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  #1  
November 5th, 2009, 11:19 AM
NutMeg76's Avatar Platinum Supermommy
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When women say that the OB has the mothers best interest in mind, at all times. I know there is no sane doctor that goes to work deciding to make a poor choice that puts someone at risk. I know many OBs really believe that what they do is for the best interest of the patient. But, that doesn't make it right. Just because a doctor really feels that doing an elective c-section at 37 weeks is okay because the baby is big, does not make it true.

So many times women are told to trust their doctors, to do what they say because they are the professionals. But, the problem is that if they have wrong beliefs, then they make flawed decisions. My doctor really believed I needed an epidural. So he continued to offer me one, over and over. I foudn that disresepctful, I said 'no' so drop it. There was, and rarely is a true medical neccessity for an epidural, comfort, a tired mom, yes it can help, but it usually isn't a life or death situation if there is time for an epidural, so why did he feel the need to push it on me?

Same thing with rupturing the membranes. No need for that, he could have, actually should have sent my butt home!!!! I actually wanted to go home.

So while I agree doctors don't do things with the express desire to harm people, sometimes their decisions do cause harm. No, they are not malicious, evil people trying to run us into the OR. It is more that they are deluded into to believing so many half truths that they think what they are doing is right.
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  #2  
November 5th, 2009, 01:06 PM
IAmMomMomIAm
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I'm sure many OBs would say the same thing about many of their patients. When an OB thinks a VBAC carries to great a risk, and wants to do a C-Section, they probably feel like WE'RE the misguided ones because we want to anyways.

I think a lot of doctors don't just run on "medical necessity." No, there's generally no medical need for an epidural. But there are mothers who benefit emotionally from a pain-free birth. Physically, no.. they don't need an epidural. Emotionally and mentally, maybe they do.

That doesn't apply to C-sections. I think a woman should have a right to choose, just like we have a right to refuse an epidural. I do think that part of a doctor's job is the comfort of the mother in question as well.

What if Susan wants a C-section at 38 weeks because she's tired being pregnant, and the doctor says "no way in Hades, Ma'am." Susan, desperately wanting that baby to be born, chooses to go do something risky (some kind of herb or bungee jumping or something) to induce labor on her own, and either Susan or the baby suffers as a result. It would have been much better to abide by her original wishes and just give her the C-section. I think some doctors fear what patients will do if they don't get their way - it's rare, but it happens. It's a possibility.

I'm not exactly trying to justify their actions, just trying to present a different side to the "argument" - another point of view to consider.
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  #3  
November 5th, 2009, 01:32 PM
moon~maiden's Avatar Cheryl~ birth truster
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but if a mom does that, that's HER choice, her free will. Not the docs fault.
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  #4  
November 5th, 2009, 02:07 PM
noworries
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A woman always needs to be educated and advocate for herself. While I agree that a doctor doesn't go in with the intention of doing something that is not the best for the patient, what they might think is best might not actually be the best. And like Cheryl said, it's your body and you should be educating yourself about what is best for you.
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  #5  
November 5th, 2009, 02:32 PM
stlgirl's Avatar Platinum Supermommy
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I agree that OBs are not out to get us, it isn't that they do these procedures purposefully to make women feel worse about their birth experiences, they just are stuck in a certain medical paradigm that views patients as statistics and technology as essential.
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  #6  
November 5th, 2009, 02:43 PM
IAmMomMomIAm
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I think something we all need to keep in mind is "hospital policy." A doctor can not allow a woman to VBAC if the hospital doesn't, however supportive he might be. A lot of Hospital Boards have certain circumstances where they instruct their doctors to offer certain procedures. The * hospital* doesn't want to take the risk of a women dying in child birth while trying to deliver a large baby, or while laboring after a C-section's been performed. The doctor's hands are pretty much tied in those situations. A doctor's C-section rate is usually on par with the hospital's average - there's a reason for that, and it isn't a C-section-Happy Doctor most of the time.
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  #7  
November 5th, 2009, 03:07 PM
Sk8ermaiden's Avatar Platinum Supermommy
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Well here the hospitals allow VBACs and the doctors don't. They really are just scalpel happy.

And as for bungee jumping mom, the doctor's job is to actually FULLY INFORM her of the risks of induction and (likely) Cesarean. The moms in my DDC who wanted elective inductions were told nothing but, "OK. What day would you like to come in?" If they had been informed, by their doctor, whom they trust, that induction comes with so many risks, these are what they are, and you're 70% more likely to have a c-section during/after which both you and your baby are 4 times as likely to die than from vaginal birth, how many moms would still push for it? Not many, I think.

I love my midwife. I believe she has my best interest at heart 100% of the time. I think she is a wonderful midwife and person and I count her as a friend. BUT I still research everything she says, and once in a blue moon, I come up with a different conclusion. I wish more women would take charge of their own births.
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  #8  
November 5th, 2009, 03:30 PM
rabbitranch's Avatar est. 2000
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I dunno, think that many OBs are really stuck between a rock and a hard place. I was reading an article awhile back about the c-section rates and a doctor was quoted as saying that unfortunately in today's society we as the public fully expect a 0% rate of injury and death in childbirth. There simply isn't any room for a mistake to be made. We're so sue happy that I don;t think doctors and hospitals have a whole lot of choices left. You can't sue a doctor who did everything in his power (needed or not) to keep you and your baby from being damaged, but you *can* sue for negligence. We punish doctors for treating patients like individuals, and using their own judgment, instead of relying on medical technology that is so grossly over-used. In some states, like here in FL, the cost of malpractice insurance that the OBs must obtain is so incredibly high that many OBs (mine included) have chosen not to have it, and to have a private injury compensation program instead.
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  #9  
November 5th, 2009, 03:52 PM
IAmMomMomIAm
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You know, I always here people say that "you're four times as likely to die from a C-section than for a vaginal birth." That's true, but when people say that it makes it sound like a ridiculously HUGE risk, and it's not. The total Maternal death rate is less than 20 in 100,000 mothers. Either way, the risk isn't exactly astronomical.

And as for bungee jumping mom - if she wanted to have baby out at 37 weeks, she'd probably sign up for a C-section even knowing the risks. And just because someone elects to have a C-section for XYZ reason doesn't mean they don't know the risks.

Doctor's can't just do what they want every time. They're limited by the mother and by their practice and by their hospital and by their state.

I'm sorry to rant, Ladies. It just upsets me when people imply that all OBs are scalpel-happy and only midwifes care about their patients. It also upsets me when people blame doctors for a women's choice. Getting a nose-job is JUST as dangerous as a C-section, but those women aren't judged nearly as harshly.
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  #10  
November 5th, 2009, 04:27 PM
NutMeg76's Avatar Platinum Supermommy
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Um, getting a nose job is only a risk for one person, getting induced early or having an unnecessary c-section puts mom and BABY at risk, that is why the way people look at it is different.

I personally do look at people that get plastic surgery with no medical need a little weird, it doesn't make sense to me. I also try to discourage people from getting orthopedic surgery when therapy hasn't been tried first. I don't believe in surgery unless it is a life saving (quality of life counts) procedure. I have two torn ligaments in my knee. I will never play competitive basketball again, but I can run and take my fitness test, I can play with my kids. The ortho wanted surgery, I opted for rehab after getting a second opinion. Three years later and my knee is still pain free. If I had opted for surgery I might have developed post-surgical arthritis and been in even worse pain now.

As for my reason for posting this in the first place is I get frustrated when women are told to trust their doctors. No, women should be told to educate themselves, to know the risks and to make informed decisions. But, until women are listened to and seen as capable of taking care of themselves, they will continue to be told to trust their doctors, and yes end up in bad situations that absolutely could have been avoided.

My post wasn't about the big bad OB trying to hurt people. Actually, it was in their defense. They make choices they think are good, and appropriate, and MANY of them really are not all that informed themselves. They base their assumptions on anecdotal evidence and NOT evidence based medicine. Which is why they do c-sections and induce for big babies. Guess what? That goes against the ACOG recommendations. The refuse to attempt external versions, they rupture membranes, they don't allow women the eat or drink in labor. All these things have been seen to lead to more complications, the evidence in research is out there to go against these practices. But doctors don't keep up with it all and do what they think is best. Even when presented with journal articles and facts some doctors will continue to cling to their old ways, because it is comfortable for them.

Women need to know, they have the right to know this stuff. And so to tell a first time mom or a woman who is seeking something different for herself to trust her doctor is doing her a huge disservice. If I need a c-section I will trust the OB to perform the surgery well and take care of me. When it comes to labor and delivery? Nope, I trust myself.
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  #11  
November 5th, 2009, 04:37 PM
Sk8ermaiden's Avatar Platinum Supermommy
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I have seen lots of people change their mind when presented with evidence of potential harm. Usually their response is, "I had no idea!" It is still the doctor's job to TRY to educate them. I don't care how small the overall risk is. If you are the one it happens to, that risk was too great.

And my point of view comes not only from what I have seen on here, but what I have read in endless studies, and what goes on in my city, where the average OB you meet on the street is out to get you into an OR as soon as humanly possible for their own convenience.

Oh, and FWIW, I know midwives who are this way as well. I know one who takes insane risks because she "believes in birth" SO much, and some who are just as interventave as an OB. And there are a few really great OBs around, but they are FEW - maybe 5-10 (in a city with THOUSANDS of OBs) and very hard to get in to see.


I just believe OVERALL you are much more likely to have an evidence-based birth with a midwife than an OB. Actually, I don't have to believe that - I know it from the research. If more women did the research and demanded proper care, the standard of care would change.
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Last edited by Sk8ermaiden; November 5th, 2009 at 04:43 PM.
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  #12  
November 5th, 2009, 04:42 PM
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  #13  
November 6th, 2009, 09:29 AM
IAmMomMomIAm
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The risk to the baby from C-section are pretty minimal. Sure it can be looked at like a nose job only effects the mother, but the difference isn't huge either way. Just like the difference between the risk from vaginal birth and the risk from a C-section birth aren't astronomical. It's not a a huge risk either way. But my rant was in response to Sk8ermaiden, not you, Meg.

I'm sorry for my earlier rant - the tone was uncalled for. But it really does frustrate me when people grossly overestimate the risk factors. You are not 70% more likely to have a C-section because you're induced. It's more like 10-20% tops. You ARE 4 times as likely to die from a C-section, but the risk is still minimal. People die in vaginal birth, too.

I really don't want to debate this though. Not here. Like I said, I apologize for my rant, but I refuse to over-exaggerate the risks of alternative birth plans just to convince women that mine is the right way to do things.
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  #14  
November 6th, 2009, 09:44 AM
NutMeg76's Avatar Platinum Supermommy
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I don't know the stats for induction leading to c-section, so I can't make a point about that.

The rate of fetal injury during c-section is 1.1%. In 2004 there were 1.2 million c-sections performed. That is a lot of babies that were injured by c-section. I wish I knew the rate of babies injured during vaginal birth, my guess is it would be similar in a hosptial environment and much lower in the hands of a qualified birth attendent (read mid-wife).

I still think though that the fact that a baby is 4 times more likely to die after a c-section make sme very hesitent to say that it is okay to elct to have one with no real good reason.
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  #15  
November 6th, 2009, 10:36 AM
IAmMomMomIAm
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I wasn't suggesting it's "okay" to elect to have one for no "good reason." But I think what you consider a good reason and what someone else considers a good reason could easily be two different things.

"Baby's too big" doesn't seem like a good reason to us, but to a woman who's friends all had 6lbs babies, a nine pound baby seems enormous and scary.

And as for the doctor, if the woman is afraid on her own to vaginally deliver a baby that she perceives as terrifyingly large, then it's better to give her the C-section, otherwise when she does goes into labor she's going to be completely terrified. If she doesn't think she can do it, she's not going to do it. She'll spend the better part of her labor begging for a C-section, and it of course has been proven that a C-section "from scratch" is healthier for mom and baby than a C-section after labor has started.

If the doctor makes an off-hand, flippant comment of "8 lbs 6 oz? Woo, big boy!" it could open an entirely unintended can of worms. He didn't MEAN to scare the holy crap out of mom, but he did.

I'm not trying to justify non-medically necessary C-sections. I don't really agree with them any more than you do. But there's always two sides to a story, and sometimes we don't know the other side. In the scenario posted above - you're right. The doctor is kind of stuck, and pretty much has a do a C-section.

For that matter, I think a breech presentation is enough reason to schedule a C-section, but I'm sure some mothers would suggest I just find a midwife to deliver the breech baby vaginally.

By the way, the MOM is 4 times as likely to die, not the baby.

I still don't understand (and somewhat resent) the implication that mid-wifes are more skilled than OBs.
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  #16  
November 6th, 2009, 10:48 AM
NutMeg76's Avatar Platinum Supermommy
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Midwives, well trained midwives, are better at physiological birth than OB, which is why they have a better track record in and out of hospital.

Are all midwives better? No, but honest to goodness 'real' midwives are better at vaginal delivery than OBs. This is not a dig against OBs at all. It is just that OBs are trained to deal with the pregnancy in a medical mindset, so they tend to look at the birth process differently. Most OBs go into the business because they want to be surgeons, not because they want to help a mother deliver her baby vaginally. Most OBs don't care to labor sit, whereas midwives revel in it. It is just a difference in their point of view.

As for the 4 times more likely, I got the number wrong for infant death, it is actually 3 times more likely, but still that is a pretty significant number. CDC Says Cesarean Triples Neonatal Death Risk - Associated Content - associatedcontent.com
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  #17  
November 6th, 2009, 11:50 AM
Sk8ermaiden's Avatar Platinum Supermommy
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I apologize profusely. It is not 70%, it is 50% more likely to have a Cesarean than a mom who is not induced. HUGE. Nowhere near 10-20% (and FTR, every single women I know in real life who was induced had a Cesarean.) I don't just make up numbers to scare people. I have been heavily researching birth for years, reading the peer-reviewed studies for myself.
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  #18  
November 6th, 2009, 12:04 PM
IAmMomMomIAm
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Quote:
Most OBs go into the business because they want to be surgeons, not because they want to help a mother deliver her baby vaginally. Most OBs don't care to labor sit, whereas midwives revel in it. It is just a difference in their point of view.
I disagree with the word "most." SOME, yes. I don't think it's most.

I don't know a single woman in real life that had a C-section because she was induced.

Henci Goer: Articles: Elective Induction of Labor <-- check out the chart at the bottom.
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  #19  
November 6th, 2009, 12:08 PM
Sk8ermaiden's Avatar Platinum Supermommy
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I am sorry you came back before me. I was going to remove my post. This is the one board that I get to come to where I don't have to debate the FACT that natural birth is safest and that the sate of birth in the US is DEPLORABLE. While I love birth and talking about birth, I have no desire to have to defend natural birth HERE. I expect it in DDC, but not the natural childbirth forum. I have to get outie because my blood pressure is rising.
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  #20  
November 6th, 2009, 12:44 PM
moon~maiden's Avatar Cheryl~ birth truster
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about a month ago there was this story all over the internet about the baby whose face was cut during the section, I can't tell you how many women in my playroom said they didn't even know that was a possibility. Really? I would say that most of the women who get sections or epidurals do not know all the risks. There is a great post by a L&D nurse on her blog ranting about women not knowing the risks involved with the epidurals they plead for. It's posted in the info subforum.
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