Mega vent! Hospitals, birth and breastfeeding.

[bolt.]

I just don't have any idea what would require a baby to be admitted alone, physically separated from his or her parents, with everyone acting like this "no you can't be in the same room" thing is normal and nessisary.

 

In my experience and my sphere any time a baby or small child needs hospital care (newborn or later) everyone suggests that the child would be best cared for if a parent stays near at hand.

 

To say "the baby will be admitted, the parents may not come, just stay out while we do our medical business" is too much, unless there is some sort of incredible risk of contagen or something like that. Forced separation of nursing infants from their mothers is hardly ever any kind of medical nessessity -- that's what makes it wrong for medical professionals to act like its within their scope to be doing so.

[TranquilMind]

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

Let me give you a scenario that comes up in my office at least once a winter. A newborn infant comes in, let’s say 2 weeks old. The baby has congestion, a slight cough and tests positive for RSV (we have the test in our office). It’s day 3 of illness. The infant is breathing fast (50 times a minute, instead of the average of 30-40 at that age) but doesn’t have an oxygen requirement and is feeding ok. Not great, but adequate, having ok wet diapers. However, you as the pediatrician know that RSV typically gets worse around day 4 before it gets better. You also know that in very young infants RSV can cause apnea, potentially life-threatening. Most of the time it doesn’t, but it can.

 

Do you admit the baby for observation? Send them home?

 

Let’s say you admit. The baby does well, never needs oxygen and feeds fine on it’s own. You discharge them after 24-36 hours in the hospital. Harm done? Well, parents probably lost work time, were stressed (if they had other kids at home even more so). Breastfeeding may have been interrupted in a hospital setting, certainly no one slept well in the hospital. Certainly a cost to insurance, and depending on their insurance potentially a large cost to them financially. Unnecessary? It certainly seems like it. Perhaps there should be consequences. A fine? Some kind of professional censure? Prison time?

 

Let’s say you don’t admit. The parents go home and put the baby to bed. Later that evening they go in to check on the baby and discover that the baby is cyanotic, having had an apneic episode which led to bradycardia. They call 911 and perform CPR. The baby is rushed to the hospital, taken to the ICU, ventilated. He ultimately recovers after a 4 week hospital stay including 2 weeks in the ICU on a ventilator. Harm done? Certainly much more stressful to the parents and potentially life threatening. Long term complications from hypoxia are likely (learning disorders, CP, hearing loss). Much bigger financial cost to everyone involved. Consequences? The parents would likely be able to find a lawyer to sue you for malpractice.

 

****

The reality is that it’s virtually impossible to tell with a 2 week old which way he is going to go. The second is much much less likely but also much much less desirable. You might argue that the you could base “unecessary†on standard practices but in a lot of cases, especially with neonates there is a certain amount of gut reaction/art to medicine. There are algorithms but we all base our decisions on a lot of other factors. In the above scenario I might take into account the parents (are they first time parents, do they have experience with sick kids, do they seem exhausted and to need a break).

 

You could argue that it has to be about intent? Did I know that it was unnecessary at the time or did I have a reasonable suspicion that the interventions might be necessary? Ok...well what if in the above scenario I changed it to say that you are seeing the baby at 9 am. I could have seen the baby back in the afternoon to follow up and see how they are doing instead of admitting them for observation. You find out later that that day I happened to be leaving for vacation at 3 pm and was in a hurry to get out of the office....Does that change things? Did I admit the baby only so I could get out of the office and out of town? How can you prove that? Maybe it’s just a coincidence that I’m going on vacation.

 

Ok...well maybe it’s “unnecessary†if I financially gain from it. (And I do think this is a good reason doctors shouldn’t profit from any kind of lab or radiological procedures.) Well, if my practice rounds on hospital patients I’m indirectly profiting from the admission as we’ll get paid for seeing the baby in the hospital. Is that why I admitted them?

 

You might also argue that my scenario is meaningless because you are talking about labor and delivery. Well, how are you going to say that one particular area of medicine can have consequences for “unnecessary†interventions but not extend that to other areas of medicine?

 

I always wade into these kind of threads with some trepidation, but I mostly wanted to just respond to the above idea. However, I have one other thought...

 

-In general I find this board to be a pretty anti-mainstream medicine place. That’s fine and for many people they have good reasons for that opinion. However, it’s never helpful to say things like “I believe that Obs and maternity nurses prey on mothers and babies" or to depict maternity nurses and neonatologists as wanting to “snatch babies†away. I may not be quoting exactly because I forgot to use multi-quote but I think I’m pretty close. I’ll give you that some OBs are power hunger, paternalistic, creatures who only want money and to fit in as many C-sections as possible before their next golf game. I’ll give you that some nurses are lazy and would rather sit and chat on break than get up to bring a baby to it’s mom. I’ll even give you that some pediatricians are arrogant jerks who think all moms are idiots. I’m aware that some of you have unfortunately only encountered these kinds of medical professionals. However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients. Some nurses (I’d say many) work really really hard and do everything they can to help new moms in this exciting, scary and stressful time of life. Some of those nurses (and doctors and doctors families) are on these boards. It’s good to realize that when we make sweeping generalizations about any profession.

 

 

What you do is to inform the parents of the likelihood of each possibility, that it gets worse at day 4, what to look for, and ask what they want to do about hospitalizing over this potentiality. That removes the responsibility to them, in my view.

 

You are right: SOME (not all!) doctors and nurses are real jerks who are in the wrong business. Experience with a few of these definitely alters ones views.

 

I've always avoided peds, and I have the top family doc in the area, indeed, I've been his patient since he started back in the 70's. He's wonderful. My mom remembers him holding hands of patients in nursing homes in his early days. Our family has been very happy with this decision, and my kids are third generation. He knows what is likely or not for our family, given our genes. Perfect result.

[Lang Syne Boardie]

I've never claimed to have all the answers. I'm just wondering if what broke it will fix it if the pendulum is swung in the other direction. Perhaps after some lawsuits start running the other direction, eventually balance will be achieved. Who knows.

 

All I know is that women are afraid of hospital births now, and are willing to risk their babies and themselves by either deliberately going to the hospital almost too late or by proceeding with home birth plans when their health care professional has deemed it to be too risky. For a developed nation our statistics around childbirth are appalling. Something has to change. I don't have all the solutions, never claimed to, plus I have zero power over any of it anyway.

[Ellie]

We were fighting this kind of carp in 1975 when my first baby was born. I'm so sad and disappointed to see that it's still going on. Sheesh.

[Amy in NH]

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

Let me give you a scenario that comes up in my office at least once a winter.

 

[sNIP]

 

-In general I find this board to be a pretty anti-mainstream medicine place. That’s fine and for many people they have good reasons for that opinion. However, it’s never helpful to say things like “I believe that Obs and maternity nurses prey on mothers and babies" or to depict maternity nurses and neonatologists as wanting to “snatch babies†away. I may not be quoting exactly because I forgot to use multi-quote but I think I’m pretty close. I’ll give you that some OBs are power hunger, paternalistic, creatures who only want money and to fit in as many C-sections as possible before their next golf game. I’ll give you that some nurses are lazy and would rather sit and chat on break than get up to bring a baby to it’s mom. I’ll even give you that some pediatricians are arrogant jerks who think all moms are idiots. I’m aware that some of you have unfortunately only encountered these kinds of medical professionals. However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients. Some nurses (I’d say many) work really really hard and do everything they can to help new moms in this exciting, scary and stressful time of life. Some of those nurses (and doctors and doctors families) are on these boards. It’s good to realize that when we make sweeping generalizations about any profession.

 

 

 

So far, this discussion has been limited to labor and delivery. I've experienced drug pushing labor & delivery nurses, OBs who unnecessarily break water and try to push pitocin on a normally laboring mother, don't provide any labor support, and just walk in to catch the baby at the end, and nurses trying to keep the baby in the nursery and feed formula when I wanted to exclusively breastfeed my normal healthy newborn. It seems that a lot of other mothers here have experienced the same treatment, and/or have friends and family who have. That is where legislation is needed - not for 2 week old babies with RSV seeing a ped in the office.

[Alice]

What you do is to inform the parents of the likelihood of each possibility, that it gets worse at day 4, what to look for, and ask what they want to do about hospitalizing over this potentiality. That removes the responsibility to them, in my view.

 

 

 

Yes, I do that, meaning involve the parent in a decision. But the reality is that many parents want a doctor to at least take some of the responsibility of the decision. I don’t mean saying “here is what you have to do and you have no choice†but they want to hear “here is what I recommend†or “here is what I would do if it was my son/daughterâ€. We know that the way we present the information will likely influence their decision. Parents should certainly be very involved in the decision but I think at least part of my job is to remove some of the burden of responsibility of making those hard decisions from them. I don’t mean that in a paternalistic way. Just that when my own kids have been very sick or hurt I get more paralyzed about decision making. It’s much harder to make a clear headed decision when I know that a wrong choice might effect someone I love more than anyone in the world. I would never want to put that burden on a parent and then have something go wrong.

 

I don’t know...maybe the population here is different. But almost all the time IRL if I present two options to a parent and leave it up to them they will still ask me for my recommendation and then they will choose what I recommend.

 

 

I've never claimed to have all the answers. I'm just wondering if what broke it will fix it if the pendulum is swung in the other direction. Perhaps after some lawsuits start running the other direction, eventually balance will be achieved. Who knows.

 

All I know is that women are afraid of hospital births now, and are willing to risk their babies and themselves by either deliberately going to the hospital almost too late or by proceeding with home birth plans when their health care professional has deemed it to be too risky. For a developed nation our statistics around childbirth are appalling. Something has to change. I don't have all the solutions, never claimed to, plus I have zero power over any of it anyway.

 

 

I replied to your post because lots of other people agreed with it and at least one person quoted you later. My main point was just that...it’s easy to call for legislation but much harder to really think about the details of what that would be like.

[mommymilkies]

I think the legislation should be that you offer care and then the patient/parent can sign that they accept the risks and refuse. And then you DROP IT. You don't get court orders that put women in cuffs and then cut the baby out of them. That's just plain ridiculous.

 

With my ds, the u/s told them he would be 9+ lbs. Because my first was a "huge" 8 lbs. 1 oz. 21" healthy infant, they were afraid I would have a huge second baby. :confused1: Anywho, the only way they would allow me to go on with a vaginal birth was to sign off on an induction. Now, the details: We were unsure of baby's EDD. I was bf and never had menses return before I found out I was pg (at almost 5 months along!). The only thing they had to go on was the u/s. Ok, so they started pitocin. It did pretty much nothing. Three hours later, they spent 1.5 HOURS trying to break my water. My cervix was so far back and high and unprepared it really did take that long maneuvering to do so. I trusted my doctor. After all, they know best, right? No. I was in such intense pain, that I couldn't stop shaking for the forced epidural-the anesthesiologist yelled at me and missed 3 times. As soon as I laid back when it was in, ds started coming out. The nurse HELD HIM IN ME so the doctor could get properly scrubbed. NO JOKE. Then he came out and was obviously small and premature. He has had neurological and digestive problems since birth. I had a seizure following birth from the intense blood loss. The aide was in the room taking my vitals, as well as more than 5 visitors. The nurse refused to believe it, despite the eyewitnesses. I never got a sorry we screwed up from anyone. But the fact is that I had no choice in this. I was poor. I couldn't have gotten a lawyer or a second opinion to save my life. And unfortunately, my story is just plain mild compared to many of my friends'. It shouldn't be this way.

 

Neither I, nor the evidence, find home birth to be dangerous for most women. However, it should never HAVE to be a last resort. It should be an educated decision, just like c-sections or hospital choice. OBs play God in this country and it's not right. We need to protect our women and children like most other developed countries do. Legalize midwifery and spread it so more women have proper care.

[Alice]

 

 

So far, this discussion has been limited to labor and delivery. I've experienced drug pushing labor & delivery nurses, OBs who unnecessarily break water and try to push pitocin on a normally laboring mother, don't provide any labor support, and just walk in to catch the baby at the end, and nurses trying to keep the baby in the nursery and feed formula when I wanted to exclusively breastfeed my normal healthy newborn. It seems that a lot of other mothers here have experienced the same treatment, and/or have friends and family who have. That is where legislation is needed - not for 2 week old babies with RSV seeing a ped in the office.

 

 

Ok, so how are you going to legislate that?

 

Who decides unnecessary?

 

I chose a non labor and delivery scenario because it’s what I see and I can talk about it more intelligently. Also, I’ve seen this topic come up enough to know that it’s a hot one. I really didn’t want to get into a discussion of particular labor and delivery interventions and whether they are needed or not. I wouldn’t have joined this thread other than that I thought the idea of “legislating against unnecessary interventions†was one that was interesting to discuss. Especially so in light of the fact that one person called for prison time and about 20 people agreed with the idea.

 

I do think that if there really was legislation/legal precedent against “unnecessary intervention/procedures†in one specialty than that would absolutely extend to other areas. For no other reason than insurance companies would jump all over any kind of government mandated list of what is unnecessary/necessary.

[claluck]

I have to agree with Tranquilmind. We cannot blanketly bash all drs and hospitals in these situations. And this is coming from a 9 month pregnant woman who is about to have a homebirth (if this baby ever decides to come lol). I have seen both sides. With my first I was induced and water broken and I had a nurse who was anxious and aggitated with my labor taking so long. Same exact hospital 16 month later with #2 and I had an awesome lineup and a totally natural delivery. With my twins I had a great dr who funny enough got reprimanded for being the only attending physician at my delivery because the other dr didnt show (I heard the nurses state they called him 3 times) and she wasn't actually an OB just a family dr attending. BUT at the same time I was very unhappy with the lazy nurses who took the babies to check stuff and then left them in the nursery unattended and screaming while I waited impatiently for them back. I actually walked down to the nursery and brought them back myself while the nurses chit chatted on the phones. (VERY small rural hospital). Next child same hospital and it was all wonderful and I insisted they never take the baby ever. But had a negative experience with the hospital so for baby #6 went out of town to another hospital where I had a mixed experience with complications created by the hospital.

 

I agree mothers are vulnerable. I am sorry but all rational thought and reasoning goes out the window when you are in labor. I actually wrote notes down for my husband about what to do for my labor this time because right now when I am not in labor I can make these great observations about what I do when I am so far along and what I need. But in the moment I cannot. My full focus and everything is just messed up. I cannot make and would not trust myself to make a competent decision if I was in active labor. This is when we need an advocate someone whose interest isn't in time or money but in the best well being for mom and baby. There are some wonderful drs out there. And honestly most of them went into the field because they care about people. Most are certainly not making a fortune on it. (I have a few dr friends and most are struggling with severe debt from medical school and are barely ever home to be with their families) Drs sacrifice alot to try and help us. I think some lose focus after so many years in practice and so many sour decisions.

 

Also I had a nurse friend once tell me that while we are looking at the situation and how wronged we were the nurses who went overboard have often seen some of those worst case scenarios. I remember being so frustrated with a nurse during my last delivery... my DH and I nicknamed her nurse pessimistic. Another nurse and I were talking about it late into the night in the nursery (my dd and I both got an infection) and she told me that that nurse had seen some pretty horrific things happen recently in L & D some nightmare scenarios and it makes it hard when you are in that position to not want to be extra cautious and take unnecessary measures.

 

I think that sometimes the professionals (and society in general) forget to take that step back and realize that in MOST cases childbirth is a natural process that will go off on its own just fine if we leave it to do it's business.

[momacacia]

To be honest, I thought this is how a lot of hospital births go. If anyone does any research (even USA Today articles carry information like this) they will learn that once one intervention is accepted (like an epidural or pitocin), it is much more likely that more interventions will be suggested or required. Sure, it was bad that they wouldn't let her nurse the baby (kinda 1970s, I was put on formula before my mom had a chance to wake up from her c-section), but unless a father or doula is willing and able to express the mother's wishes for the baby, or those wishes are expressed in a birth plan and cooperation with the plan is inforced, you get what you get at the mercy of your doctor and the hospital.

 

http://usatoday30.usatoday.com/news/health/2008-10-08-childbirth-costs_N.htm

 

 

Mama to two home/waterbirth girls and one home/drybirth boy (too fast for Daddy to get the birthpool filled ;-)

Two cord wraps ably handled and a Mamma who's never needed sewing up, thanks to wonderful midwives.

[mommymilkies]

Ok, so how are you going to legislate that?

 

Who decides unnecessary?

 

I chose a non labor and delivery scenario because it’s what I see and I can talk about it more intelligently. Also, I’ve seen this topic come up enough to know that it’s a hot one. I really didn’t want to get into a discussion of particular labor and delivery interventions and whether they are needed or not. I wouldn’t have joined this thread other than that I thought the idea of “legislating against unnecessary interventions†was one that was interesting to discuss. Especially so in light of the fact that one person called for prison time and about 20 people agreed with the idea.

 

I do think that if there really was legislation/legal precedent against “unnecessary intervention/procedures†in one specialty than that would absolutely extend to other areas. For no other reason than insurance companies would jump all over any kind of government mandated list of what is unnecessary/necessary.

 

I'm thinking of the more obvious ones, like non-medically necessary induction before the body is ready for labor. Real, evidence based care is really needed and at this point, it's something the U.S. Maternity culture is ignoring. I used to work med/surg, hospice, Emergency, phlebotomy, and then later infertility. I have not seen these problems manifest as drastically as they do in obstetrics. Perhaps part is over-conservative care (c-sections without real reasons) because of a fear of liability, or the hectic hours that OBs are forced to work. Maybe if we better educate the public about birth, increase the amount of midwives (or even legalize them in some areas!), and legislate the hours OBs can work, then we may have better outcomes. Hopefully. Let's look at the bright spots around the world and see what they do right. Just a few:

 

1. Midwives have a vital place outside of high risk births

2. Maternity care is usually free/low cost, so no worries about being forced into a bad doctor when there are alternatives

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409165/

 

http://www.medicalbillingandcoding.org/blog/the-10-best-countries-for-maternity-care/

Not a great site, but brief)

[staceyobu]

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

Let me give you a scenario that comes up in my office at least once a winter. A newborn infant comes in, let’s say 2 weeks old. The baby has congestion, a slight cough and tests positive for RSV (we have the test in our office). It’s day 3 of illness. The infant is breathing fast (50 times a minute, instead of the average of 30-40 at that age) but doesn’t have an oxygen requirement and is feeding ok. Not great, but adequate, having ok wet diapers. However, you as the pediatrician know that RSV typically gets worse around day 4 before it gets better. You also know that in very young infants RSV can cause apnea, potentially life-threatening. Most of the time it doesn’t, but it can.

 

Do you admit the baby for observation? Send them home?

 

Let’s say you admit. The baby does well, never needs oxygen and feeds fine on it’s own. You discharge them after 24-36 hours in the hospital. Harm done? Well, parents probably lost work time, were stressed (if they had other kids at home even more so). Breastfeeding may have been interrupted in a hospital setting, certainly no one slept well in the hospital. Certainly a cost to insurance, and depending on their insurance potentially a large cost to them financially. Unnecessary? It certainly seems like it. Perhaps there should be consequences. A fine? Some kind of professional censure? Prison time?

 

Let’s say you don’t admit. The parents go home and put the baby to bed. Later that evening they go in to check on the baby and discover that the baby is cyanotic, having had an apneic episode which led to bradycardia. They call 911 and perform CPR. The baby is rushed to the hospital, taken to the ICU, ventilated. He ultimately recovers after a 4 week hospital stay including 2 weeks in the ICU on a ventilator. Harm done? Certainly much more stressful to the parents and potentially life threatening. Long term complications from hypoxia are likely (learning disorders, CP, hearing loss). Much bigger financial cost to everyone involved. Consequences? The parents would likely be able to find a lawyer to sue you for malpractice.

 

****

The reality is that it’s virtually impossible to tell with a 2 week old which way he is going to go. The second is much much less likely but also much much less desirable. You might argue that the you could base “unecessary†on standard practices but in a lot of cases, especially with neonates there is a certain amount of gut reaction/art to medicine. There are algorithms but we all base our decisions on a lot of other factors. In the above scenario I might take into account the parents (are they first time parents, do they have experience with sick kids, do they seem exhausted and to need a break).

 

You could argue that it has to be about intent? Did I know that it was unnecessary at the time or did I have a reasonable suspicion that the interventions might be necessary? Ok...well what if in the above scenario I changed it to say that you are seeing the baby at 9 am. I could have seen the baby back in the afternoon to follow up and see how they are doing instead of admitting them for observation. You find out later that that day I happened to be leaving for vacation at 3 pm and was in a hurry to get out of the office....Does that change things? Did I admit the baby only so I could get out of the office and out of town? How can you prove that? Maybe it’s just a coincidence that I’m going on vacation.

 

Ok...well maybe it’s “unnecessary†if I financially gain from it. (And I do think this is a good reason doctors shouldn’t profit from any kind of lab or radiological procedures.) Well, if my practice rounds on hospital patients I’m indirectly profiting from the admission as we’ll get paid for seeing the baby in the hospital. Is that why I admitted them?

 

You might also argue that my scenario is meaningless because you are talking about labor and delivery. Well, how are you going to say that one particular area of medicine can have consequences for “unnecessary†interventions but not extend that to other areas of medicine?

 

I always wade into these kind of threads with some trepidation, but I mostly wanted to just respond to the above idea. However, I have one other thought...

 

-In general I find this board to be a pretty anti-mainstream medicine place. That’s fine and for many people they have good reasons for that opinion. However, it’s never helpful to say things like “I believe that Obs and maternity nurses prey on mothers and babies" or to depict maternity nurses and neonatologists as wanting to “snatch babies†away. I may not be quoting exactly because I forgot to use multi-quote but I think I’m pretty close. I’ll give you that some OBs are power hunger, paternalistic, creatures who only want money and to fit in as many C-sections as possible before their next golf game. I’ll give you that some nurses are lazy and would rather sit and chat on break than get up to bring a baby to it’s mom. I’ll even give you that some pediatricians are arrogant jerks who think all moms are idiots. I’m aware that some of you have unfortunately only encountered these kinds of medical professionals. However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients. Some nurses (I’d say many) work really really hard and do everything they can to help new moms in this exciting, scary and stressful time of life. Some of those nurses (and doctors and doctors families) are on these boards. It’s good to realize that when we make sweeping generalizations about any profession.

 

 

I think you raise good points. And issues that need to be carefully thought through if we want to change the way that birth is handled in this country.

 

I think one thing that would help is to give women OPTIONS. Money talks. If women want their babies kept with them at all times, want to be able to have a natural birth... it needs to be an option. And, honestly, I think a lot of women want to be active participants in their births.

 

I believe that Obamacare is going to force Medicaid to reimburse midwives? I think that is an example of where we could see legislation make a difference.

 

Our insurance only covers one hospital. This hospital varies between a 50-60% c/section rate. However, I have no other choice. There are no midwives within a 2 hour drive. If we could force insurance companies to pay for homebirth, it would encourage midwives to come here, and provide me with another option. In order for me to take my business somewhere else, I need insurance to pay for it. Or, I need another option for insurance that covers maternity and is affordable.

 

I don't think you have to start with legislating what doctors can do. Legislating what insurance reimburse might hit where it hurts... and encourage hospitals to be more patient friendly.

 

I think maternity is a very tricky area of the hospital. Doctors will disregard what a mom says in order to act in the best interest of the infant. I also feel like it is very easy to threaten mothers with the life of their child and get them to agree to anything. And, everything happens quickly. If a doctor says I need an immediate heart surgery, I might still debate it for awhile knowing that I am only risking my life. But, if a doctor says I need an immediate c/section or my baby might die, I don't really feel like I can take the time to sort out the details.

 

I also think malpractice is an interesting consideration in all of this. I have heard obs say that you can never be faulted for doing a c/s, but you can be faulted for allowing someone to labor. Somehow, these things need to be straightened out or we are going to wind up doing c/sections on everyone.

[8circles]

I am about to bust with the sheer ignorance shown here. This is at the "best" maternity hospital in town. AAAAARRRRRGGGGGHHHHH!!!!!

 

Ignorance & Arrogance. Isn't it amazing how they so often go together. Sorry that happened. Glad everything worked out anyway. I'd be livid too.

[Murphy101]

Firstly, I want to note that I actually really appreciate your opinions on medicine, Alice. I know we often strongly disagree, but I respect that you, at least as far as I know via a message board, truely seem to respect your clients choices.

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

I actually agree with this. Good medicine should be practiced because it is good medicine. We shouldn't have to legislate that because it should be the main goal and result of decent medical careby decent people.

 

However, I don't think what is unnecessary is always a hindsight consideration. Many times, yes. But often not. For example, there is absolutely zero excuse for my having had that emergency cesearen without anesthetic. None. If I'd had the money and had less tendency to blame myself (which I did), I probably should have sued, which is something i really never consider doing at the time. Because truth is some places shouldn't be in business and they do have to be forced to run an ethical business. Should it be that way? No. But should citizens have no choice about where they go and no choice about speaking out when where they have to go offers awful or even no care? No.

 

We need a hard balance between our only options being to sue and people not being able to sue.

 

 

-In general I find this board to be a pretty anti-mainstream medicine place. That’s fine and for many people they have good reasons for that opinion. However, it’s never helpful to say things like “I believe that Obs and maternity nurses prey on mothers and babies" or to depict maternity nurses and neonatologists as wanting to “snatch babies†away. I may not be quoting exactly because I forgot to use multi-quote but I think I’m pretty close.

 

Idk. I think many here are actually pro what should be mainstream medicine. Most of the complaints and problems I read here are about NOT getting what should be mainstream care. The OP is a case in point. My own frustrations are another example. I for one am adamently for and down right joyous over what is supposed to be mainstream modern medicine. Love it. Think it's awesome. I am not at all against c sections, *when necessary and when done properly.* I never wanted a home delivery. And if they ever figure a way to birth pain free without negative consequences, I'd sign fast as possible. They can sweet talk the first time moms into that natural birth stuff, give me a hospital with caring staff, pain meds and laundry and food service.

 

I don't know anyone who is turning away from mainstream medicine, tho I'm sure they exist.

 

But myself and obviously many others are desperately turning away from the lies of what media is telling us vs what we are actual able to receive as far as medical care so many of us have struggled with over the years.

 

Whoever someone tells me I'm too cynical or they just can't believe I don't trust medical professionals, I explain that it's because of SOME of the medical professionals I've had the misfortune to endure.

 

And I freely admit that I don't condemn all for the sake of my those who were my bad experiences.

 

But there is also a huge problem of closing ranks in medicine. Which means the good are only as good as the environment they are working in will permit.

 

In the OP situation? Maybe the nurses are whatsits. Idk. But it's just as likely that hospital has some moronic rules that make it a pita for the nurses to let moms in the nursery or to leave to take the baby to her or or. I have had great nurses who really had to sweat to keep their job because of crud like that. And I have had OBs who told me point blank they could have lost their malpractice insurance if they let me deliver on my own at the hospital. Sometimes it's not that the staff want to give lesser care, it's that it's the best care they can give without getting punished themselves.

 

If we could legislate THAT problem, I think that would be great, but quite frankly these days I have even less confidence in legislation than medical policy makers.

 

However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients. Some nurses (I’d say many) work really really hard and do everything they can to help new moms in this exciting, scary and stressful time of life. Some of those nurses (and doctors and doctors families) are on these boards. It’s good to realize that when we make sweeping generalizations about any profession.

 

 

I do admit that and realize that. How they can manage to stay in the business with the wackadoo turds is beyond me, so I figure they must really love medicine even more than I think they do. :)

 

I don’t know...maybe the population here is different. But almost all the time IRL if I present two options to a parent and leave it up to them they will still ask me for my recommendation and then they will choose what I recommend.

 

 

I don't think this population is different. IRL, when I have a dr I feel comfortable with, have known a long time, and basicly trust even when we don't always agree when s/he makes a recommendation? I tend to take them up on that recommendation. I think ideally, that's how it should be. I should have a rapport with the medical person so that when I need to make a decision, we can work together to find a solution. Basicly, I expect my ped to present me with my options, discuss my questions respectfully, either accept my answer or respectfully continue the dialog until we have an understanding, even if we disagree. Knowing s/he normally does that, if s/he were to become adament that they felt strongly I need to agree with them? Baring a major POV difference or something really invasive, I'm highly likely to take their recommendation bc I'm trusting that they are making this unusual change in our dialog for very good reasons that I need reconsider. If nothing else, I'll respect them enough to be willing to give what they suggest a try.

 

Sadly, I have not come across that type of medical professional very often in OB situations. little to no choices and even less discussion and truth is, once they've had me checked in at the hospital, it seemed like the PR facade was quickly tossed for what everyone in the know knew was really SOP all along.

 

Is that always the case? No. I don't think so.

 

Which isn't any comfort at all to those who it is all too common for.

 

Personally, I don't think it is even mostly the drs and nurses fault. I blame moronic insurance and CYA rules they have to tiptoe through.

[Alice]

 

I think you raise good points. And issues that need to be carefully thought through if we want to change the way that birth is handled in this country.

 

I think one thing that would help is to give women OPTIONS. Money talks. If women want their babies kept with them at all times, want to be able to have a natural birth... it needs to be an option. And, honestly, I think a lot of women want to be active participants in their births.

 

I believe that Obamacare is going to force Medicaid to reimburse midwives? I think that is an example of where we could see legislation make a difference.

 

Our insurance only covers one hospital. This hospital varies between a 50-60% c/section rate. However, I have no other choice. There are no midwives within a 2 hour drive. If we could force insurance companies to pay for homebirth, it would encourage midwives to come here, and provide me with another option. In order for me to take my business somewhere else, I need insurance to pay for it. Or, I need another option for insurance that covers maternity and is affordable.

 

I don't think you have to start with legislating what doctors can do. Legislating what insurance reimburse might hit where it hurts... and encourage hospitals to be more patient friendly.

 

I think maternity is a very tricky area of the hospital. Doctors will disregard what a mom says in order to act in the best interest of the infant. I also feel like it is very easy to threaten mothers with the life of their child and get them to agree to anything. And, everything happens quickly. If a doctor says I need an immediate heart surgery, I might still debate it for awhile knowing that I am only risking my life. But, if a doctor says I need an immediate c/section or my baby might die, I don't really feel like I can take the time to sort out the details.

 

I also think malpractice is an interesting consideration in all of this. I have heard obs say that you can never be faulted for doing a c/s, but you can be faulted for allowing someone to labor. Somehow, these things need to be straightened out or we are going to wind up doing c/sections on everyone.

 

 

Also good points. I agree with most of what you say. I agree that money talks and that if insurance companies/patients started demanding certain things from hospitals then they would be more likely to deliver (pun sort of intended).

 

Malpractice is definitely part of it, there is a lot of CYA medicine, probably more in OB than anywhere else from what I hear from OB friends. However, I left that out of the conversation because every time anyone brings up a problem in healthcare doctors cry “Malpractice reform!†I’m sure people are just as tired of that as of hearing me tell them their kid has “just a virusâ€.

 

I live in a different kind of area, where there are many more options. Your post and others here made me think about this issue more from the perspective of people who don’t have those options. I know of women in my area who have had homebirths, midwife assisted birthing center births, midwife assisted hospital births, elective C-sections to pick the date and everything in between. I agree that it’s terrible to be in a position where you feel powerless, don’t like your options and have no other option available.

[Alice]

Firstly, I want to note that I actually really appreciate your opinions on medicine, Alice. I know we often strongly disagree, but I respect that you, at least as far as I know via a message board, truely seem to respect your clients choice

 

 

 

 

 

Thank you, I appreciate that. I also often appreciate your posts as being ones that I don’t necessarily agree with but that are respectful and interesting.

 

I agree with most of what you wrote. I apologize for not responding more in depth. I can’t figure out how to do the separate quote thing like you and I’m tired and need to head to bed. I also don’t want to completely hijack a thread that was more about a bad situation for the OP’s niece.

 

If nothing else, I always appreciate the boards for these kind of conversations. They make me think about how I practice and how we do things. That’s a good thing, I think.

[vonfirmath]

I keep hearing stats like this but I'm not sure I buy it. I know LOADS of people who have had C-sections. Baby and Mom were fine. I honestly know no one, not even a distant relative or friend of a friend, who died or lost a child in a C-section. I really question that stat.

 

The only C-section I know of where the baby died, they ended UP as a C-section because of concerns about the baby not moving. It was a cord accident. Cord wrapped around the baby's neck.

[I.Dup.]

I keep hearing stats like this but I'm not sure I buy it. I know LOADS of people who have had C-sections. Baby and Mom were fine. I honestly know no one, not even a distant relative or friend of a friend, who died or lost a child in a C-section. I really question that stat.

 

C-sections are incredibly dangerous. I personally know 2 people who have had uterine ruptures when attempting a VBAC, 2 who have lost their uterus due to complications after a C-section, 2 more that had placental accreta in a subsequent pregnancy after having a C-section and they and their babies almost died, and 1 who had such horrifying complications after her C-section that she almost died (her entire abdomen was full of rot after she acquired an infection).

[bolt.]

I think the statistic is likely due to the fact that if a laboring woman or the baby in utero is actually looking to be dying, a C-section is generally attempted, even if it is a last resort.

 

Therefore fewer fatalities occur without a C-section being at least attempted, so more fatalities (proportionally) happen under C-section conditions (rather than confitions where a natural labor would continue until the point of fatality, without any C-section suggestion or attempt).

[Laura Corin]

When I had my daughter 24 years ago, my doctor was trying to get out of town to go hunting so he intentionally delayed doing a c-section so he could leave. He had one of the other doctors in his office come in and take care of it. I was NOT happy to say the least. Everything turned out ok, fortunately, but .................

 

It has always been thus. When my grandmother gave birth in Uganda in 1924, the baby was induced early so that the doctor could go away on safari. The birth was so violent that my grandmother developed a fistula.

 

Laura

[StephanieZ]

 

 

Yes, I do that, meaning involve the parent in a decision. But the reality is that many parents want a doctor to at least take some of the responsibility of the decision. I don’t mean saying “here is what you have to do and you have no choice†but they want to hear “here is what I recommend†or “here is what I would do if it was my son/daughterâ€. We know that the way we present the information will likely influence their decision. Parents should certainly be very involved in the decision but I think at least part of my job is to remove some of the burden of responsibility of making those hard decisions from them. I don’t mean that in a paternalistic way. Just that when my own kids have been very sick or hurt I get more paralyzed about decision making. It’s much harder to make a clear headed decision when I know that a wrong choice might effect someone I love more than anyone in the world. I would never want to put that burden on a parent and then have something go wrong.

 

I don’t know...maybe the population here is different. But almost all the time IRL if I present two options to a parent and leave it up to them they will still ask me for my recommendation and then they will choose what I recommend.

 

 

 

 

I replied to your post because lots of other people agreed with it and at least one person quoted you later. My main point was just that...it’s easy to call for legislation but much harder to really think about the details of what that would be like.

 

 

Also, insofar as liability for the doctor, the doctor generally remains legally liable for the medical decisions, even if the parent or patient declined care! Legally, the patient or parent is not considered to be a competent decision maker on most medical issues. Yes, the doctor has you sign an AMA form, but it doesn't really offer them significant legal protection. If something goes wrong because of a parent's stupid choice, that same stupid parent will still sue the doctor whose advice was ignored, and the parent will likely win. And the doctor might not only lose money, but even their license.

 

It is a terrible system for all involved IMHO.

[ktgrok]

I think the statistic is likely due to the fact that if a laboring woman or the baby in utero is actually looking to be dying, a C-section is generally attempted, even if it is a last resort.

 

Therefore fewer fatalities occur without a C-section being at least attempted, so more fatalities (proportionally) happen under C-section conditions (rather than confitions where a natural labor would continue until the point of fatality, without any C-section suggestion or attempt).

 

 

There are studies that compare elective C-sections with vaginal birth, that show that the elective c=sections have a much higher death rate for the mother, and higher issues for the baby as well. So even when you take out the emergency c-sections, and the ones for medical reason, the difference is still there. And really, the biggest stats aren't about the baby, the are about the mother. The mother has a 3-4 times higher mortality rate...which just goes to show that major abdominal surgery has risks.

[staceyobu]

I think the statistic is likely due to the fact that if a laboring woman or the baby in utero is actually looking to be dying, a C-section is generally attempted, even if it is a last resort.

 

Therefore fewer fatalities occur without a C-section being at least attempted, so more fatalities (proportionally) happen under C-section conditions (rather than confitions where a natural labor would continue until the point of fatality, without any C-section suggestion or attempt).

 

 

C/sections should absolutely be performed if needed. I don't think anyone would argue that fact. However, there seems to be some sort of a disconnect when the WHO estimates that the c/section rate should be 10-15% and there are many, many hospitals around the country with rates in excess of 50%. You cannot argue that major surgery does not have associated risks.

 

I worked postpartum for several years. People do have surgical complications. It is a much, much harder recovery for a mom. It is a harder recovery for the infant as well because vaginal birth helps clear the lungs of fluid. It is also the only major surgery I know of where we send someone home with a newborn baby to take care of instead of sending them home to rest and take pain killers.

 

C/sections are one of the best inventions in the entire world. We would like the 10% of mothers who need them to have surgery instead of dying. However, that doesn't mean it is the way to go for everyone.

 

There are countries in the world that are approaching a 100% c/section rate. I do NOT want to see that here.

[AimeeM]

My hospital births/c-sections were great...

[TranquilMind]

I don't want a doctor attempting to remove my responsibility for a decision. I want the facts, the whole facts, and nothing but the facts - and that, unslanted, which I know is asking for more than I will usually get.

A doctor's biases come very much into play. Sometimes, I know a lot about the topic, but sometimes I don't, especially if it is an emergent situation.

 

If they ask for your recommendation, that's different. I usually ask, but only doctors I trust. I've got a pretty infallible gut, over 50 years in, and it hasn't failed me yet. If my gut says the doctor knows what the heck s/he is talking about and that I should do it, I go with it. Otherwise, no. I've had many "no" signals from doctors, and have always been glad when I walked away.

 

Recently, I was in an emergency situation when my retina suddenly detached. I didn't have time to research - not that I could see anyway, since my eyes were dialated. I think she dialated both so I couldn't see the needles coming (wise woman!). She did a pneumatic retinopexy. My gut told me this woman was a real expert - not a faux expert - and I needed to trust her suggestion. Husband prayed with me, and agreed.

 

She did a perfect job, and it healed the horseshoe tear within 2 days - not the several week time frame. After researching, I realize she chose exactly the lowest-intervention option I would have chosen, had I been previously informed.

 

Gotta follow your gut (which, as a Christian, I believe is the Holy Spirit's operation, when you are listening).

 

Yes, I do that, meaning involve the parent in a decision. But the reality is that many parents want a doctor to at least take some of the responsibility of the decision. I don’t mean saying “here is what you have to do and you have no choice†but they want to hear “here is what I recommend†or “here is what I would do if it was my son/daughterâ€. We know that the way we present the information will likely influence their decision. Parents should certainly be very involved in the decision but I think at least part of my job is to remove some of the burden of responsibility of making those hard decisions from them. I don’t mean that in a paternalistic way. Just that when my own kids have been very sick or hurt I get more paralyzed about decision making. It’s much harder to make a clear headed decision when I know that a wrong choice might effect someone I love more than anyone in the world. I would never want to put that burden on a parent and then have something go wrong.

 

I don’t know...maybe the population here is different. But almost all the time IRL if I present two options to a parent and leave it up to them they will still ask me for my recommendation and then they will choose what I recommend.

 

 

 

 

I replied to your post because lots of other people agreed with it and at least one person quoted you later. My main point was just that...it’s easy to call for legislation but much harder to really think about the details of what that would be like.

[TranquilMind]

 

Thank you, I appreciate that. I also often appreciate your posts as being ones that I don’t necessarily agree with but that are respectful and interesting.

 

I agree with most of what you wrote. I apologize for not responding more in depth. I can’t figure out how to do the separate quote thing like you and I’m tired and need to head to bed. I also don’t want to completely hijack a thread that was more about a bad situation for the OP’s niece.

 

If nothing else, I always appreciate the boards for these kind of conversations. They make me think about how I practice and how we do things. That’s a good thing, I think.

 

I appreciate your input as well, very much, Alice!

[Leav97]

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

...

 

I think the easier approach would be to not look at individual cases. If 15% is the accepted rate for c-section (pulling a # out of thin air), then any hospital over 25% has a problem. Something in their processes or procedures is causing more c-sections. If you're that far over the recommended rate you are only allowed to charge the medicaid rate for a vaginal birth.

 

I don't know that's the right approach but, I don't think the correct approach would be on an individual case more of a general #'s.

[briansmama]

This sounds awful, but it also sounds like a terrible hospital. My ds got stuck in the birth canal and it was a long few seconds before he was breathing on his own, yet I was still able to hold and nurse him within the hour.

 

Is your niece very young, or does she look very young, by chance? I have a purely anecdotal theory that some women are more likely to get pushed around in hospitals than others. I've seen obvious discrepancies between how younger women are treated vs more assertive, mature women are in hospitals when they have their babies. It really isn't right.

[StaceyinLA]

48%!!!!! That is shocking. I cannot even imagine. Do they not realize what they are saying there? They are saying with that record that they believe almost half of women are unable to to birth as nature designed. Unreal.

 

This is NOT the highest hospital in the state. The one where my nephew works (he's an anesthesiologist) is nearly 60% - yes, you read that correctly - SIXTY PERCENT!! The hospital where he did his residency is also in the 50's. It's horrific! Honestly, they create an unsafe environment for the babies due to all of the inductions. The c-sections probably do become somewhat necessary, not because the women can't deliver their babies, but because the babies are distressed from all of the interventions and drugs.

 

 

ETA that my nephew has had words with an OB there who chastised him for not hurrying to give his patient an epidural soon enough when he was in the OR with a cancer patient. He blasted the guy and basically let him know that he could've just turned off her pit to ease her until her epidural could be given. He gets SO angry with the inductions there.

[chickenpatty]

Ridiculous! I had one brought to the NICU for the same problem. They never suggested formula. They woke me up to feed him.

 

Me too and he was preterm.

[StaceyinLA]

I agree with you but I'd also like to know if it is the hospital in the area that does high risk deliveries.

 

Not specifically, no. They definitely do some, but it is THE hospital to go to (supposedly), so they get most of the deliveries in the city, as well as many from smaller, surrounding cities.

[StaceyinLA]

 

 

I am surprised to hear this. I am assuming you mean the hospital that just built a new campus? I had all three of my kids there (old campus, obviously lol) and had great experiences. There was one nurse who kinda tried to push formula, but another nurse there at the time stopped that really quickly. And that was one nurse out of all 3 births. All the other nurses were very pro breastfeeding. I never had trouble, but some of my friends had trouble *getting* them to take the baby to the nursery at night so they could sleep.

 

Also, my 3rd baby was born really fast. I had pitocin when I was 10 cms dilated and he wasn't even engaged. But, I labored on my own to 10 and it was less than 3 hours. Anyway, he was grunting and he stayed in the room with me, they just checked him more often. He did have nore fluid in his lungs than a normal vaginal birth, but they handled it in the room. The only one of mine to have to go to the nursery was my 1st and his APGAR score was 2.

 

I am not saying I don't believe you or anything, just I have had great experiences and so has pretty much every one I know who has delivered there. I guess it depends on the dr and nursing staff you get. My own OB has delivered all 3 of my kids. 1st was induced, I went into labor on my own on my drs on call days for the other 2.

 

There is one particular hospital in town that has mid-wives and I would have to be unconscious to ever go there (in general, but I would be very hesitant to give birth there too). I went to the ER and they gave me shots and prescriptions without ever asking me what meds I was already on. I knew the meds were okay, but still. I know other people who love that hospital.

 

 

 

Are you in the area? Yes, that is the hospital. I know a LOT of people that are dissatisfied there. Of course I think it's because a lot of the doctors are just old-fashioned and awful. There are a couple of new docs that are getting a really good rep, and they handpick nurses so you can have a positive experience. Still, I think them treating your baby like it is actually YOUR baby is a rarity.

 

FWIW, the baby was sent to be with her once their 6 hours was up (ped on call told her they could keep the baby for observation up to 6 hours in the nursery even with no cause, and that's what they were going to do), and the baby has been perfectly FINE. He has nursed like a champ (they were able to put their foot down on the ng tube and formula). It was just a ridiculous scenario. They also kept them until the 48 hour mark to be sure the bloodwork didn't culture anything (like they couldn't have called them at home if it did - all the other cultures had been perfect).

 

As for the other hospital with the midwives, that is where my daughter delivered - WONDERFUL experience - like a home birth away from home. The midwives are wonderful.

[StaceyinLA]

<<I’ll give you that some OBs are power hunger, paternalistic, creatures who only want money and to fit in as many C-sections as possible before their next golf game. I’ll give you that some nurses are lazy and would rather sit and chat on break than get up to bring a baby to it’s mom. I’ll even give you that some pediatricians are arrogant jerks who think all moms are idiots. I’m aware that some of you have unfortunately only encountered these kinds of medical professionals. However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients<<<

 

I know that there are caring doctors. I have a few. The problem is that with the OBs I have encountered at births with family and friends, as well as my own experiences, the bad ones really do outnumber the good. By bad I mean inducing before due dates for no good reason, and generally just wanting to utilize every intervention known to man. In my nephew's experience (as an anesthesiologist who is constantly getting called out for midnight epidurals because the OBs induced women before they got off for the day in hopes of them delivering - vaginally or via c-section if they haven't cooperated - before morning rounds), this is a daily happening. In my nurse friends' experiences (I have 3 close friends who work l/d) at a different hospital (the one discussed in my OP), it's inductions starting at 4 or 5 a.m. with the hope of deliveries before they leave for the day. Either way, it's a sickening practice, and it puts babies and moms at risk.

[I.Dup.]

Therefore fewer fatalities occur without a C-section being at least attempted, so more fatalities (proportionally) happen under C-section conditions (rather than confitions where a natural labor would continue until the point of fatality, without any C-section suggestion or attempt).

 

All of the C-section complications I personally know about had nothing to do with the health of the mom or baby in the initial C-section. They always happened afterward, either from postop complications or in a subsequent pregnancy. Nightmare stuff.

[StaceyinLA]

This sounds awful, but it also sounds like a terrible hospital. My ds got stuck in the birth canal and it was a long few seconds before he was breathing on his own, yet I was still able to hold and nurse him within the hour.

 

Is your niece very young, or does she look very young, by chance? I have a purely anecdotal theory that some women are more likely to get pushed around in hospitals than others. I've seen obvious discrepancies between how younger women are treated vs more assertive, mature women are in hospitals when they have their babies. It really isn't right.

 

 

Actually, it's not a terrible hospital. As I said, it's considered the best in the city for sure.

 

My niece is in her 30's, doesn't look young, and it was her third child.

[misidawnrn]

Unfortunately, I see this every day! That is why I am going to grad school to become a Certified Nurse Midwife. I sent my final paperwork in after my patient that was progressing just fine in labor got a C-section because the provider was going on a trip the next day and hadn't packed yet! BLOOD BOILING!!!! I am sorry about your niece. I am glad she stands up for herself. Not many people do when faced with doctors in a hospital.

[Mama Geek]

I loved, loved, loved the OB that delivered dd. He was very blunt, worked whenever he was needed, very scientifically minded and had a nursing staff that were pro non intervention, pro breast feeding etc. He worked with one of his nurses while doing his residency and learned a lot from her. The guy loved kids, I don't think he was married or had a family of his own. If I were to get pregnant again I would go through great lengths to make sure he would be my OB again. After laboring all day without interventions, when he said the baby's heart rate was dropping way too low when pushing and that I needed a c-section it was give me the paper and I will sign, what ever you say sir. I trusted him completely before walking into the hospital in labor and so did dh.

 

Pediatricians on the other hand have been much harder to find that are good like he is.

[Chris in VA]

Just wanted to say that my insurance won't pay a cent if we check out of the hospital AMA. Not.a.cent.

[Moxie]

 

There are studies that compare elective C-sections with vaginal birth, that show that the elective c=sections have a much higher death rate for the mother, and higher issues for the baby as well. So even when you take out the emergency c-sections, and the ones for medical reason, the difference is still there. And really, the biggest stats aren't about the baby, the are about the mother. The mother has a 3-4 times higher mortality rate...which just goes to show that major abdominal surgery has risks.

 

 

IMO, saying things like this is no different then an OB playing the "dead baby" card. All scare tactics. Even with a 4x higher mortality rate, death during a c-section is very, very rare.

[Moxie]

Unfortunately, I see this every day! That is why I am going to grad school to become a Certified Nurse Midwife. I sent my final paperwork in after my patient that was progressing just fine in labor got a C-section because the provider was going on a trip the next day and hadn't packed yet! BLOOD BOILING!!!! I am sorry about your niece. I am glad she stands up for herself. Not many people do when faced with doctors in a hospital.

 

 

This makes no sense to me. I've had long labors. I've had one doctor sign-off and another sign-on. Is this some backwoods hick hospital??? Why didn't the mother protest?

[msjones]

 

I find this idea troubling. Unnecessary by whose decision? Many medical interventions only can be truly deemed unnecessary or necessary after the fact.

 

Let me give you a scenario that comes up in my office at least once a winter. A newborn infant comes in, let’s say 2 weeks old. The baby has congestion, a slight cough and tests positive for RSV (we have the test in our office). It’s day 3 of illness. The infant is breathing fast (50 times a minute, instead of the average of 30-40 at that age) but doesn’t have an oxygen requirement and is feeding ok. Not great, but adequate, having ok wet diapers. However, you as the pediatrician know that RSV typically gets worse around day 4 before it gets better. You also know that in very young infants RSV can cause apnea, potentially life-threatening. Most of the time it doesn’t, but it can.

 

Do you admit the baby for observation? Send them home?

 

Let’s say you admit. The baby does well, never needs oxygen and feeds fine on it’s own. You discharge them after 24-36 hours in the hospital. Harm done? Well, parents probably lost work time, were stressed (if they had other kids at home even more so). Breastfeeding may have been interrupted in a hospital setting, certainly no one slept well in the hospital. Certainly a cost to insurance, and depending on their insurance potentially a large cost to them financially. Unnecessary? It certainly seems like it. Perhaps there should be consequences. A fine? Some kind of professional censure? Prison time?

 

Let’s say you don’t admit. The parents go home and put the baby to bed. Later that evening they go in to check on the baby and discover that the baby is cyanotic, having had an apneic episode which led to bradycardia. They call 911 and perform CPR. The baby is rushed to the hospital, taken to the ICU, ventilated. He ultimately recovers after a 4 week hospital stay including 2 weeks in the ICU on a ventilator. Harm done? Certainly much more stressful to the parents and potentially life threatening. Long term complications from hypoxia are likely (learning disorders, CP, hearing loss). Much bigger financial cost to everyone involved. Consequences? The parents would likely be able to find a lawyer to sue you for malpractice.

 

****

The reality is that it’s virtually impossible to tell with a 2 week old which way he is going to go. The second is much much less likely but also much much less desirable. You might argue that the you could base “unecessary†on standard practices but in a lot of cases, especially with neonates there is a certain amount of gut reaction/art to medicine. There are algorithms but we all base our decisions on a lot of other factors. In the above scenario I might take into account the parents (are they first time parents, do they have experience with sick kids, do they seem exhausted and to need a break).

 

You could argue that it has to be about intent? Did I know that it was unnecessary at the time or did I have a reasonable suspicion that the interventions might be necessary? Ok...well what if in the above scenario I changed it to say that you are seeing the baby at 9 am. I could have seen the baby back in the afternoon to follow up and see how they are doing instead of admitting them for observation. You find out later that that day I happened to be leaving for vacation at 3 pm and was in a hurry to get out of the office....Does that change things? Did I admit the baby only so I could get out of the office and out of town? How can you prove that? Maybe it’s just a coincidence that I’m going on vacation.

 

Ok...well maybe it’s “unnecessary†if I financially gain from it. (And I do think this is a good reason doctors shouldn’t profit from any kind of lab or radiological procedures.) Well, if my practice rounds on hospital patients I’m indirectly profiting from the admission as we’ll get paid for seeing the baby in the hospital. Is that why I admitted them?

 

You might also argue that my scenario is meaningless because you are talking about labor and delivery. Well, how are you going to say that one particular area of medicine can have consequences for “unnecessary†interventions but not extend that to other areas of medicine?

 

I always wade into these kind of threads with some trepidation, but I mostly wanted to just respond to the above idea. However, I have one other thought...

 

-In general I find this board to be a pretty anti-mainstream medicine place. That’s fine and for many people they have good reasons for that opinion. However, it’s never helpful to say things like “I believe that Obs and maternity nurses prey on mothers and babies" or to depict maternity nurses and neonatologists as wanting to “snatch babies†away. I may not be quoting exactly because I forgot to use multi-quote but I think I’m pretty close. I’ll give you that some OBs are power hunger, paternalistic, creatures who only want money and to fit in as many C-sections as possible before their next golf game. I’ll give you that some nurses are lazy and would rather sit and chat on break than get up to bring a baby to it’s mom. I’ll even give you that some pediatricians are arrogant jerks who think all moms are idiots. I’m aware that some of you have unfortunately only encountered these kinds of medical professionals. However, you also need to admit that some doctors love medicine and carrying for patients and try their hardest to work with their patients. Some nurses (I’d say many) work really really hard and do everything they can to help new moms in this exciting, scary and stressful time of life. Some of those nurses (and doctors and doctors families) are on these boards. It’s good to realize that when we make sweeping generalizations about any profession.

 

 

:hurray: :hurray: :hurray:

[Joanne]

I also think malpractice is an interesting consideration in all of this. I have heard obs say that you can never be faulted for doing a c/s, but you can be faulted for allowing someone to labor. Somehow, these things need to be straightened out or we are going to wind up doing c/sections on everyone.

 

 

I've come to understand this challenge on a whole new level in the last year.

 

Edited out info.

 

Have a great weekend.

[staceyobu]

This makes no sense to me. I've had long labors. I've had one doctor sign-off and another sign-on. Is this some backwoods hick hospital??? Why didn't the mother protest?

 

I worked for years as an RN in maternal medicine.

 

County hospitals (and some private ones) have an ob who stays on the unit around the clock. Other hospitals (typically the better, private institutions where you would *want* to be a patient) have obs come in when they need to deliver someone. There isn't an ob on the floor unless they are needed. They may have a group that they take call with; however, I think they lose payment for the delivery if someone else does it. So, there is incentive for them to deliver so the don't lose money. Whoever is covering call for them also may not be happy if they leave town with someone in active labor about to deliver.

 

Why didn't the mother protest? Because doctors don't walk in the room and say "I'm sorry, I want to do a c/section because I have dinner plans I don't want to miss." They go in and say "I just don't think this is going to happen vaginally. You've been in labor a long time. It will stress the baby if we keep going." If you are a first time mom and have already been in labor for 8 hours and an obstetrician (who you trust because they are very polite and all your friends used them) tells you that you need a c/section, are you really going to refuse?

 

The nurse usually knows exactly what is going on. However, if you go behind the doctor's back and tell the patient the truth, your job is gone. And, if you are using your income to feed your children, you might not want to lose it.

 

Things can also get very ugly when mothers refuse. There have been mothers undergo forced c/sections per judges orders in no vbac hospitals. I have seen staff do what they felt was best for the baby despite what the mother was wanting.

[texasmama]

My only really bad birth experience came from an on call OB whom I had never met hurrying up my labor due to his own convenience. I'm still angry.

[Laura Corin]

My first birth was with a midwife, but that's the norm in the UK. I saw the same midwife throughout pregnancy; she was part of a team that covered the birth (fairly long labour so more than one shift) in hospital. I could have opted for home birth, but these are often cancelled due to staffing issues. It worked fine, but I didn't end up in labour with someone I knew well. I tore during labour and was subsequently stitched up by the on-call doctor. Some UK midwives are trained to stitch, some not.

 

Second birth in Hong Kong was with an OB - midwives don't deliver there. Saw the OB throughout the pregnancy, was with a midwife through most of the labour. The OB was late for the delivery - he rushed in saying that his daughter had been cornered by a wasp so he couldn't leave home. As this was Hong Kong, he would definitely have had a household helper, so I wasn't impressed by this excuse. By the time he arrived, the midwife was muttering about 'getting this baby out' even without his presence, which would have got her into trouble. When he dashed in, he said, 'Do I have time to change?' and she said 'No'. He listened to her and Hobbes was born very quickly (and safely) thereafter.

 

Laura

[ktgrok]

IMO, saying things like this is no different then an OB playing the "dead baby" card. All scare tactics. Even with a 4x higher mortality rate, death during a c-section is very, very rare.

 

 

 

I'm not trying to scare anyone. I've had a c-section myself. But when doctors are presenting it as the safer option, we need to realize that is NOT true. Obviously it is safer if there is a PROBLEM warranting a c-section, but a scheduled c-section is NOT safer than a vaginal birth for the mom. And yet, most women think that it is. I was just trying to correct that impression. I know that when I was planning my VBAC my parents were terrified, because they thought a schedule c-section was so much safer. I had to show them the published articles saying otherwise.

[Murphy101]

IMO, saying things like this is no different then an OB playing the "dead baby" card. All scare tactics. Even with a 4x higher mortality rate, death during a c-section is very, very rare.

 

I'd be willing to accept that as true.

 

However, there is absolutely no argument from either side of the debate that unnecessary cesearans are more dangerous to the mothers health even if she lives through it and can cause complications for the baby too. None.

 

Just because the mother and or baby didn't die, doesn't mean they don't suffer major problems and anytime those mothers voice that those complications could have been avoided and thus should have been avoided they are basicly told to shut up because all that matters is they and or their baby lived through it.

 

No. Their health matters too. And that's more than just staying alive. Of course, some times staying alive is the best we can do and I know that. But modern medicine should have a better litmus for quality healthcare than that. And in just about every other fist and even many second world country it does for pregnant women and I find that shameful in the states.

[Mom23Boys]

 

 

Are you in the area? Yes, that is the hospital. I know a LOT of people that are dissatisfied there. Of course I think it's because a lot of the doctors are just old-fashioned and awful. There are a couple of new docs that are getting a really good rep, and they handpick nurses so you can have a positive experience. Still, I think them treating your baby like it is actually YOUR baby is a rarity.

 

FWIW, the baby was sent to be with her once their 6 hours was up (ped on call told her they could keep the baby for observation up to 6 hours in the nursery even with no cause, and that's what they were going to do), and the baby has been perfectly FINE. He has nursed like a champ (they were able to put their foot down on the ng tube and formula). It was just a ridiculous scenario. They also kept them until the 48 hour mark to be sure the bloodwork didn't culture anything (like they couldn't have called them at home if it did - all the other cultures had been perfect).

 

As for the other hospital with the midwives, that is where my daughter delivered - WONDERFUL experience - like a home birth away from home. The midwives are wonderful.

 

Yes, I am in the area. I live about 20-30 minutes away from the new campus (depending on traffic) Pretty much everybody I know delivers there. I have a few friends who deliver with midwives and some who do homebirths. I know not one person who had a bad experience there and almost all of us breastfeed exclusively, past a year, and homeschool. Most had vaginal births. So, we aren't necessarily a go with the flow type of crowd.

 

Everyone* who had a section had a trial of labor first except 2, which were emergency situations. One of them was unconscious when she got to the hospital and delivered at under 26 weeks. I think most people who know her situation agree a section was 100% unnecessary at that time.

 

*By everyone, I mean in my circle of friends and people close enough that I know about their birth experiences. I am sure there are many people who I know who had convenience sections, statistically, there has to be. I just don't know them well enough to know, if that makes sense.

 

I have no problems recommending them to anyone. I don't disagree that there are people who are not happy with them, it is just not my personal experience.

 

BTW, one of the midwives is my cousin's wife. She is wonderful. I just love my GYN, so I am not switching. He does not deliver anymore though because he is getting older. Since I am not having any more kids, that is fine with me!

[Barb_]

I once had a disagreement with a doctor who was also the husband of my friend. He wasn't an OB but he knew OBs at his hospital actively managed labors including induction and ceseareans in order to work around vacation or dinner plans. He argued that doctors trained for many years at great expense and deserved normal, predictable working hours. They should be able to use their expertise in labor management to ensure most of their delieveries happened during business hours. He felt very strongly about this and he wasn't even an obstetrician.

 

Oh, and the hospital my husband used to work for (in a different state than the doctor above worked) has a 71% c-section rate. When I found out I was pregnant, we started planning our first homebirth.

[happyhomemaker25]

I'm dealing with some similar issues right now. Seriously sad.

 

My baby boy was born 2 weeks ago. I had a good labor/delivery with a midwife. He was born quickly and had some breathing issues due to mucus. He nursed for 30 or so minutes after birth. When he went to the nursery, he had low blood sugar and the nurse wanted to give him 10 cc of formula. I said ok. She said it was the "cure". Well, they stuck him again in an hour-still low so they gave him 10cc again. An hour later it was still low, so the ped said to supplement with 10 cc of formula every 4 hours and do checks after. I agreed(reluctantly). His numbers went up, but did not stay up when he was only taking breast milk. Then the ped said to give 1 oz every 2 hours. I said absolutely no. He was a lazy nurser already because of the formula. Unfortunately he quickly got used to having a fuller tummy and I had to "wean" him off the formula as mt milk came in. Although they were so concerned about his blood sugar in the hospital, they acted like he was fine to go home without monitoring it. The ped said the hospital was in the process of changing their policy about checking blood sugars because they were spending a lot of time "chasing labs" on healthy babies.

 

Yesterday I took baby in for a newborn check(first one out of the hospital). I mentioned the blood sugar and she said he was fine(without checking it!) But he was jaundice from breastfeeding. She sent me in for bloodwork and guess what the cure is??????? Stop breastfeeding and give formula for 24 hours!!!!!!! She said he must not be getting enough milk. Maybe I was not producing enough. I felt sure I was(this is my 6th-I have always exclusively breastfed for extended ages). I was able to pump. Although I am sore and it hurt a lot, I was able to pump 14 oz. Um, no problem with production.

 

When did the answer to all these newborn problems become formula??

 

So, I feel like had I not spent about 10 years of my life breastfeeding, I would be so discouraged and little babe would be on formula. So sad.

 

 

I've heard the "cure" for jaundice is formula as well. Whats funny is with my first baby she was jaundiced (after reading further I think it was from the high rate of pitocin I was given at the end of my labor). I instinctively knew though, that BFing more frequently was going to be the cure along with some sunshine. They were already talking about keeping her another day and I said, "Well I have an appointment with my ped. in the morning." They let us go with the promise we would see the ped. first thing. The first thing she said to me was just keep nursing and take her outside some. Also because of some swelling my milk had not come in yet. The next day it came in and by that night she was already losing most of her yellow color. I had to have her bilirubin checked one more time and it was perfectly normal.