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Portraying OBs as the bad guys?

Miriam left this comment in response to the article entitled, Hospital VBAC turned CS due to constant scare tactics:

Many of the stories on this website point to the ob/gyns as the bad guys.  While I believe there may be some doctors that use tactics and lies, it is overlooked that the doctors are just as misinformed and scared as the patients!

I would like to add a little clarity based on my experience as a patient who has had 2 c-sections.  I had a section 5 years ago due to “failure to progress”.  (5 minutes after the consent, while the doctor was prepping for surgery, my body signaled the progress I had been “failing” to reach with the most incredible urge to push.  However, I thought he knew best and stupidly agreed to continue with the c section.)  I have regretted it ever since.   However, I believe that the doctor truly was concerned and I trusted it, despite the fact that I personally believe I could have delivered vaginally.

The reason I believe some doctors’ concerns are sincere if not valid is because of the education, both formal and informal, they have received.  My ob/gyn was a specialist in many fields of womens’s medicine and so I trusted that.  Little did I know I was signing on an expert in surgery.   A doctor’s entire training revolves around how to interfere with something very natural… childbirth.  They are taught about evey possible bad case scenario, so they are prepared, so they are trained in intervention.

Then they go into the field and begin to learn the hospital and insurance policies that insist the doctor use these scare tactics becase they have been bitten so badly financially by unsatisfied women who sue them into making this policies in the first place.   The problem is the high costs associated with lawsuits and therefore, the rest of the vbacs suffer.  In my case, I was not ever “allowed” a second c-section because the hospital had lost a single lawsuit against a woman who hemmoraged during her vbac.  It was my “bad guy” doctor that has to pay the high cost of mal-practice to the point that, combined with the overhead of his office, he had to deliver 150 before he began to make any money.  So out of fear he falls back on his training which tells him that women need help to get a baby into the world.

Instead of blame (another product of fear) we should look to ourselves and educate each other about how to accept disappointment and best of all, how to avoid it by educating ourselves.  We can have more confidence for it’s own sake instead of walking into birth/labor with the attitude of going to war with our practitioners.

Miriam,

I agree with a lot of what you said.   I share these stories for a multitude of reasons, none of which include the desire to portray OBs as “bad guys.”

I want women to understand that there are OBs who practice in this manner.  I want to share with women the various tactics that these type of OBs use in order to passively, or actively, encourage a woman to have a repeat cesarean.  I want women to know that if they encounter these tactics from their OB that they have options.  They can find another care provider that supports VBAC.  There are absolutely wonderful OBs out there.  I had the opportunity to hear many speak at the NIH VBAC Conference this past March.

You said, “Instead of blame (another product of fear) we should look to ourselves and educate each other.”  I agree.  Yet there are many women who say, “Why do I need to educate myself?  I didn’t go to medical school.  That is why I hire my OB.  To advise me.” Being an informed patient is important regardless.

It’s not until they read a birth story like this do they see how wildly the “standard of care” can vary depending on who you hire as your care provider.  That is why I share stories like this.  To illustrate how bad the care can be to encourage women to become active participants in their care rather than passive patients along for the ride.

You talk about OBs being “misinformed and scared.”  You stated, “Then they go into the field and begin to learn the hospital and insurance policies that insist the doctor use these scare tactics because they have been bitten so badly financially by unsatisfied women who sue them into making this policies in the first place.”

OBs who have been sued over VBACs have a higher propensity to not attend VBACs in the future, but is it ethical for a doctor to encourage a women to have a repeat cesarean solely because they have been sued?

I think the most ethical thing an OB can do is be honest with the patient about their fears and refer them to a care provider who is supportive of VBAC.  Unfortunately, what some of these OBs do is either lie to the patient about the risks of VBAC vs. repeat cesarean (read Another VBAC Consult Misinforms and Scare Tactics vs. Informed Consent for more) or act like they will give the patient a trial of labor only to pull the plug with some bogus reason in the last weeks of pregnancy or even in labor.

If an OB doesn’t want to attend VBACs, they should be upfront with the patient so they have the opportunity to find a provider who is supportive.

Warmly,

Jen

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6 comments to Portraying OBs as the bad guys?

  • Very well said Jen! It’s not that we are doctor bashing, it’s that all the unnecessary c-sections are performed by doctors. It sounds silly and circular, but it’s true. We know that not all OBs are evil lying bastards, but the evil lying bastards that do these things are all OBs. How do we differentiate when we speak of them? I usually speak specifically of the OB that did my first c-section or the OB that did my second c-section. I try not to lump all OBs into that pot, but it is harder for me to trust an OB – just because they are an OB – or a CNM – just because they are a CNM – than it is for me to trust a home birth midwife even though I know there are some home birth midwives out there that are just as bad. :-( I wish we could trust them all to honestly have our best interest in their heart, however, some of them have proven time and again that they cannot be trusted.

  • I would like to see any data that shows that women are more likely to sue after a bad VBAC outcome than they are to sue after a bad outcome from a primary vaginal birth.

    I doubt there is any data out there…and I’m going to make the leap and suggest that a woman with a bad outcome after VBAC is NO MORE LIKELY TO SUE than a woman with a bad outcome after a primary vaginal birth. Its just that the OB’s talk more about the VBAC cases, and since their paradigm is that the repeat cesarean is safter…it makes sense to them to VBAC as unnecessarily risky from a liability perspective as well.

  • shane

    You are correct about VBAC moms not sueing more than other bad outcome deliveries. They almost all sue VBAC or not. Almost every bad baby or bad outcome generates a suite. The difference is when you are found guilty of any wrong doing (which is rare, the doc wins mosts suites cause most of the time they were doing what they were trained to do and were trying the help the patient) you will get a much larger verdict because you violated the standard of care by offering a VBAC in the first place. The American College of Gynecologists has published very strict guidelines on who should be doing VBACs. The guidelines are so restrictive as to be nearly impossible for small hospitals to comply with them. You are required to have in house a surgeon (OBGYN), and anesthesiologist, a call team or operating room team, the entire time the VBAC mother is in labor. These people can’t be doing anything else. They just have to sit there in case you rupture your uterus and need to go to the operating room emergently. Few hospitals have the resources to have this million dollar team just sitting there on standby for you. But if they don’t and allow you to try to do a VBAC anyway there will be a lawyer just waiting to take the case. And he will be very familiar with the American College of Gynecologies guidelines. This is really a matter of much needed torte reform, not a matter of knowing how to treat a particular patient. Of coarse women should have a right to choose. Of coarse they should understand there are increased risks, and for some people in some communities depending on the resources these risks may be acceptable or prohibitive. It is really the ACOG guidelines and a lawsuite crazy environment that need addressed, not what to do medically.

  • Courtney

    I am frustrated by the argument, whether it is true or not, that Dr must behave a certain way because of the legal climate around lawsuits and such. I’m also frustrated by the implication that the ACOG guidelines must change before dr’s practices can change. Isn’t ACOG made up of drs? It just seems like a way to pass the blame. All of this seems blatantly unethical. Drs go to med school to help people, to practice medicine. right? it seems to me that whether or not they might get sued or might not make much money after insurance premiums should really be secondary to giving the best quality of care to women. lots of professionals are undervalued and underpaid – that wouldn’t be an excuse for poor performance. teachers and social workers can’t abuse children and then argue that it is ok cause they don’t make much money. i’m not trying to inflammatory, i just think if someone wants to be a dr they should focus on the medicine and the patient first, then money and fear of lawsuits (at most) second.

  • I’m glad that this thread is aimed at not naming OB’s as the “bad guys” (or “bad girls” in my case–smiles). I agree with Knitted and Shane on the point that a bad VBAC outcome is no more or less like than a bad primary vaginal birth outcome to sue. The most likely accusation in either case, however, is “Failure to Perform a Timely Cesarean Section.” A Monday morning quarterback trial lawyer can always come along and say, this baby wouldn’t have had (nerve injury, CP, asphyxia leading to death…) if only the doctor had done the cure-all cesarean. To this end, Shane is also right that the ACOG guidelines need to be addressed. When we say that standard of care is to sit in the hospital watching for an event with a 0.4% risk of happening, it limits many of us who need to be in the office seeing patients. The only part I disgree with is that most docs don’t win their lawsuits. Most are settled because EVEN IF THE DOC IS RIGHT, the insurance company knows it would cost much more to fight the case than make it go away with money. Even as I write this, I see malpractice lawyers’ ads in the margin of this page about VBAC. For shame…

    I currently offer VBACs to my patients–one of the only docs in my area who does. Women call my office all day trying to get in my VBAC schedule. I can only offer 4 a month because I can’t shut down my whole practice every time someone goes into labor, waiting for a delivery. This brings me to Courtney’s point.

    Unfortunately, medicine is a business and most doctors are small business owners. Patient care is why we went to school, but upon graduation, we were hit in the face with the reality of how much business this involves. We have to consider money and patient care in balance because without money, you can’t take care of patients. I would lose patients left and right if I told them to bring a flashlight to their appointment because I couldn’t pay the electricity bill last month when my malpractice insurance went up or I had to spend two weeks in depositions and court instead of seeing patients, delivering babies and doing surgery. My medical assistants, office manager, receptionist, etc. expect a paycheck no matter how many patients have bad outcomes.

    I’m not sure if any of you has been sued, but I have–twice. It’s humiliating, and it doesn’t end when the case is “settled.” Even though I was dropped from both cases before any settlement occurred, just being named adds another few thousand dollars to my malpractice premiums each year. Not to mention the patients who look up the cases online and bring in printouts to my office to ask me to relive the whole situation again, and hospitals who treat me like a terrorist when I try to get privileges. In this field, your reputation is the strongest thing you have, and a few litigation-happy patients can destroy it in a minute. Poor performance is in the eye of the beholder, and unfortunately, more women are offended by a doctor with a string of lawsuits than a doctor with a high c-section rate.

    All in all, I appreciate this dialogue on an issue that needs to be addressed. Thanks for continuing to fight with me for patients’ rights and the rights of providers trying to do what’s best for them :-)

    • Jen Kamel

      Chan,

      Thank you so much for your comment and I apologize for not approving it sooner.

      Warmly,

      Jen