think, maybe she'll chime in...about a doc asking a midwife if he could watch her UA of her twins....he did, in the corner, without interfering. Now that...would be quite the lesson!

I second the "It's very hard to sue, even when you have a case." I won't go into my son's case, but basically we hear from everyone "You have a case, but we wont' take it." Read: they have no idea what kind of money they will make.

And basically, if my son would have died...which he almost did several times due to medical neglect, me yelling, do something now, them saying, nothing is wrong....if he would have died, well then, yeah, you have a case.

Never mind the hours of reconstructive surgery and the brain damage. That's nothing.

I honestly think there should be a no-fault system in place for births where there really is no one at fault...where something bad happened...and someone dies. I remember reading about it in one of the Sears' books.


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Old 06-05-2006, 08:54 AM
 
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I'm confused though about this: Do you mean as in the instance wifeandmom mentioned? I just finished reading The American Way of Birth and from what it says, this just isn't true in general. Some cases are won, sure, but very few. Most don't even go to court. Unless you're talking about the dishonest lawyers defending OBs who may skew what normal and abnormal birth are.
I was imagining a situation like that, where the doctor knows he/she is in the right and goes to court...in that case, the lawyers can get any witness they want to say whatever they want, and the jury has only the conflicting witness testimonies to go on. That, and their preconceived notions...

But as for the rest of those cases that settle rather than go to trial: Think about the reason why most cases don't even go to trial...the doc settles out of court because, as many people have said here, "a jury doesn't like a dead baby." True enough, but if the lawyers were completely trustworthy in court cases, and the actual facts of the situation were provided by both sides, then perhaps juries would make logical decisions at least some of the time. The docs would not need to fear the outcome quite so much.
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Old 06-05-2006, 12:20 PM
 
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I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
There are plenty of people who define "natural birth" as simply coming through the birth canal, or avoiding drugs or sythetic oxytocics. So you're on your back in a bed under bright lights, surrounded by several strangers, not allowed to eat or drink, with an EFM (or maybe IFM,) told when and how to push, with the baby taken away to be washed, and maybe even an episiotomy, and that's "natural". I'm sure many doctors have seen this kind of natural birth. What the vast majority haven't seen is spontaneous, instinctive physiological birth, because the hospital environment and the care givers ministrations aren't conducive to this happening.
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Old 06-05-2006, 02:36 PM
 
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I've read most of this thread, but not quite all of it. One thing really stood out to me.

I see the same theme in several places - about "moms believing birth is 100% safe", and "moms who think there should always be a perfect baby", etc. I don't feel sorry for doctors there at all. My doctors have all done the "everything's great - everything's wonderful - the ultrasound is perfect - this baby's doing great", etc., etc. I've also had the "if it were me, I wouldn't..." thing, while we consult some heavy-duty obstetrical text. They're going to make sure that I/you/whoever believe they have all the answers. Whatever their intentions might be, every doctor (whoops- except one) that I've dealt with throughout my pregnancies has done everything they could to make me believe that they could guarantee a good outcome, and that if I just let them call the shots and do what they know is best, my baby and I will be just fine. I think a lot of them get off on acting like demigods. Well - fine - if that's your particular ego trip, so be it. But, acting like a jerk when people are let down later isn't too admirable. Maybe if doctors, specifically OBs, don't want their clients to feel so betrayed when something goes wrong, those same doctors should stop climbing up on pedestals and kicking patients in the face when they try to even the playing field. (And, yes - I realize that not all doctors are like this, but it's a large enough percentage to drastically affect the culture.)

I've had three c-sections. I didn't want any of them, and I still don't believe they were necessary. I didn't sue, for two reasons. One is that I'm just not a suing kind of person. The second...I can't prove damages. A scarred uterus and PPD and PTSD don't stack up against a healthy baby, and all my OB has to say is "look at that infant - he'd have been born dead if I hadn't saved him" and I'm dead in the water. Besides, I'm "healthy" (aside from the damage to my uterus, which the obstetrical community is obsessed with, while still denying it exists).

Edit, to change some phrasing, per the MDC UA.

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Old 06-05-2006, 02:56 PM
 
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Unfortunately, the medical model is to intervene, not let nature take its course.

How and when would a doctor have an opportunity to witness a natural birth? Certainly not in medical school. And sure, one can read up on normal childbirth, but where would any medical student have an opportunity to witness one?
I personally wonder if the textbooks actually mention things like shifting positions and rather than confining women to bed. That would be part of a normal birth to me.
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Old 06-05-2006, 02:59 PM
 
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I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
I suppose if natural means without medication and vaginal then I had one,too, however, being tied to the bed with strangers pulling my legs with a spotlight on my crotch getting an episiotomy is not exactly what I call natural. Most unnatural and traumatizing,too.
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Old 06-05-2006, 03:12 PM
 
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I don't know for sure, but I know there are LOTS of women on this very board that have had natural childbirth in hospitals, so it must be occurring *somewhere*.
It does happen, but in most cases, the woman has to plan very carefully for it and actively fend off unwanted and unnecessary interventions. It takes a very strong desire to give birth naturally to be offered drugs and interventions that will "help", during the emotionally vulnerable process of labor, and turn them down. I know many women who have planned NCB in a hospital and as the birth draws nearer they often talk about an experience similar to "girding up for battle". Which they really must do (mentally and intellectually) in order to have a chance at succeeding. Even if they have a sympathetic OB or MW, there are the nurses and other hospital staff to contend with.

I studied Hypnobabies, read everything I could get my hands on about childbirth, had a great doula and a husband who was educated about NCB, a brief and pre-approved birth plan to hand out, and a low-intervention hospital with a low C-sec rate (Kaiser). I ended up getting an epidural, although I avoided Pitocin or a C-section. I do not blame the hospital for my choice to get the epidural one bit, they were great at following my birth plan - but I still did not succeed at NCB for all my months (years, really) of preparation. If I had had a different, easier labor I might have, but if I had had a homebirth I almost certainly would have.

And while I am generally pretty pleased with the way my birth was managed and my experience with the hospital was worlds away from the horror stories I have heard, it was definitely not my first choice (we chose the hospital because we did not have $4000 for a homebirth at the time - before I got pregnant I was not sure if I really wanted a homebirth so we didn't make provisions for it, and Kaiser was only a $250 copay for all prenatals and the birth). Next time, as positive as my birth experience was, I will be avoiding the hospital unless there is a specific reason to be there, and will plan a homebirth.
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Old 06-05-2006, 04:27 PM
 
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I honestly think there should be a no-fault system in place for births where there really is no one at fault...where something bad happened...and someone dies. I remember reading about it in one of the Sears' books.
I recall reading (I think in Baby Catcher, of all places) about the idea of having a central fund that docs pay into to cover damages, rather than a for-profit malpractice insurance industry. I think that in combination with strong medical boards to handle licensing and peer review, single-payer national insurance for all, and a government fund for families with disabled members would do the trick really much better than the misguided fix of tort reform. Very medical minded to patch a tiny hole like that when the whole roof is leaking. Also, it would be nice in a single-payer insurance system to try to reduce costs and improve outcomes by building upon the midwifery model of care and to cover homebirths. I'm very wary of licensure for direct entry midwives, however, for personal reasons.

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Old 06-05-2006, 05:46 PM
 
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This is essentially what the US has done for vaccine injury. If too many OB's get out of the biz of delivering babies, my guess is there would be more support for such a system. But as it stands right now, too many '3rd parties' (i.e. malpractice lawyers) stand to make too much money and have too much political influence to see this implemented.
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Old 06-05-2006, 09:38 PM
 
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Oh, and I just wanted to add... this is a great discussion. I don't want to hijack by focusing on one aspect of one post, but I couldn't not respond. It's particularly fascinating looking at it from the physician's point of view, since that isn't often represented on MDC.

Carry on with your regularly scheduled discussion, please!
Emily,

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Old 06-05-2006, 09:40 PM
 
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Well, I can't say I don't agree with you to a certain degree.

Maybe I should have said I think many docs know *in theory* what natural childbirth should look like, but they are taught and trained for all the things that can go wrong, so it's more of just this polly-anna type theory in their head that isn't really put into practice a whole lot, if at all. It's like they could recite off what normal, natural childbirth looks like, but that doesn't really HAPPEN in their world for the most part, so it's more of just a theory or how things were done way back before hospital births became the norm. I just don't think they are totally ignorant to the process of birth itself, even though it's not something that is typically seen in today's hospitals for the most part. Does that even make sense?
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Old 06-06-2006, 03:24 PM
 
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Maybe I should have said I think many docs know *in theory* what natural childbirth should look like
I think they might have a vague idea, based on what they might imagine women in the African bush do or whatever, but they have absolutely no idea what facilitates it. I think they just assume that American women are uptight and/or maybe genetically inferior, rather than that our bodies are just fine and that it is the environment that is causing our bodies to malfunction.

Either that, or they simply don't care what natural birth looks like -- it's irrelevant to them because man's idea of how birth should be is better. Sure, those African bush women might squat to give birth, but so what? Having the woman lie on her back is obviously so much better. So while they may know what natural birth looks like, they don't seem to know why it's important that it be that way.
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Old 06-06-2006, 04:02 PM
 
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Well, let's think about it this way: If your job training was entirely based on the scrubbing of barnacles from the hulls of sailing ships, and you inadvertently found out that many of the ships actually sail as well or better without the barnacles being scrubbed off, would you tell anyone? Would you stop scrubbing, or only scrub the few ships that need it?

Yeah, most doctors don't either.

(And yes, some days I do feel like a barnacle-clad sailing ship! )
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