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Monday, November 22, 2010

Technology and birth: Should a robot perform your cesarean?

I don't think Bill Gates realized he was about to open a huge can of worms when he recently speculated, among other things, that robot technology could be used to perform c-sections. The birth nerd community responded, horrified, and the general consensus among my FaceBook friends was that it would basically dehumanize the birth process even more than it sometimes already is.

I think we can all agree that sometimes, technology in giving birth is a lifesaver. And then there are those gray areas, like electronic fetal monitoring, that have a shady, somewhat dubious past, and yet are used constantly even though they have actually been shown to lead to more cesareans, instead of fewer. In some cases, the very thing that's supposed to detect cases of cerebral palsy actually fails to do so, thus also failing to identify which babies are truly in distress and do need to be delivered immediately. In the other half, it leads to more cases of distress that are questionable , oftentimes producing a newborn who is quite pissed off to be so violently thrust into this new world.

I think, therefore, that we need to be vary of our use of technology, especially in surgical births. Having a robot do your c-section might sound cool to Bill Gates, until it's you lying on the table, already feeling like a slab of meat and having that inanimate object hovering over you. If you are distressed or emotional about the birth ending in a cesarean, the robot cares even less than your physician might. It doesn't care if you're crying, upset, or having birth trauma. It can't hold your hand throughout or ask how you're doing. It can only, with another machine, check your vitals, see that you're doing okay, and proceed as usual, completely disregarding any emotional or psychological aspects that can't be registered with a machine.

When I had my first cesarean, their routine choice of medication administration was a PCA (patient-controlled anesthesia) pump. This requires an IV be inserted and the patient then decides when to inject herself with pain medication. According to nursing guidelines in the hospital where I gave birth, I was allowed no more than 10 doses in a one-hour period.

This might be all fine and good, and I can understand why a PCA pump can be helpful, if used properly: it allows the patient to determine her level of pain, while the nurse can tend to other patients. But shortly after being wheeled into recovery - probably the minute the spinal wore off - I noticed that I was in increasing pain, and the PCA pump didn't seem to be doing anything about it. Off and on throughout the middle of the night, the pump would routinely beep at me - and I knew, from my experience calibrating pumps as a pharmacy tech - that that meant there was a problem. The nurse would come in every so often, adjust something, tut about this and that, and then leave the room. A half hour or so later, she'd come back for a repeat.

After the first full day, I had tried injecting myself and nothing happened - except a horrible burning sensation up the length of my arm, which had been happening since I was in recovery - and the nurse scolded me that I had reached my maximum number of doses for medication per hour and couldn't have anymore. The pump had counted the number of doses, and it told her I had already had enough, and that was that. No doubt everything else looked good, and she didn't bother asking me why I was still in pain, even with that much medication supposedly flowing through my veins.

Finally, after my hand swelled up like a blown-up latex glove, the nurse noticed and quickly remarked how they 'had to get that thing out of there.' I had told them, numerous times, that it wasn't working, and that I felt more pain from injecting myself than anything else, at this point. I repeatedly asked, "Is it supposed to burn when I do this?" after another dose of Demerol. It was only after that that I realized the line had infiltrated at the injection site and the painkillers were leaching into my tissues, which offered little, if any, pain relief. No explanation, no apology - I only managed to figure out later that that's what happened.

I consider this episode a major technology fail. A machine can give you so many doses of something and then tell the nurse, in a nice digital printout, how much you've had, when you're due for another, and so on and so forth. It cannot, however, tell the nurse why you're in pain, or that there might be a problem. Only she can do that. And she can only do that if she listens to you as a patient.

I had tried speaking up and no one really listened. If they had been listening, perhaps they would have pulled the entire thing out from the beginning and tried again. Another technology fail lies in the fact that, with increased technology, nurses are then able to spend more time tending to other patients, and thus take on a greater caseload. Additionally, when someone does need something that only a human can respond to, they often become resentful or irritated when you do speak up and express a need that the machine failed to address. Perhaps this is why some OB's are perceived - whether for right or wrong - as cold and callous, because they expect the machine to do their jobs, to some extent: to give them results so they don't have to. In many situations, technology - as we see in the case of EFM - has replaced human judgment, which is an art form that is dying quickly, it seems, when it comes to birth. As a result, greater technology has helped patients, while at the same time, hurt them - by destroying the nature of the one-on-one patient-caregiver relationship. No robot can take the place of that.

More reading:
Bill Gates and Robot Cesareans - The Unnecesarean 


christyjames said...

Our children need not be mindless consumers of technology. The best new tech tools for kids get them making and creating and let them explore challenging computing concepts through hands on play.
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