The Most Scientific Birth Is Often the Least Technological

[gibbinator]

Apr 23, 2015 8:42:56 GMT -5 @tokenhoser said:

The thing is... it's not fine for me to home birth with my doula.

Because my health system refuses to hire enough midwives to actually provide me with a midwife. I wanted one. I was denied one because too many other women wanted one, too, and they somehow had better reasons to get one.

Don't pretend women have choices when they don't.

Very true. I don't even have the option of a midwife assisted birth where I live. It's illegal for midwives to practice in my county (they're regulated on a trial basis in 2 counties in the whole province). And your OB choices are limited to 3 practises.
Eta: oh and I don't get to choose my ob. I get referred to whoever has an opening for my prenatal care, and then it's luck of the draw who's on call at the one hospital within driving distance when you go into labour.

[longtimenopost]

Apr 23, 2015 14:16:39 GMT -5 gravytrain225 said:

I have thought about it and my original statement is too blanket. You can technically sue anyone for anything, so I guess if you are suing your OB and find a lawyer to take your case, it doesn't always mean that they did mess up. In my experience though, it hasn't been easy, so I don't see how that many illegitimate cases are going through. I also haven't done any actual research on it, just my own experiences and what my lawyer has told us about malpractice and suing an OB.

It's also been my experience. In TX at least, medical malpractice is pretty difficult. You have to find another doctor of the same specialty who will testify that there was malpractice before you can file a suit. I can imagine most doctors don't want to make such a statement, especially when there's a judgement call involved. Plus, lawyers generally don't want to take on suits against individual doctors because there's too much work and not enough payout. They'd prefer to take on hospital corporations. We thought we had a pretty clear case, but we couldn't find anyone who would take us on and my parents are both lawyers with lots of lawyer friends. Just anecdote.  

[karinothing]

Apr 23, 2015 14:59:15 GMT -5 @tambcat said:

Apr 23, 2015 14:42:59 GMT -5 karinothing said:

So my birth center midwives carry malpractice insurance. I really wonder how often they get sued. I am assuming not that often despite their lack of mandated ultrasounds becuase it is so easy to risk someone out and when bad stuff happens, they are probably already at the hospital (so the OB would get the lawsuit not the midwife). That and I think the relationship between midwife and patient (at least in my experiance) is very different than OB and patient. More of a family environment if that makes sense? Harder emotionally to sue, maybe?

I also wonder if people who go to the effort of finding a midwife, possibly paying OOP, etc., are less disposed to blame the MW for negative outcomes than people who just go through the standard avenues. I guess that's kind of the family environment/personal relationship working, but also because they have more riding on it from am emotional standpoint? I know I am not making my point clearly. Okay - I switched OBs halfway through my pregnancy with Joanna, and I think I am probably more forgiving of my current OB than I would be of my former OB because I actively chose him over someone else, vs. just going with the person I'd been seeing for gynecological exams.

eta: obviously this is all just baseless speculation. I don't even know if they get sued less frequently than OBs.

ha, I get you. I think a lot of the midwife clientle is also umm...very very religious. A lot of the midwives are as well (in fact I was very suprised when I realized this). So, maybe that plays a part into it too. (more it was God's will type of thing)

[sent]

Apr 23, 2015 14:57:45 GMT -5 longtimenopost said:

Apr 23, 2015 14:16:39 GMT -5 gravytrain225 said:

I have thought about it and my original statement is too blanket. You can technically sue anyone for anything, so I guess if you are suing your OB and find a lawyer to take your case, it doesn't always mean that they did mess up. In my experience though, it hasn't been easy, so I don't see how that many illegitimate cases are going through. I also haven't done any actual research on it, just my own experiences and what my lawyer has told us about malpractice and suing an OB.

It's also been my experience. In TX at least, medical malpractice is pretty difficult. You have to find another doctor of the same specialty who will testify that there was malpractice before you can file a suit. I can imagine most doctors don't want to make such a statement, especially when there's a judgement call involved. Plus, lawyers generally don't want to take on suits against individual doctors because there's too much work and not enough payout. They'd prefer to take on hospital corporations. We thought we had a pretty clear case, but we couldn't find anyone who would take us on and my parents are both lawyers with lots of lawyer friends. Just anecdote.  

I think Texas is one of those states where there are various regulations so people don't sue frivolously?    Something about it's the states where there is no cap on awards (damages?) that it's a problem. 

I practice in a field totally unrelated to OB, but we do take xrays on patients.  It's pretty much known that if a new patient comes in demanding "no xrays" then this is a red flag.  So if this woman was in an OB practice and said "no ultrasounds TYVM" she would've been booted immediately.  I couldn't get through the article but I sense from the comments she was in a midwife practice or something?  In the rare event that something did go wrong, she could've easily been writing the counter article "my OB didn't take an ultrasound and here are the terrible things that happened because he was practicing below the standard of care."  There would've been no mention that she was the one who asked for no ultrasounds to begin with.

      

[penguingrrl]

As someone who as a baby survived something but just barely that is now picked up in routine ultrasounds I'm angry hearing her argue against them. I was born 6 weeks early and had high fluid due to a tracheoesophogeal fistula. In 1981 they weren't doing routine ultrasounds and as far as my mother knew I was healthy. I was born early and fast (never made it to the delivery room, born in the hallway while dad parked the car) and whisked off from a small local hospital to Columbia Presbyterian in NYC. I was incredibly fortunate that a month earlier the world's leading researcher on TEF had moved there from DC Children's and his intern was the one who saw me, because most babies born with TEF in 1981 passed away.

Now routine u/s picks up most cases of TEF and mom has a chance to plan her birth in conjunction with specialists who will be on hand at delivery to perform immediate life-saving surgery. I did not relax in any of my pregnancies until the u/s revealed fluid in the stomach, meaning my children did not have TEF (it's not yet known if there's a genetic link).

So fuck her and her "routine ultrasounds don't save lives" drivel. Three years ago I was in the hospital due to complications and the head of cardio at Lenox Hill was shocked that I survived TEF in 1981. I was the oldest survivor he had ever met.

[karinothing]

Apr 23, 2015 15:07:21 GMT -5 sent said:

Apr 23, 2015 14:57:45 GMT -5 longtimenopost said:

It's also been my experience. In TX at least, medical malpractice is pretty difficult. You have to find another doctor of the same specialty who will testify that there was malpractice before you can file a suit. I can imagine most doctors don't want to make such a statement, especially when there's a judgement call involved. Plus, lawyers generally don't want to take on suits against individual doctors because there's too much work and not enough payout. They'd prefer to take on hospital corporations. We thought we had a pretty clear case, but we couldn't find anyone who would take us on and my parents are both lawyers with lots of lawyer friends. Just anecdote.  

I think Texas is one of those states where there are various regulations so people don't sue frivolously?    Something about it's the states where there is no cap on awards (damages?) that it's a problem. 

I practice in a field totally unrelated to OB, but we do take xrays on patients.  It's pretty much known that if a new patient comes in demanding "no xrays" then this is a red flag.  So if this woman was in an OB practice and said "no ultrasounds TYVM" she would've been booted immediately.  I couldn't get through the article but I sense from the comments she was in a midwife practice or something?  In the rare event that something did go wrong, she could've easily been writing the counter article "my OB didn't take an ultrasound and here are the terrible things that happened because he was practicing below the standard of care."  There would've been no mention that she was the one who asked for no ultrasounds to begin with.

      

Interseting that you use standard of care. I am not sure ultrasounds are included in the pre-natal standard of care. Or rather, I don't know that HAVING them is I think offering them may be. My midwives are required to follow the local standard of care in order to keep their malpractice insurance. But they don't require ultrasounds. They do offer them. Obviously they take on patients who don't want ultrasounds, I am not sure how this works for OBs.

I know from the bump that  many women were not offered an early ultrasounds or an NT ultrasound (the standard of care recommends them for women of average or high risk, so younger women may not get them recommended). I don't know how it works with the anatomy scan. I would be interested to hear if an OB practice would deny care to a women who refused an ultrasound.

[sent]

Apr 23, 2015 15:20:35 GMT -5 @mrsbecky said:

So someone is suing them apparently.

Yes they are. Google showed me articles about cases in Michigan and Oregon.

[sent]

Oh and I remember why I couldn't get through the article. Because of the use of the word "mate" to describe her spouse early on.

[karinothing]

Apr 23, 2015 15:42:09 GMT -5 sent said:

Apr 23, 2015 15:20:35 GMT -5 @mrsbecky said:

So someone is suing them apparently.

Yes they are. Google showed me articles about cases in Michigan and Oregon.

I wasn't trying to say they aren't ever sued, just that I wonder if the rate is different. I would be surprised if my birth center had a high rate (or a rate similar to a hospital) just because I don't know how they would stay in business. BUT a LOT of midwives don't carry malpractice insurance, so I would imagine they don't get sued as much because there isn't much point (no money to go after).

[karinothing]

Apr 23, 2015 15:52:07 GMT -5 @this said:

karinothing I can actually run a report comparing the two tomorrow. I'll report back. lol

Everything's coming up insurance!!!

Intersting thanks! Can you you compare rates on hospital midwives vs. free standing birth center midwives? I am not sure how much information you get lol.

[Deleted]

I did a one month rotation on the pediatric transplant floor. And there was a mom moved to Toronto so that when she gave birth, her baby would be in the right place for a transplant (heart). If there had been no ultrasound, she would have been born on the west coast and not been able to have surgery to extend her life and then have a transplant within days of birth.

[Deleted]

Apr 23, 2015 15:49:29 GMT -5 karinothing said:

Apr 23, 2015 15:42:09 GMT -5 sent said:

Yes they are. Google showed me articles about cases in Michigan and Oregon.

I wasn't trying to say they aren't ever sued, just that I wonder if the rate is different. I would be surprised if my birth center had a high rate (or a rate similar to a hospital) just because I don't know how they would stay in business. BUT a LOT of midwives don't carry malpractice insurance, so I would imagine they don't get sued as much because there isn't much point (no money to go after).

I would absolutely assume they are sued less because they take on less risky patients, so less negative outcomes.

And random side not, I've never worked with midwives at stand alone birth centers but the ones I've worked with in hospitals seem to not be intervention "free" as I see their patients coming in for inductions and being on continuous monitoring on a daily basis. So I assume they all practice in different ways.

[gibbinator]

Apr 23, 2015 14:30:16 GMT -5 @hannymaren said:

Apr 23, 2015 9:22:05 GMT -5 @tokenhoser said:

Has anyone here been denied the epidural they want?

No?

Fuck, I get so annoyed when we discuss these articles because posters here are OUTRAGED that someone has an opinion like "if we did OB care by evidence-based practices, it would look very different". Meanwhile, it really is the women who want to go another - safe and supported by reasearch and actually less costly to the system - way that are told they can not.

I could not have the prenatal care I wanted. I could not have the birth provider I wanted. Unless that was your case, too, I'm just over hearing about how opinions threaten you.

Apr 23, 2015 9:22:05 GMT -5 @tokenhoser said:

Has anyone here been denied the epidural they want?

No?

Fuck, I get so annoyed when we discuss these articles because posters here are OUTRAGED that someone has an opinion like "if we did OB care by evidence-based practices, it would look very different". Meanwhile, it really is the women who want to go another - safe and supported by reasearch and actually less costly to the system - way that are told they can not.

I could not have the prenatal care I wanted. I could not have the birth provider I wanted. Unless that was your case, too, I'm just over hearing about how opinions threaten you.

In Sault Ste. Marie, you can't have an epidural if you deliver at night because there is only anesthesiologist and he is too busy. Pray for daytime for no pain.
If you have a csection, they will find him, but they don't waste him on vaginal births.

Same here. I remember with ds1 I was admitted around 8pm and within a half an hour the nurses were asking if I was planning to get an epi because the anesthesiologist just finished a c/s and was going home. Options in small communities are just so different from those in cities. Still, the choice was offered even if it was limited.

I'm just now thinking about how during both my labours an ob broke my waters. I was told they were going to do it. Not told why, or given a choice. Just told. At the time I never questioned it because, you know, I was busy with labour. Even with ds2 where I arrived at the hospital ready to push the ob said something to me like "let's get this finished. I can break your waters now or wait 5mins while you get settled and do it then". Totally unnecessary in retrospect.

[anna7602]

Apr 23, 2015 14:52:27 GMT -5 @tambcat said:

Apr 23, 2015 14:50:49 GMT -5 @hannymaren said:

What's the risk to Mon and baby with having an ultrasound? Haven't those risks been debunked? Or found to be teeny?

She acknowledged that the ultrasounds themselves were probably safe, but she mentioned that ultrasounds can lead to more, riskier interventions. I'm guessing things like amnio or CVS after the NT scan or a c-section after a growth scan.

The results of my NT scan with DS indicated that it was highly recommended I get an amnio, a procedure that has documented risks. I met with a genetic counselor, she went through my file and realized I'd also had the Materniti21 test, the results of which are more accurate than an NT scan. No amnio needed. But the blood test is not routine, while the NT scan is.

With my first pregnancy, the series of growth u/s I had near the end led my OB at the time to tell me I'd probably have to have a c-section. DD came vaginally and was 7 lbs, 10 oz., not the 10-lb baby they were seeing in u/s.

So, these are the kinds of risks I think of.

[sent]

Apr 23, 2015 19:07:30 GMT -5 @tambcat said:

I do think the MaterniT21 and similar will be routine at some point in the future. I think they would be now if insurance would cover them for everyone. I wonder what that will do to the NT scan. If I had to choose one or the other, I'd pick the blood test since it's more accurate. I think some practices will do the bloodwork now if the NT results come back elevated, rather than recommending amnio.

I had no idea insurance wasn't going to cover my test.  It was presented to me by my OB and my MFM as "this is a test we do now to look for xyz things so let's get started" so I did it.  I paid the $750 bill, small price to pay for the results seeing as most of our other costs were covered.  I was 33 at the time so not quite AMA yet but these 2 OB are absolutely conservative "my way as per science or go elsewhere" types so I'm guessing that's why it was presented as "must" rather than optional?  Or maybe because they knew I would pay the bill regardless of insurance?

[curbsideprophet]

Apr 23, 2015 19:07:30 GMT -5 @tambcat said:

I do think the MaterniT21 and similar will be routine at some point in the future. I think they would be now if insurance would cover them for everyone. I wonder what that will do to the NT scan. If I had to choose one or the other, I'd pick the blood test since it's more accurate. I think some practices will do the bloodwork now if the NT results come back elevated, rather than recommending amnio.

When I was pregnant with DS my midwife thought these blood tests would replace the NT scan eventually.

[anna7602]

Apr 23, 2015 19:07:30 GMT -5 @tambcat said:

I do think the MaterniT21 and similar will be routine at some point in the future. I think they would be now if insurance would cover them for everyone. I wonder what that will do to the NT scan. If I had to choose one or the other, I'd pick the blood test since it's more accurate. I think some practices will do the bloodwork now if the NT results come back elevated, rather than recommending amnio.

Can the blood test be taken at any time during pregnancy or will you only get accurate results if it is taken during a certain window? For some reason, I feel like the blood test wasn't an option AfTER the NT scan, but I haven't dealt with any of this in over a year.

It sucks that you were OOP for that, sent.

[sent]

Apr 23, 2015 21:58:23 GMT -5 anna7602 said:

Apr 23, 2015 19:07:30 GMT -5 @tambcat said:

I do think the MaterniT21 and similar will be routine at some point in the future. I think they would be now if insurance would cover them for everyone. I wonder what that will do to the NT scan. If I had to choose one or the other, I'd pick the blood test since it's more accurate. I think some practices will do the bloodwork now if the NT results come back elevated, rather than recommending amnio.

Can the blood test be taken at any time during pregnancy or will you only get accurate results if it is taken during a certain window? For some reason, I feel like the blood test wasn't an option AfTER the NT scan, but I haven't dealt with any of this in over a year.

It sucks that you were OOP for that, sent.

I think I had blood drawn on the same day as the scan.  It's all kind of a blur but I do remember the timing (12 weeks?) was very critical.    

[KaraOrNot]

Apr 23, 2015 21:58:23 GMT -5 anna7602 said:

Apr 23, 2015 19:07:30 GMT -5 @tambcat said:

I do think the MaterniT21 and similar will be routine at some point in the future. I think they would be now if insurance would cover them for everyone. I wonder what that will do to the NT scan. If I had to choose one or the other, I'd pick the blood test since it's more accurate. I think some practices will do the bloodwork now if the NT results come back elevated, rather than recommending amnio.

Can the blood test be taken at any time during pregnancy or will you only get accurate results if it is taken during a certain window? For some reason, I feel like the blood test wasn't an option AfTER the NT scan, but I haven't dealt with any of this in over a year.

It sucks that you were OOP for that, sent.

I think I was 34 weeks when I got the blood test to confirm that Ollie had DS.

FWIW, my insurance only covered a portion of the M21 test. My part was $1800. They did negotiate it down a little, but man was I bitter paying off that bill.

[Velar Fricative]

Apr 23, 2015 14:52:27 GMT -5 @tambcat said:

Apr 23, 2015 14:50:49 GMT -5 @hannymaren said:

What's the risk to Mon and baby with having an ultrasound? Haven't those risks been debunked? Or found to be teeny?

She acknowledged that the ultrasounds themselves were probably safe, but she mentioned that ultrasounds can lead to more, riskier interventions. I'm guessing things like amnio or CVS after the NT scan or a c-section after a growth scan.

I'm the poster child for this, lol.

Although, I didn't get the amnio last time because of the NT scan, I got it because of the quad screen results. And this time, it was actually the results of the Harmony test that made me decide to get an amnio next week. Neither time was I pressured at all into getting an amnio - I was the one practically begging for it each time because there was no way in hell I was going to go through the rest of the pregnancies not knowing for sure. 

Perhaps if I hadn't gotten these tests, there wouldn't be these additional interventions. DD did not end up having any chromosomal conditions, so hindsight is 20/20 there. The verdict is still out on this baby, but if this baby has no conditions either then it's easy to say that all these tests and the needles in my belly were for nothing. But what about for everyone else where there *is* something detected prior to birth, KWIM? 

[karinothing]

@this - That is kind of what I thought. I think in a LOT of cases by the time something goes very wrong, the mother is in the hospital (i am talking about a home birth transport situation). IN those cases the midwife isn't going to have privledges at the hospital and won't be involved in the ultimate care. Plus, hospitals and OBs are going to have deeper pockets.

I would assume in hospital midwifes are direct supervison and non-hospital CNM are indirect? But I could be making that up too.

And again, I don't think it is possible to get malpractice insurance if you aren't a CNM, so that is a lot of midwives w/out it. And 99% of the time, it doesn't make financial sense to sue them since the money isn't there.