Pro-life nurse sued for removing IUD without patient’s consent

Here is the court document, which is pretty short and to the point: a woman went into a facility to have an adjustment made to her IUD, and the nurse practitioner “accidentally” pulled out the IUD.

As that happened, Defendant Olona stated “Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.” She then explained, “I cut the string than went back and gently pulled and out it came. It must have not been in properly.” Olona then stated, “having the IUD come out was a good thing.” She asked Ms. Van Patten if she wanted to hear her “take” on the situation. Without receiving a response, Defendant Olona stated, “I personally do not like IUDs. I feel they are a type of abortion. I don’t know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.” Defendant Olona stated, “Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it’s not true, they accidentally come out when I tug.”

As much as I agree with the NP’s beliefs — that IUDs are abortifacient and that Mirena (the IUD in question, which has a hormone to prevent ovulation) may not always prevent ovulation, so may also be abortifacient — I cannot agree with what she did.

Assuming that what is in the court document is true, if this NP always “accidentally” pulls out IUDs when she tugs, then she needs at the minimum better training in how to properly place or maintain them. If she is against IUDs, she needs to be in another branch of the profession so she won’t have to deal with them, or have other measures in place to assure that she won’t be called on to violate her conscience by properly maintaining an abortive device. If she thought the woman was ignorant of the possible abortifacient qualities of Mirena, then she can educate her with the IUD intact, and then remove it if the woman wants it. And if the woman doesn’t want it removed, then the NP can remove herself from the room and get someone else to serve the woman.

Now, onto what I think is even more important, and that is the Civil Battery charge against the NP:

27. Defendant Olona intentionally removed the IUD without Ms. Van Patten’s consent to do so.
28. Defendant Olona’s conduct fell below the standard of care in the medical industry, which requires consent by the patient prior to conducting any procedures.
29. Defendant Olona’s conduct and actions constituted a civil battery upon Ms. Van Patten.
30. The intentional removal of the IUD proximately caused Ms. Van Patten damages and injuries.
31. Defendant Olona’s actions arose out of the negligence in the performance of medical treatment.
32. Defendant Olona’s actions were intentional, malicious, willful, and wanton.
WHEREFORE, Plaintiff requests compensatory damages against Defendant, including loss of consortium for her and her husband, Peter Van Patten, together with all costs and attorneys’ fees.

I would like to see something of this sort brought against every birth attendant who performs “any procedure” without “consent by the patient” — especially ones that cause unnecessary pain, bleeding, or “loss of consortium” (the woman can’t or won’t have sex). If removal of an IUD (which causes a little bleeding and menstrual-like cramps; and led this couple to abstain from sex for fear of pregnancy) without a woman’s consent constitutes battery worthy of a lawsuit that will compensate for the pain and loss of sex, how much more justified is a lawsuit because a woman’s vagina is cut against her will (episiotomy), or she is coerced or threatened into or given a C-section against her will? I’ve never had any of these — IUD removal, episiotomy, or a C-section — but I daresay the pain and loss of consortium caused by intentional cutting into a woman’s vagina or abdomen is a great deal more than that which is caused by the unwanted removal of an IUD.

This is not to minimize what this woman went through. Just to say that the comparatively small amount of pain and bleeding and lack of sex (either two weeks until the DepoProvera shot became effective, or 4 weeks until she got another IUD implanted — the court document says both, but only one can be true) is nothing compared to the amount of pain and loss of sex caused by an unnecessary episiotomy or C-section. When 73% of women whose vaginas were cut during birth were not given a choice about it (Listening to Mothers Survey – II, p. 19), then something needs to change. If enough lawsuits are filed on behalf of these women and their husbands and their babies due to the unnecessary and possibly “intentional, malicious, willful and wanton” use and overuse of unwanted interventions, then birth as we know it may change.


Inductions and Deductions

It’s almost the more-or-less official start of tax season — most if not all tax-related information must be given to wage-earners by Jan. 31, so that they can compute their taxes owed by April 15. Oh, yeah, I’m doing the happy dance. Not!

There are probably numerous inductions and C-sections performed in the last few days of December. Why? Tax deductions, of course! The way our tax system is set up, children are deductions (regardless of how little money they actually cost the parents) while fetuses are not (regardless of how expensive they are — prenatal visits, ultrasounds, quad-screen tests, etc.). So, babies who are born at 11:59 on Dec. 31 get their parents a tax deduction for the whole year of 2008, while those born at 12:01 on Jan. 1 only start their tax-deductible status the following year, 2009.

I’m sure many people say, “Why not?” Of course, there are numerous medical reasons why not to choose a medically unnecessary procedure, summed up in the following statement: if it’s not necessary, then it introduces unnecessary medical risks for no medical benefit whatsoever.

But I wonder how much money people actually save by forcing their babies to be born prematurely. (I use that term deliberately — they may not be “pre-term” but since they haven’t signaled full maturity by starting the labor process, who is to say that they are actually mature?)

I’m no CPA, but from what I can gather about current tax rules, most people will get a $500 tax credit for a child (this means that after everything is figured out, you take the total amount of taxes owed and subtract $500); and each dependent also garners the tax-payer a $3500 exemption for taxes (which means that if a man with a wife and two children earned $35,000 in 2008, he gets to subtract $3500 x 4 or $14,000 from his income, so instead of paying taxes on $35,000, he pays taxes on $21,000; so to make it simple, we’ll pretend that the federal government only wants to take 10% of the money you earned, so reducing your income by $3,500 reduces the amount of taxes you’d pay by $350). There may be other reductions in the amount of taxes paid; but then again, many people will earn too much to qualify for some of these deductions and credits, so their effective “savings” by having their babies unnecessarily early may be more or less.

So, what’s the big deal? Baby is born a few days before he’s totally ready — most likely everything will be okay, and we get a neat tax deduction — yippee!

Not so fast. As I said before, unnecessary medical procedures introduce medical risk for no benefit. Most likely everything will be okay, but a certain percentage of mothers and/or babies will be harmed or put at risk. Increased medical risks tend to cost more. Many people’s health insurance is set up so that they pay a percentage of the costs. So, every added “thing” (whether it’s the medication, extra hospital stay for mother or baby, infection, epidural made necessary by painful pitocin-contractions, C-section due to failed induction) will cost the mother probably 20% of the total cost of the entire bill. Now, if you don’t have any insurance, you’ll pay all of the added costs yourself. Now your “big” tax deduction may not seem quite so big. While many people have met their health insurance deductibles (if they have them) by the end of the year, some people have multiple deductibles for multiple types of health care, and may be surprised by how much they end up paying for their “insured” pregnancy and birth — for instance, there may be one deductible for obstetrician visits; another for medical tests including ultrasound; if other doctors are called in to consult (say for heart problems), you may have a separate deductible for that; and then another deductible for the hospital charges; and yet another for the use of the anesthesiologist. Even if you only pay a percentage, those costs add up.

Friends of mine had to pay 20% of a $25,000 total bill (all doctor’s and hospital charges) for their baby’s birth by necessary C-section, or $5,000. While I daresay that most births don’t cost the parents that much out-of-pocket, understanding that some births might end up being that much — especially if a C-section is performed, or if the baby ends up in the NICU with breathing problems — just might put a damper on some enthusiastic penny-pinchers who might be tempted to have an induction to create a tax deduction for the year.

One final note — here’s the kicker — if the baby is born at the end of the year and does create a tax deduction for that year, current tax law states that children who are 17 or above at the end of the year do not qualify their parents for a tax deduction for them for that year. So by gaining a tax deduction this year, you lose it some 17 years in the future. So it ends up being six of one and a half dozen of the other — unless, of course, you or your baby lose the statistical game and end up with a medical problem caused by an unnecessary induction or C-section. At which point money becomes more or less irrelevant.

The Big Push for Midwives

Here is the main website for “The Big Push“; and here is a good summary article of the future that midwives and midwifery face. If you’re on FaceBook, you can “join the cause” and “join the cause” from The Big Push website. [And if you have FaceBook, you can also become a fan of Permission to Mother, by Dr. Denise Punger. If you like attachment parenting, cloth diapering, breastfeeding, etc., this will be right up your alley.]

In the article, some of the interesting factoids are that currently exactly half of the states have legalized Certified Professional Midwives (the main midwives that home births; although some CNMs do, and probably many more would except they would lose their bread-and-butter hospital positions if they did [and I’m not blaming them for doing so — I understand they need to eat, too!]), with a few states having upcoming legislation that if passed would legalize CPMs in those states. North Carolina, Idaho, and Illinois all have measures that may be brought up — and the latter two have altered previously failed bills to change wording so that organizations that previously opposed the measures now approve them or at least have dropped their opposition.

One problem is that many times CNMs and their organizations stand opposed to CPMs and legalizing CPMs. This article shows it, by a statement by ACNM President Melissa Avery, in speaking for her organization, which agrees that home birth should be allowed, but only if attended by CNMs or someone with equivalent training.

Recently on another blog, a CNM bemoaned the lack of unity among midwives, and said that many home-birthers view CNMs as “the enemy” or “medwives” unless they personally attend home-births. I responded, asking for her further thoughts on the statement, which she gave here. She says that if a woman came to her wishing to change care to a home-birthing CPM, she would be personally supportive of it. [“May her tribe increase!”]

Still, in view of the statement by the ACNM president, as well as the opposition from other CNMs or nursing groups I’ve heard of when CPM legislation is up in some states (which this article mentions as well), it is not surprising that many if not most home-birthing advocates view CNMs as supportive only of hospital birth and/or nurse-midwife only attended home birth.

I, too, wish for more unity among midwives and midwifery advocates. Here’s hoping!

“Born Free,” a doctoral thesis

When you see “doctoral thesis” or “doctoral dissertation,” does it almost make your eyes glaze over, expecting long words like dieythylhydroxychlorothiazide? This one shouldn’t! Written by Rixa of “The True Face of Birth” (now “Stand and Deliver”) to complete her doctoral degree, it doesn’t contain 15-syllable words like one might fear, but is written in her clear and concise style. Although it is long (368 pdf pages), a lot of it is introductory material (you know those stupid title pages that take 3 sheets of paper with 5 words apiece) and the bibliography; and it is typed, double-spaced with 1&1/2″ margins, so it’s really not as long as it seems. And it is chock-full of information.

Rixa (or I suppose I should call her Dr. Freeze, since that is her name), 🙂 had her first child unassisted, and has been a midwife assistant for both a CNM and a CPM. This paper delves into primarily unassisted birth — that is, a woman who intentionally gives birth without a midwife present — but also presents it in the background of the history of obstetrics and midwifery, discussing “Twilight Sleep”, Lamaze, the Bradley Method, etc.

Whether you’re deeply interested in unassisted birth, slightly interested, or even not interested at all (but are still a birth junkie), I think you’ll enjoy reading this paper. Even if you think UCers are crazy, at the least you’ll get a bit of understanding about who they are and why they choose to give birth without a midwife.

I’ll be blogging more about this as I read through it, so stay tuned!

Compare and Contrast

This blogger had a CNM practice for her prenatal care in her first birth at the hospital which ended in a C-section. For her second birth, she chose a home-birthing midwife (although she doesn’t specify this one’s credentials). The difference between the two is remarkable, and she writes of it eloquently:

When women refer to hospital maternity wards as an assembly line, or to themselves as lab rats, it’s not necessarily to slam hospital maternity care and those who provide it. It’s because that’s what it genuinely feels like. You’re just another face in the crowd, and treated as such. But my home midwives understood that each woman is different, and each pregnancy, birth, and baby that woman has will be different, so they must be cared for as the unique specimens they are.

And in this post, she writes of the subjective nature of birth and perceptions. She was perturbed that some people she knew had a good experience with the same hospital-based midwives that she felt gave her a bad experience, and wondered why. Then she figured out the answer — the details of the friend’s birth were similar (same stupid no-food, no-drink, monitoring, pitocin, unwanted offering of epidural, etc.) — but the friend didn’t seem disturbed by it. But she herself was. Beauty, and birth, are in the eye of the beholder!

h/t to Rixa and Angela

Contribute to a new midwifery book

Click here to read the post with the specific questions on birth and midwives and midwifery. Here is the body of the text:

I am putting together a book proposal for a guide to choosing, working and birthing with midwives, tentatively titled as above. I’ve got an agent for this project and am currently working up a sample chapter and other materials, and the organization of which I’m a board member, Citizens for Midwifery, is the “organizational author.”

I am hoping to include useful quotes from actual women who chose to work with and birth with midwives, and I am wondering if you would consider answering the following questions as fully and specifically as possible. My plan is to pull quotes from real moms that illustrate or help explain points throughout the book: I think this will greatly add to the book’s appeal and usefulness. Your input would be greatly appreciated. Feel free to skip any questions that don’t interest you or pertain to you; I know you’re busy, so please focus on the questions you most want to answer if you don’t have time to answer the whole thing. I’d rather just get a couple quotes from you than none at all. You can simply fill this survey out and email it back to me at the address below. There is no current deadline, but sometime before May 1, 2009 would be excellent, and any surveys I get back immediately will be used for the proposal itself, which would be extremely helpful

Also, if you have friends who you think would like to participate and be quoted in the book, please feel free to forward this survey to them. I am especially interested in hearing from underrepresented moms, including moms of color, working-class moms, young moms, etc., in order to get as wide a range of voices as possible, so forwarding this survey to such women would be very helpful to me. However, please know that women will be identified only by the first name of their choosing, so all answers will be semi-anonymous or anonymous. I am not including the real names of midwives, either, so if your answer contains your midwife’s name, I will change it to something else.

So go over there and send her an email answering her questions and spreading the information and insight you gained while pregnant and giving birth to your children.

And you thought ultrasound was so good…

Well, it missed a baby. That’s right — instead of a couple having septuplets, they actually had OCTUPLETS. Born at 30 weeks, and described as “stable”. Thirty weeks is good. There is a high survival rate at this stage. My prayers go out to them.