I realize that it is difficult to keep up with the obstetric literature, but I don’t think it is too much to ask that an organization that boasts about being evidence based should at least check to see that their recommendations are based on CURRENT evidence. There’s really no excuse for Lamaze International to promote an optimal C-section rate that has been withdrawn and discredited. That raises the question: is Lamaze promoting misinformation because they are so out of touch with what the scientific evidence shows, or are they promoting misinformation deliberately because they’d prefer misinformation that they like to accurate information that doesn’t serve their agenda?
I’m referring to the infographic promoted by Lamaze in today’s post on Science and Sensibility:
I used the magnifying glass to highlight the untrue claim:
“DOUBLE what UNICEF and the World Health Organization recommend.”
There’s just one teensy, weensy problem; actually it’s a very big problem. The World Health Organization (which UNICEF relied on) WITHDREW that recommendation 4 years ago, acknowledging that there was NEVER any data to support it.
In Monitoring emergency obstetric care; a handbook, published in 2009, the WHO admitted:
Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …
Where did that “optimal range” come from. It appears that Marsden Wagner, MD, a former WHO official, simply made it up. Wagner essentially admitted that there was no evidence when he published a paper in 2007 that claimed to be the first time anyone had attempted to correlate international C-section rates with outcomes.
The bottom line is that Lamaze International is aggressively promoting misinformation. The only question is whether Lamaze touts misinformation out of ignorance or as a deliberate attempt to mislead women.
In either case, it highlights that Lamaze International, far from recommending evidenced based practices, either doesn’t keep up with the evidence or chooses to misrepresent it. If you can’t belive Lamaze on a basic issue like this, how can you possibly believe anything else they have to say?
My biggest concern about a high CS rate isn’t the first cesarean necessarily, but the subsequent ones. If I am not mistaken, the rates for accreta, percreta, previa, rupture, surgical complications, etc go up with each additional cesarean, but feel free to correct me if I am making incorrect statements. So say a woman has a cesarean for breech, abruption, or some other pregnancy specific reason, and she wants more than one or two children. From a safety perspective for the health of the mother and future children, doesn’t it make sense as a preventive to offer a TOLAC?
And another question I have is when you are talking complication rates for surgical deliveries, when does the morbidity to the mother start to exceed safety rates for fetuses? I am decidedly *not* a stats person, so I am not sure that the question is being phrased in a clear way.
If it’s safe, offer it, but don’t require it. My max is pretty much two kids (a third would only happen if I won the lottery) and I’m pregnant with my first who I am strongly considering might be my only though it’s way too early to decide that. If I need a c-section for this baby and do ultimately have a second child who I am 99% sure would be my last baby, I’d just want to go right to a repeat c-section because it would be be what I am most comfortable with.
That generally *is* when a TOL is offered, as far as I know, especially if the mother wants to attempt a VBAC. I don’t think that has much of anything to do with the overall C/S rate. In any event, every pregnancy should include a discussion with her OB about risks/benefits of vaginal and c/s birth. I mean, every pregnancy is different, including subsequent pregnancies.
The correlation I see is if more women were being offered the option of vbac, then the overall CS rate would decrease.
Maybe. But I also don’t think you should take the *option* of a repeat C section away from the moms who aren’t comfortable with the idea of vbac. “More education” does not necessarily result in more women choosing vbac. And as someone else said, each case is different.
Of course not, but it seems way more common for doctors to recommend a repeat cesarean. I mean, I am positive that happens, but it seems way more common for a woman to be denied the option of vbac than forced to try for one. As an aside, in my area (a major metropolitan city), there aren’t any major hospitals that do not have 24/7 anesthesia available or have vbac bans in place because of that. The issue is more finding a provider who will support a TOLAC. Full disclosure is I am a vbac mother, with one cesarean and two VBACs. I *do not* think that every woman should have a vaginal birth or anything so absolute as vaginal birth is good and cesarean is bad, but I *am* concerned about what a high cesarean rate means for maternal health and the higher rates of complications for mothers undergoing multiple repeat cesareans.
We were technically offered the option for a c-section, but it would have required going to a hospital that was equipped to do it safely, an hour away.
That’s the problem. How many VBACS are not being offered because the hospital does not have the resources to do it safely? No amount of “education” is going to change that.
Eh. It’s possible. But I know a few women, including myself, who were offered VBAC and declined.
Not every woman will jump at the chance.
I’m pregnant with twins and have been offered the option of a VBAC a few times now (barring baby A being breech of course), and have politely declined. I think it’s great that they offered, but it doesn’t interest me.
Maybe some women just like c-sections, especially planned ones.
Same. I chose against a VBAC. Actually most women I know chose against a VBAC. The vast majority of women I know were planning on having 2 kids at most, so the consideration of future pregnancies becomes a moot point.
Right. I think family size should affect one’s decision for or against a VBAC if it’s available. For me, I’m closing up shop after this so those issues had no relevance for me either.
I know this is older but I know I had to turn down doing a TOL 3+ times. A lot of women where I am are pushed to try and hospitals have a fairly high VBAC rate but we still have a c-section rate of about 24% overall last time checked.
I can’t find the previous Dr. Biter link but I wanted to say that it shows exactly what I had previously written: that in CA, the baby pretty much has to die to find a malpractice lawyer that will take your case. He was not in a hospital, so no binding arbitration & he killed the baby. If there are other cases from CA in which the birth was in a hospital and the baby lived, I’d love to see them. Please provide.
In less than a minute (because I can’t be fussed to spend any more time doing your “research” for you), I found these from the Sacramento area:
Medical Malpractice for Cerebral Palsy – Fetal Injury Failure to Perform Cesarean Section – $1,000,000
Defendant hospital and physician’s failure to properly monitor or detect fetal distress during labor and delivery caused hypoxic ischemic encephalopathy, a condition characterized by brain damage due to lack of oxygen. This case settled for the defendants’ insurance policy limits of $1,000,000.
Medical Malpractice for Injury to Child During Birth – $1,400,000
Defendant hospital and physician’s failure to properly monitor or detect fetal distress during labor and delivery caused hypoxic ischemic encephalopathy, a condition characterized by brain damage due to lack of oxygen. During the lawsuit, we discovered that the defendant hospital employees had changed the key medical entries of the child’s distress, attempting to avoid legal responsibility. This case settled for $1,400,000.
What is so annoying about this is the truth is that if the baby dies it’s much harder to get an attorney to take the case. It’s a damaged baby case, “bad baby case”, that the med/mal attorneys salivate over. But I suspect what Ellie is upset about is she can’t find an attorney to take a case in which there are no real damages at all.
I’d take her case for the right price. I’m not a real attorney but, that shouldn’t matter since it’s not a real story.
I have been a lightning rod for anger & insults & this was not my intention. Apologies if you felt personally judged or insulted, & kudos to you if you were entertained. All sides should be considered on a vital issue of life and death like childbirth. I have learned some from the responses here, which was my intention.
As a side note, many NCB advocates and those who promote home birth are far too extreme for me. Try to go for the moderate middle & you will draw ire from both extremes. Although when I comment on NCB sites I am treated much more respectfully for questioning the extreme stances.
Few here are willing to consider that one of the reason many women seek the care of competent midwives in hospitals over that of OBs and attempt to avoid c-sections is that they have been treated disrespectfully and had very upsetting previous experience with some OBs who do not treat them as whole human beings but as fools who are irritating to deal with when they ask questions or share personal experiences, which is exactly how I was treated in this comment section. It sometimes, sadly, drives these women to dangerous extremes of homebirths, etc. Some OBs respond with a need for statistics and data instead of treating the woman’s concerns as a human.
This isn’t about homebirth. This isn’t about natural childbirth. This is about YOU. YOU. ARE. A. LIAR. A pathetically bad one at that! You didn’t hurt anyone’s pwecious wittle feeewings (that’s phonetic sarcasm). Save your apologies for people who believe your astonishing heaps of bullshit – THEY deserve to be apologized to.
We ARE the moderate middle. You have been treated MORE than fairly, had
your questions thoroughly answered, and done nothing – NOTHING – but
lie. And lie. AND LIE. You lie with links. You lie with the pig-headed wall of outright stupid you’re hiding behind. You don’t answer any questions, you dodge and scurry and backpedal. Oh, right, and you make shit up.
If you think you are the moderate middle, I’d be interested to see what your idea of an extreme c-section advocate anti-NCB anti home birth site is.
Notice how you just avoid facing your own lies? PATHETIC.
Calling your bluff. Please provide ANY comment here that is actually anti-natural childbirth.
Note: “It’s ok to have a c-section” or “the information spouted by an NCB person is crap” is NOT “anti-ncb”
Come on Kumquat, this is beneath you! I’m not convinced Ellie IS a pathological liar; and even if she is, this level of nastiness is not constructive. I really admire you as a writer, and I know how easy it is to get carried away with righteous fervour, so this is intended as constructive criticism. Stop, take a deep breath, and let it go.
Hey, thanks for the compliments Mrs Dennis. Don’t worry, I’m also pretty done with this particular troll. I’m pretty sure I’ve gotten every bit of case study I can out – and what a great practical exercise in digital footprinting!
I don’t take it as negative commentary either. I think we’re all going along (including me!) because we’re so damn dumbfounded that she keeps coming up with more. Always good to remind each other when we’re getting carried away (and no, I don’t think your comments are disingenuous – not at this point in the evolution of this troll). So thanks 🙂
and this…
https://www.youtube.com/watch?v=DuXD705WpXw
citation?
Come on, people; you’ve let yourselves be carried away a tiny bit. This thread is very ugly, and does no one any credit. It’s become ‘let’s annihilate Ellie at any cost’, and it should have stopped ages ago. Please stop it now. Live and let live.
To be fair, it would have stopped ages ago if Elle stuck the flounce. I checked in here yesterday and everyone was talking about the new Alpha-parent post. Elle came back here and asked for more and it seems disingenuous for you to scold everyone here for giving it to her. I could be wrong, but I don’t believe that you are a regular commenter here. This is not a “live and let live” kind of place. People get called out on their shit here and are asked to provide evidence and sound reasoning when they make a claim. Elle came in with a smug attitude and made a lot of claims that she couldn’t support. As a result, she made an ass out of herself and continued to come back for more. This thread would have been dead if Elle didn’t keep bringing it back to life.
TLDR: Elle is a big girl and is getting what she puts out.
Doesn’t matter how often I comment, I can read, and I’ve been reading this blog very carefully for years. I knew I’d lay myself open to accusations of disingenuousness, but you’ll notice it was only this morning I decided to comment, as it had tipped over from heated debate to all-out nastiness. I know what it is to get carried away with righteous zeal, and as an outsider to this thread, felt impartial enough to comment now. I stand by what I said. I also notice that as the thread gets nastier, the number of people posting gets smaller. I assume that means more reasoned commenters refrain from adding to the ganging-up. And yes, ultimately, this IS a live-and-let-live kind of place, if the alternative extreme is annihilate-specific-commenters-at-all-costs. The computer key is more versatile than the flaming torch.
I appreciate that Mrs Dennis. I definitely have taken offense to Ellie’s posts. I saw on her teacher facebook place that she can write more logically in that context. I suppose I find her perplexing. If it reads as nasty I think I will take a break from it. The Ellie business has nothing to do with the subject at hand (birth breastfeeding etc ) and more to do with her style.
I’ve been following Ellie-gate since the beginning. Until now, I hadn’t said anything to her directly because I didn’t want to “feed the troll”. However, she’s come back time and time again presenting her asinine stories which, in my opinion, make a mockery out of the women who’ve posted genuine experiences of trauma and loss. I wouldn’t have spoken up if I weren’t willing to bet money that what she says is BS. I’m quite sure she loves the attention she’s getting irrespective of the fact that it’s been all negative and that’s why she keeps coming back. I personally don’t care to continue the discourse with Ellie–other posters can do as they please. It’s not because I feel sorry for her (I agree with LibraianSarah she’s getting what she gives out) it’s because it’s clear to me she has no interest having a genuine debate, is only out to create drama and as long as she can continue to get the attention she craves, she could drag this thread on forever.
Yeah, I’m starting to feel like there’s no candy left in the Ellie pinata.
I remain horrified for her students, though.
Same. Let’s hope she’s not tenured.
anion “I remain horrified for her students”
I am particularly bothered by the fact someone who claims to teach English typed “are u just screwing with me” in a public forum.
Could have been worse. It could have been “R U.”
I agree that it needs to stop. Not really because of her.
In her squirming to find a believable story, she is naming real people, and libeling those doctors. If we can prevent that by ignoring her, we should.
Ellie San Martin “I have been a lightning rod for anger & insults & this was not my intention.”
Since you are still reading, I’d like to give you a piece of advice, which I am borrowing from a fellow commenter. Pablo’s First Rule of the Internet:
When you post comments on a forum, always assume that there is someone reading who knows more about the subject than you.
As I said, I’ve learned some, and I assume that experiences are varied and broad. But my no one in this comment section knows more about my personal experiences than I do, and I’ve been insulted regarding them.
Ellie–I had you pegged for a liar from the moment you started posting your nonsense back on the old thread. So far I’ve mostly stayed out of it because I don’t think trolls like you need to have fuel dumped on their fire, though it has been quite entertaining to watch you and other posters go back and forth. By now, it should be clear to you that no one cares whether you’ve been insulted over your fabricated personal experiences. I don’t think you care whether you’ve been insulted either. For one thing, there is nothing real for you to be insulted about (except that we all think you are a terrible story teller). For another thing, you know what most people do when faced with a whole group of people who are continually insulting them-LEAVE. If you were soooo offended you’d have given this nonsense days ago. You obviously love the attention you are getting here. I don’t think you even care that everyone knows your story is fake, you’ll keep this little drama going for as long as you possibly can because you have nothing better to do with yourself. What’s the matter with you? Let me guess– your mom had an incompetent doctor who dropped you on your head when you were delivered!
No, we weren’t insulted. We were often entertained, yes.
A point about the moderate middle. On many issues, there are extreme positions. In politics, the best answer usually IS somewhere in the middle, but in science, sometimes one “side” is just wrong.
And no, we don’t know about your personal experiences, but we do know that a lot of what you described is impossible or nearly impossible, hence leading me to the conclusion that you don’t understand what actually happened, either. If someone claimed that he jumped over a two-story building, I’d assume he was lying or confused just the same way.
You got the response you did because you came in here with an initial comment that used deliberately inflammatory language–surely someone with a degree in rhetoric would understand that–then proceeded to make statements of fact that were so wrong as to be laughable, interspersed with anecdotes that became increasingly hard to believe.
If you learned anything here, I hope it was that you know a great deal less than you think you do.
Erm, maybe it was describing women as ‘devolved’ and using words like ‘murder’ that caused that response.
Your sample size is low even exaggerated. You sound like you’ve seen birth and fertility through a happy lens. You haven’t seen enough to see the rare and unpredictable and devastating events that happen with a big enough sample size to even the healthiest, well cared for women. You know, women like you and your friends? It is your cohort that can take unnecessary risks like homebirth and breech and vba9c, because you’re already lucky (alright maybe not the vba9c).
The sample size of the professionals on this board? You can’t even imagine. It is not the glowing pregnant friends who see the cord prolapse, the fulminant gbs that kills in hours, the abruptions, the unrepaired tears. It is the professionals who see it, manage the tragedy, maybe tell a massaged story to avoid destroying a grieving parent, and all the while trying to care for all their other patients. So maybe you’ve been treated brusquely. Did you ever think that maybe your medical practitioner has been traumatised themselves, and has seen what that trauma does to their patients, and they desperately don’t want to see that happen to you? Maybe their ‘fear’ of a dead baby is based on experience?
No one here is feeling judged or insulted. You are just an idiot. Nearly every NCB site deletes any comment that doesn’t praise their beliefs. Your stupid comments have been left up here. Your comments actually provide an example of the ignorance out there. Most NCB sites do not propose they did home births because of bad experiences in the hospital, but rather ignorance and just trying to show one up-manship mentality. I am sure a few might say they had a bad experience in the hospital, if so goto a different doctor or hospital. No where else in life ( construction, lawyer, accounting, etc) does one feel they got a bad experience so the way to fix that is to goto an undereducated layperson with a greater risk of mortality. That is just stupid.
Have you shown an iota of respect for the women here who have had traumatic birth experiences that would have been improved by c-section? Did you bother to read my comment about my friend who should be parenting a vibrant 2-year old son, but is instead mourning him because her uterus ruptured during a VBAC attempt? Forgive me if I’m not too concerned about your feelings being hurt when you are to arrogant to consider your own behavior.
To be fair, they did cite a WHO bulletin that does state the the “WHO recommends…” maybe it’s the WHO that needs to get its act together. I tried to comment but I seem to be being ignored
http://www.who.int/bulletin/volumes/85/10/06-039289/en/
The article they cite was published by WHO in the Lancet in 1985. (Look at citation #1 at the bottom of the article.) That used to be the position of WHO.
As Dr. Amy has pointed out, WHO has abandoned that rigid recommendation. There was no evidence to support it.
I wish the NCB community would acknowledge the change. They still quote the old WHO position, because it serves their purposes.
The WHO has not abandoned 15%.
It has suggested that as only 15% of pregnancies suffer serious complications it remains a threshold which should not be exceeded, rather than a target to be aimed for.
It does not, in any way, take into account the individual preferences or desires of women, nor the differences safety profiles between delivering in resource rich and resource poor environments.
>40% of women in China have CS. For the vast majority it will be their only baby. Labour and vaginal birth are seen as unnecessarily risky. There is no concern about future pregnancy outcomes. Preserving future fertility is not a concern. Personally, I do not see the Chinese CS statistic as unreasonable given that set of circumstances.
So what if a threshold has been exceeded? Prove the harm done as a result.
Southwestern Nigeria has the world’s highest incidence of twins (44/1000 pregnancies, which is almost 5%, and about 10 times higher than their rate in Europe).
If the WHO accepts multiple birth as an indication for CS, the safe rate for Southwestern Nigeria must surely be at least 3.5% more than the recommended 15% rate?
So does this mean that 15% was never really going to be an achievable level considering that currently nobody can predict with high accuracy which mothers and babies will be in trouble or not until after the event?
Ding ding ding!
Once you have enough surgical technology that the risk of death to the mother is negligible, and enough ultrasound and fetal monitors to reliably identify POTENTIAL problems, you’re going to get a c-section rate above that 10-15%.
CC Prof, you said that so much more succinctly than I did. 🙂 I’m in the middle of studying for midterms…clearly I’m trying to procrastinate as much as possible by writing wordy posts!
And sometimes you won’t even know if it was “necessary” after the event either, because the best c/s is the one that prevents a problem from becoming catastrophic in the first place, not the one that rescues an injured baby or worse after the fact.
Isn’t that the complaint of most “unnecessarean” mothers – that the doc called for a section and then removed a healthy, pink, crying baby? Why on earth would you want to wait until that baby is blue and unresponsive?!
“differences in safety profiles between delivering in resource rich and resource poor environments.”
One of the things about resource rich environments is that you have the technology available to not only detect a potential problem, but also to perform c/s with a high degree of safety. That combination means that when the choice is between a possibly brain damaged or dead baby vs a small risk of harm to the mother from surgery, the vast majority of moms will choose the surgery.
In resource poor environments, where c/s are far less safe, the evidence of harm to the baby must be much stronger to outweigh the risk to the mother. Jeevan’s blog provides many, many examples of this – for example, the severely anemic mother with a distressed baby who may have to wait it out because the surgery is simply too risky for her. Sure, this lowers the c/s rate, but at what cost?
The “problem” of having a great deal of lifesaving yet imperfect technology is that you’re forced to make a decision when the signs start to suggest that baby or mom may be in trouble. Having information like that means you have to act one way or another, and guess what – that means you’ve gotta “own” the outcome of that decision. NCB advocates claim that they’re taking ownership of their births, but they’re refusing monitoring because it isn’t 100% perfect. They seem to be demanding a level of certainty that just isn’t possible – they want to know for SURE that a baby is in trouble before moving to a c/s. But that currently just isn’t possible. Their solution is to shun the monitoring – because if you don’t know there might be a problem, you don’t have to decide how to fix it.
A better solution is to gather as much information as you can, and, in conjunction with an expert trained to interpret and apply it, make the best decision with the information you have available at the time. Birth is to respected, not trusted. It has the power to bring forth life and also to maim and kill. That’s the reality. Ignorance is not bliss. When it’s a matter of life or death, it’s far better to err on the side of caution and be wrong than to throw caution to the wind and find out too late that you should have been more careful.
This, this, this. NCB has this weird inverted relationship with perfection. Strive for the perfection that no one can control in the “perfect” natural birth….. reject what that could truly help because it’s not “perfect.” But it feels like having control.
I agree with everything you say. The one thing I would like to add is this: monitoring (EFM) has a bad name in NCB circles because of the perception that it gives bad information or “false alarms”. I would argue that it does neither. It actually provides very accurate information. Lates and Variables (late decels and variable decels) really do show what they show: that the baby’s is being deprived of blood flow and oxygen. What the EFM *can’t* tell us is how long your baby can tolerate this level of stress without permanent damage. The decision to deliver vaginally vs CS is then up to clinical judgement (e.g. this baby is oxygen-deprived but delivery is likely to occur soon and it is unlikely that significant permanent damage will occur between now and then) and parental tolerance of risk of death/disability.
This is slightly off topic, but if accurate shows how the desire to lower C-section rates at all costs can lead to terrible tragedies:
http://stlouis.cbslocal.com/2012/10/15/lawsuit-doctors-intentionally-concealed-decapitation-of-baby-during-delivery/
I’m
enjoying this immensely. I have quite a bit of experience with
pathological liars, particularly on the internet. Dr. Marc Feldman, who
originated the diagnosis “Munchausen by Internet” (I’ll shorten to MbI) actually commented on a
blog post I wrote about that condition. Make no mistake, I’m a
layperson with only an undergraduate degree who writes from personal
experience. But I do keep up to date on quite a bit of research, and
strive to stay aware of what experts are saying. But enough about me.
In about 30 minutes (including an intermission), here is what I have learned about you.
Although
you claim you teach History, your LinkedIn shows that you teach High
School English. This is consistent with the (expired) certifications I
found searching http://www.ctc.ca.gov/lookup.html
Not history.
English. Aside from the fact that my bile rises that an English teacher
would actually claim that “sarcasm is spoken, satire is written,” this
matters because it is an irrelevant and easily provable lie.
Pathological
liars are unable to be honest about even mundane and unrelated details.
Teaching English or teaching History are about equal as far as they
fail to qualify you to educate *anyone* about childbirth. Ergo, this is a
totally irrelevant thing to even bother lying about.
A
cursory search of your name brings up Facebook and Google+ accounts –
all of which only show you being friends with your husband. Which is not particularly important, although for such a very active circle of birthing women you
know the intimate details of, definitely suspect.
Your story
not
only has a lot of holes and a fantastical amount of unlikely drama and
traumatic events, your habits of dodging questions and your
ever-changing backpedaling are all red flags. You started out writing
about yourself (on other posts by Dr. Amy) but quickly switched to
talking about high numbers of friends with bizarrely specific issues.
Finally you’ve settled on your “sister” and HER dramatic life or death
moment. Not at all uncommon for someone with MbI – in fact, it’s fairly
standard behavior. Jump around until you find the right story for the
audience so you suck up as much attention for yourself as possible. I
notice that in the time I’ve taken to write this post, you’ve gone back
to talking about your OWN terrible traumatic birth and such.
It actually struck me yesterday, when I read your comment concluding “I don’t know if the numbers cross, but if your 31 friends who liked ice
cream were among the 55 friends who had gestational diabetes, I’m sorry
for their inconvenience and suffering deprivation too.” That joke is too
smart for the character you’ve been cultivating, with your “what? Like,
1 in 100 means 100%? I can’t comprehend statistics or rate or numbers!”
replies. I’m sorry, the math in that snotty little barb is above the
“Ellie” you’ve been pretending to be.
I’ve
broken down your claims about your sister. All I did was scroll through
your comment history (click on your own name. Look! Everything you’ve
written!) and made a note of each point you made. The article you
provided to support that Victor Valley Community
Hospital closed shows that only the operating rooms closed, not the
hospital. Further, all the
information about the hospital changing hands shows that it was becoming
a for-profit hospital to save itself from financial ruin. The ratings
of the hospital health-wise are not particularly good, but nothing like
what you’ve described. I was able to locate an OB/GYN, Dr. Vijay Arora
(Not Aurora) working at
VVCH. A
cursory scan of Dr. Arora’s reviews show he probably has a strong
personality, as the comments are sharply divided. People clearly love
him or hate him.
So, here are your claims, Ellie.
I’m not going to bother pointing out the blatant errors and
absurdities. Oddly
enough (I’d say ironically, but you don’t even know what satire is), I
started at the bullet list, and it’s tone is quite different. But that’s
okay. I still have the original file of copypasta.
****
Mystery Sister (henceforth Mystir) is in labor.
Evil OB thought it was taking too long.
Evil OB lied (to whom?) that Mystir is dilated to a 5.
Two nurses said Mystir was dilated to 8.
Evil OB Inaccurately recorded her height as 6 inches “higher” than it was
This caused Mystir’s “anesthesia” for the c-section paralyzed her lungs and put her in cardiac arrest.
Evil OB did “anesthesia” by himself.
Mystir and Baby Mystir were okay, so they couldn’t sue.
The medical board wasn’t interested in the complaint.
Even though they had records and nurses.
Because the whole hospital was shut down.
Actually, Evil OB didn’t record her height wrong, it’s just a sloppy 0 that looked like a 6.
Evil OB moved to Victor Valley Hospital.
Evil OB estimated Mystir’s weight off by 30lbs.
It wasn’t cardiac arrest, it was a “code blue” and Mystir had to be resuscitated before the c/s could be completed.
Mystir stopped breathing (because she started breathing again)
Two nurses confirmed she was “fully dilated” by the time the c/s started.
Evil OB listed it as “Failure to progress” “Large baby”
Evil OB refused to explain what “distress” meant
Evil OB claimed heart rate was dropping.
Evil OB stormed off and said he “cant wait all day”
Evil OB didn’t return for two hours.
The epidural was already in (apparently placed by an anesthesiologist) before the surgery
The anesthesiologist was “gone” (apparently before ensuring the epidural was correctly placed)
Evil OB did the c/s without an anesthesiologist.
Evil OB went ahead with the surgery after the anesthesiologist left. (separate comment)
Two nurses explained that Evil OB often “lied about these things” to finish his shift early.
Evil OB only allowed women to deliver vaginally if it was <1 hour.
The nurses thought Mystir and Ellie were super awesome.
The medical board won't take any complaints as hospital was shut down.
The hospital was Victor Valley Community Hospital.
Ellie and Mystir's insurance refused their claim because it was "standard."
Ellie has spoken to "lawyers" about filing med/mal and claims to be told it was hopeless.
Ellie has heard from several parents of students who have attempted to file…something.
Most of Evil OB's patients are young teenage girls.**
**I
included this because MbI often include various forms of child
abuse/exploitation in their fictional backstory or the backstory of
their sockpuppets. So it was a flag.
The weirdest one was blaming the incorrect information the ob gave to the anaesthetist for the over-dosing that led to the medical emergency, except the ob was the one that did the dosing and an anaesthetist wasn’t present?
It just read like someone who had hear that a high spinal could cause breathing problems, but not how, or why.
Then they decided to run with it…and kind of forgot their audience (who know the difference between cardiac and respiratory arrests, and epidural and general anaesthesia, and the duties of an OB and and an Anaesthetist for a bloody start).
Ellie is not worth responding to.
Either she’s real (which I doubt) and incorrigibly uneducatable, or she isn’t, in which case DNFTT.
No, I found out about high spinals after this happened because I wanted to know what almost killed my sister and avoid it since I was 4 months from giving birth myself
Right…
But “IDK what he did…it wasn’t GA”.
If you KNEW about high spinals and that is what happened to your sister, then THAT is what a normal person would have said.
“My sister suffered a respiratory arrest after her epidural was topped up with a spinal for her emergency CS and the block went too high. I blame her psycho OB”.
Like that.
we got that info from a nurse, but as I said, don’t have the records to verify. & one of the nurses (who did not provide a statement) may have been an anesthesiology qualified nurse (CNA)
Excellent work, Kumquat! I knew it was sounding fishy, but I like to give people the benefit of the doubt.
The thing about MbI and pathological liars is that they *count* on getting the benefit of the doubt. The predatory ones will exploit that benefit as much as possible – if you call them out, they’ll just use plausible deny-ability – or “oh, I mis-spoke/you misunderstood” to undermine your suspicion.
Another trick they use frequently is to post links that “confirm” their identity, because most people see the mere offering of confirmation as enough. Most people won’t actually go see if she has a teaching cert, or google the hospital, because why would somebody lie and present data that contradicts it?
It’s a hydra of lies. A Lydra, if you will.
Not to say we shouldn’t extend the benefit of the doubt – most people ARE telling the truth, or something like it. That’s why I don’t do a post/breakdown of every lying liar who lies here (that and who has the time for THAT bs?), just when something REALLY sticks out.
Thanks for the compliments, all who’ve posted them 🙂
Kumquat, you rock my world – nice work!! How awesome that we have our very own bullshit detector here – and such a ridiculously thorough one at that! 🙂
I mentioned the LinkedIn etc., and she replied below insisting she teaches history. So I did a search on the website of the school her FB shows her teaching at and found that no, she absolutely does NOT teach ANY history classes (if you go to the school’s site and click “Catalog,” you can search by teacher):
https://hlpusd.blackboard.com/webapps/blackboard/execute/viewCatalog
And as a writer, everything about the idea of this woman teaching English makes me want to cry. Not just the issues with comprehension etc., but the basic grammar/punctuation errors and poor word choices, too.
as stated previously, in full disclosure, that catalog is old, not to mention I’m on maternity leave, and have taught at 2 other schools previously.
But you said you ARE a history teacher – and you are not, you are a teacher who has taught some history classes = LIE
Don’t forget, too, that she mentions not being sure what anesthesia was given:
“…the epidural was already in, but the anesthesiologist was gone so idk what the OB did, I don’t think it was general anesthesia, but it paralyzed my sister’s lungs[.]”
Because CSections proceed without an anesthetist in the OR…NEVER.
Pregnant women have high risk airways, you don’t start cutting without an anaesthetist at the patient’s head.
NEVER, EVER EVER.
Total BS.
I can’t decide if that was my favorite part of the story or if it was the bit about the MBOC not taking the complaint about the doc because the hospital was closed down.
whatever it was, she already had an epidural & it led to 2 different code blues, which she only remembers not being able to breathe, passing out, & her husband had followed the baby & my mom was shoved out the door
So in other words, you have no idea about the anesthesia.
I know it was an epidural, 4 hours previously, and then when they rolled her into the OR, 2 code blues
So all the other things you wrote were lies or errors.
Right…
Ellie, would you like to take this opportunity to retract ANYTHING?
You know, the bit about the OB doing his own Anaesthesia?
Or the transcription error and wrong weight estimates that were never double checked by the anaesthetist (who, as the person administering the drugs is responsible for ensuring the dose is correct, and therefore is responsible if the wrong data is used for the calculation)?
It is possible that topping up an epidural by placing a spinal caused a high block and respiratory muscle paralysis leading to a respiratory arrest. It happens in about 1% of spinal anaesthetics. It is more common if an epidural has already been in place. It is a complication you are warned of before you sign the spinal consent form. They have drills for it. Often it just happens and nothing was actually done wrong.
http://www.frca.co.uk/Documents/180%20Complete%20spinal%20block%20after%20spinal%20anaesthesia.pdf
More info on complete spinal block.
Sorry, incidence is much less than 1%, but it is definitely not vanishingly rare (reading too fast).
One of my interview questions for an OB job was a role play where you’re in the middle of a CS and the patient complains she can’t feel her arms and stops breathing, and it was a run through of the high spinal drill (although they were mean and turned it into a full cardio respiratory arrest after you got the baby out, to prove you knew your ALS algorithm).
great background information, never knew any of that. Thanks!
That was a waste of time. All you need to save the patient is seaweed and Shepherd’s Purse.
Now its two code blues, eh? As for your pitiful “oh, you made that up” defense? You really do have pitiful reading comprehension if you can’t read your own writing. As for time? About two hours all together – and that’s been good work study for me. The one who is studying how to track someone’s digital footprint.
And no, I have not lived a charmed life where I’ve never known grief or trauma. Although people who really have worked through their traumas and losses? Don’t hysterically post about it on random, barely tangentially related threads. And can usually recount their traumas coherently.
I don’t regret any time spent on this. You’re a useful case study. And I’ve learned even more when I misidentified another user as you. I don’t mind admitting my mistakes. That’s one of many ways we learn. And learning to separate “suspicious” things from actual evidence is hugely important. Plus, your relentless, determined idiocy is nicely preserved here, which may help other rational readers in the future – both in seeing through your incompetent arguments and in seeing how easy it is for a person with the right knowledge to expose a liar like you.
Ellie Mae I say we start taking bets on how many nurses we can schedule for psychiatric care by roping out the IV & removing monititor, pressing the nurse button as many times as possible for intermittent monitoring, then chat them up about how many students I talk out of nursing because their coworkers will be no better than gossiping mean girls. Do u suggest I not put in our birth plan?
What kind of person does that?! I guess it’s just hilarious to waste the time of nurses who could be caring for other patients. Who cares about those losers who need their nurses, right? Or the nurses who want to do their jobs? It’s all about you and your performance art.
“Whatever it was” strongly implies you didn’tknow much about high spinals.
I vote lying liar who lies.
No more responses.
Stick the flounce next time.
Oh well done, Kumquat! thanks for putting it all together. The “ob did the section without the anesthesiologist” and “the nurses said the doctor often lied about whatever” were the red flags to me.
Munchausen by Internet–had heard of it, but what a strange phenomenon.
and we have the nine days in the NICU for no reason whatsoever and the social work consult because she questioned the staff to add to the list now.
Well you know, NICU’s just don’t have enough legitimate patients, so they have to fill in the gaps with babies who are there for no reason to make sure they make enough money.
This brings to mind a case of where I was in a position to know the story behind a loony internet poster. She made the most outrageous posts on every doc rating site she could. Doctor actually had to file a police report because of her non internet stalking. The worst thing is the doctors can’t defend themselves because it’s against the law to violate HIPAA so basically someone can say almost anything on these doc rating sites and unlike a hotel or a plumber who can tell their side of it there is no recourse for a doctor. This is not the same person but the style is very similar.
Luckily it’s usually so full of histrionics and nonsense (much like this poster) that anyone sane and reading the reviews can hopefully seperate the wheat from the chaff. You probably don’t want patients who woudl read a story like this and believe it
Very insightful Tim! Last thing any doctor wants is to be the loon magnet in town. Seen more than once a self righteous wacky patient fire the doctor off the case and the doctor practically dancing with glee whilst the one who is now stuck with the patient bemoans his fate.
My current specialist has a poor rating from one person. Apparently he was dismissive about her ideas of using complementary medicine. Sounds like my type of doctor actually.
which is exactly why half of his patients love him. They feel rescued from TOL by his offer of a c-section & had no complications
And stingy health insurance companies just LOVE to pay for expensive NICU stays for babies whose only diagnosis is having a parent who asks too many questions.
I would think so! but not Kaiser!
That’s what I said!
That was about her own birth/daughter, so I didn’t include it. I was careful to exclude comment s that weren’t directly about the Mystir story, lest she have a tiny foothold to claim I’m full of it. 🙂
I can’t remember who pointed out that some nurses are qualified to do anesthetic work if the epidural is in place. I just learned that.
She’s clearly using the “snowflake method” of story-building.
Good Job! I feel her story was made up but couldn’t put my fingers on. I lost interested half way through her seas of commons. After reading her first 3 commons, I felt she is fishing for real life details for her story.
nope, It’s regrettable enough that I’d rather forget because I’ve worked through forgiving.
I notice that she’s changed her facebook name to “Ellie Mae”
Because that means she’s INVISIBLE! It’s not like facebook automatically assumes you’re looking for her by her full name…
Faeredae from the other thread deleted her Disqus account – isn’t that what happens when the name is replaced by “Guest”. Too bad I forgot her last name, wonder if she’s a doula somewhere.
Claribel Rodriguez did the same thing. Don’t want to stand behind their words.
Faeredae something Miller….
How intriguing! According to google, Ellie Mae’s maiden name was Miller. This is in one of the top results, btw – I saw it last night and made note, though I didn’t include it as I thought it irrelevant. NOW however…
My sister married to a Miller, it is a very common last name. I will give my benefit of doubts.
yes. But the only Audrey I know is my 2 yr old niece
Ellie, please, don’t name your minor niece on the web when you post your real name and your real maiden name. I think the posters here are safe but there are rotten people in the world and honestly either your life is an open book or you have decided to play a cruel joke on the person you are impersonating.
Audrey
Um, I’ve had that fb name as long as I’ve had a profile. I chose to enter a different name in disqus
Oh man, kumquat! You da bomb! Seriously!!! MWAHHH!!!
Is it too soon in our relationship to say “I love you”? Cause right now, I think I do!!!
Many of those things are either things I never wrote that you are inferring (nurses thought we were super awesome) and out of order and if put together not contradictory. But I am surprised I have struck such a cord with you that you dedicated this much time to altering the order of the story and picking out minor vague areas to assume that I’ve gone to as much trouble to make up a story. Since you don’t seem to understand that traumatic events (like possibly losing a family member) might cause someone’s memory to become vague & I had no records to go by, I’m merely glad that you cannot relate to such trauma.
Umm, I would like to ask a personal, related question. What is the data behind C-sections for big babies? So, my personal story is a relative who is pregnant right now and who told me that her regular OB-Gyn told her that if the baby is shown to be 8 lbs on ultrasound, she wants to do a C-section. (My relative did not like this and wants to switch doctors now.) Now, not knowing much about the topic, that does seem a little excessive…right?? Is this standard? What’s the science behind big babies, risk and c-sections? Am I missing something? Thank you!
Good question! Simply, big babies are more likely to get stuck on the way out. They are more likely to suffer birth injuries and more likely to be unable to pass through the birth canal at all. (cephalopelvic disproportion.)
8 pounds isn’t terribly big, 9 pounds is generally considered the border of oversized and dangerous, but keep in mind babies can gain a pound a week in late pregnancy, and ultrasound estimates aren’t perfect.
Of course, the exact risk depends on the exact circumstances. Is this her first baby? If she had prior labors, what happened? Does she have gestational diabetes or has she gained a lot of weight? (GD seriously increases the risk of excessively large babies.) Is she very close to or past her due date? Is there a reason the OB thinks the baby is likely to be overweight?
Thanks, Young CC! This is her first baby. My relative is maybe a little overweight, but no GD as far as I know. She still has some time – I think this came up in a general discussion of how the birth will go, not due to specific risk factors.
I think she said that she has gained a lot of weight during the pregnancy so far, though.
Take my story for what you will but I would have prefered a C-section. I am 5 feet tall and have a small frame. My baby’s head was not measuring too large for my pelvis and everything was looking good. She started experiencing distress late in the delivery and there was meconium in the waters.(I also experienced some tearing at this point) As she was far enough down the birth canal they did an episiotomy and used vacuum extraction to deliver her faster. The OB had called in the NICU team when he saw that she was probably going to be delivered in distress. She was not breathing right away and had to be resuscitated. She turned out to weigh in at 8lbs 15oz. She’s 19 and in college doing great. But I think a scheduled C-section would have been a LOT less stressful for both of us(and guess what, recovering from all those stitches while trying to care for a newborn is no fun when they are in your perineum either!) Would rather have had them in my abdomen but that’s me.
My OB told me that he would recommend a CS if the EFW was more than 7lbs6oz, because not only am I a small person, but I have a wonky pelvis that is bolted together, so all the pregnancy hormones in the world wouldn’t give me a normal sized pelvic outlet.
At 38w the EFW was 7lbs but her head hadn’t dropped into my pelvis AT ALL.
She turned out to be 6lbs 3oz, which, apparently was still too big for me. I’m happy I opted for the CS rather than to roll the dice.
Point being, 8lbs might be an individual threshold for this person based on some particular factor in her history or examination.
Thanks to everyone who posted to answer my question, here and above!
Your relative can certainly seek a second opinion–from another qualified OB–if she doesn’t want a section, but it’s always good to be prepared for the possibility and to know that it’s really not that bad! I’ve had two sections. Recovery was pretty easy with both; the first day wasn’t great but after that it was okay, honest, and you can barely see the scars. Plus, I avoided tearing and all of the other possible issues that can stem from vaginal delivery, which was nice. And, you know, I ended up with a beautiful, healthy baby.
But before she switches she should have a real talk with the OB about it and ask whatever questions she wants to ask. She may find herself feeling a lot better about the whole thing.
My OB estimated the weight of my first at “not quite nine pounds.” (I didn’t end up with a section because of weight, but because I was induced at term [per my request] and she didn’t drop). I didn’t have GD but also gained a lot of weight with that pregnancy and had to do the three-hour-horrible-orange-drink test because my first GD test came back borderline; it sounds as if your relative is perhaps in a similar situation, which is why I’m replying here. My OB was confident I could deliver vaginally, although I wasn’t thrilled with the idea–I’m pretty tiny.
She ended up 8 lb 6 oz. So my OB wasn’t far off. And really, the OB isn’t mentioning the possibility of a section because he just feels like it. He (or she) is mentioning it because it may be necessary to prevent all sorts of horrible things happening. The OB’s priority is a safe delivery where both parties end up healthy and alive. That’s what really matters, in the end.
I want a c-section if a larger baby is predicted, I’m on the smaller side and I think I have some factors that I think might give me a higher than normal chance of more severe tearing – something I am going to talk over with my doctors.
circumference of head is a more accurate measurement from ultrasound technician and also more useful in predicting struggles in labor (since it is always the largest part of the baby. Shoulder dystocia can be dealt with in many ways that are not as risky as a c-section. But if she doesn’t want advice and seems overwhelmed, a c-section could be a better option.
http://www.ncbi.nlm.nih.gov/pubmed/23132481
” Shoulder dystocia can be dealt with in many ways that are not as risky as a c-section.”
Can they? Which ways can it be dealt with?
Ways that result in 2-16% morbidity in the neonate and 3.8 to 11% morbidity in the mother.
An elective CS prior to labour is safer than an emergency CS during labour and an emergency CS following Zavanelli for SD.
I suspect Ellie thinks all SD resolves with the “Gaskin” manoeuvre.
what’s that?
the “gaskin” manouver is what you mentioned above – turning the woman on her hands and knees and asking her to push in that position. There are a few other ways of trying to free a shoulder dystocia and we drill them in hospital (whole nursing and OB team) via simulation because it is a complication that has such power to maim (both baby and mother) and kill (generally just the baby). And you can’t always get that baby out. Sometimes you have to try to shove the infant back up and take it out via CS. The odds of doing that in time to prevent injury and or death are poor.
Very poor.
Your idea of this complication only involves the uncomplicated, easily resolved kind. That’s, unfortunately, not the only kind we see.
If my baby was measuring big I’d take the CS any day. If my labour was prolonged or my pushing phase was prolonged I’d take an early/ pre-emptive cs any day. I have a friend right now that had a mostly easily resolvable shoulder dystocia with her first…I guess other than the horrible pelvic floor damage she sustained…her kiddo is fine. She’s completely torn about what to do with her second. For me, that decision is easily made. CS all the way.
Wait a minute – you’re giving out advice about shoulder dystocia, but you’ve never even heard of the Gaskin maneuver??
Ellie, please. Stop for a minute. Take a deep breath. Think about what you’re doing. Realize that spewing incorrect medical “advice” on the internet can have real life consequences on real mothers and babies who read your words and believe them. They shouldn’t, but they do. So be responsible.
Being responsible = listening to the experts who actually know how to resolve and prevent SD.
I was asked & I responded. I was told by that particular OB that that movement (she didn’t name it) was one way to deal with it, but I’ve never heard of preventing SD- unless you prevent vaginal birth by performing a c-section. Several of the OB’s I spoke with had not performed very many vaginal births or emergency c-sections, because for the past 15 years or so of their practice, they had done nothing but elective c-sections during their shifts, which would account for their lack of recent experience
You talked to “several” OBs who’ve barely performed any vaginal births because for fifteen years or so they’ve done almost nothing but elective c-sections?
An outrageous lie.
Names of those OBs, please.
John K. Moran
Il Woo Park
Patricia Bajamundi
You have named three Obstetricians who exist. Your point being? None of these doctors have any sanctions, or even complaints against them. I find it extremely unlikely that doctors in a NCB-infested area like the one you describe who did virtually nothing but C-sections would have raving, whining reviews about how terrible their trauma was. Oh, but I’m sure you have a steaming pile to explain that too.
Someone’s just got to fax that unit this conversation…
Kaiser Permanente Downey Medical Center
9333 Imperial Hwy.
Downey, CA 90242 Directions Phone Number
Kaiser Permenente has a 17% section rate:
http://www.calhospitalcompare.org/profile.aspx?h=170&c=7
(It has a 76% breastfeeding rate and VBAC is routinely available, too.)
Yet Ellie claims that there are at least three OBs there who oversee vaginal deliveries so rarely they’re not even sure how.
Ellie, you realize that by naming those doctors and claiming such a ridiculous statement was made by them, you have opened yourself to potential claims of libel?
That must be why during my repeat C-section my OB said “Aren’t you glad we ended up doing it this way, baby has broad shoulders?” (The baby did have broad shoulders and was a surprise 9 plus lbs.! No GD. I passed the test we flying colors. So, yes I was thrilled I never went into labor and ended up with a RCS!)
This was an OB that was perfectly fine with a VBAC and never attempted to talk me into a c-section and even offered to attempt to induce labor, if I wanted.
I don’t know much about how the accuracy of ultrasounds at Kathmandu medical college compares to those around here, but shoulder dystocia is NOT a good thing. Back in the day, they sometimes had to resort to breaking the baby’s collar bone.
Do tell us, Ellie, what are the risks of c-section vs. shoulder dystocia and the rates at which they occur?
Include a breakdown of baby size
I was under the impression that there is not a reliable way to predict shoulder dystocia. ??? GD was the only significant correlation I could find.
AFAIK, previous SD is another significant risk factor. The point is that the ways of “dealing with” SD, as Ellie would have it, entail waiting for a life-threatening emergency to happen rather than preventing it. It makes a great deal of sense to this layperson to consider c-section in cases where there are known risk factors, as questionable as those may be.
Oh, Ellie, babies whose mothers have GDM can be bigger around the abdomen than the head. They are at particular risk of Dystocia.
Want to know about the worst night of my career?– a totally unexpected shoulder dystocia ultimately relieved by a zavanelli maneuver and emergent C-section. Baby died. Want to know how many women or babies I’ve had die at C-section (with the exception of those infants with known lethal anomalies or extreme prematurity)? None. When you’re trying desperately to get a baby out, having already resorted to breaking a clavicle, attempted to break a humerus, cut a large episiotomy, and tried every position imaginable while knowing that the minutes are ticking by and the baby is hypoxic you can tell me how shoulder dystocias can be “dealt with in many ways that are not as risky as a C-section”.
An OB at Kaiser told me that if the patient is mobile, if she can be put on her hands and knees that the movement of the pelvis will often free the shoulder. She also said that if the patient is not mobile, there are ways to manipulate the mother’s pelvis.
did you read guest’s reply – ie the parts about trying every position imaginable (which would include the hands and knees, mcroberts, suprapubic pressure), cutting a big episiotomy, trying to deliver an arm, breaking the fetal clavicle etc etc….That Kaiser OB’s response is like a “pat pat, there there dear, don’t worry your pretty little head about it.”
can you imagine a big episiotomy, OB hands pushing into your flesh trying to get a fetal arm out…all without any analgesia because there isn’t time?
Those scenes are horrible, they keep me up at night and when you lose the infant anyway…after causing all that trauma to the mother…its really…well, it’s just…
Great. I’d rather have a c-section than potentially damage my baby and have abnormally bad tearing/damage in that area. I’d MUCH rather have an abdominal incision to heal from.
You are really an idiot. Please work on your reading comprehension skills.
You do realize that “an ob told me” is not the basis for a deep understanding of shoulder dystocia and that every time you offer a morsel of wisdom like “[s]houlder dystocia can be dealt with in many ways that are not as risky as a c-section” you make yourself look foolish and arrogant?
do you realize that “a c-section is the solution to most problems and a 30% rate is not high (adjusted to 20% of 1st time births)” sounds foolishly impatient and narrow minded? (Especially when c-sections themselves have many additional risks?)
I’m still waiting for you to provide the relative risks of shoulder dystocia and c-section and the rates at which they occur. That would actually be germane to the discussion.
Do you realize that “an OB told me” is no justification for being so smug? You have no leg to ask other “do you realize” when you didn’t even know what the bloody Gaskin maneuver was? You fail even at NCB, Ellie, because that’s something your fellow NCB know-nothings swear by. Of course, it isn’t half as effective as they think and would like you to believe but at least they have heard about it.
Apparently I did know it, but not by it’s proper title. Wow, NCB advocates are now “know nothings.” Glad to see that we’ve advanced beyond the political rhetoric of Tammany Hall. BTW, what exactly caused you to interpret which comment I made as “smug.” The fact that I had an opinion at all in the face of an OB comment on a blog?
No, you did not know it. What happens in the hospital when the clock ticks, the baby is stuck, and every minutes matter? What would you do, Ellie? Let me guess: you’ll start explaining what the maneuver is, losing time and baby’s brain cells.
Names matter, Ellie. I would think that as a teacher, you would know that.
What makes me think you’re smug? The fact that you are making wrong assumptions spoken with authority when all you have is “an OB told me”. Shoulder dystocia is the nightmare of every OB and midwife worth their salt, especially when it cannot be resolved easily. I suppose that you either didn’t hear the OB right, or didn’t understand him/her right. Given your grandiose failings at reading comprehension, I’d wager that you have troubles with listening comprehension, too.
Flippant much? Performing the zavanelli maneuver is the last resort, all other methods have been tried and failed. Hilarious how you are trying to “teach” an OB.
Maybe we need to give out some English teaching tips – you know, to make things fair.
#1. Moby Dick is way too long, assign Billy Budd instead.
Who else wants to play?
But she’s a HISTORY teacher, weren’t you listening to her?
I don’t like to feed trolls, but I love to point out lies.
according to new common core standards, only 30% of the curriculum is literature, and that is highly encouraged to be “deep” not lengthy. Therefore many administrators are dumping whole novels completely in favor of short excerpts. We will not have a very well read generation
I notice that you have not responded to my observations. How unsurprising. I do hope Dr Amy will be checking your IP address as well.
how would it help to know that I used my work computer once and then my home computer?
You’re an English teacher, you say? Oh wait, no, you lied about being a history teacher.
I thought you said you were on mat leave, how are you at a work PC when you are on leave?
Especially not when we have English teachers who are incapable of effectively communicating in and reading English.
I don’t mean to “teach” & OB. My opinion was requested & I gave it.
Ellie San Martin “My opinion was requested & I gave it”
You are extremely arrogant if you believe that Busbus’ question was directed to you.
it was a response to one of my comments…?
I love the part if your comment where you say a cs is better if she doesn’t want advice or feels overwhelmed…it’s like no informed patient could ever chose a cs over a trial of labour in your worldview!
It’s interesting how these biases come out, isn’t it?
I’ve had some terrifying moments with shoulder dystocia too.
ACOG states EFW > 5000g for nondiabetics, and EFW > 4500g for diabetics can request ECS. And no, the HC is not always the largest part of the baby. SD is common when the AC>HC, thus the dystocia. Many babies die or are injured attempting vaginal birth that otherwise would have had no injury if CS was done. Check out my next post of real lawsuits posted in just one year. And these are only a few that get entry into the journal.
My 2nd child was 11lbs (5kg exactly). Even though everything went well, I think in retrospect that I probably should have scheduled a section… No trauma from birth, etc, but I would not do it again because I think the risk to my kiddo would be too great.
1) WHEN SHOULDER DYSTOCIA WAS ENCOUNTERED
VERDICT A $5.5 million Iowa verdict was returned.
2) ERB’S PALSY AFTER SHOULDER DYSTOCIA
VERDICT A $1.34 million New Jersey verdict was returned.
3) FORCEPS DELIVERY INJURES MOTHER’S PELVIC FLOOR
VERDICT A $1,716,469 Illinois verdict was returned, which included $484,000 to the patient’s husband for loss of consortium.
4) LARGE BABY WITH CERVICAL SPINE INJURY
VERDICT A confidential Texas settlement was reached.
5) DID OB’S ERRORS CAUSE THIS CHILD’S INJURIES?
VERDICT A $1,314,600 Iowa verdict was returned.
6) 12 LB, 7 OZ BABY, BRACHIAL PLEXUS INJURY
VERDICT A $1,174,365 Ohio verdict was returned.
7) EXCESSIVE TRACTION BLAMED FOR NERVE INJURY
VERDICT An Illinois defense verdict was returned.
8) BRACHIAL PLEXUS INJURY AFTER SHOULDER DYSTOCIA
VERDICT A $72,500 Texas settlement was reached.
9) ZAVANELLI MANEUVER; BRACHIAL PLEXUS INJURY
VERDICT A Georgia defense verdict was returned.
10) Pelvic injury from the McRoberts maneuver?
VERDICT A $5.5 million New York verdict was returned.
11) 1. Severe birth asphyxia: cerebral palsy and seizures
Verdict: The insurance company ultimately paid $10.15 million.
12) 4. Shoulder dystocia, uterine tachysystole complicate vaginal delivery
VERDICT A $3.55 million Idaho verdict was returned.
13) CHILD’S ARM PARALYZED DESPITE MOTHER’S EXPRESSED CONCERN
VERDICT A $1.6 million Ohio verdict was returned against the ObGyn group.
14) MIDWIFE “PULLED TOO HARD”; CHILD INJURED
VERDICT A $950,000 North Carolina verdict was
Captain, have you ever read about these cases in any detail? Would you say most of these came down to OB judgement and it just went wrong? Or incompetence? or some of each?
Some of each
Could you share any from CA? I’d be very interested
Google Dr Robert Biter
So you can use the details to fabricate a more believable story for Babycenter or MDC or something?
You are really missing the point. These are samples of actual SD cases that do happen everywhere, including CA. Gaskins maneuver (which she learned from Peruvian midwives and decided to name it after herself), may work, but is not a guarantee. Post arm delivery after first trying mcroberts and suprapubic pressure is quicker with better chance of success.
thank you, that is helpful to know
Here is another perspective from a blog written by a mother who had PTSD from her first delivery and requested a c-section with her second. She writes about investigating, now that she has healed, what a forceps delivery is like, then compares to a c-section.
http://peaceoutofpieces.com/2013/10/15/click/
8lbs doesn’t sound right to me. I have known a lot of people to have an 8lb baby no problem. Is something else going on?
Maybe there hasn’t been an established optimal rate, but I am sure that it exists. I don’t think it should be thought of as an optimal rate of c-sections, more like the care protocols with the best outcomes and the rate of c-sections that goes along with it. C-section rates vary so wildly from place that I bought into a lot of the conspiracies about it when I was pregnant. I am genuinely curious about the reasons…
I’m sure it also changes due to changes in obgyn knowledge and technology, changes in patient demographics and health and changes due to the number of women requesting the procedure.
Does it really make sense that 1/3 of women have “devolved” to be murdered by or murder the babies that grow in them unless rescued by an OB performing a timely c-section?? What is Dr. Amy’s take on single layer stitching of c-sections and the pitifully low VBAC rate??
C-sections are also prevent disability and serious injury. Over a lifetime, a woman’s chances of dying, losing a baby, having a baby with disabilities acquired as a result of difficult labour or suffering a serious injury herself are pretty close to one third. Human life is hard: a high wastage rate is inherent in the system and it’s only recently we’ve changed that.
There is a *LOT* of pain out there, which people with ready access to obstetric care simply don’t see. With c-sections being safer now than they’ve been any time, why wait until disaster is manifest before acting?
Did you just refer stillbirths or interpartem death as “murder?” Do you have how insulting that is to anyone who has gone through that? That is a horrible thing to say and you should feel bad. Shame on you
This type of insult coming from NCB posters is embarrassing for them.
“Devolved” indeed.
Anyway, it’s not that 1/3 of women are having c-sections, but that 1/3 of babies are born via c-section. Your actual chance of having a c-section as a first time mum is much lower, even more so if you are low risk to start with. The c-section for births is higher then the c-sections for women because women are having repeat c-sections. I skewed the stats because I had 2 c-sections.
That said around 50% of pregnancies end in miscarriage and humans are still around, so it is perfectly consistent for there to be a high number of deaths.
Finally, some women are actually choosing to have a c-section. I had no interest in having a VBAC. It might not be what others choose but it was the right choice for me and I’d be grateful if people like Ellie San Martin were to keep their nose out of my business.
I didn’t mean to poke my nose into your business as I thought we were commenting on a topic (although I understand it’s a very personal topic). I’m glad you are happy with your choice and had all the options you needed. If you look at my original comment I refered to VBAC’s so it’s probably more accurate to be suprised that around 20% of women’s bodies are considered “incapable” of giving birth safely.
Not sure how you were poking your nose into my business? At any rate, more accuracy is better. Can’t think why you’d be so surprised though? My body was “incapable” of giving birth safely. Plenty of women’s are. Around 6-10% of Australia’s population has a rare disease which are mostly due to faulty genetics and around 50% of pregnancies are thought to end in miscarriage.
I feel bad that you took it that way, as it was not my intention. I’ve never heard of or seen a statistic of stillbirths that could have been prevented with a C-section so I had not considered that. I don’t feel ashamed but I hope you can accept my apology. I was refering to the idea that somehow C-sections are necessary becuase the babies are too big for the mother to give birth, and clearly a C-section is preferable to an 19th century craniotomy, or the death of the mother, I only know 2 mothers who truly required c-sections and know over 40 who regret theirs and felt coerced into it. I also don’t see the data to support that all c-sections performed are life or death issues.
Baloney! It’s all been said but comes down to risk and judgement. How large a chance does it need to be before you, Ellie San Martin, judge a c-section to be allowed? 10% chance of demise or HIE, 20%, or 50% or higher.
Who you haven’t met yet are women who lost a baby during labor and say, I wish I would have scheduled that c-section, I’d been holding my live baby now. Those mothers exist.
I’m sorry for your friends who have lost their babies. I do know two women who had still birth but it wasn’t because of labor, it was because the baby inexplicably died in the final weeks and I agree that it’s tragic
But you didn’t answer my question.
For myself? my child? When the OB or midwife takes the choice away from me or has no time to discuss options. If they give me 10 min to discuss with my husband, most of the time I will pray & trust that God will carry us through. I wish I had done more of that with my daughter instead of allowing myself to be intimidated by the hospital into being separated from my daughter. I still don’t understand why a hospital would send a baby home with a mom who had a c-section after a day but keep my non-symptomatic daughter in a NICU for 9 days. I’ve had several doctors go over the record & no explaination yet.
If you believe you experienced poor treatment please make a complaint to the OB and the hospital. Many facilities will have a patient advocate. Sorry that happened to you but it shouldn’t indict the entire profession.
I did. That’s why they called social workers to ask us why we don’t trust the hospital to care for our baby.
Sadly, I have read a lot of tragic birth stories that include the mother fervently praying for her child to be alright – as she is rushed to the ambulance, or rushed to the OR for a crash c-section. But still the baby died. I’m sure those parents wished they had an opportunity to act earlier.
How is your decision to pray instead of having a rational discussion the fault of the OB?
And personally, I’d be grateful they kept my baby in NICU at even the slightest chance it could be necessary, rather than whining about it. They discovered a minor heart murmur with my first in the hospital. It was a bit scary, and we went to see a pediatric cardiologist twice for ultrasounds and EKGs. It ended up being a fairly common infantile murmur which resolved itself, but I’m sure not complaining that they made sure everything was okay before sending us home instead of just saying, “Eh, I’m sure she’ll be fine,” and then having my baby die because of it.
I’m sorry your baby spent nine days in NICU, but I am stunned at the idea that it would have been preferable for the medical personnel to just shrug and hand her over without being sure everything was fine.
But the baby you describe had SYMPTOMS. My daughter had NONE. NOTHING. NADA. The neonatologists and pediatricians simply said that they wanted to monitor her. Why? Because they wanted to monitor her. Consult with other doctors and pediatricians sharing her record: they want to monitor her. You can sign her out against medical advice if you want. What’s the medical advice? to leave her in the NICU to be monitored. I hated to feel so frustrated around so many needy babies and parents, & I felt awful my daughter was taking up a bed. but no symptoms, nothing, just to be monitored.
And because you’re psychic, you know she would have been fine if she’d been sent straight home with no extra antibiotics. Maybe yes, maybe no. If I were you, I’d just be glad she did go home fine after a few days of extra monitoring.
Not “the baby [I] describe[d],” MY baby. And you have, once again, completely failed to understand my point, which is that I would rather my baby be monitored and checked and watched over than have something happen because they didn’t bother to do that monitoring and checking.
You said you were GBS+ (among a few other complications). That means there was a *medical reason* for them to monitor her in the NICU. The fact that you didn’t like it, or that you are too obtuse and cavalier to understand it, doesn’t mean the reason didn’t exist.
You personally might have preferred to go right home with your baby and then have her die from preventable complications, but most of us do not feel that way. You can say all you like that we’re just cowed by that silly fear of infant death, but you tell me what’s more rational: Making sure medical care is provided in case it becomes necessary, or sticking your fingers in your ears and shouting “LA-LA-LA-LA-I’M-GOING-HOME-BECAUSE-THAT’S-WHAT-I-WANT-AND-YOU’RE-JUST-BEING-MEAN!” because you know better than all those silly fear-based medical professionals who’ve actually seen what can happen?
no. what other complication did I mention? I had had 7 doses of IV antibiotics while in labor when the recommended minimum is 4. So either they skipped a dose near birth and tried to cover their mistake (in which case, of course, please give her the antibiotics, but according to hospital protocol, the antibiotics did not have to be given to her in the NICU & could have been given in my recovery room).
Ellie, you are either lying or leaving out something relevant and embarrassing. Nine days in the NICU for no reason and the social worker simply because you questioned your care, in addition to your online personality….. make me smell a rat.
I would imagine that the doctors explained exactly why they were keeping the baby in the NICU, and Ellie didn’t understand and/or stuck her fingers in her ears, so to speak.
Professionally, I deal with a lot of individuals’ problems. Not medical problems, but problems. I listen carefully to the individual’s explanations, but generally DON’T assume that they are complete or entirely accurate. It’s pretty rare for people to lie, but often they are confused or explain poorly.
I too think people rarely lie and often, especially patients under stress, don’t hear. I hope that my impatience with this one troll and her bizarre comments didn’t make it appear I am as intolerant of my patients as I am of her trolling. I am actually the nurse my former manager used to assign to the most difficult and/complaining patients because I am able to remain kind. professional and respectful of the rights of even the most difficult patients. Some reward huh?
However, the nine day stay and social work complaint are fishy. Now usually the social workers want to see any family with a baby in the NICU for more than a day or two, so that could be the only reason. But a lot of times the firing of doctors, long NICU stay, and anger about social workers are red flags for behaviors that most patients would be loathe to admit to and with so much not adding up, and the just highly annoying frequently wrong but never in doubt nature of the Ellie blog I wonder what really might be behind all this with Ellie.
I am not lying. The 1st 3 days was for the antibiotics, then an additional 7 for observation with the circular reasoning I gave. I’m still in a dispute with Kaiser about it because I have told them that I will drop it if they give a reason, like missing one of my doses of IV antibiotics, but I think they don’t want to admit to that & realize I have no basis to sue due to the arbitration agreement & that my daughter is still alive.
Please, tell us all about what you think the hospital protocols are.
Interesting that the people you are supposed to teach have the same opinion of you as you do of the people who try to help you….
Easily the WORST teacher I have ever had. Childish, played favorites, had a messed up system, and just not very knowledgable. I corrected her grammar/spelling.
Quality 34%
sometimes she is just rude to us… and what is with her wacked up grading system?
Quality 46%
06/06/03
A genuinely good person, but she just doesn’t explain things. You think her class is easy and then you look at your grade…Can be rather annoying.
I didn’t want to be flippant toward those who have had to suffer through an infant in the NICU whose life was in danger but someone made an insensitive comment in our VBAC thread earlier akin to “maybe we should offer c-sections to all 1st time moms so they can experience the safety of a VBAC.”
So in this situation, with an exception for and respect to those who have had an infant with a life-threatening illness in the NICU, maybe all parents should be ensured the safety of an extra week of observation in the hospital nursery while they go home and recover away from their infant.
Your baby had something going on. My older son (the “natural” delivery at 38 + 3) spent two days in the NICU with TTTN. I never noticed the grunting sounds, but an observant nurse did. And you know what? I’m damned glad that they were monitoring him closely. Just because you didn’t notice any symptoms doesn’t mean that there weren’t any.
Really? They kept an unsymptomatic infant in the NICU for 9 days? That is such total horseshit. Clearly, we are not getting the full picture from you. NICU care is astronomically expensive, and they don’t put healthy babies in there.
She avoids most questions, because she has no answers.
Ellie, my baby died because of an intrapartum (during birth) injury, and boy do I wish I could have had the opportunity for a c-section. And I am, by far, not the only one who has had this experience. How, exactly, do you define a necessary c-section? Because from where I’m sitting, it is plain foolishness to say I need a bona fide emergency to prove I needed that c-section. Give me a risk profile over an emergency any day. Once you get to “emergency” every minute is precious.
Exactly, Jenny. I had a c/s because the OB suspected placental abruption. Before rushing me said into the OR, he said it was possible he would get in there and find out he’d been wrong and everything was fine, but did we really want to take that risk? Of course not – it wasn’t even a question. There was an abruption, but my son survived. If there hadn’t been an abruption, it still would have been the best decision to have the c-section. That’s not a risk anyone should ever take. You don’t wait around to see what happens when death is one of the real possibilities.
wow, so sorry.
This 10000x. How close does to death or injury does it have to be? How much of an emergency?
I’m sorry but you are not an ob and you don’t have the right or ability to decide who’s c-sections were “truly required” or not. You are basically the birth equivalent of a Monday morning quarterback. It is easy for you to sit there and dismiss c-sections an not “truly required” when you are not the one who is going to be sued for all your worth if something goes terrible wrong. Hindsight is always 20-20 so if you have a crystal ball that tell which births will result in catastrophe and which will turn out “fine” feel free to hand it over.
The numbers bear it out. Why are so many c-sections performed for “failure to progress at around 5pm or 8pm? I’m speaking in reference to several mothers themselves who regret agreeing to the c-sections.
Why are so many c-sections performed for “failure to progress at around 5pm or 8pm?
Reference?
Most of the statistics don’t separate between pre-scheduled c-sections and emergency or those chosen for failure to progress or other reasons, so the statistic is difficult to differentiate between scheduling it ahead of time for 5pm or 8pm, & when an OB just wants to go home. But of those I know who have unplanned c-sections that are not emergencies, the OB put the pressure on around those times.
So you don’t have any references that show an increased rate of c-sections at 5 pm and 8 pm. Got it.
Guttmacher institute but as I previously mentioned, it’s easy to argue with that number
Where? I did not find this claim after a brief search of the Guttmacher site.
I don’t think OBs get into this field for a 8-8 shift. Your friends lie to you
Citation needed
And you didn’t address any of my points.
Most of the statistics don’t separate between pre-scheduled c-sections and emergency or those unplanned and then chosen for failure to progress or other reasons, so the statistic is difficult to differentiate between scheduling it ahead of time for 5pm or 8pm, & when an OB just wants to go home. But of many I know who have unplanned c-sections that are not emergencies, the OB put the pressure on around those times.
You know or you know someone who knows? OBs don’t count on regular hours, and I’ve NEVER heard of that and I may be a lot older than you and know of many more births. One of my own children was born around midnight and I went in at 4 am for the other and my OB was already there. You are just repeating a myth to justify your opinion. Not fact. Sorry.
It’s not myth & I’m perfecctly willing to change my opinion. Were your children born vaginally or C-section?
My children were born at 7 am after 24 hours of labour following SROM, 6 am 22 hours after induction due to PROM and at 11 pm following induction for post dates. The last was even a Friday. In my experience and from what I know there is a fault with your claim, most OBs are called in for their patients births and are not just waiting at the hospital. They come in to check on their patients but don’t just hang out in the lobby waiting. Secondly if they are an at the hospital constantly during their shift OB, then when their shift is over they would just leave, and the next OB on shift would take over. No need in either situation to worry about how fast things are progressing for OB convenience. Lastly, OBs get scheduled days off like everyone else, and also like everyone else i’m quite sure these are the days they schedule events like golf if they choose on.
and since ellis is the type who loves Anecdata so much, here’s mine.
We went to an OB affiliated with our midwives at 41wks, for a biophysical profile & non stress test. This was at oh… 1 in the afternoon on a thursday. Later on in the afternoon, we were back at the midwifes office, and the OB called to tell us that the radiologist who read the ultrasound suspected that our baby was asymmetrical IUGR, and she (the OB) recommended that we induce because it was possibly due to placental breakdown, and if that was the case the baby would be losing weight, and the longer it went on, the less likely it would be that she would tolerate labor, as well as the risk of being stillborn. So she had us go home, get our things, and come back up for her to induce. We got back to the hospital around 11pm, got checked in, and she examined my wife again and debated with herself the relative merits of cytotec vs pitocin, and decide dthat she thought my wifes cervix was soft enough already to just go to the pit. So around midnight she started the pit and went home. She came back in a bunch of times in the middle of the night to check in, and was around hourly again starting in the morning. My wife was ready to push around 9pm or so, and the baby was born at a few minutes past midnight after 3 hours or so of pushing.
24 hours of labor, 3 hours of pushing, and she amazingly, never tried to just butcher my wife up like beef cattle so she could be off to do things she found more interesting than safely delivering the baby of TOTAL STRANGERS that just happened to drop into her lap the day before. There was no talk of anything other than vaginal delivery until the last 20 minutes or so of pushing when she said that there was some decreased variability and late decels on the strip and she needed my wife to get her out quickly so that she wouldnt have to do an extraction.
So there’s your anecdata. She even came to see us and held my wife while she cried when we were waiting for the transport team from boston childrens to get our daughter ready to move. Heartless monsters in a big rush indeed.
So you’ve got nothing and you pulled that information straight out of nowhere.
I got 68% from the Guttmacher institute but I see the lack of specificity in the number, coupled with the many women I know who had an unscheduled c-section at that time of day or scheduled it ahead of time for that time of day
Not all hospitals have anesthesiologists in house all the time, also they maybe working on another case, so if an OB thinks its beginning to look like a C/S is needed they might want to try to make sure they have one on hand if needed. Just one reason a lot of OBs don’t want to wait too long to decide to go ahead with a C/S.
People in my family who had C/S: Niece twice, once due to large head, one due malpresentation of head/arm. My mother placenta previa and transverse lie, my aunt large baby w/shoulder dystocia. My Sister in law, crash C/S due to HELLP syndrome/kidney failure/Pre-E(they waited as long as they could at her request to give her daughter a chance).
Sure I guess their OBs could have waited until they were really, really, really SURE that a C/S was necessary. Of course by then the baby could be dead or suffer permanent brain damage…
Yes, OBs know that recovery from a crash section is physically harder, and may result in depression or PTSD.
Good point. If my OB said, “I can let you try natural labor, but there’s about a 50% chance you’ll need a c-section in the end,” I’d probably say just schedule it. A calm, scheduled c-section is SO much safer for the mother and easier to recover from than hours of labor followed by crash section.
You’ve got to be kidding…you honestly think obs perform more c-sections at certain times of the day because their shifts are ending? You’ve got to be kidding.
Becase most women go into labor in the wee hours of the AM , and thus, would be considered failing to progress 15-18 hours later when they were not dilating steadily? Do you think that people go into obstetrics because it’s a get rich quick scheme? There are much less hectic specialties that typically keep regular office hours (and pay much more money too!) that these Dr’s could have gone into. Unless you know, they were actually interested in taking care of women’s reproductive needs, and willing to deal with all the crap that goes along wtih it.
you think 15-18 hours is a prolonged, non-progressing labor??
If there hasn’t been any progress the past few hours, yes, 15-18 hours is non-progressing. It’s not the total length of labor, it’s whether the labor is going anywhere, and how well mother and baby are tolerating it.
No, I KNOW that 15-18 hours without progression is a prolonged, non-progressing labor. One can labor for 15-18 hours with steady progressive dilation, or one can labor for 15-18 hours with sporadic/poor or no dilation. One is “normal labor” , and one is “stalled/non progressing labor
Again, there are dozens (literally) of medical specialties a Dr could go into that pay better than Obsetrics AND don’t involve insane hours. People don’t get into Obstetrics because they are expecting a nice cushy 9-5 gig and then dramatically find out there is nutso hours and insane amounts of work that go into it.
I will have to bow out of this conversation because your complete cluelessness is infuriating, I suffered a cervical laceration and massive pph after the oh-so “natural” birth of my first child. I would have had a c-section in a heartbeat had it meant that I could have avoided that. It left me so afraid that we almost didn’t have a second child. It’s nine of your business why women choose to have c-sections, and you have yet to produce even a shred of actual evidence to support any of your claims. I am also feeling particularly raw because I am watching a friend mourn her son who should be a vibrant 2-year old, but was instead born still because her uterus ruptured during a VBaC attempt. So spare me your sanctimonious bullshit about OBs pushing c-sections for convenience.
Omg, moto. I’m so sorry for your friend.
Many of you know of whom I speak. She is doing a lot of advocacy about childbirth loss and against homebirth, but she is hurting so much and it just kills me when some idiot like Ellie parachutes in here and bitches about the c-section rate.
Oh, moto. How awful. I am so sorry for your friend, and that you had to go through what you went through as well.
I’m so sorry for your friend, moto. How unspeakably sad.
But the “Monday morning quarterback” comment isn’t even 20/20. Consider, for example, a breech presentation. Let’s say for the ease of argument that breech has a 5% problem rate. That means that it can be delivered just fine 95% of the time. So if 20 women have a c-section for this reason, then that means that 19 of them didn’t actually need to be delivered by c-section.
The question is, which one did? The problem is, not only can you not tell beforehand, you also can’t tell afterward, either, since the problems do not occur until labor. So in this case, hindsight tells you … nothing. You can’t distinguish the “necessary” from “unnecessary” c-sections even after the fact.
The reason is that objective of c-sections is to prevent problems, not resolve them. If you do a c-section before a problem has occurred, and it prevents a problem, there is no way that you can know that. You only know that you did not have a problem with the c-section. You cannot say that you would or would not have had a problem vaginally.
So the only necessary CS is one where the baby or mom is truly in a life or death situation? Ugh. Do you only wear your seatbelt when you decide to speed 95 MPH? A judgement is made that in experienced hands that labor is not proceededing well or the FHR has onimous patterns that if continued to labor either baby or mom has a substantial risk of harm. I weigh the risks and benefits of continuing to labor vs proceeding with CS and because of the current situation I now feel CS has become safer. Women are now assessing the risks of vaginal birth like urinary incontinence, pelvic organ prolapse, a wider loose vagina or worse dysparunia as a result of third or fourth degree lacerations, fecal incontinence or fistula. These women are choosing CS birth electively over a spontaneous TOL.
The seat belt analogy often is based on “I’ll use it if I intend to speed”, therefore, if I’m driving within the limit, I don’t need one. Well, that’s fallacious, if someone else hits you. Very occasionally a woman goes into labor knowing that, for some specific reason, she is more likely to have a C/S than the average, but most do not. That doesn’t mean that a perfectly OK low-risk pregnancy can become a raging emergency in minutes through no fault of the laboring mother’s.
I have a relative who refuses to wear a seatbelt unless she’s driving on the highway. Her reasoning is that she’s never heard of a person dying in a lower-speed crash so she’ll be fine. Also, the governnment is trying to take her freedom by forcing her to wear a seatbelt.
Here’s the thing. Medical science is not perfect. Technology is not magic. Doctors can use all the tools they have to try to ascertain whether a baby is in trouble or not, but there is NO foolproof way of knowing FOR SURE. So you have to take the information you have at hand and make a safe decision – the best one you can make.
Case in point – I was in a car accident at term. I was taken to the hospital, where I thought I’d be monitored for a while and sent home. But I had a nagging crampy pain near the top of my uterus, so my midwife (CNM) called in the OB. Then the FHR tracing became very worrisome – loss of variability and pseudosinal pattern, even though the rate stayed normal. The OB took one look at that, and combined with the upper abdominal pain and history of motor vehicle accident, said we needed to do an immediate c-section. He said that it appeared that the placenta was tearing away and the baby was in danger of bleeding to death very quickly. He said they could get in there and find out that they were wrong, but was that a chance we wanted to take? OF COURSE NOT. Not in a million years was I going to sit and wait to see if my baby bled to death inside me.
So we rushed down to the OR and my little boy was out within minutes, and sure enough, the placenta had begun to tear away. Careful monitoring, an OB who quickly and clearly spelled out the risks, and a willingness on my part to submit to what might in retrospect have been an “unnecessary” surgery were what saved his life. If they’d opened me up and everything was fine, would I have been upset about my “unnecessarean”? Nope. Not one bit. All you can do is make the best decision based on what you know at the time, and nothing more. And it would have been the right decision no matter what the outcome.
What a great story!! With such a happy ending, too.
I fell at 8 months and stayed overnight in the hospital. All precautions were taken, ultrasounds, blood work. I don’t remember any FHR monitoring but it was 20 years ago.
Yes, it completely makes sense that a high number of babies and even mothers are likely to die or be seriously injured through birth. Have you no sense of history? Have you never seen the high numbers of men who remarried after their first wife died in childbirth historically? Wow.
Exactly what should the VBAC rate be? (I had one, and it worked out just fine. I don’t have a problem with women who want a VBAC and are good candidates having one.) If you are describing a rate as “pitifully low” then you must a) know the rate and b) have an evidence-based better rate, right?
Actually I teach history and women’s health history is a particular interest of mine that I research in my spare time. Including in my own family as weIl as friends, yes, I know that there was not as much insight into how to prevent the dangers accompanying childbirth. Most would think that with modern insight into eclampsyia, vitamin D to prevent rickets (& therefore cefalopelvic disproportion) & modern ability to move the breech fetus in utero would drive the c-section rate down. Although granted the ultrasound to learn of placenta previa could increase the c section rate, though I don’t see by an equal amount.
As for VBAC rate, it should be available as a choice that isn’t frought with fear if OB’s are properly stitching the c-sections performed (which is why I mention double layer stitching). I know that unless the woman can choose a VBAC for her 2nd birth, then she has no choice for her 3rd, which also drives the rate up. As for what the rate SHOULD be, I will simply point out that in many areas it’s not available, period. So a woman must travel long distances to have VBAC as an option, which is sad.
Who told you or where did you read about OB’s improperly stitching c-sections?
in a piece from the Orlando sentinel, & I’ve had several friends who discovered it after the fact when they wanted to try a VBAC & were denied
Not finding much in PubMed, plus I’m not an OB. But I did find a 2003 study done in Croatia that concluded: “The best uterine scar is the one after using one layer interrupted
Vicryl and Dexon suture. The worst healing results were obtained after
two-row interrupted and continuous sutures using catgut.”
given that I wonder why OB’s would deny a VBAC based on the mother having previous single layer stitching as a reason…unless they were making it up because they simply want to deny the woman a VBAC
there are other characteristics of the scar that matter: thinning, adhesions are two that I am aware of. If you don’t have a transcript of the conversation, how do you know exactly how it was explained?
Once again, large numbers of us do not WANT VBACs. Why do you keep insisting we should be having them?
I insist that you have the choice, maybe have to endure a question like, “why are you sure?” from a 3rd party other than the OB
Why? Do you think being asked “Are you sure?” by some nosy stranger is going to make me decide I want to do something I don’t want to do? Do you think I’m too dumb to know what I want, and I need your interference or I’ll just make some dumb decision like the moron I am? Hee, giggle, I’m just a girl, how do I know whether I want another c-section? Well, my Magic 8-ball told me it’d be a good idea so that’s what I’ll do!
Why should I have to give up even one minute of my time to discuss my body and birth decisions with someone else, just because you prefer VBAC?
Go have your own VBAC, busybody. Go consult a third party about all of YOUR decisions (that is actually probably not a bad idea for you). I’m going to be over here with the grown-ups who are paid the respect of A) being assumed to know their own minds; and B) being allowed their own decisions.
According to LinkedIn you do not in fact teach History, nor are you degreed in History. Are you giving incorrect info here, or there?
(And psst…design trademarks aren’t the same as word trademarks, and you can get in serious trouble for using the R-in-a-circle to claim a word mark [not design mark] you don’t own. FYI.)
She sounds like she teaches history of the “and lo, 6,000 years ago the lord spoke and saw that the universe was filled with light, and he looked upon the light and declared it was good” sort
I never said I taught theology?
what is Linkedln?
Don’t be disingenuous. You know what it is, because you’re on it.
I just found that site, & somehow it has a profile of my name which lists two past jobs…idk how that happened. I didn’t say I had a degree in history but I do teach it. If you want to look up my credentials I passed all of the exams to get a credential in it. CA allows this through the CSET exams.
http://www.ctc.ca.gov/lookup.html
That site shows English credentials (in the form of a standardized test, but I did see your BA as well, which is not in history or really an academic subject at all, on LinkedIn), but none in History. Your Facebook and Twitter both list you as an English teacher. There is no mention of history on there anywhere. An additional search of the course catalog at the school where you teach shows you teaching zero history classes. Are ALL of those sources inaccurate, then?
You have to create a page on LinkedIn, it doesn’t happen spontaneously and it is not Created by an Intelligent Designer.
(And BTW, I am not joking, and I am not being snide, about the trademark thing. Claiming a word mark you don’t own is illegal. It CAN get you into trouble.)
I never claimed to have a degree in history, I have taught it in conjunction with English in the past, not this year. Social Science is history in CA & I do have a credential for that from a standardized test. English Rhetoric is not an academic subject now? I really don’t get the LinkedIn thing…maybe a friend created the profile or in responding to a friend’s request, I inadvertently allowed a profile? What in the world is the trademark thing??? how would I have any need of a trademark??
I in the interest of full disclosure, I’m on maternity leave now so I don’t technically teach anything for these months.
I truly hope that you are joking when you claim to research women’s health history.
*eclampsia
*cephalo-pelvic disproportion
The rest is not even wrong.
You don’t teach history.
Ellie San Martin, everyone. The gift that keeps on giving.
I don’t currently. I have in the past and I’m credentialed to teach it. 11th grade English is American literature and requires units of history be a part of it.
perhaps in your more evolved world, we should be all walking around with leaking fistulas instead of c/sec scars?
No. I happen to believe that this world is intelligently designed, but I don’t really understand your point…?
A perfect summation of this entire conversation.
Agreed.
Anyone that believes in intelligent design in this day and age is impervious to reason.
Ah, so clearly, the primordial soup came from the big bang
You don’t know what those things are, do you?
the primordial soup is the inexplicable 1st organic particles, & big bang is the bizarre explanation for how it came to be. Neither of which can be proven through scientific evidence or experimentation, & are therefore articles of faith in science.
They abso-frigging-lutely are not examples of faith in science. People work every day trying to find ways to reproduce those conditions or pprove them wrong or find other explanations. That’s what science IS. Faith would be sitting down and going “welp that’s good enough, I believe that” and moving onto something else.
which experiments have reproduced the conditions of the big bang or reproduced the primordial soup?
I believe this world is intelligently designed too, but you can’t deny it’s also fallen and has a lot of problems. Cars are intelligently designed too, but that doesn’t mean they don’t break down and malfunction… which is why it’s so important to have mechanics.
Ellie ” I happen to believe that this world is intelligently designed”
How do you reconcile the large maternal and infant mortality rates throughout the centuries prior to the last one with the characterization of the way a woman is “designed” as “intelligent”?
Why wouldn’t an intelligent design include *low* mortality rates for reproduction?
not if humans don’t investigate the existence of microbes
is the fistula comment meant to refer to single vs. double layer stitching of c-sections??
You posited the question, and forgive me I am paraphrasing, speculating if 1/3 of our population has devolved to the point that doctors must perform surgery lest their baby or themselves die..
I am suggesting that devolution is not altering our physiognomy but modern people do not tolerate putrid leaking holes from the anus to the vagina due to a prolonged difficult labor and birth. And yes, they are not uncommon in developing nations and yes our fore mothers suffered this humiliating childbirth injury.
exaclty why modern understanding of birth should not coerce women into c-sections out of fear. I’ve had several friends who almost died of nicked bladders, 12 cm hematomas & so much else from unscheduled C-sections that an OB coerced them into for “failure to progress” without giving other options. It’s not the scar I’m worried about, it’s that C-sections are taken seriously as the life-saving godsend they are instead of applied as a cure-all on an assembly line for any impatience or uncertainty during birth.
Given that the rate of bladder laceration in a c-section is something around 2 in 1000, you either have a lot of very fertile friends or they have some very incompetent OBs.
I say incompetent and overwhelmed OB’s (depending on how you define “fertile.”) If you define fertile as around 3-4 children each, then yes, both.
I call option 3. She is incompetent with facts as she seems to miss they don’t hold water when they’re removed from your ass. 753 of my friends think she is making her numbers up, and these friends are people with blogs she has never actually met.
But those ARE documented risks. Anyone who sits down with their doc for 5 minutes and says “I want to talk about the risks of a C-section” will hear about the actual risks (a discussion that should happen before a woman is ever in labor, even if she doesn’t want a section and/or has never needed a section at any of her other deliveries). Same if you want to talk about the risks of vaginal delivery.
This explains what a fistula is.
http://www.fistulafoundation.org/whatisfistula/
You do know the difference between the Total CS Rate being about a third, and the Primary CS rate being around 15-22%? When VBACs were in their hay day in the 90’s, so was it’s morbidity and mortality. What do you believe an optimal VBAC rate be? Explain the TOLAC vs VBAC rate first. Then explain who should be allowed a TOLAC, and where should it occur, hospital or home?. What is your take on Homebirth midwives not even using suture for lacerations at Homebirth? What is is take on using seaweed for lacerations at Homebirth? What is your game on the higher perinatal mortality with Homebirth as evidenced by the 2005 BMJ study, Judith Rooks CNM report, 2013 AJOG study, and CDC data from Oregon, Colorado, and other states. Not to mention, what is your take on MANA not releasing their neonatal mortality rates from their 28,000 delivery MANAstats?
I’ve never heard about home births denying needed stitches, despite several friends having one, but that certainly sounds ignorant & negligent. Seaweed sounds absurd. I personally don’t feel comfortable with home birth, but the friends I know who chose it chose it out of fear and desperation at the inhumane treatment they recieved from OB’s at the hospital. That is something I think should be remedied, rather than further trying to layer on the fear & guilt, when the guilt lies with an OB who mistreated his/her patients & hides behind statistics and hospital policy. My game is that if the medical community addressed their hospital maternity procedures & didn’t treat laboring women like illogical ignorant fools endangering their babies by simply asking a question or asking to have choices over their own bodies, women would not be desperately & fearfully driven to home births. & for a multigrad with no risk factors & a hospital/OB immediately available, why not allow her that choice without judgement?
1. It makes sense if you look at history. There’s no “devolution.” There are more lives saved.
2. “Pitifully low” VBAC rate? Does it not occur to you that one big reason for a low VBAC rate is that women do not want VBAC? I sure didn’t, with my second. My doctor–one of those evil OBs–suggested it and I shot that right down; no interest whatsoever. Or are you suggesting that I should have been forced to VBAC against my wishes in order to live up to some arbitrary ideal you have in your head? Should I have been strapped down and forced to endure labor and delivery despite the risks, in order to please and impress you? Why do you hate women so much? Why are you so determined to make us endure pain–and potentially lifelong complications like prolapses, incontinence, fistulas, etc.–when there is a perfectly fine alternative? Why are you so determined to steal choice and autonomy from other women?
The short answer to your question is yes, it makes perfect sense. The longer answer…
Evolution doesn’t produce a perfect organism. It produces a “good enough” organism. Emperor penguins fail to transfer their eggs from the mother to the father for incubation something like 50% of the time. That doesn’t matter because they transfer them often enough for the incubation by the father to be more likely to produce a living penguin than the malnourished mother incubating the egg. Similarly, if enough women give birth to enough living babies, it doesn’t matter if 1/3 don’t make it. The species continues.
So that’s the population level. That doesn’t really explain the individual level, though. One would expect that women who tend to need c-sections would have died out because they either died in labor or couldn’t produce offspring. But there’s a critical assumption being made in that statement: that the need for a c-section is genetic and it is the “fault” of the woman who is pregnant that she needs a c-section. Sometimes it’s a fluke. The placenta happens to implant in the wrong place. The fetus randomly turns its body or head wrong. The cord is looped badly by accident. In these situations, the mother or baby or both may die, not due to any genetic failure but due to chance. No evolution occurs because there is no gene to be eliminated.
Finally, the modern situation. Assuming some causes of c-section are genetic-say, a uterus that is slightly malformed and tends to turn the fetus to undeliverable positions or a tendency towards longer cords that are more likely to wrap around the fetus’ neck or inability to dilate properly, for speculative examples. In the past, these genes would have been maladaptive as women who had them would tend to not be able to give birth to living children and survive and so the genes would tend to decrease in the population. Now, with easy c-sections, the same genes have no evolutionary disadvantage at all: few women have more than 3-4 children anyway and it’s easy enough to have 3-4 c-sections. So the same genes are no longer causing deaths.
One could take it even further: Suppose-and this is entirely speculative-the genes that cause, say, poor dilation in labor and a higher chance of failure to progress, also decrease the risk of premature labor and therefore loss of a second or third trimester fetus or birth at a time when survival is unlikely and survival without major neurologic complications essentially unknown. Then women who had this gene become MORE likely to have viable offspring and it becomes a “good”, adaptive gene-for this environment.
There is no “devolution” only adaption that works or doesn’t work for a certain environment.
Intelligent design doesn’t design perfect organisms or perfect circumstances & choices either. Neither does such a high rate make “perfect” sense. Apparently it makes “good enough” sense to you. As some other commenters pointed out, (& I should have originally considered) due to repeat c-sections, the rate of women having c-sections is more like 20%. But I also pointed out, wouldn’t modern medical insight decrease this c-section rate, due to increased vitamin D preventing rickets (& therefore cefalopelvic disproportion), better monitoring of pre eclampsyia, knowledge of how to turn the breech fetus in utero, better stitching of 1st c-sections so that VBAC’s are safer etc?
Rickets may contribute to CPD, but it isn’t the only factor. There are four basic shapes of normal female pelvises (though I don’t know the percentage distribution), and the baby may end up with DNA for extra large head.
It’s not so much “modern medicine” as not working dawn to dusk in factories without access to sunlight that has decreased the rate of rickets. We don’t know how to prevent pre-eclampsia so no to that one. Better monitoring and awareness of pre-eclampsia probably increases the rate of c-sections-and of good outcomes. Turning a breech in utero rarely works and I’m unaware of any particular new information on how to do it better, so not really there either. And VBACs simply aren’t up to the safety of repeat c-sections yet. Sorry.
I’m not sure what your point is about “intelligent design”.
managing pre eclampsyia is better than being suprised by full blown eclampsyia out of nowhere
16 of my personal friends have been able to turn a breech baby in the last 2 weeks. My point is that an intelligent designer, (God if you will) designs our bodies and brains, just as an intelligent OB designs a C-section.
Goodness, your friends are so very, very fertile, aren’t they? Baby showers in your group of pals must really be something, with all those hundreds of pregnant ladies turning their breech babies in utero and being forced at gunpoint to have c-sections and being bullied and improperly stitched. It’s amazing how you remember right off the top of your head the exact numbers, out of all those friends, who’ve dealt with each unique little situation.
You know, twenty-three of my friends were thrilled to have c-sections. Another forty-seven wanted sections but couldn’t get them, and then seventeen of them had pre-eclampsia and fifty-five of them had gestational diabetes and eight of them had twins. And thirty-one of them especially liked ice cream.
Also, what if six was nine? Wouldn’t you mind?
I’m going to go out on a limb here and state that people who believe in creatio.. I mean “intelligent design” don’t usually use birth control.
LOL! “Contraceptive use is common among women of all religious denominations. Eighty-nine percent of at-risk Catholics and 90% of at-risk Protestants currently use a contraceptive method. Among sexually experienced religious women, 99% of Catholics and Protestants have ever used some form of contraception. [6]” http://www.guttmacher.org/pubs/fb_contr_use.html
We are Not talking about natural family planning where a woman tracks her cycle.
neither is Guttmacher
But most religious women accept that evolution is logical and how we all came to be. In general intelligent designers are in the minority. You did not answer the question.
Is there something wrong with fertility? ‘m at that stage in life, & I actually remember because I was always intently praying for them through it all. I didn’t say gunpoint. sorry about your 47 friends who were forced at gunpoint to labor in pain with no medication at home without the relief of a C-section, but I’m glad they and their babies survived. I don’t know if the numbers cross, but if your 31 friends who liked ice cream were among the 55 friends who had gestational diabetes, I’m sorry for their inconvenience and suffering deprivation too.
I find it utterly terrifying that someone as tone-deaf and unable to understand written communication as you are is a teacher.
Seriously.
That’s not even taking into account your refusal to look objectively at facts, or your insistence that your opinions equal truth, or your refusal to acknowledge anything which does not agree with your particular worldview (you did not answer a single one of the questions I asked you in my original reply. Should I write them again, in much more simple language, so you can understand them better?), or your reliance on anecdota that sounds more like something culled from a Victorian novel (those are books of fiction–made-up stories–that take place during the Victorian era, which was 1837-1901, and stories like the ones you’ve told about offensively patriarchal doctors desperate to cut women open weren’t uncommon then. Unlike now) than anything actually happening now, today, in modern hospitals, or the things you keep stating as fact which are completely wrong. All of those things are bad enough on their own, but they combine into a sort of perfect storm of intellectual ineptitude.
(P.S. Because I can picture you rubbing your head in confusion, and because I don’t want you replying to a point I didn’t make because you failed once again to comprehend the written word…yes, I am saying you’re not very bright. And if that upsets you? Then quit telling me what to do with my body, or that what I have done with it was wrong. I’m very glad I had two c-sections; I had no interest in VBAC, and all the busybodying and finger-waving you can do won’t change my mind.)
I’m happy for your health and happiness with your choice, I’m sorry you misunderstand my comments as judgement on you, and I pray you would allow women who would make a different choice than you the same support rather than judgement. I appologize for not answering your questions, I will attempt to do so. But my suspicion is that you cannot comprehend a person who would look at the same data you do and make a different choice.
Oh, now, don’t do that. I’m not misunderstanding your comments as judgment on me at all–and if I did think you were judging me I wouldn’t give a rat’s–and I’m happy to support any woman who wants to VBAC as she makes her VBAC attempt. Because, see, their decision to VBAC isn’t a personal affront to me, whereas the “pitifully low” number of VBACs apparently is so to you.
And, again, unlike you I certainly can comprehend people making different choices than me. I can even understand them making that choice having seen the same data. But you have not, as your comments here show very clearly; you are unaware of most of the factual information being discussed and rely for your opinions on your thousands of fecund friends and the detailed charts you keep–with transcripts of private medical discussions, apparently–about their pregnancies and deliveries.
Would it be supportive and non-judgmental, then, if I lobbied for a law whereby women desiring VBAC must meet with a non-OB third party who will ask them, “Are you sure?” And presumably justify that decision to a stranger whose business it is not? What other medical procedures would you like to see this “third-party-overseer” policy enacted with? Mole removal? Transplants? Cosmetic surgeries? Bypasses? Prostate surgery? Or is it just women who should have to answer to someone else, and if so, is that just regarding birth or should I have to check with somebody else before having, say, my deviated septum fixed, or laser surgery to correct my vision (sadly, no one “designed” me with perfect vision; in fact, without correction I am legally blind. Can you tell me why I have “devolved” from my ancestors? Why was I not Intelligently Designed to see better? Why am I defective?
are you really comparing a c-section to mole removal or cosmetic surgery?? you’ve made my point. I’m sorry about your eyes, mine aren’t great either. But we were given brains to overcome the crueler choices of evolution. I hate to have lost you in a hunter gather world without optometrists
No, it’s not a direct comparison, and no, I have not “made [your] point.” I knew you’d zero in on that because you can’t actually answer my questions.
You didn’t answer them, you know. Yet again.
please restate them
I just did, above. In addition, they all still exist here in the discussion. They haven’t disappeared, and you can easily go and re-read them and provide answers.
BTW, you do know that moles are often removed because they are or could be cancerous, right?
Or do you think that’s just those evil doctors making you fear cancer so they can slice you up and go play golf?
since skin cancer runs in my family, i’ve had them removed but then recent (last 5 years) dermatologists have explained that this is unnecessary because moles don’t become melanoma, melanoma is sometimes mistaken for moles
Got it. Jesus likes optometrists. Can’t stand Obstetricians. Makes total sense, because there is NO WAY God mean for us to be nearsighted, but he never meant for us to use our brains to help women and babies, you know, live.
where did you get that Jesus doesn’t like obstetricians? If some optometrists were performing unnecessary lazer surgeries for patients who might lose some sight & then caused the person to lose eye functions you would not find that objectionable?
Mole removal is a lot like a C-section : it’s something you can only pronounce “unnecessary” in retrospect.
actually if it is a true mole it’s always cosmetic. melanoma spots are sometimes mistaken for moles, but were never moles. but now you’re stretching it so anion doesn’t appear as flippant as s/he was.
Is there a topic on here that you don’t know anything about?
“melanoma spots are sometimes mistaken for moles, but were never moles.’
WTF? I’m unfortunate enough to have some knowledge of skin cancer and melanoma and you’re wrong.
OK, this was driving me nuts.
30% of melanoma comes from moles, however the chance of an individual mole developing into cancer is very small because there are so many of them. There are also common moles and dysplastic moles (didn’t find reference to “true moles”) and common moles only become cancerous in very rare cases.
http://www.melanoma.net.au/Melanoma/moles.htm
Except I wasn’t being flippant. It’s a serious question: What other procedures and surgeries do you believe should require third-party approval? I listed a number of them, from serious to more minor, in an attempt to discover where you draw the line. You can focus on one of the many procedures I listed and denigrate it in an attempt to avoid the question all you like, but the rest of us are not so easily distracted and will still ask for your answer.
Do you believe, then, that someone whose doctor thinks a mole is potentially cancerous, and who thus wants it removed, should have to meet with a third party who will ask her if she’s really sure she wants to have it removed and why? Or is it just women choosing c-section who are too dumb and scared to make their own decisions?
no, that could be 3rd party too I guess, but then I’d be buying into your comparison of a c-section to removing a mole, which I don’t
I didn’t make that comparison. I have stated twice now that I was not making that comparison. No one but you thinks I was making that comparison.
So you DO think that a person should have to explain to a third party their reason for wanting a mole removed? What about the other procedures I mentioned? Does it matter to you if the person desiring the procedure is male or female, or should both genders be required to meet with some other person to justify their decision to have whatever procedure it is done?
I’m not going to insult your intelligence by quoting yourself back to you. read your comment again. yes, a 3rd party should be available for psychological consult on all genders (including Transvestite, hermaphrodite or anything else) in any case that involved internal or reproductive organs
Jesus Christ. I really need to stop replying to you, because you are the thickest moron I’ve encountered in a while and it’s totally pointless. I know what my comment said; I’m not the dimbulb who keeps pretending she didn’t say what she said and misunderstanding basic sentences that my twelve-year-old daughter would have no trouble parsing.
Quit changing the parameters. You *never* suggested a “psychological consult.” You said women who don’t want to try VBAC should have to talk to a third party–you never once said a psychiatrist or psychologist or, in fact, listed any sort of qualifications you think this third party ought to have–who will ask if they’re sure and why. That is not remotely a psychological consult, nor would it appropriately be considered so. (BTW, the word you’re looking for is “transgender” or “transsexual,” not “transvestite,” but whatever; I shouldn’t expect you to have any clue what you’re talking about.)
But it’s good to know, at least, that you think a man with prostate cancer who decides in conjunction with his doctor that he would like to have surgery ought to have to make a second appointment with someone else to justify that decision to them. At least it isn’t just women you think are too dumb to make their own decisions about their bodies (although I guess I can’t blame you for thinking everyone else has as much trouble as you, given your lack of ability to see your own incompetence).
I’m done replying to you. You’re a waste of my time. You’re a lying liar who tells obvious, ridiculous lies, and who thinks because you’re not smart enough to remember them no one else is either. You remain convinced, though, that you’re the smartest girl in the room despite all evidence to the contrary, which makes you simply tiresome and irritating, like a song I hated the first time being played over and over again in the next room.
I am not the smartest woman in this proverbial room or any room for that matter. But I am a woman and a human being who deserves to be treated as such by my healthcare providers. Your attitude is exactly what no human being deserves while in labor.
But you aren’t in labor right now. You’re posting on a message board, on the internet. These people are not your caregivers.
Ellie, I wouldn’t be too worried that you are going to insult someone else’s intelligence…..
Oh? Define “true mole” for us.
Actually, a true mole is only cosmetic NOW. A naevus (mole) can become dysplastic, and a dysplastic naevus can become malignant in THE FUTURE. Up to 50% of melanomas arise from dysplastic naevi.
So the comparison with regards to CS is even more apt. Even when you remove a naevus or a dysplastic naevus you may not know whether it was one of those that was going to become malignant or not. And you can never know.
Just like the pink, screaming baby born from a CS. You will never know whether it was one of those who might have been injured or died without the CS. Or not.
Also, the comparison isn’t flippant. Melanomas kill people.
(Yes, I’ve been reading and DNFTT. But it’s an important point for people in general to avoid becoming complacent about moles. Moles need to be monitored. Like babies during labour. Just different time scale.)
Oh please you haven’t quoted any actual data yet. You just spouted on about your friend’s cousin’s sisters OB. Even if you have read the data. I doubt you would be able to understand it judging solely from the amount of failures of reading comprehension you’ve displayed in this comment section alone.
Reminds me of Kelly-still waiting to hear what her “source with ACOG” said and of course her “stats and data” (because as you will remember she quoted her own deliveries and those of a few friends as her knowledge base)
no, I said the OB dept at Kaiser in So Cal. Actually, it’s that I doubt most statistics after seeing how easily they are manipulated and inaccurate, able to prove 2 opposites.
As for your intelligence, you strike me as smart but overruled by emotion, so I would encourage you to consider topics more objectively and human beings as whole beings, including their emotions and spirits in addition to their biology instead of assuming they are simply screwed up machines to be fixed. As a teacher, I try not to consider my students as vessels to be filled with information but as human beings who are in need of guidance from people in all walks of life, of which I am merely one among many, thank goodness. My job is not to clone myself.
Hmm. Overruled by emotion, but thinks of people as just machines to be fixed.
Sure. That’s logical.
I’m not the one using terms like “devolved” here, or implying strongly that women who have c-sections are “defective.” That’s you. I’m not the one attempting to steal the autonomy and dignity of other women by implying they can’t make their own decisions and need a third party to double-check with them, because the silly things might say they want one thing while secretly wanting another.
One of us doesn’t see thinking, feeling humans here, maybe, but it isn’t me.
well, evolved would assume positive changes, so I was relaying what women feel conveyed to them by an OB telling them their body simply won’t push out a 9 lb baby (who turns out to be 7lbs). do you think every person on the planet has no problem speaking up to an educated person demanding an answer right away? I meant that a 3rd party could ask them how they feel since the OB clearly has no time to hear it. “I’ve been doing this for 20 years. You can’t have this baby, it will die if you try. I could explain if you really want, but what time should I schedule your c-section?” doesn’t leave many women feeling like they have room to think without risking further ridicule.
Please try to keep your arguments straight. That’s not remotely what you said or suggested before. Ad plenty of OBs do in fact have time to hear it, and explain it. My OB, for instance, would have liked to see me attempt VBAC and was visibly disappointed when I nixed that before he could even stop discussing it. I never felt pushed out of his office or as if he didn’t have time. I know lots of women who felt the same.
As for the quote above… Where do you live, Stepford? A doctor who behaves that way toward his patients, in this day and age (when something like half of all OBs are women, btw), would soon find himself without any (unless he’s a medical genius, in which case some women would put up with his rotten bedside manner in exchange).
Personally, I think being assertive enough to ask questions about one’s own healthcare is rather an important life skill, especially if one intends to raise children, but that could be just me.
Tell me, does your religion encourage you to ascribe evil motives to everyone on the planet, especially doctors, or have you come up with this one on your own?
It was in Victorville, CA, & most of his patients were young teenage girls. I don’t attribute evil motives to very many people, even in the cases I’ve described I didn’t speculate as to motives. My guess would be that these OB’s are impatient and overwhelmed, neither of which are “evil.”
Fun fact: Evolution assumes “adaptive” changes. Not “positive.”
thanks for the correction. I will make sure not to make that mistake again
Otherwise known as “See: Sickle Cell Anemia”
I’m sorry but the “you’re emotional so I win” argument is such bullshit. It is the opposite extreme to the “you’re mean so I win” argument. It makes the argument all about style instead of substance. At least the “you’re mean” people don’t give the victory to a clinical psychopath which is what you’d have to be to not get upset about issues where lives are at stake.
People are emotional. Arguments get heated and people get pissed off. But the augments aren’t won on the basis of who shows the least emotion just as they aren’t won on the basis of who gets the most upset. They are one on the basis of evidence which you have none. My 56 friend that I could have just pulled out of my ass is not evidence. The plural of anecdote is not data. You are done here.
I’m not trying to win. I’m trying to share another point of view that you are unwilling to consider because your fear of fetal death overwhelms your ability to consider other options. Many psychopaths don’t kill, they simply maim or play with other’s lives without regard for those people as human beings: as in “I don’t feel like dealing with a long labor, it’s easier to just cut the baby out.”
My fear of my child’s death makes it tough for me to consider other options? Sounds like the response of a normal decent parent.
Now, even when someone raises that ultimate fear, a good parent should be able to think about how high the risk of death actually is, and whether the proposed intervention could actually work as claimed. However, the risk of death when a fetal heart monitor detects distress is about 1%, which is large enough to be worth worrying about, and c-section will neatly eliminate that risk as long as it’s done correctly in time.
Yeah, those psychopaths, always doing stuff like going to school for eight years and spending hundreds of thousands of dollars, just so they can enter a healing profession and maybe get the chance to cut some people open. As opposed to, you know, just cutting people open for fun.
If you think having a c-section is anywhere near as damaging to someone’s life as having close involvement with a psychopath can be, you are very sheltered indeed.
And you know, as has been said here before…what if I decide, eh, I’m not going to put my kids in carseats or buckle their seatbelts? I’m not going to buy into that manipulative fear! I’m going to consider all of my options, and the odds are my kids will be perfectly safe if they sit on the armrests while I zip along. Nobody’s going to scare ME into seatbelts and carseats; I’m going to consider all of my options, including tying them to the roof (the sunlight will help prevent rickets, which is a huge bonus)!
wow, such a powerful and accurate analogy…lol! because strapping your child into a seat is as difficult as opening your internal organs for surgery on the chance it’s safer than the alternative. & comparing labor to placing a child on the armrest of a moving car, clearly the exact same thing. I never wrote ob’s were psychopaths, nor all ob’s or even most are incompetent or impatient, but there are many to be wary of, as is the case with midwives.
You never wrote OBs are psychopaths?
“Many psychopaths don’t kill, they simply maim or play with other’s lives without regard for those people as human beings: as in “I don’t feel like dealing with a long labor, it’s easier to just cut the baby out.””
Can you explain how you didn’t mean to imply that OBs are psychopaths in the above? You are directly saying that “I don’t feel like dealing with long labor, it’s easier to just cut the baby out” is the statement and action of a psychopath.
At least my post was hyperbole, not a statement of fact.
(BTW, it’s “OBs,” not “OB’s.” The apostrophe is possessive, not plural.)
I did write that…I wrote “many” in the attempt to show that I don’t apply it to all, but perhaps “some” would have been clearer. What do you think of ALL HB midwives? that they are completely uneducated and willfully endanger women & babies? so I guess we balance each other out.
Good lord. You clearly said that “I don’t feel like dealing with a long labor, &c” is the statement of a psychopath, and is the sort of statement OBs make. You clearly said that those psychopaths who are not out killing people are instead maiming people and playing with their lives by performing c-sections you don’t like–that is actually what your “many” referred to, is the psychopaths who are not murdering people. It did not in any way qualify “OBs,” it qualified “psychopaths.” And ultimately it’s not particularly important, because again, you were calling OBs who perform c-sections which you–in your infinite wisdom and with your BA in “Rhetoric” clutched firmly in your little fist–do not think are necessary, psychopaths. The number of them doesn’t matter so much, although you have strongly implied a number of times that most c-sections are unnecessary. Which means most sections are being performed by psychopaths. Hey, it’s your argument and statement, not mine.
I really ought to give up on trying to make you understand what you have said, and what I am saying, because you are clearly incapable of the most basic logic.
Now, let’s see. It’s tempting not to answer your question, or to reply with some sort of obfuscating nonsense (as is your method), but since I have a brain capable of rational thought, I’ll answer. As a kindness, to show you how it’s done.
I do not think that ALL HB midwives are completely uneducated and willfully endanger women and babies. Evidence–that stuff you eschew in favor of ridiculous anecdotes and your personal “instincts”–do, however, bear out the fact that a large percentage of them are, and do. Evidence shows us that even with a highly credentialed HB midwife (which is a minority of them in the US), the risks of labor and delivery are much higher for both mother and baby. Evidence shows us that many HB midwives lack the knowledge necessary to safely deliver babies if even the slightest complication arises; that they personally refuse to accept scientific evidence; and they are not capable of understanding how those lacks can do great harm, which means that their willful ignorance is indeed willfully putting mothers and babies at risk.
See, that’s the difference between us, Ellie, or at least one of them. I form my opinions based on evidence and facts; I don’t condemn an entire profession because one guy wasn’t very nice to me and it made me really mad that I lacked the knowledge to understand why he did what he did so I decided it was his fault instead of my own in order to preserve my opinion of myself.
I don’t come in here and lie, and lie again (we’ve caught you in two so far; I bet there are more), and misrepresent things, and prove my lack of understanding of and knowledge about the subjects discussed over and over again. I’m not the one who didn’t know what a fistula is, or who grasped onto some random bit of information about uterine stitching like a talisman because it was something I heard somewhere that I thought sounded smart and I couldn’t understand what it really meant. I’m not the one who has demonstrated again and again that I lack basic skills in reading comprehension and written expression–I know you don’t believe that’s true, given what you teach, but I’m afraid it is.
And I’m not the one claiming to know a whole bunch about a subject that I actually know very little about.
That’s all you.
considering 92% of births in the US are overseen by OB’s in hospitals and (adjusting the 20% c-section figure) 1 in 4 of those are C-sections, a concern regarding impatient, overwhelmed OB’s performing unecessary c-sections that women don’t want covers a MUCH larger number of births than women coerced into home births.
Ellie, honestly you seem like you are probably a nice person but you post things that are flat out false with certainty and perhaps a little introspection is in order on your part. The post about lawsuits “the baby has to die” is absolutely the opposite of how it really is. And post about the fetal heart rate was never less than 140? If you had expertise in the area you would be appalled at your statement. Some of the scariest monitor strips I have ever seen meet that description. Implying that OB’s are psychopaths who don’t want to deal with long labors whilst you spout off information right and left that is absolutely wrong makes me wonder about the validity of all these women you know with all these problems and what really might have happened in these cases. Seriously I ask you to consider that you may know a whole lot less about labor and delivery than you think you do.
Thank you for the personal compliment. Can you tell me about lawsuits & medical censures in cases that have not killed or permanently injured the baby?
That’s why I asked that OB to describe the distress, but he chose to stomp out & let my sister labor another 2 hours. I don’t mean all OB’s, but there are certainly some to be concerned about. I am very wary & consult with several to be sure because of all I’ve seen. & since I teach high school, I’ve heard even more horror stories about how young teenage girls are treated.
What about the word DISTRESS doesn’t make you pause and realize there is something WRONG and it could get worse? Who asks a doctor to “describe” distress, unless they think they could possibly know more than a doctor about what it “really” might mean?
I don’t know much, but I refuse to be guided by fear & I trust my instincts regarding obnoxious and intimidating know it all providers.
In other words, “I refuse to listen to people who’ve spent years studying and practicing medicine, because a BA in a non-medical subject means I know way more than them, and my instincts are better than any knowledge.”
Is that what you teach your students? That, for example, their instinct to cheat is better than actually learning?
Your trust in your “instincts” better be more reliable than your ability to cite truth and real information. Your “instincts” will also never save you in the event of a bleed you cannot stop, a baby stuck in your pelvic that cannot come out, or any other number of grisly and completely real scenarios…but those “obnoxious and intimidating know it all providers” could save you. You think about that.
I would not be under the care of an obnoxious know it all. I am under the care of an educated, humane and caring OB, whom I trust, because when I’m treated poorly in prenatal check ups, I refuse to see that provider again. & if I’m treated poorly in labor, that provider is banned from my room and I have back up.
And I bet they do the happy dance in the hall after being fired too! I would feel lucky to be banned from your room if you are remotely like your online persona.
That’s fine. I never had to ban anyone from my room because I did copious research on all of the providers on staff at the hospital and am able to choose them ahead of time. I passed this info on to fellow moms who are making similar choices and now 2 of those OB’s have been transferred to another hospital. If they do the happy dance, that makes about 10 of us.
you’re darn right I’m afraid of fetal death. I had a $20k IVF. I had bleeding for several weeks in the first trimester. Now I have to have an extra ultrasound because of a strange looking placenta. You bet I will do ANYTHING to increase the chance of a healthy live birth of my very wanted baby who I have been scared to death of losing several times already.
Best wishes for you and your baby, rh1985.
Thanks. she has been growing well and looks physically healthy. I think it’s probably more of a precaution at this point but I’d rather have doctors who are too quick to send me to a specialist, than too slow.
And you strike me as the classic uneducated, gullible person so beloved of homebirth midwives. Not only are you stunningly ignorant, but you have no idea how ignorant you are. You are a perfect illustration of the Dunning-Kruger effect.
Yep. In fact, unlike many crunchies suffering from Dunning-Kruger, this one actually has trouble with reading comprehension.
Since you are no longer practicing or held to any medical standard by any medical board, much less in psychology or psychiatry, nor are any of your claims held to peer review, I won’t take it too personal. Why did the science based medical blog drop you?
Guess you didn’t read Dr Amy was recently asked by ACOG to speak at their conference.
yes I did, that’s also how I found that she has not released any statistics from her practice nor has she chosen to go back into practice or submit her claims for peer review or done any research of her own. Guess spouting inflammatory language on a blog is easier
“Why did the science based medical blog drop you?”
Now your colours are showing.
“so I would encourage you to consider topics more objectively and human beings as whole beings, including their emotions and spirits in addition to their biology”
…as long as their emotions and spirits are the same as yours.
“As a teacher, I try not to consider my students as vessels to be filled with information but as human beings who are in need of guidance from people in all walks of life”
…because information might make them realize that intelligent design is fatally flawed and that science actually does work.
intelligent design IS science. look it up. & having the same emotions & spirits give us unity as human beings…we all feel the instinct to preserve life, and sadness when it is lost, for example. Also frustration at lost opportunity, bullying by those meant to care for us, etc. NOT sharing these things, I would argue, makes us either severely mentally ill or inhuman
Pretty much, by definition, it is not.
One of the most important properties of any scientific hypothesis is that it must be testable. In particular, it must be falsifiable, in that it must be, in principle, able to shown to be incorrect.
So tell me, what observation, if it would be made, would show that intelligent design were incorrect?
Nothing. There is not a single thing that could ever falsify that something was intelligent design. Even if we had a perfectly detailed and viable evolutionary explanation for everything, you could STILL always say, “Well, a designer made it look that way.”
That is why it isn’t science, but is religion.
As is the primordial soup & the big bang. Also articles of faith because the experiment cannot be tested or repeated.
I would hope that, as a teacher, you would have at least a passing regard for facts. Unfortunately, you’ve shown yourself here to be shockingly cavalier about them.
I’m not emotional, I’m passionate, and am able to effectively communicate that passion. I’m not the one who keeps changing her arguments, misspeaking, and getting all confused because facts are too hard, and I’m not the one who keeps talking about defectiveness and behaving as if there’s something physically wrong with women who don’t give birth vaginally. That’s you.
And as a teacher your JOB is to fill those student-vessels with information.
My point is that an intelligent designer, (God if you will) designs our
bodies and brains, just as an intelligent OB designs a C-section.
I’d fire and probably sue any OB that did a c-section as badly as the “intelligent designer” designed our bodies and brains. Why the appendix? Why no backup method of decreasing blood sugar? Why this huge floppy factor VIII gene that breaks at the least provocation and is critical for hemostasis? Why wisdom teeth? And so on. The human body’s a real mess, truth be told.
why the female orgasm? pretty useless too. We don’t know everything
What makes you think that the female orgasm is useless? Without it women wouldn’t like sex as much, wouldn’t bond with their sexual partners, and would have less support during child rearing resulting in fewer surviving children. Very explicable evolutionarily.
they would still like it & do it as in many other species in which females have no orgasm, or even nerves in the genital area. Why would evolution care if we bond? so evolution requires men to support women and therefore makes them inherently financially unequal?
Not sure how you determine whether animals of another species like sex or not and really not going there.
Why would evolution care if we bond?
Human babies are dependent for a long period of time. It’s hard for one person to care for a baby to the point that they are able to survive on their own (much less to the optimal time for independence) without help. Things that make people want to stay together and raise babies together are pro-adaptive in most situations because more of their mutually raised babies will survive. Got it yet?
determined by lack of nerves in the genital area. Also true of wolves, who pair for life but have lack of nerves in the genital area, as do other Mammalian species such as lions and monkeys who live in a community that care for the young rather than only one father.
Reference?
really? I thought that was common sense to anyone with 5th grade science or a visit to the zoo?
http://animals.nationalgeographic.com/animals/mammals/rhesus-monkey
Visiting the zoo taught you that animals have no nerves in their genital areas? Did you actually GO to the monkey house?
no, that monkeys don’t pair bond but live in promiscuous community
“…lack of nerves in the genital area, as do other Mammalian species such as lions and monkeys who live in a community…”
That’s a direct quote from you. You’re saying very clearly that you believe lions and monkeys have a “lack of nerves in the genital area.”
I am extremely skeptical about ANY mammals not having nerves in the genital area. Good grief, how do they know if they have to pee?
Um…your link says nothing at all about vaginal innervation in Rhesus monkeys. So it’s not just unconvincing, it’s irrelevant.
A note from Miss Pedantic here: “innervation” is when something GETS nerves or energy; “enervation” is when something LOSES nerves or energy.
other Mammalian species such as lions and monkeys who live in a community that care for the young rather than only one father.
…which do not include at least one species of great apes known as H sapiens.
“Oh, you’ll do it and you’ll like it, your pleasure is irrelevant.”
That sounds awfully rapey to me.
exactly why God designed humans (with souls) to have orgasms (& to birth the babies grown inside them 95% of the time, I might add)
Even the briefest look at historic death rates for women and babies in labor/birth, and a look at the current homebirth deathrates, shows that women are not “designed” to “birth” the babies inside them 95% of the time.
Not to mention that at least 50% of conceptions, possibly as high as 80%, fail before a clinical pregnancy (i.e. one that the woman notices) is established. And the high miscarriage rate in “nature”. Human reproduction is not really the part of biology that makes the strongest case for intelligent design.
That is a pretty damn stupid circular argument, even for you.
not if the opposing view is that humans are evolved animals
Well of course someone citing “intelligent design” thinks female orgasm is useless.
it’s called satire. If you google intelligent design, one of the proofs is the female orgasm. That’s like saying of course a person who believed in science thinks bacteria is imaginary.
What if you’re a scientist that believes in bacteria AND female orgasms?
Not to mention the theory that uterine/vaginal muscle contractions during orgasm actually work to help push/pull semen into the uterus, thereby providing a greater chance for fertilization.
There’s a reason women tend to be more easily aroused and more orgasmic in the time surrounding ovulation.
Mine aren’t useless. They keep me coming back for more. My husband likes that. So do I. See how that works?
Anyway, female orgasm boosts mood. Better mood increases overall happiness. Happiness creates a better life experience. I’d hardly call that useless!
If you’re a woman who has never experienced orgasm, I suppose you would deem the whole thing fairly useless.
For those of us who are orgasmic, good grief, is it ever useful….
if you consider yourself a spiritual & emotional being, of course. But as an evolved animal, science can’t seem to place a use on it.
“The human body’s a real mess, truth be told”
To someone who believes in intelligent design that’s fine. It makes like difficult. Life wasn’t supposed to be a bed of roses.
It’s like someone getting stuck in a maze without realizing it and wondering why the park didn’t get someone who knew how to make a straight path to do the job.
Granted I’ll get a few down arrows for this one, but who says you have to be popular or use the best turn of phrases?
Most babies turn ON THEIR OWN in the last two weeks.
And some turn the wrong way. Mine did. Head down (by feel and by ultrasound) then flipped to feet first. There are risks to turning a baby that late that should not be ignored. We discovered mine had flipped when I was already in labour and my water had broken, but even if we’d found it earlier I’m not sure I would have taken that risk over that of a planned C-section.
My first flipped late as well. Breech position not discovered until water broke followed by induced labor!
I was perfectly fine with the c-section. What I can’t figure out is why everyone else seems to think I should be upset that I didn’t have the chance to flip the baby back to head first. Healthy baby and Healthy me = Happy Me, Happy Baby and very Happy Dad!
“16 of my personal friends have been able to turn a breech baby in the last 2 weeks.”
Boy, I wish I was that popular. 16 personal friends who had breech babies, and breech babies that turned. What percentage of pregnant women do that. And ALL your personal friends have been pregnant? I assume not. So out of interest, how many personal friends do you have? To give you the benefit of the doubt it was probably meant 6. I have a regular number of personal friend, and between us we’ve produce a lot of babies (average 8 babies per woman). I can only think of one who had one breech, and in her case, it turned into breech at the end, not the other way around. Sorry, but your statements are sounding more and more implausible.
Okay, you are full of shit.
You are aware that there are risks to turning the baby? Right? I believe Dr. Amy has a post about that, in which she lost a baby. ?? No time to find it, but it stuck in my head because my first baby was breech.
Omg please stop with these insane claims that our bodies are perfect because they were intelligently designed. Yes, I believe we have a creator, but I’m not foolish enough to look at the world around me and decide that everything is perfect because it was designed by God. Hell-o! Imperfect world here, remember? Because the way my appendix blew up and needed to be cut out in the middle of a hurricane last year is some pretty nice proof that our bodies and this world aren’t perfect. The severe preeclampsia I suddenly developed is another. So we can either stick our heads in the sand and pretend everything is lollipops and rainbows, or we can live in the real world, where Shit Happens. And deal with it. Intelligently.
God has kind of a sick sense of humor, and tends to play Can You Top This? with Mother Nature.
LOL. 16 in 2 weeks. Can’t you at least make your stories believable?
Yep. And the treatment for pre-eclampsia is delivery. By the safest and most convenient means available. Only in unusual circumstances is delivery delayed for a woman with pre-eclampsia. (Though it should be pointed out that not all women with pre-eclampsia go on to c-section. Many deliver “naturally”.)
I failed to see the “see more” option, so again, I apologize. I don’t see the need to answer questions (?) that I didn’t see before (the comment seems to be further explanation of evolutionary connections to needs for c-sections)…we will have to agree to disagree that c-sections are preferable solutions with even the slightest doubt. Many times women are treated as a faulty incubator rather than a co patient with the baby.
the pitifully low VBAC rate??
I’m not Dr. Amy, but what I have to say about it is, VBAC is associated with higher risk of neonatal death and other serious neonatal complications.
So you feel it should never be an option for anyone?
No one should be lied to and told that it is as safe as a repeat c-section. No one should be forced or coerced into taking VBAC as an “option”. I strongly suspect that most women, given full information, will choose a repeat c-section, prioritizing their child’s life and health over the risk of another scar. Thus, there will be a “pitifully low” VBAC rate. If some individuals make a different decision, that’s fine with me. As long as they understand the risk they are taking.
I chose a VBAC, but was told I was an excellent candidate as the reason for my C-section was a non-repeating one (footling breech position), my baby was estimated to be on the small side (she was 6 lb 6 oz at 39 weeks, her brother had been just 7 lb 5 oz at 40 weeks, 6 days) and I was otherwise healthy. Had my C-section been for failure to progress, a big baby or something likely to happen again, I would have been signing up for a second one.
I don’t think that a comparison of VBAC vs ERC without taking into account the risks of the specific situation is actually terribly useful. I’d say the same about vaginal vs C-section deliveries in general.
Do you believe that women should be forced into having VBACs if they are uncomfortable with the idea? Or coerced into them by claims that they’re perfectly safe and that only someone “devolved” or “too posh to push” would consider an ERC?
No, but I think that women who want a VBAC shouldn’t be coerced into a repeat c-section. What is “too posh to push?”
Do you think that telling women, accurately, that their babies are at increased risk of dying if they have a VBAC is “coercion”?
“Increased risk” is too general, & “dying” covers only the worst case scenario. If that increased risk is from half a percent to a full percent of aspirated breathing at birth (but survival), then yes, that’s coersion. & isn’t the woman in more danger than the baby in a VBAC?
Asking for more information is nearly always reasonable.
The relative risk of dying is 0.39 for a ERC versus VBAC, that is, a baby born by repeat C is about 40% as likely to die as a baby born by VBAC. Babies born by ERC also had a 0.4 RR of serious neonatal morbidity (birth trauma, apgar 1.5 L was lower in the ERC group.
so…does that mean a VBAC baby’s risk is 61% higher? that figure is confusing. I’ve never even heard of a baby dying in a VBAC, nor has any of the OB’s I’ve talked to, with 207 years experience between them.
There are stories of such instances right here on this blog, if you look.
If you take a ratio such that the VBAC baby’s risk of dying is set to “1” then the ERC baby’s risk is 0.4. In other words, about 2.5x lower.
Wait, I’m confused. Are those OBs who’ve never heard of a VBAC death the same OBs who refuse to allow VBACs because they want to play golf, so they instill terror into mothers to force them to submit to the knife?
They told you they’ve never heard of a VBAC death but tell their patients “you’ll die if you do this?”
My goodness!
Ellie, that’s another completely bizarre statement. If you haven’t heard of a baby dying in a VBAC you have done little research. I flat out don’t believe you that you know OB’s who have never even heard of a baby dying in a VBAC. That’s just nuts.
Kaiser. Call them and ask their OB department. They give statistics but I couldn’t find one who had ever heard of a particular case. I’m glad to read the guest because it broadens my understanding
If Kaiser OB’s have never ever ever even heard of a VBAC fatality, then they must think that VBAC’s are the safest way to give birth, like, EVER. So are they pushing all of their patients to have VBAC’s, or what?
What about first time moms – will they offer them c-sections so they too can someday experience the incredible safety of VBACs?
No? What’s that you, say – – – oh, those OB’s are telling moms that VBACing is too dangerous to attempt?
Your statements make no sense.
Then those OB’s aren’t doing many VBACs and/or getting very, very lucky. I’m pro-VBAC, I encourage a TOLAC (trial of labor after cesearean) in all women who appear to be good candidates. I’ve only refused to offer women TOLAC if they met specific criteria (prior classical incision, multiple prior c-sections, breech). The majority of my patients who would be good candidates for TOLAC still choose repeat c-section after a detailed discussion of the risks, benefits, and alternatives. I’ve also seen 3 uterine ruptures due to VBAC–all 3 babies died, all 3 patients had life-saving hysterectomies. This is in a hospital with 24-hour in-house OB-dedicated anesthesia.
wow, were those TOLACs in the operating room? I recognize that HBAC is risky but never thought that a baby could die in a hospital VBAC….
No. TOLAC occurs in routine L&D rooms. The first sign is often sudden, sustained fetal bradycardia and/or loss of fetal station. Even if you assume the deceleration is immediately noticed, several minutes will be spent on intrauterine resuscitation measures (O2, side positioning, stopping pitocin, placing internal monitors, etc). In the best of circumstances the diagnosis and call for stat c-section probably takes 3-7 minutes. Then, a 2-3 minute transport to the OR, 1-2 minutes for prepping and draping, 1-2 minutes for induction of general anesthesia, 30 seconds-1 minute from incision to abdomen. In a massive uterine rupture the placenta and fetus have generally detached entirely from the uterus and are floating in the upper abdomen, exsanguinating. At a minimum, 10 minutes of blood loss at that rate is lethal. More frequently a uterine rupture is much smaller with less fetal blood loss and less likely to result in demise.
have you seen this when the previous c-section(s) may not have been necessary or emergent (since it’s a VBAC)? I recently had a friend whose son lived but she had an emergency hysterectomy during a VBAC. Her 1st c-section was because the OB was impatient with a 13 hour labor, 2nd was scheduled because of the 1st, & nearly killed her with a nicked bowel, which is why she didn’t want another c-section. I feel awful for women who have so much trauma related to their births!
I don’t believe the stories of doctors becoming impatient. I had my son at 35 weeks 5 days because I was leaking fluid. I was no where near ready, but they induced my labor and let me labor for 30 hours before I had him. No one ever even mentioned a C-section because everyone was doing fine and even though it took forever it was always moving along.
I agree. But what she wrote is that she had never HEARD of a baby dying at a VBAC and neither had any of the OB’s she had talked to. The notion of an OB not ever hearing of a baby dying at a VBAC is absurd or terrifying. I vote for absurd given her other posts.
I wouldn’t want to place myself under the care of an OB who’d never even “heard” of a VBAC fatality. That tells me that he either a) hasn’t delivered enough babies to have been exposed to such an event; b) he doesn’t keep up with the literature/doesn’t educate himself on how these fatal cases unfold and HOW THEY CAN BE AVOIDED; or c) doesn’t speak to his colleagues. Or all three. Either way, that’s not an OB I’d ever hire.
I didn’t
wow. those are pretty catastrophic ruptures. how sad. I will keep that in mind
What part of uterine RUPTURE sounds like it wouldn’t be catastrophic??? Seriously!? My mind boggles.
“It is usually asymptomatic and does not require emergency surgery.”
http://www.patient.co.uk/doctor/Uterine-Rupture.htm#
“The overall risk of perinatal death due to uterine rupture was 6.2 percent. The two studies of women delivering at term that reported perinatal death rates report that 0 to 2.8 percent of all uterine ruptures resulted in a perinatal death (Guise 2010).”
This was from an NIH VBAC conference report but I couldn’t get the link to work. I interpret this to mean that IF there is a uterine rupture, then the risk of death is 6.2%
You quoted out of context.
That quote was from the section on incomplete rupture.
The relevant section for what people are talking about is this
“The initial management is the same as for other causes of acute fetal distress – urgent surgical delivery.”
incomplete what? did you write “rupture?” as in, a rupture that is not catastrophic?
Not really. A “pretty catastrophic” rupture is when both mom and baby died. Or when baby died and mom lost her uterus. Babies dying during ruptures is hardly unusual.
Yes, I was going to say that of the 3 people I have known to have a uterine rupture during labor only one of the babies lived.
You know who else is hovering in the background, evaluating risk? The medical malpractice insurers.
No one has mentioned it yet, but if there is a small chance of a bad outcome and the OB wants to do a c-section, but the mother wants to keep waiting…since there’s such a small chance, etc. That mother will probably still sue for malpractice if the OB was right.
actually in CA there is no ability to sue unless the baby dies. Even severe injury is not grounds for suit & the awards are limited so severely that most women don’t bother. But I agree that it is a major part of the problem.
actually in CA there is no ability to sue unless the baby dies.
Are you serious? What is your data for this claim? Two seconds on google got me several California based lawyers who specialize in birth injury lawsuits.
Her ass as is the basis of all her claims.
http://abclocal.go.com/kabc/story?section=news/state&id=9209339
The article you reference says nothing about “only being able to sue if a baby dies.” It is simply talking about CA’s monetary cap for non-economic damages in medical malpractice suits; i.e., the money you can get from pain, suffering, inconvenience, etc. In CA, the most you can get for non-economic damages is $250,000.
Economic damages, such as the money it would take to care for a physically injured or brain-damaged baby, remain unlimited.
You can sue whether the baby lives or dies, and, in fact, will probably be rewarded a lot more if the baby lives because your economic damages are likely to be much higher.
you have none because the baby doesn’t work or earn. mom is already on medical leave from work.
Economic damages for severe birth injury = lifetime cost of care for a disabled child, including medical treatment and basic life care. That’s lots and lots of money. Again, you don’t understand civil law at all.
Economic damages extend to more than lost wages. They include things such as past and future medical bills and therapy. So, yes, for an injured baby (or mother) that will requires medical help, there are economic damages.
Um…this comment made me laugh in disbelief. If a baby is disabled, a court can and does award damages to compensate for the loss of future wages that that baby would have earned. Same goes for the mother. That is completely separate from an award to pay for past and future medical bills.
Honestly, I’m not trying to be mean here, but *usually* when a person is as utterly clueless as you seem to be, they sort of suspect that they are and don’t keep making ignorant and erroneous statements about subjects that they clearly, clearly don’t understand. I’m actually a little bit embarrassed for you.
Repeating the error of citing an ABC-news article about a limited section of the statute does not make you correct and it does not make you look any better informed. In California, you can sue whether a baby dies or not. You can be awarded three types of damages (that I’m aware of):
Compensatory (aka economic) damages: That is the cost of caring for an injured person, and, in some cases, the cost of lost wages. There is no limit to the amount you can recover in California.
Non-economic damages: (sometimes known as pain and suffering.) This is what your article is referring to and these are capped at $250,000 in California.
Punitive damages: These may be awared in cases where a plaintiff can prove that a provider acted fraudulently or with malice.There is no cap on these i California.
The California statue provides limitations on what percentage of a med-mal award attorneys can take: Up to 40% of the first $50,000.00, 33.3% of the next $50,000.00, 25% of the next $50,000.00, and 15% of damages exceeding $600,000.00.
All of this is very easy to find. If you bother to look.
what you CAN sue for and what a lawyer is willing to work with you to sue for are two different things. Call up an ambulance chaser & see if he wants to take your claim. I’ll give you one of my coworkers examples: wife was left to push by herself for 2 hours, no nurse, no OB. OB marches in, says it’s time for c-section. By the time they get in, they realize he’s actually in terrible distress, so in a rush, they slice his main artery in his arm. But he lives, mom is stitched up. Insurance agrees to provide counseling for mom, & BTW, you signed an arbitration agreement with our hospital agreeing not to if we offer a settlement.
http://www.huffingtonpost.com/spencer-aronfeld/arbitration-agreements-medical_b_1263951.html
First, hospitals and doctors in your area sound so dangerously incompetent I’m amazed that people leave the hospital alive. Second, you really don’t seem to understand how citations work around here.
You tell a frankly incredible story and then use an article about medical malpractice in Florida (not even for OBs!) as your evidence. What?! I clicked the link expecting something local to you and about malpractice in obstetrics. Usually, when people link to articles to back up a position, it’s on point.
You have been a very entertaining addition to this thread. I can’t wait to see where your next flight of fancy takes us.
I used to be friends with a girl who turned out to be a
compulsive liar. At first I thought she was a nice person and I felt bad questioning stories because, you know, some people really DO have extraordinary things happen in their life. As our friendship continued I started to notice that more and more of what she said didn’t add up. When I questioned her about it, the stories would change ever so slightly to allow for an explanation and eventually the things she made up just got stranger and stranger. I’m starting to feel Déjà vu reading all these comments……
And the continual posting of totally irrelevant links is just
bizarre.
http://www.vvdailypress.com/articles/rooms-38176-shut-amid.html
That must be why there are so few med-mal lawyers in California and why OB med-mal insurance rates are so low.
BTW, you have every right not to sign an arbitration agreement.
yes, and that hospital then has the right to refuse you service
Actually, if you’re in labor, the hospital does NOT have the right to refuse you service. It’s called EMTALA.
exactly why many women stay home to labor so long and wait to go into the hospital
No, a hospital doesn’t have the right to refuse you service if you’re in labor or have an emergency. Google EMTALA. It’s been law since 1986.
Unless you’re in labor.
which is why so many women resort to home births and birthing centers or choose to simply wait until the last minute to come in.
Really? How many? And can you enlighten us with the number of hospitals that require patients to sign arbitration agreements?
Most statistics are around 10 yrs old, this is the most substantial and it’s 15 yrs old. The studies often only cover how often arbitration is actually used, not how often it is offered or required. unless you can find something, I’d be welcome to it. Most of my So CA area is so saturated in Kaiser (which requires a signature if you are a member) so that’s why I write about them.
http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1036&context=lcp
That’s really interesting, but it has nothing to do with the question I asked you.
are u just screwing with me because you want to demonstrate lack of reading comprehension? I repeat, I can’t tell you how many because most statistics are old and not specific.
No. I asked you a direct question on the off chance that you might be able to demonstrate that you had any idea what you were talking about. The proper answer, when you don’t know the answer to a question, is “I don’t know.” Not posting a link that has nothing to do with the question.
See this is why we look up information before we make claims instead of making claims and digging around in order to find information that is somewhat related to the information we pulled from our rectums.
ask them for a list of suits they won & how they got around the arbitration and which hospitals
Nope, sorry, in all states, especially more litigious ones like CA, you can sue for injury to a baby that might have been caused by birth trauma or other failure of obstetric care. In fact, the payout for a severely brain-damaged child requiring a lifetime of care will generally be HIGHER than the payout for a dead one.
see here
http://abclocal.go.com/kabc/story?section=news/state&id=9209339
Jocelyn explained below why that article has nothing to do with what you just said. If a careless obstetrician resulted in a brain-damaged baby, you could sue for the lifetime cost of care (maybe several million dollars!) plus $250,000 for pain and suffering.
that’s exactly what the article said. But that OB will not pay for the care. The hospital or malpractice insurance will. And it will likely not affect his/her medical license.
No, doctors do not pay malpractice suits out of their own pockets. Most of them don’t have $5 million in cash just lying around. However, if the malpractice insurance makes a large payout in a particular doctor’s name, that doctor’s premiums will go up, and if a doctor has too many lawsuits, he’s probably not going to be a practicing doctor for much longer.
This is how liability insurance works. Just like car insurance, really.
Severe injury is not grounds for a lawsuit? Are you saying that no one can sue for a brain injured infant? Now you’re making up legal claims just like you’ve been making up medical claims. Do you actually check what’s true and what’s not or do you simply write whatever pops into your head?
no, I’ve spoken to lawyers about filing medical malpractice & heard from several parents of students about what they have attempted to file.
Funny how you keep on receiving advice from professionals that is just so wrong. Doctors, lawyers.. Very strange.
It’s like they say about relationships, or jobs for that matter. Anyone can have one go sour, and it’s probably not your fault. If several in a row go wrong, you’ve got to look at the common denominator.
Before trying to teach folks here about a law, you might want to actually read the law: Cal. Civ. Code 3333.2.
Are you familiar with John Edwards? He ran for president. You might want to review his legal career.
lol! yes, & as far as I could tell, never practiced in CA
What is up with the “all or nothing” attitude so often displayed? Combative much?
I’m wondering that myself. Do you see computer ate nym’s comment as allowing for VBAC in certain circumstances (that do not include an ignorant patient willing to risk her infant’s life)?
She didn’t say nobody should have one, she said they have a higher risk. There is a higher risk to driving, but people still choose to do it. I’ve taken higher risks myself in discussion with doctors and they’ve not always been happy with my choice but agreed it was a valid and ‘safe enough’ option.
Homebirth can also fall into that category. It’s not up to me to decide for anyone what to do, but I will want to make sure that they are certain they know the real risks and aren’t just relying on wishful thinking.
I don’t see it as anything other than a fact based on statistics. There are risks to being pregnant and risks with both vaginal and C-section births. It doesn’t mean that everyone needs to start jumping conclusions (pregnancy is BAD! C-sections are BAD! VBACs are BAD!) it just means that you have to discuss with your doctor your personal risk factors so you can make an informed decision. That doesn’t mean that it will be the answer you want either. Your doctor isn’t obligated to reassure you that you were designed to be pregnant or give birth or that your body knows what to do or that since your friend had X, Y or Z happen, you will or won’t.
As I said overtly in so many words, if a woman understands the risks and benefits and wants to go for a trial of VBAC that’s her decision and none of my business. It’s when women are not told the risks or are coerced or shamed into VBACs because we have a “pitifully low VBAC rate” that I am concerned.