Bet she will!

What if you found out your doctor and nurses had a bet going on as to when you’d give birth, if you’ll end up with a C-section or episiotomy, etc.? Do you think that would have some bearing on the kind of care you receive? If your doctor thinks that all first-time moms and most subsequent moms need an episiotomy, what do you think your chances are of coming through childbirth uncut? If your doctor has you marked out for a C-section, do you really think he’ll try to ensure that you will have a vaginal birth, just because that is what you wish?

No, I don’t really think that doctors and nurses really have a betting pool on their patients (although, years ago, I did hear of a Las Vegas hospital or nursing home that had to fire some of its employees, after it was discovered they were betting on when their terminal patients would die), but does it really matter whether the doctor has money riding on it or not, if he has prejudged you as needing a C-section?

This is more than just a thought-provoking post. This post was inspired by numerous posts I’ve read recently that have come together in my mind in a new way. The main “other post” I read was by a woman who feels like she was railroaded into an unnecessarean. Of course, I only have her point of view to go on, and can’t ask her doctor’s opinion. While she has some legitimate beefs with the care she received, if her perspective is correct, she did fit several risk profiles (including being overweight and having diabetes and having a 9lb+ baby — although these in and of themselves do not require a C-section), and she may have been unaware of something that happened in labor from a clinical perspective, so it is also possible that her cesarean was indeed necessary and kept her baby safe. She does not think so, and is planning a home VBAC if she gets pregnant again, because of the care, or lack thereof, she received at the hospital.

But in reading her birth story, she relates that the doctor had strongly encouraged her to choose a C-section before she went into labor, and even said that she’d end up with a C-section anyway. It didn’t matter that she wanted a vaginal birth; it didn’t matter that she wanted to give birth without any medication at all. Her doctor grudgingly allowed her to go into labor (as if he really had a choice to force her into an elective C-section), but there was a thread running through her birth story of consistent undermining of her wishes and desires to have a vaginal birth. So while I was expecting the story to end more along the lines of, “so I ended up having a vaginal birth despite my doctor,” I was not too surprised to see the doctor keep pushing a C-section, and the woman finally consenting, without any indication of a real medical reason. (Although, again, she may have been unaware of something that had happened to indicate a C-section.) The actual diagnosis given was “failure to progress,” with the explanation being that she was too fat for the baby to descend into the pelvis, and the baby was also too big to descend lower into the pelvis and dilate the cervix. Of course, I would have just suggested that she be given more time, as long as the baby’s heartbeat was fine, but that suggestion would not have been taken well. You see, the doctor had determined that she ought to have a C-section before she even went into labor. So, the doctor was ultimately proven right. Or was he?

The fact that she ended up with a C-section does not necessarily indicate that the C-section was necessary to save either her or her baby’s life or health, any more than the fact that I give my kids peanut butter and jelly sandwiches for lunch when they ask for pizza is an indication that PB&Js are necessary for them. Reading her birth story indicated to me that the doctor had made his mind up to perform a C-section on her, and he had a “don’t bother confusing me with the facts” attitude. So, no, I don’t really trust that the doctor did what was medically indicated. Rather, I think he decided that she should have a C-section, and chose every opportunity he could to force-feed her a C-section, until she finally gave in and submitted to it. That is certainly the impression she has.

The other stories are mainly L&D nurses’ stories of patients they’ve taken care of — they advocated for them to have a vaginal birth and some succeeded, while others did not. Some of the stories make my blood boil, because the doctors just don’t care. Sometimes they are knife-happy; other times they are just selfish and want to go home and stay home, and not have to be called back out to catch the baby later; and sometimes they have just marked out a woman for a C-section, and jump at the earliest opportunity to coerce her into one by telling her that her body has failed. Hearing these stories from mothers who have gone through this experience, but may miss clinical reasons that truly indicated a C-section, so feel like their C-section was unnecessary, but are wrong, is one thing; hearing these stories from experienced L&D nurses who can unequivocally say, “I know her C-section was unnecessary,” is another.

So much depends on your care provider’s philosophy! Do not underestimate how important it is to choose your midwife or doctor and birth-place wisely!!

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6 Responses

  1. When I give tours of our birthing unit, I advise the patients to ask what their individual providers C/S rate is, not the hospital’s C/S rate. There is a massive difference between providers. I feel bad for the women out there who do not have the education or experience to even ask the question. I doubt they are blog readers. How do we reach these women, who disproportionately receive C/S and vaginal C/S (aka episotomies) because they do not know enough to protest? Trust me, as a nurse on the scene we can’t exactly wrestle the scalpel from the doctors hands. Nursing can sometimes suck.

  2. So true, the attitude and beliefs of the care provider can have a huge impact on the birth!

  3. RR,

    The sad thing is, you shouldn’t have to do it, and I shouldn’t have to do it! When I took the hospital tour during my first pregnancy (in case I had to transfer from home), out of the other 5 or so couples there, NOT ONE brought a pen & paper, and almost no one asked any questions (other than things like “where is the machine for ice chips”). At the time, I was probably 2/3 of the way done with the Bradley series, and our sessions were always filled with back-and-forth, questions-and-answers by the instructor and us students, consistently talking about the evidence, our rights, what questions we needed to ask, etc. The difference between the two classes was astounding to me.

    How are we to reach women who don’t even know they are lacking vital information? I don’t know. I do what I can — talking to people I know IRL as well as blogging here, but I know it’s limited. Most women don’t know, and the don’t even know they don’t know!

    Hey, maybe along with whatever they’re teaching nowadays in sex education, they can talk about questions to ask when you’re pregnant BEFORE you go into labor. Get ’em while they’re young!🙂

  4. I still can’t wrap my head around the fact that doctors are legally required to provide the material risks/benefits/alternatives of every procedure including non-action, and are just not complying. When this legally required material is not provided, any procedure becomes assault and battery upon the mother and the baby. Nurses who are seeing these things and are not reporting them are guilty by association. This constitutes violence against women and child abuse, happens every day in droves, and has been swept under the rugs.

    One: requiring a woman to sign a blanket consent form in order to be admitted is an abuse of power and any signature obtained in this manner has been obtained under duress.

    Two: no matter how many childbirth classes a woman has attended (or not), doctors and others are still required to provide the material risks/benefits of any proposed procedure, and failure to do so is assault and battery.

    Three: any person who is witness to or participates in assault and battery should be in jail unless they come forward as a whistle-blower.

    Four: just because some are not maimed or dead does not make this behavior any less heinous.

    Five: pick up any Sheila Kitzinger birthing book, like “Freedom and Choice in Childbirth” and it becomes apparent that the same key evidence based topics, induction, epidural, lithotomy, episiotomy, cesarean, have been discouraged for over 30 years by the dates of some of her source citations. 30 years! Supposedly it takes 10 years to change clinical practice in the face of peer reviewed evidence. We have gone straight in the opposite direction despite the evidence that these practices are emotionally and physically harmful for mother and baby, and are 20 years overdue for major maternity reform.

    Six: health care providers are protected by standard of practice laws, the so called “Bolam” test, where if another practitioner will testify on their behalf that what they did was the standard of practice, then it is acceptable. Therefore, the reason that there has not been maternity reform for well nigh 30 years in the face of evidence based studies, is the fact that en masse, practitioners increased their use of dangerous procedures knowing that they would be protected by the fact that everybody else was jumping off the bridge too.

  5. PS- It really irks me to see what looks like victim-blaming in the form of “Well, she should have looked into it…” Again, healthcare practitioners are legally required to provide the material risks/benefits before any procedure, and in any field of health. To refrain from doing so is criminal and civil assault and battery, and by placing the responsibility on women to KNOW AS MUCH AS THEIR DOCTORS is to absolve abusers.

  6. OK, so I’m not really supposed to be spending more than a few minutes on this temp internet connection (I’m off all week— boooo), but the PB&J-pizza analogy just made me crack up!

    We should make a whole post of silly analogies for fun one of these days.

    Hope you and yours are well.

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