OB-GYN-L Messages for May, 2005: Re: sponses: Does it matter how the baby is born?(long)

Re: sponses: Does it matter how the baby is born?(long)

From: Anna Meenan, MD

annam@uic.edu

Sun May 22 22:12:23 2005

OTOH, I also understand the current liability crisis and the risk to one's career, life savings, and sanity that even one lawsuit can cause. I understand that it's impossible to fulfill a lawyer's definition of informed consent, and that the most loyal patient you've ever had can turn on you after a bad outcome, no matter who (if anyone) was at fault. I'm tired of reading articles about the current liability crisis that dismiss the threat to the defendant by quoting statistics on how many suits are eventually dismissed and how many end in verdicts for the plaintiff, as if such a suit was no big deal. I've been there, done that (as have a large number of at least the U.S. providers on this board), and it IS a big deal (a GINORMOUS big deal, as my teenagers would say), even if they dismiss you from the case.

I find myself more and more pointing out to my patients how the current crisis is affecting the care I can give them, and the choices they have (the most recent being a multip with 3 prior easy vag deliveries carrying a 6-lb. frank breech baby with a well-flexed head. I could not find a single OB in 2 counties who would allow her to deliver vaginally). I tell them all to contact their state and US reps and senators if the lack of choice upsets them. All these women who can't get VBACS when they want them, need to be calling and writing their reps if they don't like the situation.

I was home yesterday for my mother's 80th birthday party and we were reminiscing about her best friend who couldn't make it to the party, how she was one of 8 children, the last of whom was apparently born by complicated vaginal dilivery, leaving the baby handicapped in some way, and the mother did not survive. My mom told me Edie's father farmed out the 8 kids to neighbors in Minnesota and moved to Chicago to find work (the Depression, you know), where he raised his kids long-distance by living in one room and sending everything he made to the folks who raised his kids. I said to my mom, these days he would just sue the OB, and no matter who (if anyone) was at fault, the lawyer would parade the seven motherless children and newborn handicapped baby through the courtroom and collect several million to raise them, ruining some OB's career in the process. Times have certainly changed.

-- Anna Meenan, MD

At Sun, 22 May 2005, Garry E. Siegel, M.D. wrote: > >Well said, Charlie. > >The reality is that any of those women, who justifiably are in favor of >VBAC and vaginal birth, could just as easily throw their thoughts aside >if they were the plaintiff. > >Garry > >>--Apple-Mail-3-1028151327 >>Content-Transfer-Encoding: quoted-printable >>Content-Type: text/plain; >> charset=ISO-8859-1; >> delsp=yes; >> format=flowed >> >>As I've stated on this forum in the past, unless people are willing to >>share in the risk why would any of us be willing to put our career at >>risk? Patients and lawyers have put us in the unenviable position of >>defensive medicine. I'll also admit that a number of colleagues have >>certainly assisted by testifying against each other. The one aspect >>that has not been covered in the discussions of "medical malpractice >>crisis" is the career ending nature of lawsuits. A single lawsuit now >>has the ability to force any one of us out of a profession that we have >>committed significant effort. I think those 3 respondents have some >>very valid points. However, who would be willing to take a 1 in 100 >>"crap shoot" that the next VBAC that they attend will end their career? >> >>************************************************************************ >>**** >>************************************************************************

>>************************************************************************ >> >>-- >>Charlie Chambers >>Hood River, OR USA >>cchamber@alumni.rice.edu >> >>"...not because I regard fishing as being so terribly >>important but because I suspect that so many of the other >>concerns of men are equally unimportant-and not nearly >>so much fun." >> John Voelker >>************************************************************************ >>***** >>************************************************************************

>>************************************************************************ >>On May 22, 2005, at 7:55 AM, Stmidwife@aol.com wrote: >> >>> >>> Here are some responses, I from some of the people at the >>> perinatal pysch center in Santa Barbara, not sure which one, I posted >>> to two facilities. There were 3 responses as of yesterday. >>> >>> Response #1 >>> >>> Let me compare my c-section and my VBAC. 24 hours >>> after my c-section, they took out my catheter so I >>> could go to the bathroom. I was in tears because it >>> hurt so much when I had to go, but I had to ring the >>> nurse (threee times) and wait for her to come and help >>> me get out of bed (first I gave myself two pumps of >>> morphine so that I could handle the pain of getting >>> out of bed). I almost past out on the toilet and two >>> nurses had to give me smelling salts repeatedly. Then >>> they had to help me get back in bed. One hour after my >>> vaginal birth, I had to go to the bathroom, and I got >>> up (all by myself), walked to the bathroom by myself >>> and did my thing. >>> >>> Five days after my c-section, my parents were fixing >>> dinner for me and I thought I'd help make a salad. I >>> was up for 10 minutes to toss the salad and the pain >>> was too much so I had to sit down. Four days after my >>> VBAC, it was too hot to sit at home so we took the >>> kids to the mall, walked around for two hours, let my >>> 2-year old daughter play at the playground, and the >>> only part that was uncomfortable was having to go to >>> the bathroom without my peri bottle. >>> >>> I think it's great that he has patients that are >>> "fully functional" after 36 hours. I didn't feel >>> "fully functional" for over a month after my >>> c-section. >>> >>> But pain goes away. The lasting impact is the way I >>> felt about both births, which is dramatically >>> different. I never felt that I "gave birth" to my >>> daughter. Instead, I had an operation and came home >>> with a baby. >>> >>> Response #2 >>> >>> Well that depends. >>> Obviously the most important thing is that baby and mom are healthy >>> and baby has a safe arrival but why subject a mom to MAJOR SURGERY >>> (c/s) if it is not warrented? >>> Vaginal births are natural and are the INTENDED delivery method. Our >>> bodies were designed for this. To have a c/s out of convienence is >>> ridiculous. >>> Also how about all the moms who want to have a vaginal birth. >>> This is a gift to us. Something only us women can experience so why >>> shouldn't we? >>> I felt extremely cheated after my c/s. I felt I missed out on some >>> great secret that woman for eons have experienced. >>> It wasn't until I went on to have a succesfull vbac that I felt >>> fulfilled in my birthing experience. >>> Saying the delivery method is overated is absurd. Healing time for a >>> c/s is longer than a vaginal birth. I know this because I've had both. >>> I think it's sad that obgyn's and hospitals are not only pressuring >>> moms to have c/s but allowing them to believe that it's easier or that >>> it doesn't really matter how baby is born. >>> Aside from being major surgery, I'm sure you can agree that c/s can >>> cause many other complications. >>> How about the fact that you will be away from your baby for hours to >>> possibly one or two days. What about the fact that you can't nurse >>> immediately after birth? What about the woman who can't bf for several >>> days and their babies end up being supplemented with formula by well >>> meaning hospital staff and then baby won't take the breast? >>> Breastfeeding is the best possibly nutrition for baby, why would you >>> want to risk it? >>> I'm not saying that if it's a high risk pregnancy or there is other >>> forseeable complications that a c/s isn't optimal but in a normal >>> pregnancy a c/s is not the route to go. >>> In my opinion there are far too many dr's these days using scare >>> tactics to push moms into c/s's and In my opinion I think said dr's >>> are getting a little upset that more mom's are arming themselves with >>> knowledge and sticking to their guns instead of caving in to said >>> scare tactics. >>> >>> Reponse #3 >>> >>> >>> First of all I think physical health is whats >>> overated. Physical health means very little if your >>> emotional and mental health are lagging far behind. I >>> would rather be missing an arm and be emotionally >>> sound and whole than have a perfect body and be an >>> emotional basket case on prosac. >>> Even for those who don't agree with the previous >>> statement, emotional issues can greatly effect >>> physical health. >>> Also the baby and mother are hormonally and physically >>> wired to be healthier when their birthing and bonding >>> needs are met. These needs are not very complex or >>> dificult to accomodate - and I really have a hard time >>> seeing what the big PROBLEM is in respecting and >>> honoring those needs. >>> They need to be respected as people and individuals >>> with rights, choices, and voices >>> They need to be together, not seperated >>> They both need to be recognized as owners of their own >>> bodies, and be respected as such, not to be pushed >>> around or ignored, handled carlessly or casually, or >>> coerced >>> They need their privacy and dignity to be respected >>> and honored by their caregivers >>> >>> These are very simple and sensible things, that do not >>> cost anything but a moment of pause and consideration >>> from their caregivers. Unless one has a god complex I >>> really don't see the objection to "allowing" basic >>> human rights during a natural process. >>> >>> Regarding VBAC and homebirth. It's the OB's and >>> Hospitals and insurance companies own doings that move >>> many women to these "extremes". If a woman knows she >>> is likely to get what she wants/needs at home but not >>> at the hospital where do you THINK she is going to >>> give birth. >>> I think that the medical profession ignores to some >>> extent the psychological aspects of childbirth >>> especially the way c-sections and forceps/vacuum >>> deliveries affect a womans self image, and perception >>> of her body. >>> Most women feel like they have lost something when >>> they are not able (by reason or fault) to give birth >>> naturally. As a woman who has given birth at home >>> without drugs (and it was a long painful labor mind >>> you), I must say that I would be a totally different >>> person if I had not given birth in the way I chose. I >>> would have a different profession, different parenting >>> style, different relationships with my son and my >>> spouse, and I don't beleive I would be as happy. Birth >>> is the beginning of a lot of change for everyone >>> involved. The tone of the event will resonate on the >>> lives of the family for at least 6 months after the >>> birth and will affect in no small way alot of what >>> they do and how they do it. >>> I am rather appauled at the way these issues are >>> dismissed so lightly by womens care providers. "first >>> do no harm" eh? >>> Faith >>> >>> >>--Apple-Mail-3-1028151327 >>Content-Transfer-Encoding: quoted-printable >>Content-Type: text/enriched; >> charset=ISO-8859-1 >> >><fontfamily><param>Lucida Grande</param>As I've stated on this forum >>in the past, unless people are willing to share in the risk why would >>any of us be willing to put our career at risk? Patients and lawyers >>have put us in the unenviable position of defensive medicine. I'll >>also admit that a number of colleagues have certainly assisted by >>testifying against each other. The one aspect that has not been >>covered in the discussions of "medical malpractice crisis" is the >>career ending nature of lawsuits. A single lawsuit now has the ability >>to force any one of us out of a profession that we have committed >>significant effort. I think those 3 respondents have some very valid >>points. However, who would be willing to take a 1 in 100 "crap shoot" >>that the next VBAC that they attend will end their career? >> >></fontfamily> >> > ><fontfamily><param>Helvetica</param>************************************* ************************************** >> > ><fontfamily><param>Helvetica</param>************************************* **************************************

>><fontfamily><param>Helvetica</param>************************************* ************************************** >>Charlie Chambers >><fontfamily><param>Helvetica</param>************************************* ************************************** >> >>Hood River, OR USA >> >>cchamber@alumni.rice.edu >> >>"...not because I regard fishing as being so terribly >> >>important but because I suspect that so many of the other >> >>concerns of men are equally unimportant-and not nearly >> >>so much fun." >> >> John Voelker >> > >************************************************************************* ***</fontfamily> >> > >************************************************************************* ***</fontfamily>

>>************************************************************************* ***</fontfamily> >><fontfamily><param>Lucida Grande</param>On</fontfamily> >>************************************************************************* ***</fontfamily> >><fontfamily><param>Lucida Grande</param>May</fontfamily> 22, 2005, >><fontfamily><param>Lucida Grande</param>at</fontfamily> 7:55 >><fontfamily><param>Lucida Grande</param>AM</fontfamily>, >><fontfamily><param>Lucida Grande</param>Stmidwife@aol</fontfamily>.<fontfamily><param>Lucida Grande</param>com</fontfamily> >><fontfamily><param>Lucida Grande</param>wrote</fontfamily>: >> >><excerpt> >> > ><fontfamily><param>Arial</param><smaller><x-tad-smaller> </x-tad-smalle ></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>Here are some >>responses, I from some of the people at the perinatal pysch center in >>Santa Barbara, not sure which one, I posted to two facilities. >>There were 3 responses as of yesterday.</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> > ><fontfamily><param>Arial</param><smaller><x-tad-smaller> </x-tad-smalle ></smaller></fontfamily></excerpt><excerpt> >> > ><fontfamily><param>Arial</param><smaller><x-tad-smaller> </x-tad-smalle ></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>Response #1</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>Let me compare >>my c-section and my VBAC. 24 hours</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>after my >>c-section, they took out my catheter so I</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>could go to >>the bathroom. I was in tears because it</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>hurt so much >>when I had to go, but I had to ring the</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>nurse (threee >>times) and wait for her to come and help</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>me get out of >>bed (first I gave myself two pumps of</x-tad-smaller></smaller></fontfamily></excerpt><excerpt> >> >><fontfamily><param>Arial</param><smaller><x-tad-smaller>morphine so >>.

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