In my promise to peruse obstetrical blogs, I came across Kevin, MD's Blog on prophilactic cesarean for PROM (premature rupture of membranes) & breech presentation. It seems the premature delivery caused the baby adverse health consequences for which her mother is suing the attending physician and the hospital. See Kevin's Blog & NWAnews article for more information.
There are numerous responses to Kevin's blog. Though some go completely off topic, I agree with the inanity of many medical lawsuits and the subsequent CYA tactics physicians and hospitals undertake to reduce their liability risks. Believe me I have heard them all when it comes to obstetrics. But let us look more closely at this case, from my laymans point of view. Mom admits inlabour with PROM. Baby is found breech and mom continues to labour as they call the physician. The physician, upon hearing both ROM & Breech, orders a caesarean over the phone. Now, let us look at the risk/benefit ratio of surgery to vaginal delivery.
Baby is breech, but we don't know actual presentation (frank, footling, complete). There was no infection (already assessed) and an ultrasound four days earlier proved prematurity (reports don't reveal how many weeks gestation). Uumbilical cord prolapse would most certainly have been ruled out (via FHT) as this was not an emergency given the reported reasoning for the surgery. So we have a mother labouring normally preterm with no infection, no cord concerns and a breech presentation. The real risk of a cord concern is now low given that her water has already broken and the cord didn't descend with the waters release. Yes there will always be a risk of nuchal cord, short cord, etc. but these are managable with a skilled attendant.
This leaves one thought. The physician doesn't have the skills to attend a breech delivery. Completely plausible in today's cut-when-breech mindset in obstetrics based on an imperfect Canadian breech trial. I continually find it shocking that even obstetricians don't have breech experience when they are the so-called experts on high risk deliveries. I can somewhat excuse the delivering family practitioners who are unable to gain that vital experience, like I witnessed at a rural Canadian hospital some years ago. My client was sectioned despite her clearly textbook perfect breech labour (no meds, frank breech, quick labour, baby already "bumming" on admitting) by the family physician who was also the head of obstetrics in that hospital. This physicians fear was palatable when ordered her cesarean and he literally ran out of the room after voicing his decision, leaving everyone in the room shocked. Yes physicians are human, I am the first one to admit that. I have seen firsthand the effects of PTSD on attending physicians who had experienced a previous bad outcome. But compassion comes with humanity, especially when in the office of healing, and I am left wondering if the physician in the story above did not have a similar fear or lack of experience. My heart goes out to everyone involved in this sad case.
1 comment:
I believe physicians, like mother-to-mother birth helpers, want a healthy mom and baby but the difference is paradigm. We believe as a culture that technology guarantees safety. We, and especially allopathic medicine, maligns and disdains chiropractors, massage therapists, midwives or those who heal with their hands. Even when their results are exemplary. ESPECIALLY when their results are exemplary, come to think of it.
In residencies surgery and complex procedures are fought over by residents. The normal, heal-with-your-hands is un-glamorous. Low-tech birth is wet, sticky, grunty, women's work and is more so.
Consequently when all your toolbox holds is a hammer everything looks suspiciously like a nail.
Especially if you hold the power and money and PR machine in your sway to convince the public that their very life is in your hands, that your "condition" is inherently dangerous, and without you and your tricks, their health and even existence is threatened.
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