[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.

[DoulaLC]

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.

[J_9]

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). 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.

[DoulaLC]

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.

[rikkifarkas]

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<

[rikkifarkas]

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

[ScottGem]

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.