Sunday, December 19, 2010

Courageous Or Foolish?

Every once I a while, a story catches my eye as I scan the news websites. There was one this morning on CNN with this catchy title, "Mom Defies Doctor, Has Baby Her Way." The article describes a story where mom was going to have her fourth baby. Her previous three were born via C-section. Mom did not want another C-section done, and "defied" her doctor's order for the procedure. "You're being irresponsible," the patient was told.

The middle of the article talks about the current thinking and statement of the American College of Obstetrics and Gynecology saying that "it's reasonable to consider allowing women who've had two C-sections to try to have a vaginal delivery." Of course, there's risks with proceeding with a vaginal delivery and risks of another C-section.

What's always interesting to me are the comments following the article. I applaud the physicians in there who are fighting back the anti-physician sentiment and those who are pushing (no pun intended) the only home birth agenda.

In this article, this person is being held up as a hero - as someone who defied the paternalistic medical establishment and did it her way. Good for her, or is it? What if that 0.4-0.9 percent possibility of severe complication occurred and there was a problem with mom and/or the baby? What would happen then?

According to the court of public opinion, there would be always someone to blame for the bad outcome, and I'm not thinking that people would be pointing fingers at mom. They would of course, people would be blaming the doctor and the entire medical establishment for not fully explaining the risks of a choice like this. And, of course, there would be the usual lawsuits when a bad outcome happens.

My point is this. I'm all for patient empowerment, and I have written about the rise of the e-patient (empowered patient), in the past. But, in the US healthcare system, there is still not enough patient responsibility that has occurred among all patients. Good outcomes are usually attributed to patient's taking initiative and bad outcomes are usually attributed to bad doctors. This frustrates me. Isn't there somewhere in the middle that both those perceptions can meet?


rlbates said...

Good points, Dr A. I had a patient recently who attempted a vaginal delivery after two C-sections. Didn't happen. She told me that when her section was finally done as she failed to progress, she was on the verge of rupturing her uterus. She felt as if heaven had intervened just in time.

Anonymous said...

I just had this conversation with one of my L&D nurses. I've been a traditional Ob/Gyn for several years and I'm leaving to run a birth center and support licensed midwives. The response to this decision has been interesting, from both sides. "The natural community" sees me as a rare find--a physician sympathetic to women's rights. (Most of the doctors I know are actually very sympathetic to women's health rights). "The medical community" isn't sure whether their previous respect for my practice methods was warranted. At the heart of it all, I believe, is a lack of respect on both sides for the autonomy and view point of the other.

NeoNurseChic said...

You only hear about this side of the story. None of the mothers who had uterine rupture and ended up with babies with severe HIE are running to the presses to say how they defied the medical community to push forward with a natural birth. But the publication of stories like this will continue to spread the idea that to be a "good mom" you would get away from the medicalization pronto. I think things have to be decided on a case by case basis, with the risks and benefits being weighed and clearly understood by all parties. I don't think media stories like this that hype one way or the other are a good thing.