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Nov 29 2013

It’s Not Divine, It’s Just Childbirth and Sometimes it goes wrong

I am an oddity in the whole “Natural/Medical” birth argument.

See, I am pro-medical birth. Staunchly so. I think the absolute BEST possible outcome of childbirth is at the hands of trained medical practitioners with the proper support structure and proximity to said support structure if things go wrong or expert help is needed.

But I train home birth midwives. These conduct deliveries for a large number of rural women who never could get to a hospital in time. At least this way they have technology and sterile equipment.

But the natural birthers and the pro-choice tell me repeatedly that the act of birth is nearly divine and designed to be perfect. That us doctors would rather slash and stab women than use the natural process.

[TW - Stillbirth]

This is just a daft thing to say. There is plenty of evidence that the Natural Birthers often have stillborn children and while they foist these on the medical system (birth complications are carted off to the hospital and the outcomes are classified as hospital related) the indications are clear.

Sometimes this well oiled system goes horrifically and spectacularly wrong. I have lost a mother on the table because of how wrong it went, I have seen babies die in utero and babies die during birth. I have even seen one twin kill the other in utero just by the pressure of two foetuses in a space really meant for one. There are babies born without heads and there are babies born perfectly healthy but who are hurt permanently by the mechanism of birth.

One of the things I have tried to do is instil the concept of value for each child. The idea is that if each child is valuable then parents will have fewer of them. And unlike other places when I am working in the delivery room, If a stillbirth occurs, I allow the mother to keep the baby for a short while and even pay for  a priest to do a proper cremation and funeral ceremony and issue a paper with the name of the child, and the hand and footprints.

It brings closure for one and many mothers are distraught at the end because it’s usually something they have done.

The last one was a woman who came in with profuse  bleeding per vagina. She had not had a trip to the ultrasound since conception and the midwife made a terrible error.

See sometimes the position of the placenta can lie over the os of the cervix. Doing a per vaginal exam would cause the placenta to rupture and haemorrhage. If she had come in earlier we could have tried to save the child but now it was a struggle to save the mother.

To treat this you need “so much blood” that you actually run two simultaneous IV lines. In the aftermath she lost her uterus. All for the want of a single free ultrasound…

It’s not her fault, she didn’t see why. It’s not our fault because we really cannot tell everyone. She was just one of the voices that fell through the cracks in our system.

Even though her baby and to her it’s a baby. We may see it as a foetus but to the mother who wants a child it”s always going to be her baby…. had to be delivered in pieces we still let her see him. We paid for the funeral.

It’s nice to see other people do the same thing. We may think about hard cold facts and the like but sometimes you have to take a step back as an atheist and bite down your tongue when it comes to the private views of others.

We may not think it’s healthy to cradle a dead foetus or treat it like it’s alive but to that mother in that moment that is her baby and no logic is going to change the way she feels. So let her have the time. Treat the stillborn as people.

This is a story of how someone did it in the USA. It’s odd but touching.

24 comments

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  1. 1
    Giliell, professional cynic -Ilk-

    Avi

    But the natural birthers and the pro-choice tell me repeatedly that the act of birth is nearly divine and designed to be perfect. That us doctors would rather slash and stab women than use the natural process.

    No, I think you’re going wrong here, even though I agree with the rest of your post.
    The pro-choice* position is that the choices about birth must be with the woman, not because they magically know what’s best, but because the other alternative is forcing women into treatment against their will.
    This is not a trivial thing. There are cases in the USA where women were forced into c-sections. Just imagine the horror: you are forced into a hospital, sedated and the people cut your body against your explicit wishes. They literally do to you whatever they want to and you have no longer any control over this.
    This doesn’t mean that women will not make bad decisions, but we know that with each and every thing in life: people make bad decisions, especially people who believe in woo.
    I think it’s wrong to have a homebirth if you have access to medical facilities.
    I think it’s wrong to go with untrained practisioners if you have access to trained providers.
    But still I recognise that forcing women to make the “right” decision is a serious violation of human rights.
    I don’t believe in “birth-magic” and yes, I think it’s a narrative we need to stop. We fully recognise that pregnancy and birth are horrible and dangerous when we discuss abortion access, which is why you will hardly find any pro-choice person who believes that the process is near perfect. They don’t suddenly become unicorn farts because you want the baby.

    *I do not deny that there are people who are pro choice AND who push birth-quackery, but that’s not a mainstream position.

  2. 2
    Avicenna

    The reason for the common c-section in the USA is that obs/gynae has the HIGHEST litigation rate. Doctors don’t want to take a risk with their entire career at stake because a difficult birth went south. Better to go for the safer option.

    I repeat. In a medical emergency do you want to push through the labour and have a child with Cerebral Palsy or have a C-Section? Difficult pregnancies seem to be the main reason for such conservative care while the entire certificate midwife industry seems to think that difficult births are a doddle. I have repeatedly seen both literature from the midwives themselves and from women who experienced it pointing out how negative lie and poor proportions were treated as nothing.

  3. 3
    Giliell, professional cynic -Ilk-

    Avicenna
    I do not deny that there are good reasons for high c-section rates. You’re now arguing a straw man. I patently think that the world would be a better place if people understood risks and statistics ( I once spent an afternoon arguing with somebody who claimed that giving women with strep B antibiotics during labour was ineffective because it only reduced the risk by 1,5%. They just couldn’t understannd that by reducing the risk from 2% to 0,5% you actually reduced it by 75%)
    Actually, I’ve written about the obvious conflicts a few days ago. You can clearly see that I’m not against medical birth, c-sections etc. I’m also on record for saying that a woman should have the choice to opt for a c-section for no other reason than that this is what she wants.
    The only thing I’m taking issues with is your characterization of birth-woo being the pro choice position. What I’m saying is that a c-section must be the decision of the woman (this includes the consequences!) It is inacceptable that women are arrested during labour, handcuffed, brought to a hospital and forced into a c-section. This has happened and this will happen again.
    Again, I’m 100% pro medical birth. Women and babies are actually quite good at dying in childbirth. I had my children in a hospital, with a trained midwife* AND an Ob/gyn. I think that every woman in this world should have access to that kind of care. Yet still she must be free not to go there.

    *It’s a licensed medical profession in Germany. Midwives are trained specialists, not people who just like to watch babies being born.

  4. 4
    Avicenna

    So is Chiropractic and Homeopathy…

    Doesn’t make them valid. There are also two sorts of midwives. Nurse Midwives are the “real deal”. The CPMs are unfortunately quacks. Their entire education and ethos is “birth? pfft! nothing! Let’s take stupid risks because grrl pwr!”

    If Choice Harms Patients then it’s not medicine.

  5. 5
    rq

    In a medical emergency do you want to push through the labour and have a child with Cerebral Palsy or have a C-Section?

    I still think it is important for women to make the decision for themselves, not have it forced on them. It’s their body, they’ll be facing the consequences. For some reason, the idea of bodily autonomy and consent still wins out over fears of litigation for me (what about litigation for illegally tampering with her body, against her express wishes or without her permission??).**
    What would help is a lot more real, hard information in the pre-birth period. Too many prenatal courses are all about sunshine and breathing exercises, and they have a very strong tendency to wave away any questions about complications or emergency situations. “Oh, they happen, but never mind your pregnant little head about it, it’ll be fine!!!” Until it isn’t.
    Women need to know that things can go wrong – and not at the hospital during contractions, but beforehand. To think about it, to figure out a response, and then, yes, if they choose to attempt vaginal birth over a C-section, so be it. Women need the real statistics, they need to know the options, and they need to know them beforehand. I think there’s a huge cross-cultural idea that pregnant women shouldn’t be scared or shouldn’t be faced with unpleasant facts (it’s pretty prevalent here), because it’ll somehow (a) damage the fetus or (b) make them too frightened to try to go through proper labour (and (c) choosing a c-section for the sake of a c-section is a Bad Thing*). I think that practice needs to stop. Becoming pregnant is putting yourself at risk, and you need to know all the risks, and the real risks. That’s the only way pregnant women can become more informed, and thus better, patients, able to work better with their doctors, even in emergencies.
    All that being said, I love the medical establishment, I love all advances in medicine that allow many more women (and babies) survive childbirth, and I wouldn’t have done it any other way (that is, I would not have done it without the medical support that I had).

    ** The only situation where I could possibly understand a doctor performing a medically necesssary procedure on a patient without express permission is if the patient is unconscious and in an immediately-life-threatening situation – and what this situation is, may vary quite a bit from patient to patient, location to location.
    * I actually think a c-section should be a matter of choice even/especially if you are terrified of going through proper labour. Or even if you have weird numerological ideas about birthdates. Or whatever reason. That’s what medicine is for, isn’t it? To help us live our lives the way we would like to live them, and to be less beholden to our ‘natural’ biology.

  6. 6
    rq

    I think Giliell is speaking of Nurse Midwives, the kind we have here, too.

  7. 7
    oolon

    You’d love the hypnobirthing classes I’ve just started with my wife. The claims can stretch credulity, specifically the video where the founder claims babies delivered by a calm, pain-free hypnobirthing mother are calm babies. Example she gave being a mothers baby never crying, when it did out of the blue once (wtf O_o) she played the CD and it immediately laughed and went back to sleep.

    Cannot find any evidence for outcomes for babies born of mothers using this method of antenatal preparation. But there is some evidence from an Aussie study that mothers had less pain, as reported by them. But also a significant (Small 75, I think, group tho) difference in c-sections and use of an epidural. Although contrary to the claim that if you do it “properly” you simply won’t need either (Strongly implied at least so far). The hypno-mother group had 1/5 incidence of c-section and 1/2 of epidural. Less than the control, but still far from all “natural”… Thinking I may bring this up in the class, gently, cos it seems to me the class so far is setting 20-50% of the mothers up to feel like failures.

    Also would be interested to see if the other advice they give, more general midwifery than hypnobirth, stack up. Specifically the advice they give about posture ->
    1. Don’t cross your legs as this messes up your tendons (?) and puts the pelvis in the wrong position
    2. Sit up straight, never slump. Wife is 30 weeks and apparently slumping or putting your feet up in anyway other than sideways lying on the sofa stops the baby engaging properly.
    3. Walking up and down stairs nearer the time helps get them engaged properly.
    4. Lots more of these… I’m rather suspicious of this as it’s presented as just “known”, but then they also suggest aromatherapy and TENS, studies of both show no effect at all.
    Cannot find if studies to prove the effectiveness of this advice given by midwives have actually proven it in any sense. A lot of it seems to be silly, especially since this is our second and they don’t engage until a lot later on in second births (So I’m told) … So what difference can it make! Especially of interest to us as last time after an extremely painful 70hr labour, due to back-to-back and head off to the side not engaged properly, she had a c-section. At the time we didn’t give a toss as she came out healthy and safe. Now I think some of this is making my wife feel it was her fault somehow. But the flip side is if there actually are proven ways to avoid back to back then I’d like to make sure we are doing them as going for a VBAC is her aim.

    The reason I’m happy to go along with the classes (Not that I have much input!) is that I think a “natural” or birth with as little medical intervention should be the aim as that is what she wants. Drugs and surgery all make it a less pleasant experience if they are not required and not wanted. But there should be zero shaming either way, informed choice free of negative pressure from doctors and woo-birthers IMO.

  8. 8
    Avicenna

    rq – Litigation for doctors is death. You may think it’s selfish but I have invested nearly 9 years into medical training. If I lose my job I will be “fucked”. Worse than any other profession. That’s why doctors earn well. It takes a major amount of specialisation to be a doctor. Do you think it’s fair that I should lose my career and a significant chunk of earnings solely because patient decides they know more?

    No doctor will accept an increased risk of litigation in an already litigious field without a waiver protecting doctors from poor patient compliance and correcting pointless medical litigation. No job would EVER accept that.

    Doctors always settle. Even if they were right. The actual court case would do more damage. And all those settlements add up.

    The CPM exist in a lot of countries. You would be surprised since they look like NPM. If you aren’t looking for them specifically you may completely overlook their effects.

  9. 9
    Hamza

    We must use hospital or educated doctor for this purpose, because many time due to lack of knowledge many mothers died, its common in Pakistan, there are many women’s which do so, without any education which often result in mothers died.

  10. 10
    summerblues

    This is no longer just one life in a wanted pregnancy. What we choose to do will affect the potential(s) inside us. Wouldn’t you agree that we women have the responsibility to make sound choices for not only ourselves but to the potential life (lives) within, that we agreed to host? Where’s the line between “my body, my choice” and the potentials that we agreed to carry? Personally I think that choosing to refuse pre-natal/delivery care in the name of “my body, my choice” is a lousy way of showing female autonomy and independence.

  11. 11
    Gen, Uppity Ingrate and Ilk

    Where’s the line between “my body, my choice” and the potentials that we agreed to carry

    When it’s no longer my body. Just like with abortion.

    Av, please re-read Giliell’s posts. She is not saying what you’re saying she is saying. No one here is arguing for the woo-woo “Divine natural birthing goddess” crap. At all.

    And I do understand that doctors have to cover their asses and that people are litigious assholes and that even one litigation can be the death of a doctor’s career, but even given that to unilaterally decide to remove a woman’s bodily autonomy out of fear for possible litigation is a pretty anti-woman (and unethical) stance to take IMO.

    I’m a huge fan of yours mostly, but please consider what women are saying here, as well as the implications of your position.

    I signed the standard waiver before childbirth stating that I consent to the procedures necessary etc. etc but added a part where I clearly stated taht I do not, and never will, consent to an episiotomy. (The reasons for that is not relevant, but they involve childhood abuse). I talked about it with my doctor for 9 months during my pregnancy. He knew taht is was my greatest fear. That I would rather tear so bad that I poop out of my vagina than have sharp instruments near my genitals again. That I would LITERALLY rather DIE and/or stillbirth than have that happen to me again.

    I ended up being tied to a delivery table with nurses holding my upper body down, shouting “NO, NO EPISIOTOMY!”, crying, BEGGING him not to do it, helpless to stop them while I was held open and cut.

    Are you going to tell me that that was not abuse?

  12. 12
    summerblues

    “When it’s no longer my body. Just like with abortion.”

    This is not an answer, more like an evasion. When you agree to host it’s no longer just about you. IMO, this is too close to what the pro-forced birthers say: no respect for life.

  13. 13
    rq

    Gen
    I’m so sorry for your experience.

    Avicenna
    I understand litigation is bad for doctors, and that you invest a lot in your education. A lot. (I’ve been following your blog a bit and you mention it many times, and the work that you do, so yeah, I believe you when you say there’s a lot invested there!! And contrary to what you may think, I do have huge amounts of respect for you and the work that you do.)
    But as a woman I also invest a lot in my life and being a person who likes to at the very least be informed about impending medical procedures and the reasons for them.
    And I’m just saying – a doctor could also, theoretically, be sued for going ahead with a procedure against a patient’s wishes, no? So, you could be litigated against either way.
    And mostly, what I would like is more information for women prior to actual childbirth.

    The CPM exist in a lot of countries. You would be surprised since they look like NPM.

    I’m aware that they can co-exist in many countries, and surely do in my current one. However, when it’s the midwife forcing medical procedures on me, I’m pretty sure I’m working with the nurse kind.

    summerblues
    The baby now gets a say in how I get it out of my body? I thought it was still my body.

  14. 14
    rq

    summerblues
    “When I agree to host”??
    Until the hosting is at an end, it is still my body and I still have a say in what happens to it (I should hope). I have a say in how the hosting ends. Otherwise, the other ‘host’ word you’re looking for is ‘hostage’.

  15. 15
    Giliell, professional cynic -Ilk-

    Avi

    So is Chiropractic and Homeopathy…

    I was talking about nurse midwives

    If Choice Harms Patients then it’s not medicine.

    There’s a lot of wrong here.
    a) Nobody said it was medicine. It’s not about medicine, it’s about human right. You have the right to refuse treatment, even if that kills you.
    b) Why do you think that it’s a choice between no harm and harm?
    What do you think is the harm to a woman who is being forced into a hospital, who is held down while somebody starts the anaesthesia, who is crying and begging and who knows that now people will slice her open? Is that “no harm” to you?
    And what do you think is the harm to all women who understand that as soon as they are pregnant they can be treated like objects?

    Litigation for doctors is death. You may think it’s selfish but I have invested nearly 9 years into medical training. If I lose my job I will be “fucked”. Worse than any other profession. That’s why doctors earn well. It takes a major amount of specialisation to be a doctor. Do you think it’s fair that I should lose my career and a significant chunk of earnings solely because patient decides they know more?

    If you read the comment I linked to you will see that I raise that problem. There IS obviously a conflict of interest. But it’s no solution to say “therefore women have to submit to whatever procedure any doctor deems necessary without having any rights to refuse.”
    BTW, litigation does not work the same way all over the planet. In Germany it’s notoriously difficult to get compensation for malpractise. Laws are under reform now, but it used to be the case that if something could also happen without the doctor making a mistake then it didn’t matter that the doctor did make a mistake that most likely caused the damage.

    summerblues

    Personally I think that choosing to refuse pre-natal/delivery care in the name of “my body, my choice” is a lousy way of showing female autonomy and independence.

    Well, I agree. But we’re not all the same. What’s fine with me isn’t fine with everybody. I had an episiotomy, too. It was uncomfortable but no big deal. Compare it with Gen’s account. Therefore only the woman who is concerned can make that decision.

    Where’s the line between “my body, my choice” and the potentials that we agreed to carry?

    How many babies are worth a woman?
    There are no easy answers here. C-sections are wonderful things. They are often done to avoid potential complications, so a woman schedules it beforehand. Not all babies would have suffered damages or severe complications during a vaginal birth but some would, and some would have died. So they are saved. Still, c-sections increase the risk for women. It is a major surgery after all. So some women die who would have been fine with a vaginal delivery. The number is much smaller than that of the saved babies, and it’s a small increase in risk, but the law of big numbers still means that they die. The decision to take that risk must be with the woman.

  16. 16
    summerblues

    Pregancy/childbirth is not a religion. A fetus is not a sacrificial lamb. I’m not even sure what to call women who attempt to sacrifice themselves as martyrs at the altar of “my body, my choice.”

    I’ve been wondering where some of this extremely ugly pushback has been coming from when I argue with pro-forced birthers. Unfortunately now I think I’ve a better idea why. We got this repro system by accident. It’s a privilege and a pain in the ass at the same time. It’s power: life or death, healthy or unhealthy. And our control over it is mostly illusional: doesn’t matter how much planning we do, how many decisions we make, how healthy we try to live…things can still go very, very wrong. What is this conceit that I’m reading here. This sounds more like tyranny that “rights”. It also sounds way too much like some are trying to tell the doctor how to do his or her job. Yes, yes, we have the right! to abort/carry/take care of ourselves/not take care of ourselves/refuse treatment/accept treatment/refuse procedures…and on and on. Doesn’t make it smart, doesn’t make it ethical. You want to carry a pregnancy to term, great…then you accept that things won’t always go your way. And, no, the medical staff should not be forcing procedures unless it’s medically needed. But I must ask…why in hell are you carrying a child to term if you are going to just allow it to die by refusing treatment? What the hell are you trying to prove? If the situation has reached the point of “it’s you or the baby”, yeah…make your decision. But..refusing medical care throughout? Not taking the advice of professionals during the pregnancy, like you know better? You honestly think you know better than your OB/GYN or midwife? I don’t need to sacrifice a fetus to prove that this is my body and my choice. Why do you. We have the choice, that is if we’re at least middle class/live near large cities/have medical insurance/transportation. I bet we here would have no problem walking into a clinic to have our abortion past the picketers and shoving their Bible quotes back down their throats. But this attitude of “I know better and will dictate”? We are not Goddesses in spite of the fact that we do have the power of life and death.

  17. 17
    Gen, Uppity Ingrate and Ilk

    Look, at the end of the day you’re either going to accept and trust that most pregnant women are doing the best they can with the resources available to them and making the best decisions they can in their own circumstances and lives that you know nothing of with the resources / knowledge available to them or you’re going to believe that women are selfish bitches who would sacrifice a baby on the altar of her independence (wow, who does that sound like?) The anti-choicers have the same problem.

    It’s like I said the other day at another place:

    It’s the old song and dance number “women don’t know what’s best for them” and “women are selfish crazy bitches who kill their own babies all the time given half a chance” and “any woman’s needs are a priori subservient to the needs and/or wants, real or imaginary, of any baby she might conceive and/or produce”.

  18. 18
    Gen, Uppity Ingrate and Ilk

    You honestly think you know better than your OB/GYN or midwife?

    And yes, I did know better about whether I could handle a certain procedure or not. Or are you going to tell me what happened to me was not abuse?

  19. 19
    Pen

    I think the absolute BEST possible outcome of childbirth is at the hands of trained medical practitioners with the proper support structure and proximity to said support structure if things go wrong or expert help is needed.

    Actually, that does not exclude giving birth at home. But really our point of view should be evidence based. I believe the research shows that western women who give birth at home, after being found low risk by ultrasounds and other pre-natal care, when they have midwife support and ready access to hospital backup are as safe as women giving birth in hospital. Surveys that include homebirths without medical support and accidental births outside of hospitals with these medically supported homebirths show worse outcomes than hospital births.

    I believe in the Netherlands homebirth is still standard for low risk births, one reason being that since they are set up to do it that way it lowers their costs. In Britain and France it’s an option, which the health services sometimes grumble about supporting because they’re not set up to do it.

  20. 20
    Giliell, professional cynic -Ilk-

    It also sounds way too much like some are trying to tell the doctor how to do his or her job. Yes, yes, we have the right! to abort/carry/take care of ourselves/not take care of ourselves/refuse treatment/accept treatment/refuse procedures…and on and on.

    No, and yes. To have a choice to refuse treatment is a fundamental right. That is even a fundamental right when people are wrong. That is all the argument is about. I can think that people are wrong to make decision XYZ and still uphold their fundamental right to do so.
    I don’t want to tell the doctor how to do their job, I want to tell them what job they are allowed to perform on my body.
    BTW, doctors are not allknowing nor always right. There are still doctors who hand out antibiotics like candy, who don’t change their clothes after treating highly contagious patients, or who wear their examination gloves while handling cardoors, doorknobs, elevator-buttons etc. Should I just let them do or am I allowed to insist on them changing the fucking things?

    Doesn’t make it smart, doesn’t make it ethical. You want to carry a pregnancy to term, great…then you accept that things won’t always go your way.

    Ah yes. I pretty much realized that the day the doctor told me my pregnancy was no longer intact and that I needed an abortion.
    It was also the day I got some of the best and some of the worst medical care in my life.

    And, no, the medical staff should not be forcing procedures unless it’s medically needed.

    Fixed that for you. I see that you didn’t bother to answer my question about how many women you’re willing to sacrifice for the sake of the fetus.

    But I must ask…why in hell are you carrying a child to term if you are going to just allow it to die by refusing treatment? What the hell are you trying to prove? If the situation has reached the point of “it’s you or the baby”, yeah…make your decision. But..refusing medical care throughout? Not taking the advice of professionals during the pregnancy, like you know better? You honestly think you know better than your OB/GYN or midwife? I don’t need to sacrifice a fetus to prove that this is my body and my choice.

    Who are you talking to?
    Who here in this conversation who flat out refuses medical care throughout? Or are you just happy bashing all that straw?
    Oh, but since we’re talking about “refusing advice of professionals:
    During my thrid pregnancy I flat out refused the advice of a professional. Yes, he pretty much pulled the “dead baby” card. I knew he was wrong and he was an idiot. Because actually 3 other professionals sided with me, one of them being his boss. So, tell me, who was right? The one who said that I was totally risking my baby’s or the three people who said there was actually no reason for that?

    Why do you. We have the choice, that is if we’re at least middle class/live near large cities/have medical insurance/transportation. I bet we here would have no problem walking into a clinic to have our abortion past the picketers and shoving their Bible quotes back down their throats. But this attitude of “I know better and will dictate”? We are not Goddesses in spite of the fact that we do have the power of life and death.

    At this point you cross the border into ignorant idiot territory. I don’t know what Gen’s legal situation is, but I live in a country where I can’t have a legal abortion outside some very narrowly defined exceptions. I can have an illegal but not-prosecuted (at least at the moment, could, of course, change) after jumping lots of hoops and then just during the first 12 weeks.
    And no I “don’t know better”. Again, you’re bashing your straw here. I know that I not only have a body but a psyche, too, and I know that things come with risks and I reserve the right to weigh the risks for myself.
    At the same time I encourage women to look at the actual evidence, try to make them understand what risks mean, combat woo and fight for better reproductive healthcare access.
    What are yiu doing apart from valiantly fighting strawpeople on the internet?

  21. 21
    Giliell, professional cynic -Ilk-

    Gen

    And yes, I did know better about whether I could handle a certain procedure or not. Or are you going to tell me what happened to me was not abuse?

    I think there must be a massive glitch on the internet.
    You and me and rq argue for better care within the medical system and that women should still have the basic human right to refuse treatment regardless of consequences and what appears on people’s screen is “I want to labour alone in a pond in the woods while drinking Bourbon because then a unicorn will come and kiss my ass”.

  22. 22
    dianne

    Litigation for doctors is death.

    Not always. OBs in the US are expected to be sued at least once in their careers, often more than once. This is competent OBs who don’t do anything wrong, because if there’s a bad outcome (but with a living child), the parents have no other way to pay for the rehab their child will need except for suing the hospital and the doctor. There are other reasons, of course, but that’s a basic one. It’s bad, but not necessarily career ending. In the US.

    I’m not a fan of litigation. I don’t think it either protects patients adequately or protects practitioners from nuisance suits. OTOH, I’ve more than once gotten an administrator to back away from an ill-considered “money saving” policy by pointing out that if we did X and something went wrong we’d have no real defense in a lawsuit. In short, the system has its uses, even for someone within medicine.

  23. 23
    dianne

    As far as I know, the only time a procedure can be performed on a non-consenting adult patient (outside of pregnancy) is if the patient is in a reversible altered mental state, there is reason to believe that the patient would want the procedure if they were in their right mind, and the procedure is life or organ saving. Otherwise, no. No giving blood to Jehovah’s witnesses, even if they’ll die without it, if they don’t agree. No chemo to patients who want to cure their Hodgkin’s lymphoma with prayer, even though they would have an up to 98% chance of survival with chemo and essentially no chance otherwise. But with pregnancy the rules suddenly change and the patient abruptly has fewer rights than a corpse: you can’t take organs from a corpse if the patient said before dying that they did not consent to donation.

  24. 24
    summerblues

    I did more research and agree totally with the author. This kind of talk, “natural and divine”, undermines everything that we are trying to do in getting good reproductive health care out there to all women. If the anti-choicers get hold of this, we will never hear the end of it.

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