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Heh. Seems appropriate. :lol:
"I'm not young enough to know everything"
If what I type feels like spin and makes you dizzy, you may need to have your ears checked for buildup, because you're clearly balance impaired.
Cerumen impaction is not my problem. You might have a different type of impaction.
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Makes sense, but there's an important difference here
She wasn't demanding that the hospital provide a service that was either not normally offered to its' patients or was not medically or ethically justifiable
She was asking that they *not* perform an (allegedly) unnecessary and unwanted surgical procedure
And though it's not clear, it appears that the hospital was going to call DCFS if she didn't have a c-section - even if she went to another doctor or hospital
So, let me get this straight: this woman's doctors have recommended C-Section. Get new doctors. Hospital won't allow natural childbirth. Go to another hospital.
"I want you to cut off my leg without anesthetic." Any doctor or hospital should be able to refuse that request.
What's your problem with this? Hospitals aren't bound to allow what they believe is an unsafe procedure. Why do you think they should be forced into it?
After doing a little reading, it looks like VBAC after up to 2 C-sections is clearly accepted. She would have been attempting after 3 C-sections.
http://www.acog.org/~/media/ACOG Today/acogToday0810.pdf?dmc=1&ts=20140805T0056102994
I would think her other option would be simple. Show up at the hospital in labor and refuse to sign the consent for C-section.
Already simply showing up at the hospital would increase morbidity and mortality for her child. Whats more important?
Acog does good work-like recommending the ultrasound prior to abortion that planned parenthood requires, but cried about when a state required it.
Texas Laws and Policies :: Greater Texas
None of these laws have anything to do with enhancing the health or safety of the patient, but merely establish bureaucratic barriers and add unnecessary emotional and financial stress to an already difficult decision. ACOG opposes any legislation that dictates medical practice and/or that interferes with the doctor-patient relationship. State legislators should not be determining the conversation between a woman and her doctor, regardless of the issue
Yeah, we really only have one side of the story here, and I imaging the hospital is constrained about stating the details due to privacy laws.
It may be that there's something about the woman's condition that makes a natural childbirth entirely inappropriate. Therefore, reporting her to DCFS might be a reasonable thing to do.
But we don't know enough to say
First of all, can you show me that ACOG recommends ultrasound?
ACOG Supports Oklahoma Court Decision Ruling Ultrasound Act Unconstitutional - ACOG
And can you give statistics showing that the mortality rate of the infant increases - I would think that if her uterus ruptures, that a crash C-section would be done and the infant would stand a good chance of being fine - the mother might be in substantially more danger.
But whether or not to have a major surgical procedure - including risks of anesthesia and postoperative complications might be something a little less cut and dry - if you are the one under the knife.
Why should CPS be involved in this at all. What business is it of theirs?
What if the doctor had concluded a natural birth would kill her and the baby?
I can show evidence, its current best practice as stated by acog. But you need to understand what you are reading-ACOG-in your link does NOT say they oppose u/s in abortive procedures-they say they oppose govt mandates for diagnosis (as do I). Because its already the standard of care, and because of its benefits they support the technique. The issue, is politicisation of terms like transvaginal (calling it rape, and disregarding its better sensitivity and lower pain for many patients). There are publications from acog and pubmed that I can't post here, but that recommend the same, as do other groups (ACOG is not the sole "authority" for the issue, family practice and radiology are prominent as well. I work internal medicine and we listen to ACOG and ACR.
http://www.acog.org/~/media/Departm...oundMandates.pdf?dmc=1&ts=20130709T0142491575
National Guideline Clearinghouse | Ultrasonography in pregnancy.
ACOG Practice Bulletin No. 101: Ultrasonograp... [Obstet Gynecol. 2009] - PubMed - NCBI
http://www.acr.org/~/media/a79db56d3b054a04bee05e8250a67a5a.pdf
This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for
patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not
intended, nor should they be used, to establish a legal standard of care1. For these reasons and those set forth below,
the American College of Radiology and our collaborating medical specialty societies caution against the use of these
documents in litigation in which the clinical decisions of a practitioner are called into question.
The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the
practitioner in light of all the circumstances presented. Thus, an approach that differs from the guidance in this
document, standing alone, does not necessarily imply that the approach was below the standard of care. To the
contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in this
document when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of
the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of
this document. However, a practitioner who employs an approach substantially different from the guidance in this
document is advised to document in the patient record information sufficient to explain the approach taken.
I can show evidence, its current best practice as stated by acog. But you need to understand what you are reading-ACOG-in your link does NOT say they oppose u/s in abortive procedures-they say they oppose govt mandates for diagnosis (as do I). Because its already the standard of care, and because of its benefits they support the technique. The issue, is politicisation of terms like transvaginal (calling it rape, and disregarding its better sensitivity and lower pain for many patients). There are publications from acog and pubmed that I can't post here, but that recommend the same, as do other groups (ACOG is not the sole "authority" for the issue, family practice and radiology are prominent as well. I work internal medicine and we listen to ACOG and ACR.
http://www.acog.org/~/media/Departm...oundMandates.pdf?dmc=1&ts=20130709T0142491575
National Guideline Clearinghouse | Ultrasonography in pregnancy.
ACOG Practice Bulletin No. 101: Ultrasonograp... [Obstet Gynecol. 2009] - PubMed - NCBI
http://www.acr.org/~/media/a79db56d3b054a04bee05e8250a67a5a.pdf
As for your second q, Im not here to teach you and this is not a superficial medical discussion, but I will hit the highlights anything that impacts maternal bleeding in significant quantities (hypovolemia/exsanguination) means the child has tops several minutes-the first thing compromised will be fetal/placental blood flow. We dont use the term "crash c-section", but an OB wont attempt to ligate or repair anything without at least a general, and possibly a vascular surgeon-these specialists are NOT a normal presence in the OB theater, and thats time the child wont have. OB's ARE trained in perimortem CS but thats not going to be done here.
The first thing to remember is we aren't getting the entire story-we dont know this patients history or risk factors, we know what a media source says-this alone makes it highly unlikely we have the full picture. As I stated earlier in the thread this is a high risk procedure, and this woman has had 2 prior CS's-so the uterine scarring and surgical adhesions are more likely to lead to complications. The ACA did very little to address tort and has made high risk specialties MORE defensive. This is the result. The other issue is so many vbacs lead to failure to progress, leading to increase risks of fetal anoxia, erbs palsy, etc. When you say things like "the infant would stand a good chance of being fine" without the data what you are saying is you'd like this to be the case, and hope its true. Some reading, but your best bet would be to admit you dont know.
Practice Guidelines: ACOG Updates Recommendations on Vaginal Birth After Previous Cesarean Delivery - American Family Physician
Ob Gyns Issue Less Restrictive VBAC Guidelines - ACOG
Vaginal Birth After Cesarean and Uterine Rupture Rates in Ca... : Obstetrics & Gynecology
And the first link clearly speaks to unnecessary procedures!I don't see where it says what you claim it says. Can you quote from one of those links showing that the OK requirement is consistent with current best practice?
The last link does say this, which seems to contradict your claim
What if the doctor had concluded a natural birth would kill her and the baby?
I don't see where it says what you claim it says. Can you quote from one of those links showing that the OK requirement is consistent with current best practice?
The last link does say this, which seems to contradict your claim
Can you quote actual points that state the ACOG recommends ultrasound. In your links I see references to unnecessary testing (referencing ultrasound with abortion). One of your links did not work for me and another was to a publication that I was able to open.
In terms of the uterine rupture....first of all, the available literature seems to totally discourage VBAC if the woman has had more than 2 C-sections. She has had three.
In terms of making her have the child C-section.....C-sections have not just anesthesia and surgical risks, they have risk of post operative complications.
She has to sign a consent for surgery for a reason. It is inherently a potentially dangerous process.
I see more risk to her than the baby. If she is already in the hospital with her OBGYN there for the delivery, a crash C-section can occur in minutes - especially when the mother is already in a place that can manage this.
I see this as a risk to benefit issue. Just like any other person having a procedure, they get to choose what risks they are willing to take for whatever benefit. Every day in this country, patients do not chose the path medically or surgically that their MD thinks is best. Not unusual. It is choice. Not so sure why this situation would be any different.
Now, if the facility is unable to manage a patient that needs a crash C-section, that needs to be known to all pregnant patients who are considering delivering their baby that facility.
But like I said, VBAC is usual, but it seems that it is acknowledged that usually discouraged after 2 C-sections. But as a CPS issue. Please. Forcing a woman to have a surgery - way to go medival on her.....
I think I've already made clear Im not interested in continuing the discussion with you.
On best practice you need to understand what that is-its NOT a policy from the top, its comes from practice-the clinics UP, In my links, ACOG states that most clinics perform this as the standard. THIS is how best practice is determined, and for good reason-as you can see this type of thing is missed by a casual reader.
On best practice you need to understand what that is-its NOT a policy from the top, its comes from practice-the clinics UP, In my links, ACOG states that most clinics perform this as the standard. THIS is how best practice is determined, and for good reason-as you can see this type of thing is missed by a casual reader.
As for the rest, you are repeating things as if it changes the issue. OB's are sued even after waivers, etc all the time-all they need is a lawyer to say the pt didn't really understand what the complications meant. They dont want to perform the procedure more because of the much HIGHER incidence of failure to progress (around 1/3 of cases-which often revert to emergent CS, compared to 3-5% chance at the highest risk of uterine rupture-which is of course catastrophic and also much higher than the gen pop.)
Have you ever been on the receiving end of a report to child protective services? I know a person who was, and you clearly don't have a clue as to how that goes. First things first, they come and take your children, then they decide if they should give them back.
At that point, she'd basically had enough, so she told my father to take her home in defiance of the hospital's orders.
OMG, I am so sorry she was treated so badly. That is just inexcusable, what they did.
I see that some people here are trying to re-frame this as an abortion related issue. That does not seem to be the case
At issue here is whether or not a provider can be compelled to provide care (they can) and under what circumstances.
This is not a case of someone trying to force a provider to perform a service they are not prepared to perform, such as one they lack experience, training or equipment that is needed. This hospital has and does provide medical services for women who deliver babies "naturally". However, the details show that the woman had contraindications for a VBAC. So the issue here is "at what point are doctors allowed to refuse to perform a service and on what grounds are they allowed to do so?"
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