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#1 of 116 Old 09-03-2006, 02:02 AM - Thread Starter
 
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I've had two c-sections, one emergency (prolapsed cord; no, my membranes were not artificially ruptured and no, I wasn't in the hospital attached to montiors or 'tied to a bed' when it happened, but that's not the point) and one elective. Both times, I was thoroughly informed about the risks involved with the procedure. Two different nurses, at least two doctors, an anesthesia specialist... in each case, I had at least 5 or 6 people explaining risks and procedures. Nobody ever said or even remotely implied that having a c-section would be safer for me or better in any way. In the case of my first (the emergency), I was certainly told that it was safer for the baby, but not in my second; there was risk to be had either way. I was given statistics for both VBAC and repeat c-section, for me and for her.

Everyone kept asking me if I understood, telling me not to sign anything if I didn't know what it meant. With my first, this went very quickly and there was a definite sense of urgency. With the second, I was in labor and they had a nurse reading everything out loud and following along under the words with a pen, talking to me and Mike before giving one of us the pen. In fact, when I decided during my pregnancy that I wanted to VBAC, I was asked to visit an OB, read several sheets of information laying out the risks of VBAC and of repeat c-section to myself and my baby, and sign that form. This was standard procedure for the hospital; there was an OB and a nurse in the room, to go over *everything* on that form. They didn't want me to sign if I didn't understand the risks involved in either choice, for me or my daughter.

How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me. :

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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#2 of 116 Old 09-03-2006, 03:44 AM
 
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I can assure you that any mother in the United States who has had a c-section anytime recently signed a consent form for the procedure. And I can guarantee the consent form listed the risks associated with a c-section.

How the VERBAL exchange goes between patient and doctor can be much fuzzier I am sure.

But the WRITTEN part is cut and dry, and I'd be more likely to believe a woman flew to Mars and back to birth her baby before I'd believe she had a c-section without signing a consent form first.

Of course, if mom is physically unable to sign a consent form, one can be signed on her behalf by whomever is available to make medical decisions for her at the time. And if she arrives unconscious with nobody available to consent for her, docs are able to perform a section based on the assumption that the mother would prefer to have life saving surgery for herself and/or her unborn child.

Otherwise, there is a consent form that every.single.woman. signed. Whether or not she read it, whether or not she understood it, whether or not she was coerced into signing it, whether or not her doctor outright lied to her about the risks, etc....I can guarantee that it was signed.
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#3 of 116 Old 09-03-2006, 12:30 PM
 
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You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.
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#4 of 116 Old 09-03-2006, 12:35 PM
 
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I've wondered why there don't seem to be any lawsuits about HAVING a C/S done, as opposed to NOT.

I believe this is because doing a C/S is considered to be the MOST a doctor can do. Thus if a C/S didn't turn out well, there was nothing better that could have been done (kind of like if CPR is administered to someone who drowned and they died anyway, well, what else could you do?). Whereas having NO C/S resulting in death or injury - is a situation that (judges and juries believe) showed a lack of proper response, i.e. a C/S (like having someone drown and NOT performing CPR).

This makes sense given our managed-labor culture. Birth is inherently a dangerous thing (we believe); we need people DOING things about it. A C/S is the ultimate thing to DO about a birth.

I've not had or been offered a C/S but I know many people who have. One friend my age is on Medicare and she believed that she was not given the proper care during her labor and birth (ignored by staff and left alone) and at some point her mom dragged someone in and they said the baby was in distress. My friend does not know any more than this, no-one explained (and she didn't ask). She said she was told they would "need" to take the baby, sign here, and off she went. She was not told any risks or even really much what happened.

I also know another woman, the wife of the doctor my mom works for (doc is NOT an OB). She has had 3 children, all by C/S. I don't know why the primary C/S but I do know that she told my mom that she liked it better this way since it was "easier and safer." She liked being able to schedule the delivery, and that seemed to be her primary motivation, but she also mentioned safety. I don't know if she knows any of the risks; one would hope she would. FWIW they are Indian and I believe they have an even more extreme C/S culture than we do.

Homeschooling mama to 6 year old DD.

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#5 of 116 Old 09-03-2006, 12:36 PM
 
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Originally Posted by caned & able
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.
She didn't say that. She just said there would be a consent form not that it was an indication that the women were properly advised.
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Whether or not she read it, whether or not she understood it, whether or not she was coerced into signing it, whether or not her doctor outright lied to her about the risks, etc....
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#6 of 116 Old 09-03-2006, 12:39 PM
 
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Originally Posted by caned & able
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.
She didn't say that. She said every mother signed a document (which I'm sure VIRTUALLY every mother did - but probably a couple didn't). And admitted the verbal exchange probably varies.

It's up for debate whether signing a document is proper advisory, and I doubt many people here will say that it is enough given many factors (such as: time pressure, feeling intimidated, poor reading skills, low knowledge of medicine and physiology, and even just the routineness of signing contracts with tiny print and not reading it which we do all the time in this culture - for the phone service, mortgage application, release of medical records, etc.).

Homeschooling mama to 6 year old DD.

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#7 of 116 Old 09-03-2006, 12:45 PM
 
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In my many years as a childbirth educator, I have known many women who were 'promised' a perfect baby if they would 'consent' to a surgical birth. These women were told such stories as the baby would have a nice round head and not be damaged and squeezed from the trip down the birth canal or bruises from forceps or a vacuum extractor; no episiotomy stitches is also sold as a plus.

The fact that the squeezing in the birth canal may help the baby prepare to breathe and that forceps, an extractor, or an episiotomy are not a necessary part of a vaginal birth is not told to expectant mothers.

Initially many women feel the surgery was very necessary. Then they begin to realize it may not have and become angry.

Just "deliver from above", a heavenly experience. Who wants to deliver from below!
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#8 of 116 Old 09-03-2006, 02:49 PM
 
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Quote:
Originally Posted by eilonwy
How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me. :
hmm...first section: Flawless pregnancy - no complications. Labour was going well - arrived at the hospital at least 8cm dilated (10 during contractions). It was determined that ds1 was frank breech, and I was told that I was having a section. I said "no" - several times. I was completely ignored, and wheeled into OR. I consented, in that I had preregistered at the hospital, which includes a "blanket" consent. I didn't sue, because...well, I just don't. My financial situation at that time was such that I had $125/month to live on after the rent was paid...a lawyer was out of the question. I just promised myself a VBAC next time, and focussed as much as I could on my baby, not my scar (it helped, but I was still a wreck).

Second section: I'd been trying to conceive for 10 years, with only three miscarriages (all quite close together) to show for it. However, my fifth pregnancy had gone without a hitch, just like my first. My doctors (FP & OB) were both very positive about me having a VBAC. At 39 weeks, my FP determined that my baby had turned breech. I went for an ultrasound to confirm. The next morning, I was woken up by a phone call from the OB's office telling me that my section was scheduled for the following day (39w, 2d). I went ballistic. I had a couple of conversations with each doctor that largely consisted of me crying, freaking out and stating that I wanted to at least wait for labour so that the baby might have time to turn (only partly true - scheduling without labour just felt wrong). OB said my baby was too big (u/s had estimated 8lb.15oz.) to turn. I thought that sounded stupid, but neither doctor would listen, and my mental state was not good. (I've had a lot of emotional upheaval and issues over the primary section, the inability to conceive and the miscarriages - I'm not sure I'm totally emotionally stable on the issue of my reproductive life.) I allowed myself to be badgered into the second section, because I couldn't find a single toehold in the medical wall of "this is the only way to go".

I was assured that my baby would be healthy with the section. No risk to me was ever disclosed. I was, of course, told not to eat or drink, but not told why (I did already know, but I wasn't told). And, yes - when I arrived, I signed the stupid form - I didn't even read it. I'm not sure I was capable of reading or comprehending anything at that point, anyway. I was kind of hoping that something would go wrong, and I'd die on the table, instead of having to live with another section, so the risks didn't seem very important. The form only confirmed that my OB had discussed the risks of the surgery, anyway (he hadn't).

After they'd taken dd, my FP got around to telling me that two sections meant an automatic repeat.

Third section: I got pregnant, with hesitation, because I finally decided that another section was better than not having a baby. I didn't like it, but I thought I could handle it. After a month straight of nightmares, I told my FP I wanted a VBAC. She was totally unsupportive, but said we could talk to the OB. He wasn't very supportive, but said that he understood that psychological factors are also important, so we'd go ahead.

I got negativity and pressure from my "care" providers the entire pregnancy. I looked into the local midwives, but they couldn't take me because I'd had more than one section. I couldn't find any other doctor/midwife who was more supportive. (It was during that pregnancy that I found MDC.) There was nobody to switch to. At 41w,4d, my OB told me that if I chose to "continue this course" (ie. wait for my baby instead of having a section the following day), then he'd withdraw from my case. So, I cried for about 24 hours, and went to the hospital and had my section. Once again, I signed the stinking consent form that says I was "informed of the risks". (I'll make it clear that I was not - my section was presented to me as the only safe option, and a guarantee of a "healthy mom and healthy baby".) At first, I tried to be positive - I was recovering well, and I'd at least gone into labour first. My doctors had wanted to schedule for three weeks earlier, so that was a little victory, at least.

Well - that was long. To make it short: No. I've never been informed of any risk involved in having a c-section. They've consistently been presented to me as the safe way to have a baby, and I've been consistently assured that a section was necessary for a healthy mom and healthy baby. I wish I'd had the guts to go unassisted (although a homebirth wasn't a really reasonable option with my last two, as I was living at my mom's house), because my desire to have a "care provider" present put me a position where I was too easily bullied and coerced.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#9 of 116 Old 09-03-2006, 05:39 PM
 
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Originally Posted by caned & able
You can guarantee that every single mother across the US has been properly advised?

Amazing how you get around.
Please go back and READ what I wrote.

I can guarantee you that every single mother signed a consent form.

That can be vastly different than 'properly informed', something else I clearly addressed in my post.

I am more likely to believe a mother flew to Mars to birth her child before I will believe a doctor performed a section on a woman WITHOUT a consent form signed for the procedure.

I am not above admitting when I am wrong, and if there is a case of a woman being operated on against her wishes WITHOUT a consent form, my advice would be for her to sue the doctor for everything she could, as there is simply NO WAY she would ever lose that lawsuit. Consent forms are required for a reason, and when I see it announced on the nightly news that a woman was sectioned WITHOUT signing a consent form, I'll believe it then.

Oh, and I also addressed the issue of when mom is physically UNABLE to sign and how that works, so if there is any confusion on that matter, please go back and carefully read that portion of my post as well.
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#10 of 116 Old 09-03-2006, 05:49 PM
 
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It is generally taught to students in medical school that women in labor are temporarily insane. That is clear in the older obstetrical texts, i.e., Williams' Obstetrics. I wonder how it can be justified that any woman in labor can legally consent to any procedure.
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#11 of 116 Old 09-03-2006, 05:52 PM
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Originally Posted by wifeandmom
I am not above admitting when I am wrong, and if there is a case of a woman being operated on against her wishes WITHOUT a consent form, my advice would be for her to sue the doctor for everything she could, as there is simply NO WAY she would ever lose that lawsuit. Consent forms are required for a reason, and when I see it announced on the nightly news that a woman was sectioned WITHOUT signing a consent form, I'll believe it then.
The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!" It's all in my medical reports and everything, and, yet, no lawyer would touch my case.
And, that was only the beginning of my horrendous birth experience.
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#12 of 116 Old 09-03-2006, 05:53 PM
 
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Addressing Storm Bride's experiences for a moment, Wifeandmom, would a hospital blanket consent form count as a "permission to section" form?
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#13 of 116 Old 09-03-2006, 05:57 PM
 
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Originally Posted by MamaInTheBoonies
The nurse held my hand and "made" me write my name, even though I was screaming. "NO!!!!"
Is this considered informed consent?

That is sadistic!
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#14 of 116 Old 09-03-2006, 06:00 PM
 
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Originally Posted by caned & able
It is generally taught to students in medical school that women in labor are temporarily insane. That is clear in the older obstetrical texts, i.e., Williams' Obstetrics. I wonder how it can be justified that any woman in labor can legally consent to any procedure.
Valid point, one that DH considers every time he 'consents' a woman for an epidural during labor. How can a woman in agony, demanding pain relief RIGHT NOW, truly even give thought to the risks of an epidural when the alternative, in her mind at least, is simply DYING of pain?

So what is the solution here? Doctors aren't going to operate without a consent form signed. Period. So if mom cannot possibly consent while in labor, who CAN?

And is your argument now that the consent form signed isn't the point, that a woman in labor cannot consent in the first place, therefore the doctor should do what exactly? Refuse to operate cause mom can't consent properly? Doc would get sued for NOT operating if something went wrong, and they know it.

I've yet to read about a woman having surgery that did NOT sign a consent form. I'm reading where women signed forms KNOWING that the information contained therein was NOT accurate. Why is that suddenly the doctor's fault?

If you don't want to sign it, DON'T SIGN IT. But don't whine about signing it later claiming you had no choice BUT to sign it. Nobody is holding a gun to your head, and I'd venture to guess that most docs would refuse to operate on a conscious woman who REFUSED TO SIGN THE CONSENT FORM.

By signing it, you are legally agreeing to whatever is written in that document. If it says 'My doctor has explained the risks.', you read that and know it's not true, but you sign it anyway...whose fault is that? It is so incredibly unrealistic to come back later and say 'Well, he SAID such and such' and expect that to hold more weight than what is actually IN WRITING.

This goes for ALL contracts, consent forms, permission slips, you name it. You sign it, you better know what it is you are agreeing to.
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Are you saying your DH is not responsible for the damage that he may do to a woman in labor because she signed for it while in labor?

Have you ever gone to court?

Some people think they have the right to do whatever they can get away with as long as they can cover their butt with paperwork.

To Sapphire-Chan, it is generally agreed in the legal community that as long as the doctor is acting within the standard of care, no malpractice was committed.
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#16 of 116 Old 09-03-2006, 06:16 PM
 
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Originally Posted by caned & able
Is this considered informed consent?

That is sadistic!
Ok, now that I'm thinking further into the realities of the situations being presented, the lawsuit thing may or may not be a 'slam dunk' if mom refuses a section.

Here's why...

If the prevailing standard of care is to section for x, y, z condition, and mom REFUSES a section under those conditions, I can see how a lawyer would refuse to take the case regardles of her refusal to consent.

Why?

Well, let's take a breech baby for example. Prevailing standard of care in most hospitals is to automatically section. There is NO research supporting vaginal breech delivery without an experienced provider, and even then, it's questionable as to what is safer.

So, if mom comes in with a breech baby, insisting that they deliver said baby vaginally REGARDLESS of the fact that it is NOT supported by research unless the hospital happens to have someone on staff with experience in delivering this type presentation, how would a lawyer ever win that kind of case? Especially when the bottom line is that if something DOES go wrong during that vaginal breech delivery, mom is going to sue (and probably win) regardless of the fact that SHE is the one who insisted on doing it that way to start with.

If we eliminated the threat of lawsuits, the birth climate would change dramatically. Of course, some lawsuits are worthy, so it would also open up an entirely different set of problems.
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#17 of 116 Old 09-03-2006, 06:32 PM
 
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sorry

but "informed consent" with or without signatures on yellow papers has been a travesty in both my boy's births
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#18 of 116 Old 09-03-2006, 06:32 PM
 
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Originally Posted by caned & able
Are you saying your DH is not responsible for the damage that he may do to a woman in labor because she signed for it while in labor?
Huh? Where would you get that idea?

What I was saying is that DH considers this concept of a woman in labor not TRULY being able to consent to getting an epidural if she's in such pain that NOT getting the epi, in her mind at least, equates to dying in agony on the spot. How can a woman truly weigh the risks vs. benefits when the only thing she sees at the time is that she thinks she's going to die without some relief right that very instant?

But then that very same woman who was BEGGING for him to just give her the epidural wants to then come back and say 'Well, he never told me I could have this or that go wrong as a result of the epidural or I wouldn't have gotten it.' So they have a consent form that must be signed outlining all of these complications as it's the best system they can come up with.

Anyway, what my own DH would likely never be held responsible for would be the woman who comes back and says 'Well, he never told me I might have x, y, z complication from my epidural.' when said complications are stated in black and white right there on the consent form that mom signed.

As long as he does nothing NEGLIGENT or beyond the scope of his license to practice or outside of what is considered standard of care at the time, then NO, he will not be held responsible for complications.

He's never been sued himself, but we know several who have. One such case WAS lost as a direct result of the anesthetist deviating from the standard of care in that particular case. All of the other cases we've known about personally never made it to court because what the patient was suing over was a known risk factor of whatever procedure they were having, and the complications suffered in each case were NOT the result of negligence, deviation from standard of care, outside the scope of practice, etc.

Quote:
Have you ever gone to court?
For what?

Quote:
Some people think they have the right to do whatever they can get away with as long as they can cover their butt with paperwork.
DH is personally very content to sit on his butt in the call room, never putting in a single epidural while working L&D. He gets paid the same either way, and there's no chance of being sued if he's watching ESPN. He ceratainly doesn't have this attitude of 'getting away with whatever he can' in terms of putting in epis for women in labor. Unless you count getting away with NOT putting in an epi for anyone, cause like I said, he gets paid the same to sit there watching TV as he does to deal with a dozen women in labor all screaming at him at once.

He doesn't go around the unit weilding his big needle just looking for some unsuspecting woman to stick when she least expects it. He talks to each woman in labor when they are admitted (per hospital policy), introduces himself, gives the woman a run-down of what anesthetics he can use if she so desires, and tells her to let the nurse know if/when to call him should his services be needed. Then he does just that...waits for the nurse to page him if his services are needed.

He detests working L&D because women in labor are NOT known to be rational creatures and lawsuits arising from L&D care are WAY more likely than in other areas of practice, regardless of whether or not said lawsuit has any merit.

Anyhow, DH has the right to practice within the scope of his license as long as he does so competently and with due diligence.

Quote:
To Sapphire-Chan, it is generally agreed in the legal community that as long as the doctor is acting within the standard of care, no malpractice was committed.
This would be my best guess as to why no lawyer would take on whomever's case that was 'forced' to sign the consent form, although I'm not certain cause I can't remember off the top of my head why they said she needed surgery to begin with.
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#19 of 116 Old 09-03-2006, 06:40 PM
 
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Here's how it goes around here.

"Ok, here is the paperwork for your c-section. Sign here saying you allow us to do anesthesia and here to allow us to give blood products if you need them, and sign here consenting to the surgery, and initial here saying that we are not responsible for any jewelry or personal items. Have any questions, ok, now lets get you that epidural and get your baby out."

If the mom stops to read the stuff, the nurse stands there tapping her foot and looking at her watch.

Now, this isn't every case, I'm sure, just the ones I've seen.

FWIW, the last anesthetist was the best care provider we saw the entire trip. He even came back in later to sit and chat with the family. I've never had an experience like that.
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#20 of 116 Old 09-03-2006, 06:48 PM
 
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I think the larger issue is that often women do not give truly informed consent. Signing a form may give the doctor some legal protection, but it does NOt equal truly informing the mother of the risks of a C-section. Do doctors say to women, "You are three times as likely to die from having this operation, instead of birthing vaginally?" My guess is no.

Is it really possible for a woman to give truly informed consent when she is faced with the choice: either have this operation, or your baby will die? For the vast majority of mothers, they truly believe that their baby will be likely to die. They are not able to carefully weigh the pros and cons when a doctor plays the dead baby card.

Sometimes, a baby IS truly likely to die. The World Health Organization puts that figure at about 10% of the time. And for that 10% of the time, I am thankful that C-sections exist. (This 10% figure does not take into consideration other medical conditions beyond fetal distress which makes vaginal birth too risky for the mother, so saying that 10% of babies need to be born via C-section is probably artificially inflated.)

But the other 25% of the time that C-sections are performed are likely for non-emergent situations, and even though a woman is led to believe it's what's best for her and her baby, the statistics show that babies and mothers do better with vaginal deliveries.

So no, signing a form does not equal informed consent.
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#21 of 116 Old 09-03-2006, 06:57 PM
 
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Originally Posted by MsElle07

So no, signing a form does not equal informed consent.
So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.

And then there are the people who are going to blame anyone other than themselves no matter how much of an explanation is given. We know of one OB who was sued for a VBAC rupture related neonatal death. I *know* what the policy is in that particular clinic for addressing the risks of VBAC vs. ERCS because it's the same clinic I used when pg the second time myself, so I went through that entire consent process.

Even though everything was done to inform mom of the risks, to prevent rupture, to deal with rupture when it was detected...well, sometimes the baby is STILL going to die no matter what the doctors in question do. And so it was with this woman, who then tried to come back and say 'Well, they never told me that my baby could die if I tried for a VBAC.'

Which was a load of crap...she wanted to VBAC, so she did, and the results were less than what she wanted, so she wanted to blame someone else. Thankfully she was laughed out of the lawyer's office when it was realized the very extensive consent process that was in place when she consented to this VBAC attempt.

In the end, it was the string of signed forms that protected the OB in question from being sued, despite this woman's desire to blame the doctor for HER choice and its very unfortunate end result.
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#22 of 116 Old 09-03-2006, 07:01 PM
 
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I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section? Therefore, if she consented, it simply MUST be because she was coerced, as sections aren't 'necessary', aren't ever the 'preferable' way to give birth, etc.

When people have the attitude of 'Why would a woman EVER agree to a section?', I can see where this idea of 'informed' consent being impossible to obtain comes from, despite the fact that the entire thought process leading up to this conclusion is bizarre at best.
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#23 of 116 Old 09-03-2006, 07:07 PM
 
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Well - that was long. To make it short: No. I've never been informed of any risk involved in having a c-section. They've consistently been presented to me as the safe way to have a baby, and I've been consistently assured that a section was necessary for a healthy mom and healthy baby. I wish I'd had the guts to go unassisted (although a homebirth wasn't a really reasonable option with my last two, as I was living at my mom's house), because my desire to have a "care provider" present put me a position where I was too easily bullied and coerced.
That's how I feel it went with my csection too.

Mama to my spirited J, and L, my homebirth: baby especially DTaP, MMR (family vax injuries)
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#24 of 116 Old 09-03-2006, 07:28 PM
 
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I'm not sure. I have the feeling that some OBs just think they know best and you don't need all the information, just enough to get you to choose what they think is right.

I was never told how big a deal a c-section was. I was never told how painful it was or how long it would take to recover. I was never told that the hospital would soon revoke the ability to VBAC.

I was utterly and truly uninformed. I thought a c-section was easier and less painful than a natural delivery.

Mom of a 7 yr old, 4 yr old, and 1 yr old. Wow. How did that happen?
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#25 of 116 Old 09-03-2006, 07:50 PM
 
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I've yet to read about a woman having surgery that did NOT sign a consent form. I'm reading where women signed forms KNOWING that the information contained therein was NOT accurate. Why is that suddenly the doctor's fault?
How about because women who are harangued, hassled, bullied, and scared are not "consenting" in the legal sense of the word? I was told for months that I could die (with such emphasis that they might as well have said WILL die), that my baby could die (with even more emphasis), the VBA2C just too risky, that all "we" - the doctors - wanted was a healthy baby and a healthy mom. I tried to find another caregiver - couldn't find anybody. Sure - I signed the stinking form. I'd tried to research my rights if I went into labour with no doctor, but I couldn't find anything (I'm not in the US). At the end, I was told I'd have to go it alone if I did anything but what the OB had determined - within the vile standards of "care" - was best for me.

When you're in a mental place where you're just hoping the knife slips and you don't have to face life afterwards, the wording of a document doesn't really matter much.

How is it not the doctor's fault when they deliberately back someone into a corner and make threats in order to get that signature? More to the point, how is it not the doctor's fault when a woman is wheeled into OR saying "no" and trying to sit up to remove her IV? I don't care what I signed when I was admitted to the hospital...I verbally refused consent and was completely ignored.

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#26 of 116 Old 09-03-2006, 08:13 PM
 
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I will also add that I sometimes get the feeling around this board in particular that a mother simply cannot EVER give 'informed' consent to have a section because, well, if she were presented with the 'facts', why would she EVER agree to a section?
Really? Where have you seen that?
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#27 of 116 Old 09-03-2006, 08:20 PM
 
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So what is your suggestion?

I'm not saying that a signed consent form is perfect, because quite obviously it is not.

However, our court systems simply cannot handle a bunch of 'he never said this' or 'I was never told that'. Thus the consent form in writing, while imperfect, is certainly preferable to 'he said, she said'.
Consent forms should be read to the mother and father during an office visit before labor begins, for starters, so mothers have a chance to absorb that information before being faced with labor. The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."

Haven't we all consented to treatment at some point without reading every single bit of the fine print? Of course. I am an educated woman, not intimidated by doctors or medical jargon. Two years ago I went to the ER because I had been vomiting up everything I put in my mouth (including water) for four days, with no improvement. I had a nursing baby. When I got there I was so miserable that I gladly consented to anything they wanted to give me to make me feel better. I did not read the three page consent form in its entirety. I did not feel well, my head hurt, I was nauseous, etc. Most people do not read the consent forms they sign.

Because women are seeing their care providers regularly throughout pregnancy (usually), it would make sense that their care providers discuss the risks of the procedure that they are 35% likely to have when their child is born. Unfortunately, part of the problem lies in the fact that many doctors are not up to date on their research and/or are inherently biased toward C-sections, which will alter the advice they give to women.
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#28 of 116 Old 09-03-2006, 10:04 PM - Thread Starter
 
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I think the larger issue is that often women do not give truly informed consent. Signing a form may give the doctor some legal protection, but it does NOt equal truly informing the mother of the risks of a C-section. Do doctors say to women, "You are three times as likely to die from having this operation, instead of birthing vaginally?" My guess is no.
Mine did; both OBs who performed the sections, and both anesthesiologists told me about the differences involved in spinal vs. epidural anesthesia. In the case of my first section, I was *strongly* advised to take the spinal because it would start working more quickly and time was of the essence, but with the second I was given the choice.

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#29 of 116 Old 09-03-2006, 10:26 PM
 
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How is it possible that a doctor who is supposed to be a responsible party could advise/coerce a woman to have a c-section without once mentioning risk to her own health as well as her child's? I'm having a difficult time wrapping my head around it. I thought that our society was too lawsuit-happy to allow anything of the sort to happen; at the very least, wouldn't the doctors want to cover their asses?! They must be aware of the risks involved, why aren't they aware of potential lawsuits? That doesn't make any sense to me.
There is a saying, 'The only c/s a dr has even been sued for is the one he didn't do.' Of course I have read of 2 lawsuits about c/s that weren't needed in the last few years but I am sure there are way more the other way.

I have also read a few news stories of women who were forcibly secitioned (as in lawyers went to court and got a court order to section her). In the one case the women left the hospital, the hospital got the court order in case she returned but she had gone to another hospital where she safely delivered a healthy but very big baby (but apparently not her largest which is what the section would have been for). I would bet money that the only risks they were informed of is what would happen if they didn't have one.

A woman may have all the risks about a c/s but she might not have the correct risks for vaginal birth. In other words she might belive that having a c/s would save her baby because she had been led to belive that a vaginal birth would be much riskier (And I am not talking about actual need here - and I can't belive here on MDC do I have to make such a disclaimer : )

Anyhoo - informed consent if one of those things that probably needs to be discussed long before labor. Of course drs take 5 min in an appt and hospital child birth classes probably don't perpare you properly, so education is difficult. And I'm not talking just c-birth here. Everything pregnancy, labor, and birth related.

Expecting #9.  Always busy hsing.
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#30 of 116 Old 09-03-2006, 10:47 PM
 
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The consent forms should include actual risks, such as, "Maternal death is three times more likely than a vaginal birth. Infants are twice as likely to be in the NICU for ERCS, etc."
Ah, but then we'd have to ALSO include all the pesky risks of vaginal birth as well, and what on earth would we do if a woman looked at the very real list of risks associated with vaginal birth and thought 'Uh, no thanks, just give me the section.' I can just imagine the uproar.

As it is, what's the episiotomy rate in hospitals today? Regardless of the what the rate SHOULD be, we'd have to tell first time moms that they have a 1 in 3 chance of having a episiotomy. We'd have to tell them their baby had a 1 in whatever chance of dying from a whole host of things during vaginal birth...NOT just the stuff suggested thus far, which very convienantly focuses on the real risks of sections.

My point is we'd have to give them the ENTIRE picture, with ALL of the numbers, and if I were a betting woman, I'd say the elective c-section rate would only go UP if we did that.

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Most people do not read the consent forms they sign.
And that means we can then blame the doctor because????
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