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Sunday, December 11, 2011

Doctors perform cesarean - on woman who wasn't even pregnant

This article made the rounds again on Facebook and reminded me that I still wanted to write a blog post about it. It's been a year, and Jill over at The Unnecesarean did one then too, but it obviously bears repeating: and a resounding "WTF?!"

How does a woman who only looks - but isn't really - pregnant just 'walk in' to a labor and delivery ward and attempt to have a baby without:
1) complete medical records from her pregnancy care provider
2) a vaginal exam to check for dilatation of the cervix
3) fetal heart tone monitoring after a two-day induction?
4) and once you check the cervix and don't detect a fetal head, no ultrasound to determine baby's position or
5) if there really even is a baby there to begin with??


Even people who've never given birth before can likely guess that there is something seriously messed up here. (Actually, for those who want a completely natural hospital birth, to be left alone for two days to labor might be a dream come true...)

She apparently showed up in their hospital "asking for a c-section" and they made the pregnancy diagnosis. Later, however, the resident was found to "not have enough experience to make the pregnancy diagnosis and doctors should have conducted their own exam." No kidding.

Most of us could and do easily make a "pregnancy diagnosis" - it's called buying a $6 pregnancy test and peeing on a stick. And if that doesn't do the trick, I bet any one of us could easily pick up that ultrasound transducer, slather our stomachs in gel and somehow figure out how to get a rudimentary image to pop up on the screen. So what happened here?

Of course, the group of residents and physicians in question received no other disciplinary action other than a stern warning and a "letter of concern" (said with booming authoritative announcer voice) and that was about it. Which says a lot about the state of obstetrics and maternity care in this country these days.

As one commenter - who happens to be a homebirth midwife - said:
And all they get is a "letter of concern"??? As a homebirth midwife, I would get my license yanked for far less. Just goes to show the double standard.
Preach it, sister!

It is a double standard. And the comments - as well as the almost lackadaisical approach the medical staff takes - is troubling to maternity patients who are otherwise said to be "demanding," "seeking attention," blah blah blah - as if it's all their fault. If this woman had a rare medical condition (a false pregnancy, or "hysterical pregnancy," as the article says) that fools her body into thinking she's pregnant when she's really not - who can blame her? Hell, sometimes I get weird flutters and sensations (that are no doubt gas bubbles) that would convince me, if I didn't know any better, that I was pregnant. The idea of calling it a "hysterical pregnancy" immediately conjures up women who are desperate, mentally ill and out of control, running around in circles around the unit with their arms waving madly, "I just need to have a cesarean! Agggghhhh!"

And not only does this take a turn that suggests this woman is clearly at fault and to blame, but if she is mentally ill, there is that stigma as well: and therefore reason to issue a complete lack of sympathy for her. As if to say, Oh, first she thinks she's pregnant - now she's crazy! *snort* Crazy hormonal women! 

Per Wikipedia:
"Research shows that 18% of women with pseudocyesis were at one time diagnosed as pregnant by medical professionals. 
The hallmark sign of pseudocyesis that is common to all cases is that the affected patient is convinced that she is pregnant. Abdominal distension is the most common physical symptom of pseudocyesis (60–90%). The abdomen expands in the same manner as it does during pregnancy, so that the affected woman looks pregnant. These symptoms often resolve under general anesthesia and the woman's abdomen returns to its normal size.
The second most common physical sign of pseudocyesis is menstrual irregularity (50–90%). Women are also reported to experience the sensation of fetal movements known as quickening, even though there is no fetus present (50–75%). Other common signs and symptoms include gastrointestinal symptoms, breast changes or secretions, labor pains, uterine enlargement, and softening of the cervix. One percent of women eventually experience false labor."

Apparently some women even have a positive pregnancy test. 

This article mainly focuses on the psychological aspects of it - women who have tried unsuccessfully for years to become pregnant; those who have suffered pregnancy loss; etc. The actual medical problems, like pituitary problems, are kind of glossed over - probably because when it comes to certain hormone-related illnesses, they are clueless. Chalk one up for the crazy lady again! 

It's amazing the number of comments passing this off as no big deal, blaming the woman for attention or just kind of blow it off and hope no one notices.
Dena Konkel, assistant director of public affairs for the medical board, said the case was "unique." "The board was mostly concerned about the management of patient care," she said. "It may have fallen below the standard of care." 
"Some would argue that this is not disciplinary in nature -- it doesn't limit their ability to practice medicine," said Konkel. But, "it creates a public record, something that can be looked up and read about what happened."
Yeah, that public record that future patients can look at that basically points in all directions to these clowns. And the sad part is that people will still trust them, still keep going to them, as if nothing happened. They'll likely read this story and think, "That woman was mentally ill - it's not really the doctor's fault." "Unique" isn't exactly the word I'd use to describe this situation; I think completely effed up is way more suitable. Using a word casually like that to categorize this event is completely ignoring the fact that yes, it "may" have fallen below the standard of care - by completely ignoring or bypassing all protocols in place to protect both the mother and the baby. Are they really that hands-off that they did no vaginal exams on this patient? I doubt it.

I wonder if perhaps this person just came in, perhaps in pain, and the resident took one look at her and didn't know what to do with her. I've had only one resident in my pregnancy care, while in the hospital, and I could read him like a book: he was young, uncomfortable, and wanted to parrot exactly what he was told to say and do from his superiors. When I presented him with my opinion, firm and respectfully, he backed down immediately, like he had the spine of a jelly fish. I wondered if he'd ever encountered an informed patient before that just didn't take his word for it?

The article indicated that the resident who dealt with the patient was trained in ultrasound. So why the heck didn't they do one? To at least check for the position of the baby's head, since it didn't sound like they had any prior medical records for her? No explanation was offered. Of course.

Something to consider, however, is that in some parts of the state - including those counties surrounding the area where this "birth" took place - there are as many as 5.5 percent of women seeking little if any prenatal care at all. This could explain why there were no medical records (we can assume) or why the seemingly blasé attitude towards the lack of records. Unfortunately this may not be all that uncommon in hospitals where certain factors (like lack of education, poverty and lack of health insurance) mean a woman has not sought proper care in pregnancy.

While this case happened in late 2008, it took the state medical board a year to investigate, and the public first heard about it two years after it happened. One physician still works in the facility, but doesn't deliver babies anymore; another has since left the hospital. It makes you wonder just what went on behind the scenes: was there more than a slap on the wrist? Why didn't the patient sue? Did her mental status have something to do with it? Her economic situation? Why haven't we heard anything from her - or at the very least, seen her on an episode of Jerry Springer? Her neighbors, her friends - surely someone would have seen that she looked visibly pregnant and now, has no baby to show for it. I hope it wasn't a case of her just being too embarrassed to say anything, perhaps for fear of even more stigma should it come to light as a psychological condition that makes her look "crazy." And consider the tone of these doctors - who don't want to come right out and take the blame - it almost makes it sound like they're blaming her and her "mental condition" for all of it.

A certain percentage of false pregnancies are due to mental conditions; but not all can be attributed to that. Some believe that a truly false pregnancy (as opposed to a simulated pregnancy, where the woman fakes it) originates from the pituitary and hormonal imbalances. This is, after all, where breast milk production generates as well, and why some women who were not even pregnant can breastfeed a child. In fact, I remember distinctly a client at the mental health facility where I worked who was lactating - and had never been pregnant. She was concerned, because she knew she wasn't pregnant - didn't want to be pregnant - hadn't even had sex recently. I'm sure the already-existing mental health problems she was already experiencing only added to the "it's all in your head!" ideology.

False pregnancies are apparently fairly common in animals - who knew? But they don't do it to seek attention or as the result of a mental condition. According to Wikipedia, "symptoms of pseudocyesis are similar to the symptoms of true pregnancy and are often hard to distinguish from it." We can give the doctors a pass for not knowing, but not the patient? Especially when a simple ultrasound could have avoided two days worth of expensive induction procedures and a completely unnecessary scar on this woman's uterus. 

More reading:
Doctors perform c-section on non-pregnant woman
False pregnancy


Anonymous said...

Thank you for posting this and your wisdom in analyzing it. I'm sitting her in a nursing school lecuture on birth and I'm reading your blog because it is more informative than the complicit medical model presented in school.

Along the lines of "hysterical" pregnancies and the utter disrespect shown to women with these types of biological processes, we need to get rid of the word "Hysterectomy" from our language. The uterus is not, nor has it ever been, the source of hysteria. That label belongs to the person reacting to a woman with legitimate medical concerns.

The Deranged Housewife said...

Excellent observation - the root of that word harkens from a time and place in medical culture that is now obsolete and yet we still use that word.