The impact of baby Landon’s death from insufficient breastmilk continues to reverberate around the world and lactation consultants continue to whine that such deaths are not their fault.
The brutal truth is that lactivists lie and babies die.
A new paper from the UK provides more tragic examples.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both symptoms and maternal concerns were routinely ignored.[/pullquote]
The paper is Neonatal hypoglycaemia: learning from claims by Hawdon et al. It’s a risk management paper, published to alert clinicians and managers to potential causes of lawsuits.
The authors found:
…In this 10-year reporting period, there were 25 claims for which damages were paid, with a total financial cost of claims to the NHS of £162 166 677 [over $250,000,000 at the 2011 exchange rate].
Hypoglycemia is low blood sugar. Severe hypoglycemia can lead to severe brain injuries. Two examples were included:
The child is severely disabled and requires 24 hour care support. It has not been established whether the brain injury will have any impact upon life expectancy although limited mobility and cognitive deficits would contribute to a loss of life expectancy and her medical needs for the rest of her life are likely to be complex.
And:
She is mobile indoors but cannot walk properly on uneven ground or on even ground for more than 200 metres. She requires assistance with dressing, cleaning after toileting and has to have food cut up. She has no sense of danger to herself or others, acts in a dangerous and destructive way and requires constant close supervision.
Most cases involved well known risk factors for neonatal hypoglycemia including low birth weight, poor feeding behavior, maternal insulin dependent diabetes and hypothermia.
In most cases insufficient breastmilk intake was the cause and poor feeding behavior was the primary symptom although there were a few cases where other factors were involved (one case of neonatal hyperinsulinism and one case of neonatal sepsis).
For 21/28 (75%) babies, it was the abnormal feeding behaviour which caused clinical concern. Of these 21 babies, 2 were also described as hypotonic, 5 also as cold, 1 also as irritable and 1 also as sleepy.
Eight out of 28 (29%) babies were described as hypothermic, either in isolation or in combination with poor feeding or being sleepy.
One baby was described as being hypotonic in isolation, and one baby presented with cardiorespiratory collapse.
For two babies presenting clinical signs were not documented.
In fully 36% of cases, mothers felt there was something wrong with the baby but could not get the staff to take their concerns seriously.
The authors provide four examples:
‘By the third day he was sleepy and disinterested in feeding. His mother asked for assistance to latch him onto the breast and voiced concerns that he was not feeding. His mother continued to alert staff to her problems in getting the baby to feed and the fact that he was sleepy.’
‘The mother informed the midwifery staff on the ward on a number of occasions on this and subsequent days following the baby’s birth, that she was concerned the baby was not sucking when feeding was attempted and she was concerned he was not feeding properly. These concerns were not heeded, resulting in the baby not being fed adequately and ultimately causing his collapse due to hypoglycaemia.’
‘The mother felt she had expressed concerns on multiple occasions about baby’s feeding technique both on delivery unit and on the ward but she felt she had not received adequate support. These concerns were not listened to.’
‘The parents brought the baby to the accident & emergency department with feeding problems and episodes of rolling his eyes. Seen by the paediatric team. After giving advice on feeding to the parents, baby was discharged home. The parents continued to be concerned and brought baby back to accident & emergency 3 days later. Blood glucose levels were not measured and parents told they could take him home.’
The authors issue a number of recommendations including:
Babies presenting with abnormal clinical signs, including abnormal feeding behaviour and hypothermia, must undergo detailed and documented assessment including measurement of blood glucose levels …
Maternal concerns, especially with regards to feeding, should not be discounted and should be followed by a detailed and documented history and assessment of the baby’s condition.
In the presence of clinical signs, once a diagnosis of hypoglycaemia is suspected or made, this constitutes a clinical emergency.
Babies with risk factors for neonatal hypoglycaemia or abnormal feeding behaviour should not be discharged from postnatal ward to the community without assurance that the milk intake is sufficient to prevent hypoglycaemia…
There’s a theme that emerges here and it is quite ugly: both symptoms and maternal concerns were routinely ignored. Mothers were reassured that their babies were fine when no clinical investigation had been undertaken.
That’s what happened to baby Landon, too. His mother recognized that something was wrong and her concerns were dismissed out of hand.
Keep in mind that this paper involves only injuries from hypoglycemia in which successful lawsuits were filed; there were undoubtedly additional cases. Moreover, it does not include lawsuits for damage resulting from neonatal dehydration, smothering in the mother’s bed and falls from the mother’s bed, all known to be associated with the relentless contemporary promotion of breastfeeding.
The real problem here is quite obvious; it’s the magical thinking that surrounds breastfeeding. That includes the belief on the part of nurses, midwives and lactation consultants that serious breastfeeding problems are rare, when, in fact they are common and that believing you can breastfeed is the key to successful breastfeeding.
So lactation consultants and others falsely reassure mothers that everything is fine when in reality the baby’s brain cells are dying. In other words, lactivists lie and babies die.
What do you think about the research connecting peripartum cardiomyopathy to breastfeeding? It looks like “breast is best” could be literally killing some mothers. https://www.sciencedaily.com/releases/2017/03/170308083721.htm
“Research has shown that women with PPCM produce an abnormal breastfeeding hormone that leads to programmed cell death (apoptosis) and damage to the heart muscle.”
…
The researchers found cases of PPCM in all 43 countries studied. All women with PPCM presented at the same age, and with the same symptoms and heart size, despite different ethnic backgrounds and huge disparities in socioeconomic factors and access to healthcare.
“Our data shows that PPCM is truly a global disease, and irrespective of where you live, what healthcare system you have, what nutrition you have, and what education you have, you can get this disease,” said Professor Sliwa.
“The disease presented quite uniformly despite occurring globally in different ethnic groups and in very different healthcare systems,” she continued. “This tells us that PPCM is to some extent a biological disease and women might have a genetic predisposition, which is probably a cellular and cardiac signalling abnormality. This is not a disease with marked differences between ethnic groups.”
Wow!
OT: Did you know that there’s an equivalent of SIDS in the bird world? I did not know this, though it makes perfect sense that it would exist. I’ve never worked with baby bird, just rescues, so baby bird issues aren’t high on my radar of things to watch for. My vet called it maladaption, and it is the fate that one of my son’s young budgies suffered yesterday. With five other birds in the house, I paid for a necropsy to make sure there was nothing contagious. The vet didn’t find it necessary to repeat all the labs from his new bird check up just a week ago, so it was done pretty quickly. YK was devastated and cried horribly saying he’d failed his little birdie and it was all his fault. My vet is amazing and spent time reassuring him there was nothing he could have done and he took great care of his birds. Have I told you guys how much I love my vet?
So then we had to go to the orthopedist’s office, where we found out YK needs major reconstructive surgery on his shoulder. That’s scheduled for April 5th. On our way home I had to stop by the bird store to get some supplies for the other birds and YK was hanging out in the nursery and fell in love with this little lovebird. He was smiling for the first time all day, and I’m a sucker. So, meet Donovan. Or Donna. Not sure if he’s a boy or a girl. I’ll get a DNA test in the next couple months to find out.
http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_2207_zps9yegcwwm.jpg
Love it!! I had a hand-raised Lovebird when I was in college and through the early years of my marriage. I loved him and was so sad when he passed.
What a sweet little bird! I hope it does really really well and I’m so glad YK was able to fall in love. A new friend is the best.
Oh, I love lovebirds!
So pretty! Tell YK I’m sorry about his other birdie; I don’t know much about baby animals, particularly birds, but even a stranger on the Internet can tell he was doing a great job, and that there really was nothing he could do. I’m sure the budgie enjoyed their time with him whilst they were alive.
Your vet really does sound fantastic. I take it he’s avian specialist?
Thanks you. And yes, Dr. J. is an Avian specialist. Actually, he’s one of the oldest, if not the oldest, active avian and exotic practices in the US. Listing internships with him on resumes is a bragging point for younger Avian vets. He’s just an amazing vet in all respects. I’m really lucky that I live in the same city as he lives.
All the books and websites by the BF activism groups I’d read told women they should fight hospitals on formula supplementation, or, at least, fight using a bottle b/c of “nipple confusion.” Glad the nurses at the hospital I had my son at hadn’t read them – when my son started having feeding problems and got groggy, they immediately tested his blood, and were able to start supplementation and IV glucose before his hypoglycemia got into the danger zone. I shudder to think what could have happened had I followed the advice of those books.
OT but hoping for some insight. My child was prescribed Amox-Clav yesterday and I picked it up last night from the pharmacy. I’ve only just noticed now it says keep refrigerated. I feel terrible. It was at room temperature inside a cabinet for about 18 hours. Is it ruined? Should I give tonight’s dose anyway? My pharmacy doesn’t reopen until morning. Thanks for any help.
The pharmacy should have verbally told you to refrigerate it. If they did not, they should replace it. I expect you’ve spoken to them by now, hopefully it worked out.
A regular commenter here has mentioned a PPD Facebook group that is very supportive, would they be willing to share which one it is? I’m awaiting formal diagnosis and treatment, and a little community would help. Thanks.
I don’t know what the facebook group is, but I have been through PPD! Many hugs to you…for me, it took the form of *never* feeling like I was doing it right, and being afraid my baby would be taken away for his own safety if anyone saw the state of my house. Oh, and crying all day…
It’s my group. I’m the one with all the parrots in my profile and cover photos! You’re welcome to join. If your FB profile is locked down tight enough that we can’t tell you’re a mom, just send me a message to let me know you’re a mom so I can approve you.
https://www.facebook.com/groups/evidencebasedppdsupport/
Slightly OT but still releveant: https://www.buzzfeed.com/rosebuchanan/more-than-half-of-the-nhs-staff-surveyed-say-theyre-working?utm_term=.nkEJz8Krq#.geK0ol9Qx
https://www.buzzfeed.com/laurasilver/doctors-say-theyre-right-to-voice-their-fears-about-the-nhs?utm_term=.mgXJ8m5kx#.yyGNxvgWX
>:(
Aww dude, not good. I wonder if there’s the anti-govt vein that runs strong in the US, too, that says underfund programs so people will think they’re awful and demand privatization?
we call ’em the Republican party. Only half sarcasm, the libertarian streak is a mile wide in the US.
I’ve dealt with hypoglycemia 2 out of 3 times, due to GD. Both times, hospital took it very seriously. I had undiagnosed GD during my second pregnancy. It was figured out when I gave birth to a 9 lb hypoglycemic baby. His levels were actually borderline, so they let him stay with me, but he was topped off with formula after each feed for the first 24 hours and they kept testing every 3 hours. After 24 hours, his level were stable enough that I could exclusively nurse him, and they remained stable enough that we were discharged after another 24 hours of watching his levels.
Third baby I was diagnosed with GD and also had a partial placental abruption at 27 weeks. At 36 weeks the placenta totally crapped out and luckily I had a scheduled NST that day, so they picked up the distress and I was taken in immediately for a c section. Baby was born with blood sugar in the 20s (and I was told that while the GD didn’t help matters, it was more due to the bad placenta than the diabetes). Obviously he went straight to the NICU. I pumped for him, and after the first day, I was pumping enough that they didn’t have to give him formula, but of course it was there as needed and I knew if they felt he needed more, he was going to get, no question. Also they were pumping him full of sugar through a central line. I couldn’t nurse him directly until the line came out when he was a week old. He stayed in the NICU another 48 hours after the line came out, to make sure my milk was enough to keep his blood sugar where it should be.
Oh, and nipple confusion is BS. He took to the breast just fine even after 7 days of only bottles. And my supply was just fine too.
My girl manages to drink with 4 different nipple types just fine.
My boy never seemed to notice either, let alone care, when we changed nipple types on his bottles (except at the very start when his mouth was too small for most nipple types and he needed specialist premie ones).
That’s how you can spot the difference between science-driven and ideology-driven health care. The science-driven struggles to improve. The ideology struggles to prove that it always was, and always will be, right – despite the evidence.
EXACTLY.
The thing I am wondering is, if the woo types are all about how the mother-baby bond is “natural” and how babies and mothers are innately so sympatico, why are they so quick to dismiss mothers who say “I think something might be wrong…” either in terms of breast-feeding or birth?
Because at the very root of all of this is the unwaveringly misogynistic view of women as objects and vessels, not as people.
The heart of it all is to keep women quiet, subservient, and tied down to an impossible standard of birth, motherhood, and childcare that is completely opposed to womens’ autonomy and personhood.
That includes – in fact, it REQUIRES – devaluing and dismissing everything she says in favor of the ideology.
Because birth and breastfeeding are ‘natural’ and ‘perfect’.
Listening to a mother that feels like something is wrong goes against everything they believe in. After all, if you trust your body, it can’t fail.
What they really mean is “Listen to your body, unless it is telling you the wrong thing, in which case, listen to ME”.
This – a thousand times this!
The draft of the local guideline on infant weight loss that is currently in the process of being written literally didn’t suggest a midwife do *anything* except check the latch, encourage pimping with *maybe* a top up of expressed breast milk from a cup or syringe (no bottles, because nipple confusion) and reassure mum until the weight loss was 12.5%.
And at 12.5% it suggested contacting the Trust lactation advisor, not the GP or Paediatrician.
No BM check, no suggestion to measure vital signs and check capillary refill, as long as the baby is peeing no other assessment was advised.
I’m hoping that the rather scathing email I sent might have prompted a re-think.
I’ll certainly be sending a link to this research paper to the authors as well.
If they write a guideline that leads to babies being harmed, I want there to be a paper trail, and that they knew exactly what they were risking.
“encourage pimping”
Sorry, I know this is a serious discussion, but I LOLed.
They’re breast milk pimps all right…
Autocorrect on my phone is not my friend…
And my serious comment is… I saw a comment a couple weeks ago on the facebook post of a new mom with supply concerns. One of her friends popped in to say “make sure they’re using the weight chart for breastfed babies and not formula fed babies because they’re not the same”. What?? So they’ve got [made up] separate growth charts now?
The post was rather old by the time I saw it and I think by that time mom was supplementing so I didn’t respond with outrage.
This is so so so common. Lactivists insists doctors are using growth charts created by Similac. A SIMPLE google search shows that the CDC recommends US pediatricians use the WHO charts up to two years of age
7% is when you start looking into the situation, 10% is when you feed immediately, 12.5% is a medical emergency.
What source could they possibly have that shows 12.5% is safe, normal or reasonable? How could they possibly think that any time cushion exists at that level of weight loss?
Just like CPMs…you don’t head to the hospital until the situation is SO dire that it’s almost unrecoverable. It’s a great system! /sarc
Wow, at 12.5% our pediatrician would not let us leave her office with our 4 day old baby without watching us feed some formula (which baby gulped down, promptly conked out, and was obviously, visibly relieved). We then had to return daily for about a week for weigh-ins. Later that day, I did see a lactation consultant who rather weakly tried to argue that 12.5% was not concerning because babies get “overhydrated” when the mom gets IV fluids during L&D. But to her credit, I guess, she did not do anything else to try to undermine the need to supplement with formula that week until my milk came in.
Ugh, trying to argue with the pediatrician in abstention and supporting starvation through pseudoscience is more than enough to take away any ‘credit,’ IMO.
I’m loling at “encourage pimping.”
I wonder about more subtle effects of early starvation that are not being properly reported and attributed. Developmental delays, learning disabilities. Brain cells are fragile and need nourishment!
My personal anecdata: My son was starving and dehydrated due to insufficient milk production. He was term but small and had some hypothermia in the hospital, and likely hypoglycemia, though I don’t remember that being checked when we were readmitted. Supplementation started on day 3, when he started gaining weight and peeing more than once a day.
At two years and 1.5 months, he has a speech delay. He understands what is said to him, makes amazing connections between books or TV shows and the real world, but he reliably pronounces maybe 10-15 words, with maybe 5-8 consistent “baby signs,” gestures, or sound effects. He’s getting weekly therapy and I follow up with his therapist’s suggestions throughout the week, and he’s improving but very slowly.
Are these things related? Was the early dehydration and 11% weight loss a contributing factor to his current speech delay? Will he have other delays or major challenges when he starts school? I don’t know, and ultimately it doesn’t matter much with regard to his care. But I wouldn’t be surprised if they were connected. Frankly, I’d say we lucked out in the face of these reports.
I wonder about that too. My daughter also lost 11% of her birth weight before she started gaining and at one point the health visitor noted that my daughter seemed ‘cold’.
I didn’t know that was a warning sign and followed their advice to just chuck a few more layers of clothes on her. I didn’t realize that hypothermia could be a sign of poor nutritional intake.
I tried to exclusively breastfeed for 6 weeks before my midwife stepped in and told me it was time to supplement.
My daughter is nearly 3. And like your son she has speech delays, as well as having been recently diagnosed with mild autism spectrum disorder. While I’m aware that there is a significant genetic component (dyspraxia runs on my dad’s side of the family) I’m wondering if her failure to thrive when she was a newborn contributed to it in some way. Guess I’ll never really know, but it does make you wonder.
It does, doesn’t it? I hope your family is getting whatever help your daughter needs. We’ve been lucky in that regard, but I know not all families are.
We only managed to get her diagnosed just before Christmas last year. So now we’re waiting on our local health board to get back to us to let us know where she falls with regards to their services.
Fortunately getting the Child Disability Allowance set up for her was pretty straightforward so we can use the extra money for things like playcentre and other services.
Otherwise I’m just trying to take things one step at a time and do what I can to help her overcome some of her issues (she’s very antisocial when it comes to kids around her age so we need to work on that). One day at a time. Some days are great, some are nightmarish. But we get through.
Not to mention all the subtle disabilities that can result from various grades of avoidable birth asphyxia at home birth – which are not even measured let alone reported.
Jesus Christ.
In what universe does “Hey, my kid who is not eating well is now cold and/or limp” not trigger a very detailed once over by an experienced peds/NICU nurse at the very least?
In the Universe the NHS now inhabits I’m afraid – it’s not just breastfeeding but everything connected with pregnancy and birth that is assumed to be just dandy and going swimmingly (or would be if the mothers would just relax, get out of the medical staff’s hair and go concentrate on their breathing or something) until cast iron proof emerges that this is not the case (and cast iron proof will of course not come along until the baby is in serious trouble or beyond help because they have decided everything is probably fine so will not order the tests that may show otherwise). To be fair its also a cost thing as well as a belief thing, if they can convince themselves everything is fine they can discharge the patient without any expensive tests, procedures or hospital stays, whilst convincing themselves and the mothers that they are being lovely and empowering to her and her child, not letting those nasty interventions near the precious naturalness of it all etc. The majority of the time they luck out and everything is OK but when it isn’t, it really isn’t.
Wouldn’t this just lead to more costs down the road though, if a baby is severely brain injured, but survives? If so, you’d think they be about the preventive medicine.
a: thank you for using ‘preventive,’ I love you forever, and b: didn’t Dr Kitty mention something about the godawful amount it costs per-pregnancy if you amortize the damages payouts?
The NHS now spends 1/3 of the maternity budget, £500 per birth, on indemnity payments.
Now, I realise that when you are used to US medical costs, this probably doesn’t seem like much, but it is.
Neonatal damage cases usually settle for 7 figures (£162 million for 25 cases in the paper used above is very typical).
Why is that taken out of the maternity budget specifically? Shouldn’t NHS apportion money without indemnity payments, just for the needed health care, and then have an indemnity pool? Of course, the specializations that have higher indemnity costs might have to answer for those, and do something(s) to fix that, but how is it going to be good for mothers and babies to apportion money to their care that isn’t actually for their care?
NHS finances are a black box.
Money goes in, goods and services come out.
At the end of the day the money all comes from the same source.
The indemnity has to be paid, the going rate is £500 per birth, it is what it is.
If the indemnity costs were lower it wouldn’t necessarily free up more money for maternity care. It might free up more money, but that could be spent anywhere in the system.
It isn’t like women get a budget, and once it’s spent, that’s it.
Ah okay. I wasn’t sure how money was apportioned, because I could totally see it going like that in the US. Thank you for clarifying it!
I’m in the process of writing up a formal complaint about the registrar I saw at my OB appointment last week for exactly this reason. I’m 24 weeks and have lupus, yet he still refused to refer me for GD testing because my mom and sisters don’t have it. Three of my grandparents were diabetic, and my mom was pre-diabetic a few years back but able to get it under control before it went full blown, AND the lupus puts me at about 2x the risk for developing GD. And then he had the GALL to tell me I should never be comparing the system here to the US system because the US system only cares about lawsuits and the bottom line. Even snorted derisively when I said that forceps fell out of use because they weren’t safe and said ‘yeah not safe for their bottom line’. As if the NHS is a bottomless pit that doesn’t care about its finances? So I’m filing a formal complaint; I was trying desperately not to have to give birth privately instead of on the NHS, but circumstances prevented that, and he has basically in one appointment completely destroyed my faith in their provision of my care. Calling tomorrow to insist on the GD testing and make sure it’s noted that he is NEVER to participate in my care again.
Good for you!
Insist on seeing only a consultant at future appointments.
Geez, he could compare it to the Canadian System then.
Here EVERYONE gets the test for GD around 22-24 weeks, no matter their risk factors. Those with risk factors actually get tested twice, once around 12-14 week and the standard 24 weeks. My OB still has been checking my urine for glucose every single appointment I have, regardless of my 2 GD test or how I’m feeling.
People decline the testing all the time.
Yea, sure, they can totally decline, it’s their right. But it’s still offered to every single pregnant women.
It’s horrible that people who actually have risk factors and want to take the test are not able to.
It’s universal in Israel too, at 24-28 weeks.
The NHS IS known world-wide as good at controlling costs, but at the cost of choice.
Agree with Kitty that you should insist on seeing the consultant next time.
Good on you – let us know how it goes, from my own struggles with the NHS if you raise enough of a stink you can make them be reasonable. BTW, with the forceps thing, might I suggest as a start putting on your birth plan that you do not want forceps under an circumstances and point out that this is on there at every midwife or consultant appointment? The NHS tends to be very keen on birth plans (largely because they then encourage women to put down how much they don’t want drugs/interventions) so that will help. Also, since there is these days always a better option than a forceps delivery, you can simply refuse medical consent for them to do it at the time – thus forcing them to offer you a better/safer alternative (probably a c-section). They’ll hate it (and probably you) but you and your baby will stay safe!
Ironically, that’s actually how the whole thing started! He then spent the next I don’t know how long trying to talk me out of that because apparently there’s a slight risk of the c-section cut going to far and nicking my bladder (not an issue, I’ll take it if it means not risking breaking my boy’s neck). Even after I mentioned I was fine with the vacuum if it was absolutely required, he goes on about how it will depend what the doc on floor wants! No it won’t, this isn’t negotiable. This is MY baby, this is MY choice.
Luckily I have a husband who will fight for whatever I want in this, and he’s 6’2 and built like a grizzly bear so won’t get much guff just because he’s so terrifying when angry 🙂
That’s the spirit! Its just infuriating (and horrifying) that you have to go through all of this just to keep your child safe – fighting for him/her with the very people who are supposed to be your allies in that regard.
How odd, but not surprising! Everyone in my area (Cambridgeshire) gets tested for GD unless they opt out. I wound up having forceps. I asked about a c-section, but she was so far down they would have needed to try and pull her head back through. She wasn’t stuck, my contractions weren’t getting the job done. Her heart rate was accelerating and it only took two pulls with low forceps. I did ask if they needed kelliland and would not have consented to those. Another American not impressed with maternity care here. My pre-natal and post natal care sucked. I wasn’t happy with the forceps, but I felt like it was all in hand and was explained so I wasn’t actually upset with that part. Good luck!
Can I ask what you mean by kelliland? I presume it’s an autocorrect because I can’t find anything on Google, but not sure what you meant.
But yeah risk of not being able to get a section if he’s too low worries me, but that’s why I’m okay with ventouse (I think that’s what the vacuum is called?). I’d rather him come out looking slightly alien than risk forceps.
And I definitely agree; from what I’ve heard about care for low-risk women, I’m actually *grateful* to be high-risk, because it means they actually are paying attention to me and giving me the level of care I would expect as standard back home. You know, except for this one particular toolbag.
Ventouse isn’t always appropriate. So she wasn’t well positioned for ventouse. Also, whoops! Spelled it wrong. Kielland forceps are the ones they use when the baby is high up and hasn’t turned. So they rotate and pull the baby down. Those are the most risky forceps. They have pretty much been banned in the US and hardly anyone uses them here in the UK. It is much safer to do a section than use Kielland forceps.
I would have trusted my former OB ( who delivered my daughter, but had retired by the time I was pregnant with my son) to use Kiellands, because he was the person who got called by other OBs when he was in the hospital. Vaginal breech, twins, rotational forceps, CS for accreta- he was the guy.
When he was the one saying that he thought my chances of a vaginal birth were under 10%, and if that it would probably be instrumental, and he would recommend an epidural on arrival, because it would be “a long hard slog” …yeah, that elective CS was a no- brainer and he was totally on board with it (he was obviously relieved that a likely disaster was averted).
Mostly, when I told medical staff that my first CS was on his recommendation, they were perfectly accepting of it. Second time around, when he was no longer my OB, there was definite “well, maybe you should just give it a go and see” vibe.
And I was not playing.
When it comes to VBAC, they were trying to talk me into consenting to a TOLAC if I went into labour spontaneously. BUT when I said that if I came in labouring I wanted an epidural ASAP and a CS and that I would not consent to AROM, oxytocin augmentation, instrumental deliveries or any intervention if the purpose was to enable a vaginal delivery, because to me the risks were unacceptable when compared to CS.
I got some looks, but the consultant wrote “not for VBAC- CS on arrival if SOL” in big letter in my notes and that was that.
I’d rather they think me an entitled, bossy bitch and I get what I want, than be the model patient and end up with something I didn’t.
Likewise, I threw a tantrum when they tried to send me home day 2 post CS with just paracetamol and diclofenac for pain relief. I got some opioids and a much better recovery, and they maybe had a little think about their analgesia policy.
Ugh, the analgesia policy in the US is utterly horrible right now. They’ve pretty much decided that anyone who asks for painkillers at any time while in a hospital is drug seeking and they treat you as such. In the meantime, thousands upon thousands of chronic pain patients are denied care and medication because of guidelines that are 1. not law an 2. admittedly biased by the CDC and god forbid if you should now have a car accident or have arachnoiditis or any long term or permanent pain condition that isn’t cancer, because you’ll find no one to treat it an no options given for treatment except suck it up.
It’s way easier ’round these parts (Bay Area) to get marijuana prescription for pain than opioids.
Tell me about it. I have severe migraines (3-4 DAY affairs when they occur) and the triptans don’t work for me. The last time I had to go to the ER for an intractable migraine (a couple of years ago) I got the general “step therapy” of drugs. IV Phenergan, because “it can stop a migraine”, then Toradol because “NSAID” and “works great for migraines”, then an injectable triptan because “if it IS a migraine, the triptan will stop it cold”, then comes the questions that insinuate that I’m a drug seeker, then finally, almost grudgingly, comes the Demerol/Stadol/Morphine/whatever they use for pain management, which will work enough so I can semi-function and the fractals in my head calm a bit.
But getting to that point is a long, drawn-out affair that leaves me in pain hell while the appropriate “narcotics as a last resort” steps are taken. Would they do the same for a burn victim/broken bone/other painful condition? Because they can’t “see” the pain and because I know what generally will and won’t work and they don’t cotton to patient-suggested medications, then I get the run around. Because I keep rescue medications on hand at home, I am then on a narcotic database that gets checked whenever I need a refill for my Lortab 10’s. I am then asked about every single medication on that list (Lortab 10’s for the Very Worst Migraines and Midren for all other migraines are the usual suspects) Last year I had shingles TWICE, one was complicated by a secondary skin infection and bronchitis, both of which involved narcotic medication: Tylenol 3’s for the shingles (both times) and codeine cough syrup for the incessant coughing, plus an inhaler. I had to justify/accurately remember all the meds on my printout so my doctor (who I’ve been seeing for over 15 years) would refill my Lortab and Midren.
I *get* why people want to crack down on narcotic prescribing/usage, I really do. But having to physically go to the doctor’s office to pick up a paper prescription for certain pain meds because they are NOT ALLOWED to call/fax/digitally send a narcotic prescription to your pharmacy is a major inconvenience and aggravating. Getting your driver’s license scanned every time you drop off and pick up your painkiller prescription is a pain as well. Having to decide if your migraine hurts badly enough to actually take one of your prescribed medications because you are limited on the number you can get, refills can’t be prescribed/called/faxed/digitally requested by the doc, and wondering if the next migraine will be worse, so you will need the painkillers more then than you do now, all of that really sucks. A lot. Making it more difficult for those people who need/depend on narcotic painkillers to obtain their medication is not really addressing the issue. Neither is limiting the number of pills. And by limiting I mean doling out 10 at a time and requiring the patient to physically pick up the paper prescription from the doctor’s office.
I have a friend whose daughter takes ADD medication. She could only get one month’s worth at a time, had to make the trip to the doctor’s office monthly to pick up the paper prescription and she had to turn in the unused medication when they adjusted the dosage. Basically, if her daughter had to increase from 5 mg to 10 mg because the 5 mg wasn’t working any more, she not only had to go pick up the paper prescription, she had to take the unused 5 mg pills with her and give them back to the doctor. That is insane.
With you all the way – if I hadn’t been a complete PITA patient as far as my midwives were concerned I’m sure they’d all be hugely sympathetic as I mourned my stillborn son, but I’m much happier with my healthy 5 month old and all the nasty looks the midwives could give me until discharge couldn’t alter that!
You might want to remind him that “caring about lawsuits” actually means “caring about making sure nobody gets hurt.” Somebody has to get hurt or killed before a medical malpractice lawsuit can happen.
You know, supplementing all babies until milk comes in is much cheaper than carefully monitoring to see which ones need it, with a bonus of zero brain damage and a drastic reduction in phototherapy. I’m just saying.
This is why I’m ready with my formula to sneak into the baby friendly hospital.
If I have another baby it’s top of the list of things to pack in my hospital bag!
Unforunatly ideology grips things in tandem with cost cutting and how can they feel like they’re nature’s little angels whilst (appearing to) save money at the same time if they supplement (they would also probably argue that the cost of the formula makes this a waste of money since the majority of kids will not need it)?
It’s similar to the logic that pushes home birth and birth at midwifery led centres as much cheaper than the dreaded c-sections whilst ignoring the costs from the additional number of damaged children/emergency ambulance runs that occur when the former go south.
There is nothing wrong with sufficient milk, human, enhanced cow, or enhanced soy juice. There is something severely wrong with the professionals not recognizing a baby is starving!