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Saturday, December 11, 2010

The Obstetrical BS Series: My Doctor will Tell me Everything! Part I

"I'm 38 weeks and am going in for an induction
tomorrow. What should I expect?"
Photo credit: Karol 
A lot of times when I hear women asking pregnancy and birth questions, the usual response is, "Your doctor will tell you everything! Don't worry!" I think we can all agree that this isn't the case, most of the time.

Some doctors do take the time to inform their patients, true - but many do not. Many cannot, because they are often limited to the typical 4 1/2 minute visit that consists of little time to go over your aches, pains and other complaints. I remember asking my doctor about having no urge to push during my last labor, and wondered why. His quick, tidy response was "We'll help you with that when the time comes." I wasn't exactly sure what that meant, but it didn't sound like much of an answer to my question.

Later on in the pregnancy I had a lengthy discussion with another doctor in the practice who then asked me, "How do you know so much?" I'd like to think it's probably refreshing for him to see a patient who truly is informed and can make decisions accordingly. I imagine some doctors wish their patients were more informed, and they feel bound by time constraints that prevent them from delving into a topic that can't easily be answered with a "yes" or "no."

As mentioned in my last post about inductions, I am amazed - overwhelmed - saddened - by the number of women who go into something as serious as an induction of labor with no preparation or information ahead of time. Countless women ask at zero hour what they can expect of an induction, with it looming large in the headlights in a matter of hours. Would you prepare so poorly for brain surgery? Probably not. Even my gastroenterologist - her secretary, even - prepared me more thoroughly for an upcoming procedure in more ways than these women are.

Outside the scope of obstetrics, uninformed consent is a huge problem - and the source of more costly procedures that are completely unnecessary. I remember those commercials in between cartoons while growing up in the 70s and 80s - "Knowledge is power!" And if you don't have that knowledge, you've effectively been rendered powerless.

Considering the rising induction/cesarean epidemic, I think more childbirth classes should cover inductions more extensively. While I took a class seven years ago, I don't remember it being given more than a passing mention.

While I don't doubt that some women won't listen to their doctor's warnings about the risks, it sounds like not many doctors are even bothering to mention the risks. I consider what my doctor told me about the risks of primary cesarean - nothing. Had he done so, I'm sure my attitude about it would not have been so casual, that's for sure. I think that's what contributes to the rising problem of inductions - attitudes about them are way too casual because women are simply uninformed about what can and does often happen, and how it can change their perception of "normal" birth. A few women I've talked to don't even realize that an induction ending in cesarean is not really a successful outcome - at least I don't think it is. But unfortunately, there apparently is little criteria defining what a "failed induction" really means.

Perhaps doctors need to draw up a realistic outline of the risks and benefits of labor induction - and have the patient sign off on it. I know this is what I had to do when signing consent forms for doing a VBAC. Of course, this might actually force the physician to be more forthcoming with how he handles inductions, and some aren't willing to admit to more aggressive practices, I'm sure.

When it comes to overall pregnancy and birth questions, perhaps a list of recommended reading would be helpful. Then again, unfortunately not all pregnancy books are the same, and can offer wildly different, sometimes slightly inaccurate, ideas about what's normal and what isn't. And there's nothing saying that patient will actually read them, either.

If anything, I think some doctors mitigate the risks or outright lie about them, simply because they don't want you to change your mind. I've heard some doctors say that Pitocin contractions aren't worse than regular ones, for instance, even though lots of women feel this isn't true. Perhaps for a number of reasons, inductions hurt more because you are more monitored and allowed less freedom of movement, which is no doubt why so many women choose an epi during an induction. If a woman knew that perhaps her labor could be more painful, or at least more intense, during an induction, she might decide against it.

People blather on about "just talk to your doctor" about the risks, but I think you'd be hard-pressed to find one who is up front and on the level about it. Conversely, perhaps not many women ask beforehand (or perhaps their concerns are rebuffed) simply because inductions have been so routine. And sometimes, even when you do try and tell them, it's like they put their hands over their ears and sing, "La la la!" loudly to block you out. They don't want to hear anything negative or that sounds "wrong." They might as well go into the labor and delivery unit with a blindfold on and paper bag over their heads.

I felt badly when a thread showed up from a woman 40w6d who was on the verge of an induction. She wanted to know what to expect, and namely if it hurt more than a traditional labor. She had no cervical dilatation or effacement, and was facing an induction in less than 24 hours. By the time I responded, 11 hours had passed, so I figured she was already well on her way to whatever by then. I looked on, horrified.

It reminded me of that Sally Field movie where the mother is stuck in heavy traffic and on the phone with her daughter. Suddenly the mother can hear something going on in the background, as her daughter is attacked by a stranger in the house. The mother can do nothing but listen, helpless. Sometimes I feel like that - like if only we could better inform patients ahead of time, they might not have to go through this stuff. It's like being on the edge of a cliff, holding on to her shirttail, and you can't get a footing before she goes over the side, tumbling into a cascade of interventions that are probably neither wanted nor necessary.

More reading:
"The Benefits Outweigh the Risks" - My OB Said What?!?
"I highly doubt you have the intelligence to read a medical journal." - My OB Said What?!?


MollyO said...

I had that same help-less feeling recently when I was hired to doula for a friend. They didn't call me when it was time and she ended up with all the interventions and a section. I don't know that anything would have gone differently if I was there, but I felt so useless. At a meeting post-birth we were talking through her story and she said, sort of to herself, "Maybe some of those things weren't necessary". Broke my heart since she had the forethought to get a doula.
This post reminded me of exactly why I want to move over to child-birth education. While it's a part of what doulas do, it would be great to do it for many people at once. It's sad how little research people actually do before hand. And I think there are lots of good OBs out there that do take time to talk with patients, but so many are overloaded that they simply don't have the time or get defensive when asked questions. I wonder if they've had one or two too many of the "just informed enough to be uppity" ladies that bring in 8 page, supper detailed birth plans and now the OB somehow thinks anyone who asks informed questions wants incense and twinkle lights and some old hippy/medicine woman drumming in the corner. I know of a woman who went to the hospital tour with this super detailed birth plan and was asking the nurse about the circumcision policy. She was having a girl. That was a woman who needed a doula! If only to inform her of general hospital practices and what can and can't be worked around (i.e. she had "no IV" in her birth plan. I always let my clients know that IVs are not required for most births around here, but they WILL insist on a hep-lock. Not even worth fighting on that one. Don't want a cath in your hand? Stay home! :))
Sorry for the long ramble. Really enjoying the series!

The Deranged Housewife said...

Why was she asking about the circumcision policy if she was having a girl? Curious.

I agree - sometimes it's too much and you forget that even as predictable as it can be, it's still not *that* predictable. Then there are those I wish would go out on a limb just a little and given that chance, would probably do just fine. There are also those that no matter how educated/informed they are, it's not enough. More on that later! *sigh*

Thanks for your great comment. I know exactly what you mean about those who suddenly realize that perhaps things could have turned out differently - I feel so bad and wish I could say more than "I know, because it happened to me, too."

Sara said...

A coworker's wife is 35 weeks pregnant, and he told me that today they're going for another ultrasound. She is AMA, GD, and now they're telling her that her fluid is low. Here's the thing, though- her sugar is well-controlled, but they're saying that "because there is more blood flowing to the baby's heart and brain, the baby is being damaged by diabetes". Umm....or it could be that that is what is the most vital parts of the baby right now?! They are actually thinking of inducing her at 36 weeks for those reasons alone! I told him that he really needs to do research and try to hold off an induction, as those were not reasons to induce early, but he just wasn't taking me seriously. I feel that she will end up with a failed induction and c-section, and it's just like watching a train wreck. Probably their baby would be in the NICU for at least a few days, also.

Trbobitch said...

Lie straight from my OB's mouth (and I am pretty sure she believed it 100%): Epidurals do not interfere with breastfeeding, the medication does not cross the placenta and nothing gets to the baby.