Thursday, October 11, 2012

somebody has got to pay

This is a little rant, slightly off-topic, but on a subject that is near and dear to my heart: natural childbirth.

A bit of background: my husband is an OB-GYN. I had one highly interventionist birth and two natural ones. I am not a crunchy granola type, but I read up quite a bit on natural birthing and midwifery. Therefore, I do believe that most babies can be born safely, without medical intervention or assistance and probably not even in a medical setting. Or, as my husband would paraphrase: an OB should have small hands and big behind, so that he could sit on those small hands with his behind and let the birthing commence.

However, there is a subset of women who do require medical assistance, whether in coping with prolonged labor, pushing baby out, or for obvious fetal distress. There are extremely overweight patients, diabetic, with multiple health issues, requesting an epidural and laboring on their back. Needless to say, by the time it comes to pushing, they might not be very active participants at all. They cannot flip on all fours to resolve a shoulder dystocia. There are women who are scared of the pain, so they prefer epidural and whichever drug cocktail during labor. Finally, there are clear indications for c-section. Unlike what a lot of militant midwife literature would lead one to believe, c-section was not invented in the 20th century to streamline doctors' schedule, c-section has always operated as a last resort. Till 20th century, the choice used to be between the life of the mother or the life of the baby. Nowadays, most people expect a happy ending, where everyone goes home safe and sound.

Why am I writing this now? That's because my husband is attending a birth of a woman whose baby has been in distress since 4 am. (It is 9 pm now). This woman chose to labor at home with a midwife for a VBAC. So far, so good, more power to her for trying to swim against the current, making her own choice. The problem is, the midwife did not have a doctor backing her up, so when the baby showed signs of distress, the woman was brought to the nearest hospital and they called the doctor on call, who happened to be my husband. Now, the happy ending would be a section right then and there, but the problem was, this lady wanted an epidural to cope with the pain. Epidural slows labor down. Epidural confines mother to the bed. Epidural does not allow one to walk and use gravity to bring the baby lower into the pelvis. In short, a patient with an epidural is not laboring as effectively as one without. By the time my husband got there, the woman was dilating, but the baby was high up in her pelvis, nowhere near the delivery, and showing those signs of distress for which the midwife brought her in in the first place. The other problem was, this lady was adamant about not getting a repeat c-section.

All of this dragged on the whole day. I understand that woman's perspective: nobody wants a major abdominal surgery. She probably envisioned a very different birth, and a certain amount of control over the situation. She wanted to be given a bit more time, let the things progress on their own.

But I would like all patients like this to understand the situation from our perspective (my husband's and mine):
My husband has been up and at the hospital since 4am, when the nurses called him in. He had another two c-sections scheduled today, together with a gynecological surgery. He has not been home the whole day. I have not seen him the whole day and neither did the kids. This is not a nine-to-five job, with a round of golf and martinins to take your mind off things. So we  adjusted to a very different day from the one we were supposed to have. (Not golf and martinis, but, maybe an outing to Bruster's after dinner and some help in tucking kids into bed). Now, this lady's baby has been in distress for so long, that there is a possibility that something might be wrong with it. There might be some oxygen deprivation, some developmental delays, or some other form of damage. And that's where the lawyers come swooping in. This patient did not have a previous relationship with a doctor, so, instead of thinking about how she might be responsible for any possibly bad outcome, a scapegoat will be found. A scapegoat in the form of an evil doctor, who SHOULD have done something different. By this point, all natural hopes go out the window, and it becomes a malpractice suit, because someone has got to pay.

An average obstetrician gets sued four times during his career. The lawsuits are usually brought by the patients who do not have a relationship with a doctor, the walk-ins. The insurance companies are so worried about losing a case that they often choose to settle, even if the obstetrician did nothing wrong. And it is easier to accuse an obstetrician of wrongdoing when nothing was done, than when medical procedures were performed, such as a c-section.

I am all for natural childbirth, women's education about what our bodies are meant to do and as few interventions in labor as possible. But next time someone goes on a rampage blaming obstetricians for every singe thing that went wrong, please spare me.

1 comment:

  1. While I avoided medical interventions as much as possible during my two births, I still did my L&D in a hospital. Both times I avoided the epidural and yelled it out.