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Re: VBACFrom: ainsron (ainsron@sbcglobal.net)Sat Dec 18 11:28:50 2004
How does one design an "informed consent" process or form that really allows the mother to take the risk for herself and/or her fetus? No matter how much information a patient receive, there is always the possibility of suing for a bad outcome, even if they have been told ad nauseaum that there is a significant chance or a one in a million chance; if they are lucky (or unlucky depending on your perspective) enough to be the one who gets the bad outcome, then they could also be lucky enough to get the jury that will award them with $20M for making that choice. Is a mother really able to objectively pick a risk for herself and her fetus without allowing her self-interest override the interests of the fetus? Is a mother who chooses a VBAC with a 0.2% chance of uterine rupture and minimal chance of death or major long-term problems over a scheduled C/S with minimal chance of long-term problems making the best choice for herself and her fetus when the risk of the same adverse event to the fetus of death or major morbidity (cerebral palsy, learning disabilities, etc.) is as high as 50% if the uterus ruptures and 0% if she has a scheduled RCS? Maybe the consent needs to be revised. Perhaps we need to redesign the informed consent process. The physician should be offered a consent form by the patient, informing him that she will sue him, cause his malpractice insurance to drop him and ruin his career when an adverse outcome occurs. Reminds of the patient I cared for 20 years ago. She was a Hmong patient and needed a C/S for fetal distress due to an abruption, but she would not sign the consent without the permission of her husband who spoke limited English. At first, he refused. To convince him of the gravity of the situation, I told him that if I didn't operate, his wife and his baby could die. He reluctantly signed the form for his wife, with the poignant reply, "if she die, you die." You can bet I was very careful in the care of that patient. Ronald E. Ainsworth I think it's been demonstrated that the risk is at least about even, and the mothers should be given the informed consent to pick who takes the risk, they or their feti. Joe P.
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