Wednesday, September 24, 2008

Reactions to the Caesarean series

The publication of our series on the rising Caesarean rates in Columbus and across the nation has launched an interesting conversation.

First, I learned from Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, that on the same day the story about VBACs ran, another Columbus mother had a successful VBAC birth with Dr. Jospeh Tate in Atlanta. She wrote: “One of the Columbus moms who was pregnant at the time of your article gave birth today with Dr Tate in Atlanta - a successful VBAC after THREE cesareans, 10 lb 2 oz baby!!”

I’ve enjoyed reading about the insights and experiences on this subject of everyone from doctors and mothers to husbands and fathers – both in comments left on the Ledger-Enquirer Web site and in e-mails I’ve received. I’m going to share excerpts from a few of those e-mails that haven’t yet been posted online. And I hope more of you will join the conversation – either with a comment here or after one of the online stories, or by posting your own birth story under “forums” on the mom2mom site.

First, though I have an important clarification to make. Val Staples, the Opelika doula interviewed for one of the Sunday stories, has not only attended hospital births as the story suggested (due to my miscommunication with Val). All of the VBACs she attended were hospital births, but she said 8 to 10 of the 85 total births she has attended were home births – and she herself birthed her last three children at home. It’s an important clarification to make, since Val found herself disagreeing with Dr. Joseph Eikelberry and Dr. Joseph Tate, who both mentioned their opposition to home birth in the story.

In an e-mail Val offered this rebuttal:

I believe that home birth is a safe choice for a majority of expectant mothers. It has only been within the last centuries that birth has become a hospitalized event. And maybe if the United States could boast superior health statistics as a result of our highly technologically-influenced interventions, I would agree that everyone should birth in the hospital, but we just can’t. There are women who have educated themselves and have come to the conclusion that home birth is the choice for them, and I think that we should be able to do so legally.

Val also sent me a copy of a letter she wrote to Dr. Phil, who is soliciting home birth “regret” stories on his website for a future show. Here are a few excerpts from her letter:

Dear Dr. Phil,

I know you are soliciting home birth horror stories, but I REALLY hope that you are planning to present a balanced view…

Terrible things can happen at ANY birth -- regardless of the location. But the majority of home births are wonderful experiences for the mother and her baby.
I birthed in the hospital, and after the abuse I received at the hands of hospital staff, I decided to birth my last three children at home. I had no complications, and I am very happy with my experience.

Home birth is not a choice for everyone for many reasons. Midwives are trained to carefully screen their patients and refer them to a specialist if there are reasons that home birth is not a safe choice for them.

If you want drama, maybe you should investigate how certain states are refusing to allow couples to have a safe home birth with a midwife if that is their choice. People are crossing state lines to be able to have the kind of birth environment they want because these states are trying to stop home birth….

Another interesting e-mail came from Terri Allen, who told her story of having a VBAC some 25 years ago with Dr. Thomas Malone (a doctor featured in the story because he continues to offer VBAC in Columbus). She wrote:

I read your article today in the Ledger-Enquirer regarding VBAC with great interest as I was in the position of making a decision regarding that option in l983. My first delivery in 1981 was a C-Section. It was necessary due to placenta previa and breech positioning of my baby. My OB recommended I consider VBAC for any future deliveries.

In 1983 I found myself once again expecting a baby. We had relocated to Columbus, Georgia, and I began the process of not just locating a new OB, but trying for one who would consider VBAC. I opened the phone book yellow pages and began calling and asking right off the bat whether the doctor would consider VBAC. The response was "absolutely not" and pretty much communicated incredulity that I would even ask. I finally landed on Dr. Thomas Malone. Thank God! Dr. Malone reviewed my medical history, my previous pregnancy and delivery records and agreed that I was a good candidate for VBAC. He furnished my husband and I with medical journal articles and other information that related to the pros and cons of VBAC. He did not try to push one way or the other and made sure we knew of the potential risks.

There was no question to my husband and I that we would attempt this "controversial" delivery option. I am happy to say it was a good decision. I went into labor (all back labor) shortly after midnight and delivered a beautiful baby girl at 8:30 a.m. I used no anesthesia, went home in 2 days and recovered quickly.

I appreciate so much that this doctor was willing to step out on a limb for us. We had no medical insurance at the time so he also took the risk of us having to pay him in installments should the need for a C-Section have occurred. Obviously, he and his son are still leading edge OB's and I applaud their continued concern for the best interest of the mothers in their care.

Finally, Dr. Frank Saucier wrote in to offer his personal experience with VBAC and some insights into the state of maternity care through a doctor’s lens:

I am a local FP trained physician who formerly delivered babies including doing C-sections. Our first child had significant failure to progress (including failed forceps & vacuum) due to his hard-headedness--he would not mold. We then had 3 other very healthy children via VBAC at TMC by Dr David Roberts (who is no longer in Columbus). It was years ago when malpractice was common but still much less common than now. Plus, we knew David personally, he knew us well, and we all knew that he would do his best, and that whatever the outcome, we would not sue.We lived in China for 7 years, and I delivered several expat children there because I was the only doctor they trusted. Since China has a "one child policy", their C-section rate was about 55%--obviously only first deliveries since no second child means no VBAC. They did this because "parents only get one child, and if something goes wrong during delivery, we are responsible for that child's infirmity". (This is their thinking, not a direct quote.)

This point leads into a letter to the editor I wrote today which might be published:

Regarding the explosion of C-sections in the US, it is quite simple to understand why, and the reasons are the same as those which raise the overall cost of healthcare.

1. Expectations. The US population now has an expectation that healthcare is a right; that we should have perfect health with no pain at all times; that medicine is an exact science with definite, objective, clear-cut solutions & cures; that “I can do whatever I want to my body”, and the doctor has to fix it. In reality, of course, medicine is an art based on science and statistics, and the best doctors know how to best play the statistics based on their experience and skill. Even the best doctors make mistakes, and even in the best circumstances without mistakes, bad outcomes occur unexpectedly.

When healthcare, including a laboring mother, does not clearly go “perfectly”, the patient often loses all sense of reality and risk and wants the most secure/lowest risk plan followed. While doctors often know that patient fears are not sound, perhaps even downright unreasonable, if something goes wrong, it leads to problem #2.

2. Legal liability. We have far too many lawyers in this country needing to make a living, and they, with good reason, want to find work to feed their family. Some will find any way they can, even by immoral means, to file a lawsuit they know is not malpractice but that will likely generate income. This happens every day and creates realistic fear among doctors, especially obstetricians whose patients can have life-long infirmities from a bad outcome. Should a patient with a bad outcome be even slightly upset with the doctor, a lawsuit is much more likely; this greatly influences a doctor’s decisions, thus increasing the level of care and cost of medicine.

He adds more in his e-mail to me:

I now work in the emergency department at The Medical Center, and we take care of everything that comes in--we have to as law tells us we must care for people without regard for payment. …

Everyday I see the attitudes: You must take care of me and do what I want because I am the patient and the patient is always right…. We see the above expectation that they are owed everything to get healthy, even if they smoke, drink too much, eat too much, don't take their medicines or follow doctor's orders--it is their right!

We will only get out of this mess--high healthcare costs and everything else--when we get common sense back in play, when folks realize that we live in an imperfect world, and that pain and disease happen; when we get real legal reform and a loser-pays system. When folks have realistic choices of health insurance options---everyone doesn't need a Ferrari of health insurance--most do fine with a Ford or Chevy...

And that’s just a few perspectives among many. Go here and here to read many more comments about the stories that ran Sunday and Monday – and join the conversation if you like.

1 comment:

Mitchell Clan said...

The shocking thing about the story, imo, is how when asking people why there are more cesareans you often get the reply "well, because of liabiility". Where else in the world does a physician get to cut people open, cause permanent damage to the mother's body and increase her and the baby's risks, all justified because it saves the doctor from being sued? We have stated for years in every newspaper in America that it's OK for doctors to do this in the name of liability. It's ok for them to do elective cesareans that lead to mother's deaths because she might have had a "big baby". It's ok for doctors to do inductions without medical indication (and 41 weeks (assumed)of pregnancy is NOT a medical indication for induction, neither is 40 weeks, 2 days) leading to a cesarean that will follow that mother and baby for life, with adhesions, future cesareans, infertility, asthma...
These are all OK because we said that liability was MORE IMPORTANT of a risk to the doctors than the lives and quality of living of women. We've stated this so many times, we actually believe it's real. We as a society accept and believe that morally it's ok to do these things and we've instituted it as NORMAL AND ROUTINE CARE and sold it to women as their rights and options!