Hi,

I recently gave birth in a hospital via c-section. I was administered potocin without my knowledge or consent and I feel my rights were violated. IS there any legal action I can take. I know that hospital have a time out rule that before any procedure/medicine is given to a patient they are required to explain the risks or benefits of that medical intervention. Somehow the drug got in me without my consent even after I spoke with my dr regarding this at a previous office visit that I did not want any intervention because I wanted to minimize my risks of a c-section.

Please let me know thanks

Were you or your child in any way injured from the administration of this drug?
When was the drug given; before or after your personal doctor was there?
Furthermore, did you know that they were going to induce or speed up labor?
Why did you need the c-section and was it caused by the drug to your knowledge?

I'm asking all of this because the drug is linked to increased need for c-section, but if the drug was not the cause of the need for the c-section and both you and the baby are healthy then it seems dumb to sue the hospital.
Furthermore, if your doctor wasn't there at the time and no one else but him/her knew about the wish to not have intervention, then it would also seem dumb to sue because you didn't tell the people at the hospital your own wishes, your doctor doesn't have ESP.

If on the other hand you told them NO don't give me anything then you may have a case; though how you wouldn't notice the IV that they put in your arm or the needle is beyond me :-)

If you could tell us the circumstances of the administration it may help a little more, because stuff like this have a very fine line with the law; it depends on so many factors. And I think that the law you are referring to would be in place for something larger like an actual surgery, but I'm not sure about drugs. I'll have to look it up, but it might be that they can just tell you what they want to give you.

Check this out: I have heard of women being given pitocin without their direct consent. How does this happen? - Labor and Birth - Pregnancy Today (http://www.pregnancytoday.com/expertqa/labor-and-birth/i-have-heard-of-women-being-given-pitocin-without-their-5882)

Basically any procedure performed by a doctor is done with the medical necessity in mind. Its up to the doctor to make the determination of whether the drug or procedure is necessary.

If your doctor can medically justify administering the drug, then you have no case. If they can't then you have a good case.

And you asked the doctor why you needed it and he told you what.

When you deliver a baby in today's society the first thing they do is stick a needle in you and put you on IV fluids. Then the doctor can put in pitocin through this iv. When you are in the midtst of pain and very vulnerable laying on a bed you don't notice if something else is going through your I've line. I also slept a while. So of course I did not know that he already adminitered it to me. By no means would I have consented to the drug my first child resulted in a c-section due to pitocin distress causing the heart rate to go down. This time the heart rate was also going down but I think he did the c-section because he allowed me only 5 hours to labor and then he decided that my body would not progress further. ( he gave me the pitocin just to speed things up for no reason other than its 3:00 in the morning and he is tired.I just found this out today after calling him. I want to know if I have any rights in regard to the fact that I did not want that drug in me due to my previous experience.

Do you have any proof that you informed him you didn't want it? And again, it comes down to whether he felt it was medically necessary and whether a panel of OB/Gyns would agree.

Contact an attorney familiar with malpractice suits to see if you have a case. Unless you can prove that the doctor acted imprudently with willful disregard to your wishes, I don't know if you have a case.

I understand your feelings here. But that's why we have doctors, because their medical knowledge is better than ours and they are supposed to be trained to make these decisions. I'm not saying its right, but if he can show it was a medical necessity, and especially since you don't seem to have been harmed, I can't see you winning.

Dear Fr_ chuck

Today I called my dr to please explain to me why he put the drug in me without my consent after I told him of my views before I gave birth. He said that its just regualr standard of care and he always does it and he's sorry he didn't get my consent( he probably just forgot). I told him he robbed my chance of a vaginal birth and I called him only to implore of him not to do this to any other woman and take advantage of them and try to speed up labor because they want things to go quickly. Can you imagine he only gave my body 5 hrs to dilate I was already 5 cm dilated and he didn't want to wait he felt lets just throw pitocin in and put that baby under stress because that is what the drug Does. This happened 9 months ago and I can't get over my feelings of trauma, vulnerablity and being taken advantage of. As a woman I should have some say and rights as to how my birth should go.

You can't sue the doctor if you don't have damages. What are your damages as I don't see any.

I don't want to sue for money. I want to know who I can report this to so that this does not happen to other woman

Contact the chief of OB/GYN of the hospital.

And by the way I do have damages I recently had an ectopic probably caused by adhesions that form after surgery. NOt to mention the mental agony and fertilaty problems that arise when you have scar tissue in your uterus from c-sections

Thanks I will do that

After reading this thread a few times, I'm confused as to what the question is. This is what I found on the WebMD website:

Triggering contractions. The drug Pitocin can bring on contractions to induce or move your labor along. Pitocin is an artificial form of the hormone oxytocin, which triggers and strengthens contractions. It's delivered through an intravenous (IV) tube in your arm. Your doctor will start with a small dose and will gradually increase it until your contractions are strong and frequent enough for the baby to be born.

Was there a valid reason that labor needed to be sped up? Like Scott pointed out, doctors know a lot more about our body than we do. There may have been complications that you couldn't see but your doctor did.

Also, I'm sorry for your ectopic pregnancy. However, I doubt that it was caused by having 2 c-sections performed. An ectopic pregnancy is when the egg implants itself somewhere other than the uterus; it's typically caused when one of the fallopian tubes is damaged and won't allow the egg to pass to the uterus.

and by the way i do have damages i recently had an ectopic probably caused by adhesions that form after surgery. NOt to mention the mental agony and fertilaty problems that arise when you have scar tissue in your uterus from c-sections

I have to ask... how long ago was it that you had the c-section and the baby? If its been to long you can't sue. Second, do you have any idea how many babies are born via c-section in this day in age... not that big of a deal, the health risks are way lower than they were 10years ago. However, if you had your first child with a c section then you have increased chances of needing another c-section for further children... which could be why your doctor was worried and hurried it up for you.
If you think that you had an etopic pregnancy because of the scar tissue, maybe you should see a doctor instead of assuming that that's what it is. If there is something wrong it could propably be fixed.

Just go see another doctor besides your own and get a second opinion.

DEAR THIS 8384,

ORIGINAL QUESTION was my patients rights of informed consent were violated when the dr gave me pitocin without my consent after I discussed with him the risks of pitocin.
After my previous c-section experience with the use of this drug I fully had the right of patient autonomy to consent or refuse to this method of speeding up delivery. I spoke with my dR afterwards to question why he used pitocin and he said its just his standard of care.
Under EMTALA ( emergency Medical treatment and active labor act) it requires hospitals to admit women in active labor, explain the risks, benefits, and alternatives of all proposed treatments, and to honor their treatment wishes including the right to decline treatment.

Risks of using Pitocin
Risks for Mother

Mothers using Pitocin frequently report increased pain with contractions. Most mother using Pitocin also use pain medication to handle the increased pain.

Pitocin use requires continuous monitoring to detect complications and/or progress which interferes with mobility.

Pitocin use requires an IV for administration.

Pitocin use can cause long contractions and contractions with double peaks.

Pitocin use slightly increases the possibility of a uterine rupture.

Pitocin use increases the likelihood of a fetal malpresentation or malposition.

Pitocin use is associated with an increased need for cesarean surgery for distocia and fetal distress.

Risks for Baby

Pitocin use increases the likelihood of depressed fetal heart rate patterns.

Pitocin use increases the chances of Fetal Distress due to decreased oxygen availability.

There are increased risks to your baby if you have a cesarean surgery

After educating myself about the possible risks of pitocin I have the right to decline this
Active method of induction and I was robbed of my right to birth naturally since nobod bothered to get my consent.
Also regarding ectopic till today the medical field is uncertain as to why they happen but they do list risk factors that increase your chances and adhesions (scar tissue) from previous pelvic surgary(c-section) can be a cause.
Pelvic scar tissue (pelvic adhesions), can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy.

To learn more about the effects of pitocin during labor you can visit the Ican WEbsite
International Cesarean Awareness Network (http://www.ican-online.org/)

Thanks for taking the time out to reply to me.

Rikki

I understand that you're upset; that's completely fine - it's your body and you are entitled to do what you want with it.

Was your doctor aware that you didn't want pitocin? Before I delivered, I typed up an entire list of what I did and didn't want during the birth of my daughter, using the outline from the What To Expect When You're Expecting book. It addressed multiple issues, including yours - administration of drugs. If he wasn't aware, then he may not have seen a problem with it as this is a commonly used drug. And as with any drug, there are side effects. The pitocin may or may not have caused a need for your second Cesarean; there's really no way to tell. As Gernald pointed out, your 1st Cesarean may have increased the necessity for the 2nd.

After educating myself about the possible risks of pitocin I have the right to decline this active method of induction and I was robbed of my right to birth naturally since nobod bothered to get my consent.

You are still missing the point here. Despite your decision to decline a doctor has to make a snap decision based on circumstances. If the doctor can justify his use of the drug and a medical board will uphold his decision then you have no case.

As to the ectopic, yes, the C-Section may be a contributing factor, but you have no proof that it was a causative factor.

You have to understand that if you disagree with a doctor's actions or think you were harmed by it, you have two options. Either report it to the hospital department head or the doctor's boss if he was part of a practice or sue. And to sue, you have to have proof of wrongdoing.

After educating myself about the possible risks of pitocin I have the right to decline this active method of induction and I was robbed of my right to birth naturally since nobod bothered to get my consent.

After re-reading this, I have to ask: did you know about pitocin prior to delivery or did you investigate after all was said and done? From what you typed, it sounds like you weren't aware of the drug and are upset after learning about it... but that's an assumption, which is why I'm asking.

Dear Gernald,

It is aleady nine months since my last c-section and I can't begin to tell you the mental pain and feelings of being violated that My informed consent rights were abused. If you never have gone through a c-sectio you can not comprehend the mental pain a woman goes through. After having experienced already an activley managed labor ( the use of medical interventions for unnescessary speeding up of labor with my first child for no reason except that the dr had to leave later on .
I spoke with my doctor and I informed him I wanted to labor without pitocin cause it can increase your chance of uterine rupture and it would lead to a cascade of interventions that will no doubt end with a c-section ( my baby's heart rate went down due to the pitocin)
I would have declined this standard medical intervention if they would have had the decency to let me know that they were giving it to me because it was my DR standard method of care.

I spoke with my dr numerous times during our ob visits about my views on this drug. I told him about my previous experience with pitocin and that the baby also did not tolerate the artificially induced contraction. The thing I am upset about is that every body screams patient rights but in my case when my rights of informed consent were violated nobody cares. The dr apologized to me he said its usually his standard method of care to speed up labor with pitocin ( pt comes in lets get them out as quick as possible) . But still I did not consent to having this drug run through my body and that was a gross violation of my rights which is the right of patient autonomy ( The right to exercise self-determination and autonomy in making all medical decisions, including the decision to refuse treatment).

Some women welcome the effects of this drug but I was desperatly trying to avoid another c-section and I researched a little the benefits of laboring naturally and I have the right to refuse any drug that will artificially begin my labor.

Pitocin didn't artificially begin your labor:

I have the right to refuse any drug that will artificially begin my labor
As you stated that you were already dilated to 5cm when you were given pitocin.

Can you imagine he only gave my body 5 hrs to dilate I was already 5 cm dilated
If you're dilating, then labor has already begun.

The question still remains: was there a legitimate reason to speed up your delivery? Maybe there was an issue with the your and/or the baby's health and pitocin needed to be given; I don't know for sure because I wasn't there.

Dear scott,

The wrong doing is the fact that the dr did not get informed consent from me in a non emergency situation( speeding up labor because it is standard of care).

The doctrine of informed consent/refusal is upheld by common law; case law; Constitutional law (the right to privacy and self determination protected by the 1st and 14th amendments); federal law (The Emergency Medical Treatment and Active Labor Act and The Patient Self-Determination Act); international tort law (which US courts sometimes cite); state law; state mandated medical ethics; and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). The doctrine of informed consent/refusal upheld by these laws provides all patients, pregnant or not, with certain fundamental rights:

It is aleady nine months since my last c-section and I can't begin to tell you the mental pain and feelings of being violated that My informed consent rights were abused. If you never have gone through a c-sectio you can not comprehend the mental pain a woman goes through.



You've already received lots of very good, to the point legal advice here. I see no violation of your rights. I see a Doctor making the best decision under the circumstances (which can range from your health to the baby's health to staffing problems). If you don't want "this" to happen to any other woman, then write a letter to the head of OB/GYN at that particular hospital.

I choose my Doctors based on their education, experience - expertise, if you will. I don't tell them what the best course of treatment is. They tell me. I'm not medically educated and I don't think you are, either.

What "mental pain" does a woman go through because of a c-section? If you feel like less than a woman because you didn't give birth vaginally you have more problems than simply being administered a drug you did not want or chose.

This is turning into a message board with "Dear so and so" as the heading.

The question still remains: was there a legitimate reason to speed up your delivery? Maybe there was an issue with the your and/or the baby's health and pitocin needed to be given; I don't know for sure because I wasn't there.[/QUOTE]


Yes, I was 5cm dilated and not dilating fast enough for him ( it was only 3 hours that I was there) I spoke with my dr afterwards he said that he gave me pitocin because that is his standard method of care. Pitocin is not only used to start labor its used to speed up labor if the woman is not dilating fast enough. A woman by choice can allow herself 72 hours to labor and get her cervix ready for dilation.

If My dr would have had the decency to consult with me and uphold my rights of informed consent then I would have chosen not to try to speed up my dilation with drugs and rather let my body naturally labor to decrease any extra stress on the baby(pitocin causes stress on the baby) . My dr did apologize that he did not ask me if this was the direction I wanted to go. Remember not everybody wants to speed up their labor because with medical intervention there is always a risk ex: fetal distress.e . His apoloogy is no consolation for me because he still robbed me of my right of informed consent and he took me down the path of medical interventions that I so desperatly wanted to avoid. The reason he performed the c-section Quote" I wasnt going anywhere".

If My dr would have had the decency to consult with me and uphold my rights of informed consent then I would have chosen not to try to speed up my dilation with drugs and rather let my body naturally labor to decrease any extra stress on the baby(pitocin causes stress on the baby) . My dr did apologize that he did not ask me if this was the direction I wanted to go. Remember not everybody wants to speed up their labor because with medical intervention there is always a risk ex: fetal distress.e . His apoloogy is no consolation for me becuase he still robbed me of my right of informed consent and he took me down the path of medical interventions that I so desperatly wanted to avoid. The reason he performed the c-section Quote" I wasnt going anywhere".


You are not a trained medical professional. He is. You are going to lose this argument.

You have asked additional questions, stated additional "defenses" without answering questions already asked.

This has turned into a discussion board and I think it's time to close or move to family and children.

The reason he performed the c-section Quote" I wasnt going anywhere".

I'm sorry, but that doesn't make sense whatsoever. What does "you not going anywhere" have to do with a c-section?

Also, you keep arguing that you shouldn't have been given this drug without answering the question, so I'll ask it again: was there a legitimate reason for speeding up delivery?

>Moved from Other Law<

The question here is what do YOU want? You already got an apology from the doctor. So what more do you want? If you want to sue the doctor, then consult an attorney. If you want to make sure the doctor doesn't do it again, then talk to the hospital's head of OB/Gyn.

As a labor and delivery nurse I am going to re-open this thread to clear a few things up.

Okay, what pregnancy was this for you? First? Second? etc.

What was your complaint when you went to the hospital, by this I mean were you admitted because you were in labor? How far dilated were you when you went to the hospital? What was your due date?

Pitocin is a manmade form of a naturally occurring hormone in your body called oxytocin. It is routinely used in labor and delivery and does not need a signed consent from the patient as it is non-invasive.


A woman by choice can allow herself 72 hours to labor and get her cervix ready for dilation. This is partially incorrect. If the membranes are ruptured the fetus needs to be delivered within a 24 hour time. You never, I don't think, mentioned that your water broke.

Yes, there are risks with pitocin, there are risks with labor and delivery. I don't know your pregnancy health history, but things like PIH, gestational diabetes, etc can increase the risk for ceserean section.

Again, the use of pitocin does not necessitate the need for a signed informed consent. There is risk for C-Section ANY TIME a woman is in labor.


how you wouldn't notice the IV that they put in your arm or the needle is beyond me :-)

All laboring women get an IV for fluids, usually Lactated Ringers (LR). A second needle, or IV, is not necessary for pitocin.


I'm sorry, but that doesn't make sense whatsoever. What does "you not going anywhere" have to do with a c-section?


This means that she is not dilating at the proper rate and is causing the baby to become distressed. It's called failure to progress and is a very common cause of ceserean sections.


my first child resulted in a c-section

You are very LUCKY that your doctor allowed you to even labor. VBAC's are very uncommon and very dangerous to mother and baby. Once a section, always a section is a common phrase. Why? Because once a mother has a section she is at risk for uterine rupture during the labor process, putting both the mother and child at risk. The mother will be at risk of profuse bleeding, causing something called DIC (Disseminated intravascular coagulation), which in and of itself is extremely dangerous and possibly deadly. It places the fetus at risk for hypoxia, hypovolemia, and possibly death.

Again, you are very lucky you had a doctor who at least let you try to deliver vaginally.

Things could have been worse you know. At least both you and the baby are alive.


he gave me the pitocin just to speed things up for no reason other than its 3:00 in the morning and he is tired.

I'm sorry to be the bearer of bad news. But this is not why the pitocin was given to you. The doc does not need to be present until you are dilated 10 centimeters, 100% effaced and at 0 station or even 1+ station (depending on how far he is from the hospital). I frequently PIT women when the doctor is at home sleeping and there is no need to call and wake him until labor is imminent.

In all honesty, the doctor was looking out for your best interests.

As a labor and delivery nurse I am going to re-open this thread to clear a few things up.

Pitocin is a manmade form of a naturally occurring hormone in your body called oxytocin. It is routinely used in labor and delivery and does not need a signed consent from the patient as it is non-invasive.


That's good info, and it, essentially, negates any chance of a malpractice suit.

So lets summarize the issue here. The OP was aware of the use of Pitocin and had made her doctor aware that she did not want it used. The doctor decided to overrule her request, probably in the name of medical necessity. The child was delivered and mother and child are doing OK.

So, the OP is unhappy because of this. But the question remains as to what she wants to do now.

The doctor decided to overrule her request, probably in the name of medical necessity.

He did not overrule the request out of medical necessity, rather, the OPs choice to attempt a vaginal delivery. Had the doctor been prudent, he would have scheduled her for a repeat C-Section rather than letting her labor due to the inherent risks of a VBAC delivery.

He was simply trying to satisfy her desire to have a vaginal delivery.


That's good info, and it, essentially, negates any chance of a malpractice suit.

Yes it does. If the OP had a VBAC and had suffered the negative consequences I have outlined above, she would then have a chance for malpractice. The doctor was simply looking out for the well being of the mother and the fetus.

The doctor was simply looking out for the well being of the mother and the fetus.

That was my guess, which is why I was continually asking the OP if there was a valid reason for speeding up delivery. She constantly side-stepped the question, claiming that her doctor only did so because he was impatient. I personally found that quite hard to believe, as my OB/GYN wasn't even working the day I delivered; she was going to her kid's soccer game. I had a brand-new doctor that I had never seen before deliver my daughter, so I don't see why a doctor would rush any woman into labor.

That was my guess, which is why I was continually asking the OP if there was a valid reason for speeding up delivery. She constantly side-stepped the question, claiming that her doctor only did so because he was impatient. I personally found that quite hard to believe, as my OB/GYN wasn't even working the day I delivered; she was going to her kid's soccer game. I had a brand-new doctor that I had never seen before deliver my daughter, so I don't see why a doctor would rush any woman into labor.

We don't rush anyone into labor. Pitocin is delivered at what is called milliunits per minute. If delivered too fast it is called "pit to distress" which means that we pit the mother until the baby is distressed. Do we want that? NO!! It places our licenses as nurses and doctors at risk.

Pit is increase in 15 to 30 minute increments. Slower depending on the individual. It can be turned off at any time if the fetus is in distress ( I did this twice last night).

Pitocin is on a pump, which means that it is delivered at a constant rate per hour.

We NEVER rush a woman into labor as we don't want to put that baby into the NICU.

Oh, I wasn't implying that you would; I hope it didn't come off that way! The OP seems to think that her doctor did, though. That's why I mentioned it, as well as my own experience. If the doctor was in such a hurry, as the OP implies, he could have just taken off and let another doctor deliver... I really don't believe he just wanted to get the baby out for his own personal satisfaction.

Oh, I wasn't implying that you would; I hope it didn't come off that way! The OP seems to think that her doctor did, though. That's why I mentioned it, as well as my own experience. If the doctor was in such a hurry, as the OP implies, he could have just taken off and let another doctor deliver....I really don't believe he just wanted to get the baby out for his own personal satisfaction.

No, you did not come off that way at all. I was simply trying to explain how things work in an L&D. We call the doc frequently through the night, but we don't need him/her until the baby crowning, of course depending on her Gs and Ps (meaning how many times she has been pregnant and how many living children she has).

For instance... I am a G5P4. Which means I was pregnant 5 times and have 4 living children.

IF things occurred as the OP said, and her doctor told her his use of pitocin was standard, then it very well could have been a case of his wanting to move things along.

Pitocin, and rupturing membranes, are often used to speed things up. If there was a true concern for baby's well being, a c-section would have been done in the first place. Introducing pitocin increases the possibility of distress for baby, hence the need for continuous monitoring of baby's heartrate to be sure there are no adverse effects. The use of pitocin in this case only increased the possibility of uterine rupture because of the previous c-section. VBACS are far less of a concern until pitocin gets used.
Pitocin should only be used when truly medically warranted. However, along with rupturing membranes, it is currently one of the more commonly used interventions in childbirth.

It is important to keep in mind that just because something can be done, doesn't mean that it should be done.

If nothing else, since it was not an emergency situation, the OP should have been made more aware of what was going on. It is when women feel things are just done to them in childbirth that they come away with a poor birth experience. Even when things don't go how you had hoped, being part of the decision making process and having your questions answered go a long way in helping women come away with positive feelings about the experience.

We have established that the doctor was within his medical rights. So any further discussion of that part is moot.

The only further help we can give the OP is if she explains what she wants to do now.

We have established that the doctor was within his medical rights. So any further discussion of that part is moot.

The only further help we can give the OP is if she explains what she wants to do now.

I won't revisit the issue of medical rights, however since the OP has already spoken to her doctor, and has heard his reasoning for the use of the intervention, she can file a complaint with the practice and/or with the medical board of her state. However, other than perhaps some personal satisfaction of taking some sort of action, nothing will be done is this type of situation. If, by chance, it is a managed group practice, there may be some sort of discussion about how to better handle similar situations in the future.

She can share her experience with other women so that they can be better informed about their role in their labor and birth. They should know that they have a say so in what goes on, they should be asking questions, they should have the use of interventions discussed with them, and they should be part of the decision making process.

I hope she is able to come to terms with how her birth went and find some peace in knowing that she may be able to help other women and families.

I dont want to sue for money. I want to know who i can report this to so that this does not happen to other woman

I recently saw a documentary titled*pregnant in America*.
It was very interesting and discussed your concern at some length.
It is a very eye opening expose.

I recently saw a documentary titled*pregnant in America*.
It was very interesting and discussed your concern at some length.
It is a very eye opening expose.


Patiently waiting for J_9.

I recently saw a documentary titled*pregnant in America*.
It was very interesting and discussed your concern at some length.
It is a very eye opening expose.

I have just finished watching the trailer to this "expose." As a medical professional, a mother, and a woman who has delivered a child both at the hospital and at home, I can see both sides of the coin here. While many labors are uncomplicated, there are those that pose serious risks to mother and child.

I recently saw a documentary titled*pregnant in America*.
It was very interesting and discussed your concern at some length.
It is a very eye opening expose.


Similar to The Business of Being Born.
There is certainly a time and place for all interventions, but there is no doubt they are used more than truly medically necessary. It has become so routine that it is often not questioned. However, some are starting to want to see the pendulum swing a bit back towards the other direction. If you are in the profession long enough, you see it swing back and forth in varying degrees over the years.

Be prepared for the twists and turns of my story, in the end it will all come together.

Last night was a very interesting night in my Labor and Delivery department. In between two natural deliveries (no pitocin and only stadol for pain relief) I asked the doctors I work with why we routinely use pitocin rather than going natural as we did last night. I also asked why the US has a higher C-Section rate than many other countries. The answers I got were quite interesting.

In the US it is the standard of care to increase the rate of pitocin by 2 milliunits per hour ever 30-60 minutes. In Ireland for instance, the standard of care is to increase pit by 6 milliunits per hour every 15-25 minutes. This is triple the dosage that we use in the US. Ireland's C-Section rate is approximately 10% - 12%, where ours is 25% - 30%.

If you had a choice, walk 25 miles to work or drive your car, what would you do? Well, most of us would drive our car as it is faster, correct? Pitocin helps speed delivery along, as our vehicle speeds us to our destination. In small rural hospitals, such as the one I work in (we only have 4 labor rooms) we routinely use pitocin as a means of speeding things along. It has nothing to do with money, but rather patient satisfaction and something called EMTALA (here is one article for instance Log In Problems (http://www.medscape.com/viewarticle/516438)). To get the patients who are the patients of our doctors to deliver with THEIR doctors, we must speed things along. We would not want to send them via ambulance or personal vehicle to a hospital the are not accustomed to, nor a doctor they are not familiar with, risking delivery in an ambulance or car. So, we use pitocin so that we can accommodate the needs and wishes of our patients.

Now, back to the percentages. Whether using pitocin or not, here in the US if we see multiple decels, late decels, variables, etc (signals a baby is in distress), we rush to the OR for a C-Section. Why? It is due to the litigious nature of the American society. Rarely will you see parents sue a doctor for doing a stat c-section with a bad outcome because the parents feel that the doctor did everything in his/her power to deliver a healthy baby. Now, this baby may have severe disabilities due to various reasons, yet in their minds the doc did all he/she could to save the baby.

On the other hand, if we see these decels and lollygag along for a vaginal delivery, the rate of malpractice lawsuits rise dramatically. These parents not only sue the doctor, but the nurses involved as well as the hospital. I'm sure most of you have seen commercials on television for babies born with cerebral palsy for example.

Now, we have one set of parents... They have two children... The first born with handicaps because of the hypoxia associated with prolonged labor and a vaginal delivery, the second born has no defects due to a stat section, yet the pregnancies and labors were identical. Many of those parents will sue for the first born because they felt that the doctor waited too long to make a decision whether to deliver or to "cut."

So, in the end, it is due to the litigious nature of society that we have an increased number of c-sections. Doctors trying to save lives vs malpractice suits.

Now, before you say anything, I have been on both sides of the coin. I have been a medical malpractice researcher primarily in "bad births" and I am now a labor and delivery nurse. As a medical AND legal professional I have to look to see if the standard of care was breached.

The other thing I have noticed by following this thread is the VBAC.. (Vagnial Birth After Ceserean). The OP was attempting to have a vaginal birth after a ceserean. This increases the risk of another ceserean by over 50%. This is the reason most doctors in the US will not do a VBAC... again, litigation due to complications, including but not limited to hysterectomy.

In the end, it is litigation that drives OB/GYN's to major abdominal surgery.

I agree wholeheartedly, litigation is a very big factor for the ceaserean birth rate. The problem remains, that with the increased use of intervention, such as pit, you will see an increase in the need for surgery.

Lower the use of any intervention, but in particular pit, and you will help lower the ceasarean rate to where it was years ago and to the goal for where it should be is.

It is important to not only look at the c-section rate, but also the rate of the use of pitocin and when the determination for its use is made.
It simply it not medically necessary at the rate it is currently used. Case in point... look at the decrease in intervention use and c-section rates when a doula is present. If the interventions were truly medically necessary, you would not see the reductions that you do from that one change in variables.

The vast majority of women will be able to have a successful VBAC, as was seen 10-15 years ago. Even if the OP had only a 50% change of having a VBAC, she had no chance with the repeat ceasarean. The risk of uterine rupture is quite small with a VBAC (and it is still present even with a c-section) but unfortunately litagation has scared doctors away from them... and sadly that is understandable. (malpractice insurance costs have caused some OBs to opt out altogether) The use of pit increases that risk a bit, so the OPs doctor actually put her at a slightly greater risk by introducing pit and virtually guaranteed repeat surgery.

C-section are so common place, most people don't give the risks a second thought when making decisions regarding their birth that could increase the likelihood of surgery becoming necessary. However, the risks, which are greater than in a vaginal birth in most cases, are considered expected because they are more inherent to that type of surgery. Many families are not even aware of what the risks are for different interventions in the first place so that they can make informed choices. This is why many women happily say yes to inducing or augmenting their labors or even ask for it to be done. I am often asked by women what can they do to start their labors when they hit 37 weeks.

We are currently where the climate of birth is medically managed. (unfortunately it is the same in some other countries as well... inductions with the use of pitocin or syntocin has increased in many areas in the last 10 years). As you said, J_9, a driving factor is liability, but also because it has become more common and thus, for quite awhile, went without question. That is starting to change however. A recent March of Dimes study has put OBs on alert for the increase in inductions... I know this was recently presented to physicians at the two hospitals I mostly work out of. Will it change their way of practice in some situations? That remains to be seen as we collect the data over the next year.

When medically managed, the labor process can be controlled, or regulated, and the thought is there will be fewer surprises. If things start to go down hill in the process... a ceasarean can always be done. But it is also time management... and this is why you often seen the same interventions being used to help many women along... such as rupturing membranes and using pit. Some doctors, and midwives, do still unconsciously, or perhaps even consciously, follow old Friedman's curve as a time frame for labor progression to some degree.

Long winded, sorry... stepping off my soap box, but it's my job to see families become more educated in the process of birth, what options they may have available to them, to be truly informed in all aspects of the interventions and procedures that they may encounter, and to know that they often have more say so in their birth than they realize.

The purpose is not to question their doctor's judgement, but to know what questions to ask their doctor in the first place.

Dear doula,

Thank you so much for your beautiful answer I am actually the one who was attempting the vback and I used a private dr not a group who assured me that he would help. Just to clarify I was 5cm dilated when he came in the room to break my water. After screaming and speaking with him on the phone(nine monthe later) he admitted to me that he gave me pitocin because that is his standard of care . Then I cried/yelled to him how could he have done that with out at least consulting with me or asking for my consent after I went down this road of active management of labor with my first son. Then he told me to calm down and that the pitocin was not what caused the section. He than had the audacity to tell me that my pelvic was to small. I really went ballistic because this is something a dr suspects way before you are in the delivery room and there are x-rays to take to see for sure. Then he tells me verbatim " I was going nowhere " now after my research on reading vbac books I realized he meant that I was not dilating at the DR 's norm rate of 1cm per hour. It was only 5 hours at that point and I cried to him on the phone who gave you right to decide to let me only labor for 5 hours . Woman sit for 72 hours and no one stops them if the heart rate is stable. I remember right before my c-section he told me I was fine and the baby but that we were going no where. I remember asking him to take off the epidural that was lowering my blood pressure and to stop the pitocin and let me walk around but he shook his head and said no. Remebering back I was in no position to argue I really thought that he meant my baby was in danger. Attached is the letter I am working on to send to everyone in the hospital. I will send this letter to every birthing organization every womanr rights groug to my state legislation anywhere as long as I am heard and this does not keep on happening to all birthing woman allover America. This is not a question of suing for money. Money is not at all driving me I have no legal rights to sue for damages because they make you sign a blatent consent form before entering the hospital. I am doing this for my daughter and your daughter who in the future might not be even given the right to give birth naturally.


here is the letter( I am still working on it to perfect it)

>Addresses Removed<
Dear Dr.

On may 7th 2008, I admitted myself into {name removed} Hospital's labor and delivery unit expecting my second child. My first child was born via c-section due to the cascade of interventions that induction and augmentation had caused. I researched the risks and benefits of the use of Pitocin and I felt for this delivery I did not want this drug anywhere near me. I know that the doctrine of informed consent/refusal is upheld by common law; Constitutional law (the right to privacy and self determination protected by the 1st and 14th amendments); federal law (The Emergency Medical Treatment and Active Labor Act and The Patient Self-Determination Act); international tort law (which US courts sometimes cite); state law; state mandated medical ethics; and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). The doctrine of informed consent/refusal upheld by these laws provides all patients, pregnant or not, with certain fundamental rights:

The following is my statement on how my above rights were violated during my active labor at {name removed} Hospital. I had spoken previously with Dr. {name removed} on a regular ob visit indicating to him my extreme concern with the use of Pitocin and I strongly stated I don't want that drug anywhere near me. To my extreme anger I found out that I had Pitocin running through the I've lines without my knowledge or anybody having the common decency to ask me if I would consent to this medical treatment. The legal term for failing to obtain informed consent from a patient is called battery (a form of assault).

It is now 9 months after my birth and I cannot shake the sad feelings of having been vulnerable and taken advantage and yes actually feeling assaulted.. Dr {name removed} failed to get my consent and neglected to inform me of the risks/ benefits or alternative care to the active management of labor with Pitocin. The fact that I had no idea that I was given Pitocin had robbed me of my right to exercise self-determination and autonomy in making all medical decisions, including the decision to refuse treatment with Pitocin.



Of course I ended up with a probable unnecessary c-section. Dr. {name removed} demonstrated a total lack of understanding and respect for woman and birth.


Sincerely,

A deeply saddened and violated mother.

>Names Removed<

By the way I forgot to mention my daughter was 6 lbs 4 oz

Attached is the letter I am working on to send to everyone in the hospital. I will send this letter to every birthing organization every womanr rights groug to my state legislation anywhere as long as I am heard and this does not keep on happening to all birthing woman allover America.

I would strongly suggest that this is NOT your best course of action. If you have paid attention to everything you have been told here, the vast majority of OB/Gyns are going to read this letter and totally dismiss it, believing that your doctor acted according to his best medical judgement.

At worst, your doctor will sue you for slander.

If you want to send this to the head of OB/Gyn at the hospital, that is one thing. You do have sufficient reason to complain to the hospital. But to broadcast this to other people and organizations that were not directly related to the birth.


Money is not at all driving me I have no legal rights to sue for damages becuase they make you sign a blatent consent form before entering the hospital. I am doing this for my daughter and your daughter who in the future might not be even given the right to give birth naturally.

First, you cannot sign away your rights, so even if you did sign a consent form that does not remove your legal rights. Having said that I do not believe you have any grounds for a suit. We have gone over that part at length in this thread so I won't repeat it.

So, if your goal is change the way OB/Gyns deal with situations like yours in the future, then I suggest you start an advocacy group and lobby the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) to change accepted procedures.

I would suggest that you NOT pursue this as a vendetta against your OB/Gyn as that will tend to negate your position. Don't even mention the doctor or hospital, just deal with the situation and lobby for change.