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.
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.
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