Patients

Pregnant Women Warned: Consent to Surgical Birth or Else

As hospitals and courts collude, pregnant women are being excluded from fundamental decisions about how they give birth.

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darius norvilas/Flickr

Jennifer Goodall was about to have her fourth child when the ordeal began. Having given birth to three previous children through cesarean section—a surgical procedure that allows a baby to be delivered through a woman's abdomen—the Cape Coral, Florida, mother wanted to try a natural delivery now. But in early July, Bayfront Health Port Charlotte—the hospital where Goodall had been planning on giving birth in about two weeks—told her it wasn't permitted. A letter from Bayfront's chief financial officer said if she attempted a "trial of labor," the facility would report her to the state's Department of Children and Family Services, seek a court order to perform the surgery, and do the procedure "with or without (her) consent" if she stepped foot in the hospital. 

With help from the National Advocates for Pregnant Women (NAPW), Goodall sought a restraining order to prevent the hospital from taking action. There are risks and benefits involved in "c-section" delivery, both for first-time mothers and those who've had one previously. Goodall weighed those risks before coming to a decision, and was flexible should problems arise.

"I would definitely consent to surgery if there were any indication during labor that it is necessary," she said in a statement. "I am trying to make the decision that will be safest for both me and my baby, and give me the greatest chance at being able to heal quickly after my child is born so I can care for my newborn and my three other children."

In the United States, the percentage of babies born by c-section increased from 4.5 percent in 1965 to 26 percent in 2002. By 2012, it stood at 32.8 percent, according to data from the National Partnership for Women & Families. For women who have had a previous c-section, having a non-surgical delivery the next time around—a process known as vaginal birth after a cesarean section, or VBAC—can be quite controversial.

In the 1980s and 1990s, federal guidelines promoted VBAC as safe and the American College for Obstetrics and Gynecologists (ACOG) actively encouraged it. In 1999, however, ACOG updated its guidelines, after research began suggesting it might be more dangerous. After that, the VBAC rate shrunk from 27.4 percent of births in 1997 to 12 percent in 2002 and 8.4 percent in 2009. But "neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery," according to a study published in Annals of Family Medicine that looked at California data from 1996-2002. By 2010, ACOG was back to saying that VBAC was largely safe. 

An analysis of 203 previous papers on VBAC found mixed outcomes. Overall rates of harm were low for both VBAC and repeat elective c-sections. The newborn mortality rate was 1.3 per 1,000 births with VBAC, compared to 0.5 for repeat c-section. Maternal mortality was 13.4 percent per 100,000 births for repeat c-section, compared to 3.8 percent for vaginal delivery. The authors concluded that "VBAC is a reasonable and safe choice for the majority of women with prior cesarean." They also noted mounting evidence that the more c-sections a woman has, the riskier the surgery becomes.

None of this means that Goodall's choice was necessarily better. But it was reasonable. This wasn't some particularly risky, out-there thing that she wanted to do. In a 2010 statement, even the National Institutes of Health (NIH) stated that "when trial of labor and elective repeat cesarean delivery are medically equivalent options, a shared decision-making process should be adopted and, whenever possible, the woman's preference should be honored."

ICAN/Facebook

But federal District Judge John E. Steele disagreed. In denying Goodall's request, Steele wrote that she has no "right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment." 

That might sound semi-sensible, until you remember that the procedure Goodall wants to compel is actually the absence of forced surgical procedure. Mary Faith Marshall, director of the Center for Biomedical Ethics & Humanities at the University of Virginia School of Medicine, said that "given the clear statements from ACOG's Committee on Ethics and other professional groups that coerced or court-ordered medical procedures are not ethically justified, it is stunning that a hospital would threaten such an action."

Why would a hospital threaten such action? Fear of malpractice lawsuits seems to be the biggest reason. "Concerns over liability risk have a major impact on the willingness of physicians and health care institutions to offer trial of labor," the NIH noted. A 2009 ACOG survey found one-third of obstetricians stopped offering VBAC because they feared liability claims or litigation. (In addition, 29 percent said they had begun doing c-sections more often to avoid liability.)

The Florida Supreme Court has held that physicians aren't liable when they respect the decision of a competent and informed patient to delay or refuse a procedure. Bayfront Health could have simply made Goodall sign liability waiver paperwork, points out Farah Diaz-Tello, a staff attorney with NAPW. Instead, "what probably happened is … the hospital calculated their risk and thought that the better course of action would be to scare her away from coming in so that she would quit the practice."

In a written statement Monday, Bayfront spokeswoman Marti Van Veen said the hospital isn't opposed to vaginal births after c-section unilaterally. "Each patient has unique circumstances, and we rely on the clinical judgment of the physicians who work with their patients to make sure the birth plan is safe and supports the best possible outcomes for both mother and baby," Van Veen said.

But it doesn't seem like Bayfront Health was willing to "work with" Goodall. In the July 10 letter threatening action, CFO Cheryl Tibbett told Goodall: "We sincerely hope that you will trust your physicians and our staff to do the right thing for your unborn child, and family." Apparently doctors always know best and a patient's own preferences and decisions are a mere inconvenience to work around. 

"Instead of respecting my wishes like they would for any other patient, my health care providers have made me fear for my safety and custody of my children," said Goodall. "I know I'm not the only one to go through this; I'm speaking out because pregnant women deserve better."

Improving Birth/Facebook

Rather than simply find another care provider, Goodall decided to fight back. But finding another provider isn't always so simple, either. In Goodall's case, let's remember that Bayfront rejected her birth plans just a few weeks before she was due.

Under any circumstances, finding a trustworthy new obstetrician and facility in such short time might be difficult, especially in less-populated areas. But this is compounded by circumstances like Goodall's. In the three counties surrounding her home, very few facilities will allow VBAC. Across the U.S., an estimated 40 percent of hospitals have VBAC bans, according to the International Cesarean Awareness Network. 

The New York Times recently told of a Wyoming woman forced to travel 180 miles for a hospital that wouldn't force surgery on her for the birth of her second child. In one 2009 case that drew attention, a pregnant woman had to give birth at a hospital six hours from her own in order to avoid surgery. In both cases, the women and their babies turned out fine.  

Cristen Pascucci, vice president of ImprovingBirth.org and founder of Birth Monopoly— a group devoted to improving maternity care by inbuing it with more "consumer power"—said she's spoken to hundreds of women around the country who have been forced into c-sections. With encouragement from her group and others, these women have been sharing their stories on social media and petitioning individual hospitals to end the practice. 

"People do all sorts of things that create health risks—smoke, downhill ski, delay heart surgery, don't keep to diets," says Diaz-Tello. "In no other circumstance do you see doctors telling competent patients that they lose the right to decide what happens to them if they step foot in a hospital as a result." 

Goodall ultimately gave birth, via c-section, at the Cape Coral Hospital. She attempted a natural delivery to start but when labor wasn't progressing, she consented to surgery. "I welcomed my son into the world … consenting to surgery when it became apparent that it was necessary," Goodall wrote on Facebook. "This was all I wanted to begin with." 

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  1. Having not read the article i am guessing the litigation rate of baby doctors probably plays a role in why the hospital is doing this.

    1. And yes i have no idea why they keep giving babies medical degrees.

    2. I wonder which procedure costs more?

      1. I think that’s the real thing, at root – there is no way to know how long a natural childbirth is going to drag on, which impacts how long you need the room, how long the doctor and all those nurses have to stand there, etc. I’m just taking a wild guess, but I’m going to say at least $25 a minute in payroll alone?

        You can predict within minutes, however, how long a c-section will typically take (generally shorter than the shortest natural delivery), and you can schedule it in advance.

        If the person paying has no connection with the event itself (like how we do it now), it’s easy to see which method they’ll tend to want to go with.

        1. Bill & Square win. Read a story about this a few years back. You both noted the most salient points.
          Doctors have tee times to keep. Also, 10th grade biology teacher taught that the more natural way to give birth is on all fours but docs did not like that….like looking in a mirror. F’n body mechanics is all they are. Rip the customer off just the same.

          The old “submit” is the new “consent”
          It’s her body until labor day.

          1. “Also, 10th grade biology teacher taught that the more natural way to give birth is on all fours but docs did not like that..”

            Most natural way to have sex, too. Alas, women are always having opinions about how things should go these days, wanting to know what’s going on and stuff.

            “Doctors have tee times to keep.”

            This is pretty much a slur. Doctors have lawyers and regulators to fend off. Also, they get paid for the time they are in the hospital. A natural birth can buy a lot of tee times.

            And some doctors even get fulfillment from helping people prosper healthfully!

            1. //Most natural way to have sex, too.

              If you have no problem never being face-to-face with the girl you’re making love to, or even just “plowing”, you have no soul and no kink/sense of play.
              Also, missionary is clearly a strong part of our nature, as the human penis developed to be much larger in order to engage in sex in that way. Obviously you can do doggie too, but the large penis compared to other apes is for the sake of doing missionary

              1. That was kind of my point, aside from the large penis bit, which I did not know.

      2. “Why would a hospital threaten such action? Fear of malpractice lawsuits seems to be the biggest reason. “Concerns over liability risk have a major impact on the willingness of physicians and health care institutions to offer trial of labor”

        She can thank all the med-mal lawyers for this.

        This is why lawmakers should have done some kind of tort reform instead of passing the horrendous ACA aka Obamacare

        1. Actually, in Texas they did do tort reform and capped lawsuits and put more restrictions on the lawsuits.. but it didn’t help their cesarean rate at all. It’s because physicians aren’t really afraid of lawsuits, although that’s a small factor. IMO it’s that they prefer to be “in control” and perceive surgery to be more “in control” than vaginal birth.

  2. Why would a hospital threaten such action? Fear of malpractice lawsuits seems to be the biggest reason.

    Well, she did prove that she’s willing to take them to court.

    1. I would feel like getting sued over non-consent for a surgical procedure is a bigger threat…

      1. Here’s what I’m guessing happened. The hospital doesn’t have any specific policy against VBAC, but the doctors were concerned that a VBAC delivery in this woman’s case would be particularly risky given that she’d already had three cesarean deliveries. Rather than treat her like an adult, explain the risks to her, and get her to sign a waiver, her OB reported the situation to the hospital’s risk managers, who promptly freaked the fuck out and concocted these threats to push her out of the practice.

        The OB and the risk managers should be taken out and horsewhipped.

        1. Maybe it’s libertarian paranoia (and a complete lack of experience in this situation), but something about FYTW’s scenario rings truer than just about anything else presented.

          1. Or, the docs did everything the way you wrote, treating her like an adult all along, and she got enraged and demanded they do the delivery the way SHE wanted it, not the way they felt was the safest and likely best outcome.

            I’m not really clear why someone who’d had three C-Sections would want to go the vaginal route anyway? Just so she could feel what it was like? I’m not a childbearing age female so I’m not going to go any farther with this query.

            I will tell you one thing, though, after working in a hospital over 25 years — you can spot the litigious people a mile away. And mostly you try and be as honest and straightforward as possible, and document, document, document.

            1. Did you read the part about some data showing the more C-sections you have the more dangerous?

              Did you read that C-sections in some cases have 13.4% mortality for the mother as opposed to 3.4% for VBAC while worst case for VBAC for baby was 1.3%?

              DId you know that vaginal births are better for babies since it squeezes fluid out of the lungs?

            2. Or, the docs did everything the way you wrote, treating her like an adult all along, and she got enraged and demanded they do the delivery the way SHE wanted it, not the way they felt was the safest and likely best outcome.

              If that’s the way it went down, Florida law gave them the option of getting a binding waiver.

              They didn’t. They threatened to report her to the state and perform the surgery without her consent.

              Next stupid defense of these assholes?

            3. Or, the docs did everything the way you wrote, treating her like an adult all along, and she got enraged and demanded they do the delivery the way SHE wanted it, not the way they felt was the safest and likely best outcome.

              If that’s the way it went down, Florida law gave them the option of getting a binding waiver.

              They didn’t. They threatened to report her to the state and perform the surgery without her consent.

              Next stupid defense of these assholes?

            4. Someone who had 3 prior c-sections knows exactly what the recovery time is, the pain you go through, and the limitations it puts upon you. It also means they know they already have 3 young children at home they will need to care for, with those restrictions in place. As for being litigious, she didn’t sue them. She essentially filed a restraining order. By mentioning litigious people, you’re implying she was in it for the money but there was no money. There WERE bills, though. Bills for the lawyer she had to hire to tell this hospital to back off.

        2. I’ve yet to see a doctor perform a procedure they thought increased the risk of death for a patient, or for two patients in this case, merely because a patient signed a waiver absolving them of liability.

          They adhere to their oath first and foremost. And if they thought performing a VBAC violated that oath with other options present, they were not going to do it the way she demanded.

          1. This seems to be the case.

            It’s unfortunate the hospital pulled in the threat of government, and it’s problematic they can do that. But that isn’t the crux of the issue here.

        3. Waivers don’t mean anything. The Supreme Court has ruled that you cannot waive your right to sue and therefore there is no such thing as a binding waiver to litigation.

          Yes people smoke, drink, and are obese, and I as a doctor am allowed to refuse medical treatment to those people except in emergent circumstances. This woman was trying (and succeeded) in forcing a group of physicians to take on a procedure (overseeing a delivery) and liability against their will. She could have gone to another hospital. She could have hired a midwife.

          1. sorry no.

            the hospital has some sick perverted laws surrounding it. like it cannot refuse service to someone in emergency.

            its bullshit concepts like this that make them so deranged. it causes all kinds of secondary effects where noone’s rights can be very effectively respected.

            so the hospital says to itself, well if this lady shows up mid-labor, we are going to compel her to have the procedures we think are best, against her consent.

            there is no need to compel if the hospital can refuse to treat. they just say ‘we don’t offer that service’ and she leaves.

            individual consent over their own body is sacrosanct. hospital mandates notwithstanding. hospital is way out of line, but behaving normally for an entity that is put in an impossible situation.

      2. I would feel like getting sued over non-consent for a surgical procedure is a bigger threat…

        I don’t know how far a plaintiff would get if it was on court order.

  3. After three c-sections, it all but ceases to be a decision the woman should participate in. VBAC becomes more dangerous every time you have another cesarean delivery. After Liberty was born, the doc told us that we might, might, have one more chance at a natural birth but they would want to do a scope to analyze the scar tissue ahead of time to determine if the risk was even worth it.

    Women and their babies die during VBAC because the scar tissue can’t expand the way the uterus can. And every cesarean adds to the scar tissue. I think this might be a case where the experts need to be given deference as an advocate for the unborn child.

    I’m sorry if I find this controversial, but we’ve done a lot,of research into VBAC, and it’s all,pointed in the direction of deference to the surgeons decision.

    1. VBAC? I’m guessing Vaginal Birth After Cesarean, but I had to think about it for a while. I wouldn’t have thought there was a common acronym for that.

      1. RTFA Chief

        1. RTFA??! What does THAT mean?

          (runs away)

      2. Yeah, R&P (rip and pluck). Not sure why it fell out of common usage.

    2. I think this might be a case where the experts need to be given deference as an advocate for the unborn child.

      And I think you can fuck off. The patient gets to decide how much or little deference the expert is entitled to. For a butthurt OB to threaten to report the woman to the state if she doesn’t submit to his recommendations is fucking contemptible.

      1. I agree.

        Sloop, WTF?

        These fucking rent seekers THREATENED to run to the state if she did not do as they dictated. Then they THREATENED to perform the surgery WITHOUT HER PERMISSION.

        Check and mate.

        1. And don’t give me any totalitarian pretext about the “best interests of the child” either.

          I trust that you have followed the Justine Pellitier case here in Mass?

          1. Apples and oranges. There was controversy between two,sets of doctors in that case and the judge deferred to the ones on their side of the CT-MA state line.

            If the woman in this case found a doctor willing to do the VBAC, then why didn’t she just go there and not try to force a doctor to do something they believe violated their Hippocratic oath?

            1. Children’s Hospital, in Boston, kidnapped Justine, a 14 year old. The hospital then teamed up with Deval “mini me” Patrick’s Department of Children and Families to keep the kid from her parents.

              Justine had previously been diagnosed by her Tufts Medical Center doctor with a mitochondrial disease that caused her to have trouble, inter alia, with eating and walking.

              In February of 2013, when Justine was experiencing some problems, the doctor informed her parents to take her to Children’s Hospital and to see his gastrointestinal colleague.

              The parents took Justine to Children’s and she never saw her doctor’s colleague. Instead, she was diagnosed with somatic symptom disorder and when her parents tried to take her from Children’s, armed thugs forcibly prevented that from happening.

              1. The state colluded with Children’s in the kidnapping of Justine.

                She was a captive for 16 months before being released.

                The problem rests with the collusion of the medical people and the state. Here, this woman wanted the federal court to enjoin the hospital from calling Florida’s version of the DCF and filing a complaint of child endangerment.

                In a free society, we can not stand for that – particularly where, as here and so often, the pretext advanced by the medical people for their THREATS TO GO TO BIG DADDY GOVERNMENT is the child’s welfare.

                Don’t you want those who threaten to go to the child care commissariat to have their fingers amputated?

                And please, stop with the whining about the threat of litigation – if you are so good, do your job.

                in a free society, if you fuck up, WHY SHOULDN’T YOU FACE RUINOUS DAMAGES?

                1. Like I said, apples and oranges.

                  Look, I have a lot of respect for you and value your opinions. I just disagree in a case where the rights of multiple parties come into conflict and one party has to have an advocate for,them. I believe this issue have case and it doesn’t look like any other medical,facility was consulted for their opinion. It so, she would have delivered there. Easy-peasey.

                  In the Pelletier case, another doctor’s (at Tufts) diagnosis was ignored by a court and she was forbidden from crossing back into CT by the MA government. Conflicting opinions where the right of the patient to choose a course of action was not respected.

                  See why I think this is different now?

                  1. Yes, I understand the difference between a teenager being able to express her wishes regarding treatment and a fetus not being able to do so.

                    As opinionated as I am, I have had mixed feelings / thoughts about abortion all of my adult life. Yet, for purposes of this situation, I can’t help but point out that the same concern for the fetus would not appear to be on the mind of the medical people in performing abortions.

                    True, I don’t know what this woman’s OB-GYN thinks of abortion or the hospital’s attitude. I make the point to illustrate that the concern for the fetus may not apply with respect to all procedures / situations.

                    One other thing:

                    Sorry that I am so heated – you would think that I was going at with TAO aka Neoliberal Kocktupus (or whatever the fuck he calls himself now) or Tulpa or dunphy or cytotoxic.

                    1. Don’t be sorry for being heated. I’m a big boy and I can have big boy disagreements with people I have respect for.

                      I,wish the unknowns in this situation were clear but I just can’t find them from ENB’s story or the linked pieces. That might change things in my mind.

                    2. For what it’s worth, if the hospital had reported this woman, the report would’ve been screened out (i.e. not investigated) because still-developing fetuses are outside the Florida DCF’s jurisdiction.

                      Still terrible for them to even make the threat, though.

                    3. Actually, it wouldn’t be the first time a woman in Florida has undergone a forced c-section. There was a mom around 10 years ago who was IN LABOR and almost ready to deliver when a sheriff’s deputy was sent by court order to take her to the hospital for her surgery. It was instigated by the hospital and a physician that wasn’t even her own. And they tried to retain custody of the infant.

            2. try to force a doctor to do something they believe violated their Hippocratic oath?

              You have lost your mind, dude. How long have you been collectivizing doctors as being saints? Has it been terribly long that you believed doctors to be infallible Top. Men?

              Doctors do not take the Hippocratic Oath. Sure, they make take some Socialist approximation but they definitely do not take the Hippocratic Oath. The original Oath actually mentions abortion and assisted suicide.

              The thing you seem to be missing here, Ken, is that a C-section for liability purposes is a surgery. A vaginal birth, however, is not. The move to more C-sections has nothing to do with patient health and everything to do with reduced liability for doctors.

        2. You think that if the woman’s innards split during VB and she died from the effects and the kid was DOA that there wouldn’t be a whopping great malpractice lawsuit?

          Anybody here willing to underwrite the docs in a future similar situation?

          1. No.

            But I am willing to let doctors get binding waivers from their patients. If you counsel a patient against VBAC and she goes ahead with it anyway, you get a fucking waiver, and she can take her malpractice lawsuit, print it out in 192-point blue italic zapf dingbags, cram it halfway up her ass, and light it on fire.

        3. I knew my opinion wouldn’t be popular here. And I have a great deal of respect for individual rights. I think everybody knows that. But I also believe that the rights of the unborn child are every bit as important as the rights of the mother here. And I am dead certain, based on personal experience and plenty of consultations with OB’s and surgeons on the issue, that the doctor must be deferred to in a case where the rights to life and liberty of multiple parties must be recognized.

          Sorry if I’ve hurt anyone’s feelings or if I’ve caused anybody to lose respect for me. It’s just the way I feel.

          1. Sorry, no deference.

            You do know that iatrogenic death is among the top causes of death in this here USSA? Physician fuck-up.

            Again, if you, as the doctor, fuck up, why shouldn’t you face ruinous damages?

            1. Again, if you, as the doctor, fuck up, why shouldn’t you face ruinous damages?

              You should. But should you be forced to perform a procedure you think is inherently more dangerous for one of more of the parties involved (mother and child in this case)?

              I believe the woman should have been free to find an alternate facility that was willing to do the delivery her way. It does not look like she sought that out OR she did and received the same answer,elsewhere. That’s what is important but is unfortunately missing from this story.

              I’d really like to know if she sought that out and what the results were if so. It might change my opinion.

            2. I’ll hazard that a lot of the so-called “iatrogenic” death is WAY overestimated based on some pretty broad variables which are extrapolated without much foundation.

              In fact, the numbers that have been tossed around would make you think that the single most dangerous thing you could do in life is go to a doctor.

              Remember to look at who the source is of certain studies, and what their goals are, and if the study results might just support those goals.

              1. Totally agree with your last paragraph and I have often been assailed for expressing that perspective.

      2. The patient doesn’t get to decide if the surgeon refuses to do it. And it wasn’t the OB. It was the hospital. I would assume they conferred with the Ob and surgical team before informing her.

        Our OB told us we got one shot on VBAC and then he would refuse to attempt delivery. The surgeon after the first said the same and the one after the second said we might get one more chance but they’d want to do a scope beforehand to look at the scar tissue.

        Trying a VBAC after three cesareans is extremely risky, bordering on irresponsible and unnecessary risk. That goes for the mother and the unborn child. I’m sorry, but they are making a sound decision with the interest of BOTH parties to the birth in mind. And I just think that’s reasonable.

        1. Then they should have told her that on her first or second visit. Instead they apparently waited until just two weeks before her due date.

          1. I can only hope this was the first time she approached the hospital,on the issue. I can’t tell from the story or,linked articles if she made her intentions clear all along.

            If she did, the hospital handled it poorly. If she just told them and they reacted this way then I can’t fault them.

            1. Google the dangers of VBAC are greatly exaggerated.

              I knew that there would be a treasure trove.

              1. I know from the research I did. And I’m a generally skeptical person. We know we,might have one more chance. And we plan on taking it if the professionals tell us they believe it is a reasonable risk. If they tell us otherwise, we will not.

                My surgeon sister-in-law has also advised us a great deal.

                1. Okay, I wish you well, either way.

                  Again, sorry for being so amped up about this. I can’t begin to tell you how often I was raging against Children’s Hospital and mini-me (props to WRKO’s Jeff Kuhner for coining the oh so apt description of Gov. Patrick) and DCF during the time Justine was kidnapped.

                  1. Having a child with a serious issue (Reason), I am shit scared I will end up in a situation where I am not allowed to make parental decisions. BUT, I don’t think this woman was making a decision that was in the best interests of her unborn child. And I think that if she were able to find a facility that agreed with her, she would have delivered there. And I think in the cases of conflicting diagnoses (like in the Pelletier case) or conflicting plans for,delivery (if they had been presented here), the right of the parent to make the decision for their child is a given.

                    1. She –did– find a facility that let her try for VBAC you non-reading-the-article-person.

                      I have a feeling all of your “research” has been done about as thoroughly as you read this article.

        2. The patient doesn’t get to decide if the surgeon refuses to do it. And it wasn’t the OB. It was the hospital. I would assume they conferred with the Ob and surgical team before informing her.

          The surgeon has no responsibilities in a VBAC delivery anyway. What’s he going to refuse to do? “I refuse to watch from a distance as you push out your child vaginally!”

          Okay. Whatever makes you happy, dude.

          If the OB refuses to assist with a VBAC delivery, fine; but (a) don’t pretend that you’re doing so out of professional responsibility when the medical literature is equivocal and (b) give the patient enough notice so she’s not going to be inconvenienced trying to find a new OB before her delivery date. It would also be good for you to (c) advertise to your patients that you’re kind of a tool, so that they can make an informed choice about whether to stay in your practice.

          Beyond that: this hospital didn’t merely decline to perform the delivery. They also threatened to report this woman to the state and perform surgery on her without her consent. Nothing excuses that, and your apologia for it is pathetic and disgusting.

          So, again, fuck you.

          1. I agree with your sentiments on this. 🙂 People who disagree that she should have been able to decline a surgery when she had full agency and was fully informed… A big fuck you, to them.

            People are also forgetting a few things. Cesareans are riskier with each one performed, VBAC’s are less risky with each successful one.. With each cesarean the pregnancy itself is much riskier to both mother and baby. With every VBAC, the risks go down of serious pregnancy complications.

            Do people not understand that the words “VBAC has risks” is leaving out the words “and so do cesareans” … ??

    3. According to whom? A meta-study cited in this very article found that VBAC is about as risky as another c-section.

      If the patient’s OB-GYN — who knows her and her body best — believes it’s the wrong decision, that’s something else altogether (even then, the patient should do what she wants unless it’s completely unreasonable). But this decision was from the hospital’s CFO.

      1. No, that decision was relayed to her from the hospital’s CFO…a member of their board, I would assume, which is somebody authorized to inform her of the hospital’s decision to not do,what they deemed a dangerous and risky procedure that violated their mission and Hippocratic oath.

      2. Your “study” won’t help much in a malpractice suit.

        Nothing is too risky for he who doesn’t face the consequences.

        1. You have no fucking idea what you are talking about.

          Malpractice lawsuits are negligence claims alleging that the doctor’s conduct fell below the professional standard of care. Mainstream medical literature to the effect that VBAC is approximately as risky as a cesarean is pretty powerful evidence that either delivery method would be a reasonable, professionally-accepted alternative under the circumstances. It certainly wouldn’t help a plaintiff claiming that for the doctor to perform a VBAC delivery was an unreasonable departure from professional standards.

          I truly wish that you armchair attorneys, who have never been closer to law school than driving past one, would shut the fuck up about what would and wouldn’t be helpful in litigation.

          1. But…..

            You are speaking logically as if attorneys only took med mal cases that were legitimate and substantial. There are far too many bottom dwellers who will sue anyone hoping they can settle their nuisance suit early, that it will be worth the while of the doc and the defense atty to just get it over with.

            The malpractice insurance annual fees for OB/Gyn docs are just stunning. I can’t even imagine why anyone would put up with it. They really must love what they are doing. (And definitely, if you are in medicine, delivering a child is one of the few “happy” jobs we have, so that may be why some do it.)

            1. The guy I was responding to was arguing that the meta-study would be unhelpful in a malpractice lawsuit.

              He’s wrong. Egregiously wrong. The level of his wrongness approaches the Platonic ideal of wrong.

              The fact that there are lots of unscrupulous asshole attorneys who file borderline med-mal claims because the costs of litigation incent defendants to settle rather than fight is completely true, but also completely beside the point.

    4. see my post above.

    5. Cesarean also becomes more dangerous every time you have a cesarean delivery.

      The risk of hemorrhage, needing a hysterectomy, surgical complications like a cut bladder, adhesion complications, infection, etc. all go up with every cesarean section. The first one is the least risky one. After that the risk goes up just as the risk of VBAC goes up. It’s not one-sided risk increase, it’s two-sided.

      Conversely, after every successful VBAC.. risk goes down. VBA3C is not necessarily more risky than a CBA3C. The pregnancy/birth itself is risky.

      Does a uterine rupture pose more risk for the baby than other issues related to risks involved with having been a c-section uterus (the risks of severe pregnancy complications also rise with each c-section. including fatal things to the baby like abruption, previa, accreta) itself and the converse decrease in risk to the baby with every successful VBAC? I think that is up to a mother and doctor to decide together, not up to the doctor to decide for the mother unless that is what she decides.

      This mother considered all of the factors and decided she wanted to deny a treatment. That does not give a physician the right to give her surgery against her will.

    6. This is inaccurate and against ACOG policy.

  4. The solution isn’t for the mother to force a doctor to do a proceedure that he doesn’t want to do. Rather, the mother should find a doctor is comfortable with what she wants. If she isn’t able to find a doctor to do it then she might want to thank a trial lawyer.

    1. She’s gonna be hard-pressed to find a doctor willing to do this and also adhere to “Primum non nocere”.

      1. “I get you rape you on your wedding night?”

        1. I don’t think it’s rape if you’re a nobleman.

          1. “I get to sex up on you on your wedding night while your husband sobs in the shed”?

  5. Well, trying to go natural birth after three c-sections doesn’t seem the wisest decision, but we all know that if they’re having babies, then they’re really not that smart in the first place.

  6. Those guys totally knmow what time it is. Wow.

    http://www.WentAnon.tk

  7. “trial of labor”

    Nice. I suppose “labor of love” was already taken.

  8. Why didn’t she pursue using a midwife if she wanted a natural birth?

  9. I sure wish RC Dean would comment on this. His opinion is one I’d put a lot of stock in.

    1. I just telephoned a friend of mine who is an expert at debunking allopathic non-sense and he told me that the “dangers” of post cesarean VBAC are, indeed, greatly exaggerated.

      1. We were told the same thing….after one c section. After two,the dangers increase a lot because there is more scar tissue where the uterus needs to expand. We were told after a third there is no,way they would risk the life of the mother or baby. Period, full stop.

        Maybe it’s a liability issue, but they sure used a lot of scientific terminology and pictures to,explain it.

      2. Sorry dude, you used the words ‘allopathic nonsense’ – you’ve completely lost any credibility regarding this topic.

        Allopathic is the term of choice for ‘naturopaths’, ‘homeopaths’, and other ‘proponents of alternative medicine’ to refer to the shit that actually *works* vice the shit they do.

  10. “A letter from Bayfront’s chief financial officer ….”

    Medical decisions made by bean counters. At least with Ocare fully implemented that will be a thing of the past.

  11. I talked to two docs about this very thing recently — one a family physician and the other a surgeon. They said that any surgery is very risky, especially when it’s on the belly. And they said the whole reasons OB-GYNs are doing so many C-Secs is because it’s convenient for them. Most docs I know want to get paid a lot and don’t want to be hassled. C-sections give them that. They can schedule it and it be done in an hour or whatever.

    1. Again,anecdotal, but they kept Kara in labor for 18 hours with Liberty before telling us they were giving up on a natural birth and going to a cesarean.

      Reason was a planned cesarean because of her omphalocele.

      1. No doubt there are solid medical reasons to do the c-sec as opposed to vaginal especially in your case. But these two doctors explained to me at lunch why more and more births were done by c-sections on the first go ’round– convenience for the doctors.

        1. On the first go around, yes.

          The calculus changes a little after one cesarean. After two or three it changes dramatically.

          1. That isn’t the ACOG’s stance. They say VBA2C and VBA3C are reasonable options for many women.

  12. I’m hoping it’s 1.3 dead babies per 1000 births and not 1.3%

    “1.3 percent per 1,000 births with VBAC”

  13. At what point did women start telling us all how LONG their babies are? And why do they think we care? What am I supposed to do with this superfluous information, compute the baby’s BMI?

    Just go back to telling me what gender and how many pounds. This thing ain’t gonna stand up so I don’t need to know its height.

    1. Because obese babies are now a things, so weight can be a misleading indicator?

      Who knows?

    2. It’s been (or was?) pretty common for decades perhaps to include length in birth announcements. Why? I don’t know. Maybe the most special baby once got a blue ribbon at the fair, like the biggest watermelon, handsomest chicken, loveliest hog call, etc.

  14. I had a VBAC and it was completely uncontroversial. I requested it; my OBGYN agreed. No big deal. After multiple C-sections, it can lead to complications, though. The patient discussed this up-front with her doc, the doc agreed to her preference then went behind her back and scheduled the C-section. The doc was just dishonest. If the doc had leveled with her from the start there would be no controversy here.

  15. Honestly, I’m not sure how anyone can defend this woman. A business is trying to attempt to refuse a certain service to a potential customer for whatever reason. Period. For whatever reason, I feel like the responses to this article wouldn’t be the same if it was a restaurant refusing to serve a client.

    Yes, they threatened to go to court, in this case, but it’s not like they said “if you don’t consent to allowing us to give you a c-section, we’ll force you to have one.” They said “If you step foot in this hospital [i.e., if you try to make us give you a VBAC], we’ll be forced to compel you to have a c-section.” This seems pretty open and shut to me.

    1. i disagree.

      they aren’t declining her service. they are saying once its underway they will compel her.

      you don’t get to compel others.

      the hospital’s proper use of agency here is to refuse to do business. anything more than that is vice and a perversion of contract.

    2. I am a professional (a lawyer). My client hires me. I give my client the best legal advice I can. But my client is the master of the representation. If he doesn’t like my advice, and would prefer that I argue what I consider an unwise alternative, I have two choices: one, I can withdraw from the representation in a way that doesn’t prejudice my client, or two, I can swallow my wounded professional pride and do what my client is paying me for, while getting an acknowledgement from my client that they’re proceeding against my advice.

      I do not have the option of telling my client, “No, fuck you, I will argue your case the way I want to argue your case, and if you try to stop me I will report you to the state for being out of your mind, and do what I want anyway.” If I tried something like that, I would probably get disbarred.

      Physicians professional obligations aren’t quite the same, but they’re roughly analogous. The patient is paying the doctor to perform a service. The doctor’s job is to give the best possible medical advice. The patient is free to accept or reject that advice. In the latter case, the doctor can withdraw, or he can get a waiver and proceed. Available options do not include “threatening to make bullshit allegations about the patient to the state unless she consents to the procedure I’m recommending.”

      1. I would say the wrinkle here is that said client won’t show up at your doorstep in an emergency situation requiring legal services you are obligated to give. The hospital said to the woman, if you show up here, this is what we will do.

        1. Exactly. The hospital didn’t say “We’re going to compel you to get the surgery that we want to give, no matter what.” They said “If you try to force us to let you have your baby here, we will get authorization to do it the way that we think is best, regardless of what you say.”

          She was free to have VBAC if she wanted, and in fact, she did; she just couldn’t do it at that hospital.

          Sorry to break it to you, but you do not have a right to compel a physician to assist in your procedure against their wishes.

          1. Sorry to break it to you, but you do not have a right to compel a physician to assist in your procedure against their wishes.

            Sorry to break it to you, but yeah, you do. Part of what it means to accept a patient is to accept that the patient may choose a course of treatment contrary to your best medical advice, and that if you decide to continue to treat the patient then you’re going to have to do so on the patient’s terms.

            If the patient shows up at the hospital, the doctor’s options are to (a) turn the patient away, or (b) treat the patient the way the patient demands to be treated. Anything else is a grotesque breach of your professional obligations.

      2. a professional (a lawyer)

        Oxymoron. I knew there was something about your postings that screamed “scum bag”.

        1. It’s true. I leave slime trails behind me as I walk.

          It’s nothing compared to Warty, though.

        2. It’s true. I leave slime trails behind me as I walk.

          It’s nothing compared to Warty, though.

    3. The hospital, if it doesn’t want to oversee vaginal births, needs to close its maternity ward.

  16. Hey Y’all? Seems to ME that the whole idea that a woman’s body CAN be invaded, by “foreign” ideas in her brain, holds water!!! Holy Water, Sacred Amniotic fluids, even! INVADED, I say, to the detriment of her unborn child, by ANY “foreign” ideas that her body belongs to HER and not to The Government Almighty, which OBVIOUSLY loves her unborn child WAY, way more than she EVER will be able to!!! The idea that our bodies belong to US and not to Government Almighty, is SACRILEGE!!! Such “knowledge of our bodies” is “Carnal Knowledge” permitted to ONLY those with Law and/or Medical degrees! Enforcement, as usual, should fall upon ASSFUCK, which is the Government Almighty agency known as “Almighty Servants Suppressing Foreign Unlawful Carnal Knowledge”?

    1. We must protect our nation’s precious bodily fluids.

  17. The problem here is the same problem I have with allowing doctors to decide when a patient in a coma should be taken off life support; doctors have far too high an opinion of themselves. My Lady graduated from Johns Hopkins (math science). During the five years we were onand around the Hopkins undregrad campus, we met all of two pre-med students who did not deserve to be terminated for ostentatious assholery. Neither intended to become a surgeon.

    I gather that Sweden, where doctors have a great deal of authority, has persistent and recurring scandals concerning euthanasia and forced sterilzation.

    Doctors are mostly jumped up mechancs. There are a small number who are, in fact, as wise and comassionate as doctors are held to be, but the percentage is too small tombe a sound basis for policy. The rest of them should do what they are hired to do, provide their patients with the best advice they can when asked, and otherwise shut their gobs.

  18. dumb bitches are too fucking stupid to understand when they are being used.

    the radical left talks about choice on the bleeding edge of immorality, but just as soon as it becomes old hat their progressive streak demands it be regulated by top men.

    yesterday it was healthcare choices (now mandatory for many situations), today its abortion (will become mandatory if top men get their wish).

    they just need a replacement wedge issue which is more morally inflammatory then casual sex and killing fetuses. that will be framed as ‘choice’, and compulsory abortion will be framed as for the ‘greater good’.

  19. “My Body, [The Department of Children and Family Service’s] choice!”

  20. Is nobody realizing how fucked up it is that our courts are so fucking litigious and unpredictable that huge medical decisions are being made for millions of mothers just to avoid fucking lawsuits?

    When the fuck are we going to revamp our liability system?

    Oh and fuck, lawyers and leftists love to point out the percentage of money compared to the economy that monetary damages are, and of course it’s low, like 3-5%. But that doesn’t account for this massive chilling effect. How people avoid doing certain economic activity, and how prices rise to deal with insurance/liability

    And you know what? I know a lot of you guys above are talking about getting a liability waiver from the mother. And technically, for now, yes, it is airtight. But this shit changes all the time. It’s only a matter of time before some judge decides they don’t mean shit. And even before that, every time you have to use your lawyer, even if the case is summarily judged and trial avoided, IT COSTS A LOT OF MONEY TO BRING YOUR LAWYER OUT.

    1. It’s actually not “just” to avoid lawsuits.

      Tort reform in Texas didn’t touch the rising cesarean delivery rate there..

      It has more, IMO, to do with physicians perceiving vaginal birth to be more risky, even if the face of clear information to the contrary.

      It’s kind of like how physicians denied for about 20 years that their filthy hands covered in the germs of the dead could possibly be the reason women were dying of childbed fever at high numbers, even when the research was clear many were still in denial.

  21. what’s wrong

  22. Pick another hospital or STFU.

  23. The first mate had a difficult birth for the first one. C-sectioned. The next three were V births. The 3rd happened so fast that her regular doctor didn’t get to the hospital before #3 arrived.

  24. First that faggotty business with the teen girl in MA. Now this shit. So hospitals are now authoritarian enemies?

  25. Do people not understand that the words “VBA3C has risks” is leaving out the words “so do cesareans” ??

    People here who are dissenting against this woman need to do more research into this topic.

    With each cesarean delivery the risks of the pregnancy and birth (vaginal or cesarean) go up and up. The vaginal risks are not necessarily more than the cesarean when you weigh out –ALL– of the risks involved both to the mother in surgery, the baby, the epigentic changes, and the future risks of pregnancy to both a baby and mother.

    With each vaginal birth after cesarean, the risks of the pregnancy and birth (as compared to the comparatively more risky status of a woman who has only had cesareans) go down. A woman who had 1/2/3 cesarean deliveries and 2 or 3 VBACs has a lower over-all risk level to mom and baby than a mother opting for her Xnumber c-section.. So when you ban VBAC, it also ushers in higher risk.

    Are they going to start doing forced sterilization/abortion in the “better interest” of women since on paper a 4th c-section is much much riskier than a 1st one?

  26. VBACs are dangerous. The scar is a weak point that may not be able to handle the pressure of contractions. Vaginal births do not happen in a surgical suite nor are they sterile. If the scar eviscerates the mother will have to be rushed into an emergency c-section without the necessary prep leaving her open to infection. The trauma and loss of blood can kill both the mother and infant. Many hospitals won’t do a VBAC because of the risk, though some will. If it’s really that important to you there are other places to give birth, including your home with a midwife present. Just keep in mind that you’ll be assuming the risk and gambling with yours and your baby’s lives.

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