How do they get away with it?

[Rohan]

OK, so I watched the 'Deliver Me' program last night on Discovery. Did anyone else see it? It's been ages since I've watched that kind of thing and I was totally horrified. I know it's filmed in the US and that's a whole different world when it comes to giving birth. But I would have thought that in such a litigous society someone would see a problem with the show - how do they get away with it? How do they not get sued when they're directly contravening guidelines set down by their academic organisation ON THE TV? In the US it's ACOG, right, like our RCOG? How could they possibly get away with inducing due to size at 38 weeks, or augmenting labour immediately after SROM? Both of these are against the standard practice of their governing body - yet they're supposed to be afraid of being sued?! I'm confused.

Did anyone else see it? Don't get me started on how they sabotaged those poor women's births either I wouldn't mind if that's what they signed up for, but so many were going in saying the exact opposite and the docs just put them on the medical fast track for intervention.....

Blergh. Sorry for the rant, I'm not watching that again......

I do wonder how my first labour (lots of "We need to do X") would have turned out if New Assertive Lemon ("No, I'm not doing that") had been there rather than Original Timid Lemon ("Well, I really don't want to do that if it can be avoided...").

I agree with you there portandlemon.

I am a good girl and I am quite happy, in new circumstances, to be told what to do. Because I expect people to do as they are told when I am doing my job (i.e. practicing what I know) I (stupidly) expected medical people to work out what was best for me and not to take some sort of mental box-checking approach.
Therefore when told "please get on the bed, have this monitor strapped on and lie still (for HOURS) so that we don't lose the trace" I just obeyed (albeit with a lot of complaining and asking "please can I move off the bed?" and being told "no").

You can guarantee that if I am ever in that position again I will simply unstrap myself and go for a walk...

Message withdrawn

Hope I don't get flamed for saying this, but I actually think many midwives and doctors are ok with women saying 'no - I understand the risks and the benefits of this procedure and I would prefer not to have it'. The problem is that women are just as risk averse as doctors and midwives. We're all at it. Tell women that their risk of s/b goes from (hypothetically because I can't remember the figures) 3 in 1000 births to 4 in 1000 births after 40+14 and the vast majority of women will opt for a routine induction at two weeks past their due date - even those that really don't want any intervention. Same goes for most interventions.

I've been there myself - I think we all have. It's a disease of modern life and it doesn't stop with pregnancy and birth. I've got a 9 year old who's been begging to be allowed to walk the 800 yards to school gate by herself in the morning. I can't bring myself to let her - because of the 1 in 100000 risk that she'll be snatched by a weirdo on the way there.

Would want to put a disclaimer here though: I do recognise that communication is a massive issue. Sometimes these choices are communicated to women as though they don't have a choice: ie (for example) "if CVS doesn't work we'll book you in for a c-section next week" rather than "if cvs doesn't work we'll need to sit down and discuss what happens next as regards whether you want to try for a vaginal birth or have your baby operatively".

Yes, I think that's probably partly it (the communication issue), Tittybangbang. I didn't feel at all listened to in my first labour (when at the time I thought I was making it clear that I didn't want to have [procedure X] done (actually it was only the syntocinon, but that started the whole cascade of interventions thing)) and was surprised by how easy it was to turn down intervention in my second labour when I gave a firm "No".

Maybe the trouble it that we're British and have been brought up to say "Well, I'd rather not, if you don't mind terribly..." when we mean "No! No way!". So we think we're trying to refuse something but to the HCP it comes across as dithering and being in need of firm guidance.

I think the problem is Port that if you turn down an intervention you have to be prepared to accept responsibility for the consequences - good and bad. I was the same as you in my first labour, and the same in my second - when I turned down the things I didn't want and that I felt were not of benefit to me and my baby - despite a lot of pressure from my consultant. Don't know how I would have felt if it had all gone pear shaped. Fortunately the birth was ok and I felt vindicated afterwards. I had a horrible childish urge to make another appoinment with my consultant for the sheer pleasure of going 'ner ner ner ner ner - I was right!'

I think alot of it comes down to the confidence of the midwife / consultant concerned.
My dd was continually monitored via scalp electrode because I had an ovarian cyst which they thought was going to interfere with her passage down the canal...it didn't and at the time I was glad of the monitoring because that's what i was told at the time.

6 months later when I went to have the cyst out and was signed off by my actual consultant (rather than the 1 I saw at the time of birth) he told me that by the time I was 5cm dilated and was actually in hospital the danger had passed. So I didn't need the continuous monitoring and could have walked round for the entire labour rather than being stuck on my back with my legs in stirrups.

Now pregnant again - was looking forward to being slightly more in control this time only to find out its twins and already struggling a little bit to be involved with decisions...oh joy!

Mmm yes, but if you accept an intervention you have to be prepared to accept the consequences (and responsibility for the consequences? Not sure, but you're going to feel responsible), which seems a bit rough if you were trying to refuse the intervention.

In my first, labour, for example, it wouldn't seem rocket science that if someone's been dilating slowly but consistently, you stick her immobile on a bed for several hours and she stops dilating, then letting her get off the bed for a bit and try different positions to see if things pick up again is at least a reasonable alternative to pumping her full of syntocinon. Especially as there's no cause for concern other than "not progressing quickly enough" no foetal distress or anything (and if there were to be foetal distress then syntocinon would be contraindicated anyway). There just wasn't a risk to postponing administration of syntocinon the doctor at the time didn't even claim there was, just ignored the fact that I didn't want it. I tried to refuse the syntocinon but after being ignored I technically "accepted" it and wound up with the entirely predictable consequences (syntocinon -> epidural -> relative immobility -> c-section). It turned out that DS was asynclitic, which meant that they could pump me full of enough syntocinon to get me to dilate but it wasn't going to get him into a position where he could actually be born. A more active birth with committed old-school midwives trying to identify the reason for the lack of progress, rather than just "fix" it with stuff in a drip, might have corrected his position (and then the dilation would have followed, and he'd have been in a position where he could actually be born).

Sorry, rambling ranty post there, not all of which relates to my original point. I've been surprised at how much more angry I am about DS's birth since having DD, I think because at the time I thought "well, it might not have worked out anyway" but after a breeze of a birth with DD I strongly suspect that there was no reason DS couldn't have been born vaginally given a less time-focused interventionist approach and a bit more old-fashioned midwifery.

But we're all alive and well, at any rate. So I shall get off my high horse.

Going back to the start of this thread, though, it seems that in most US hospitals they'd have had me on syntocinon hours and hours before they did in the UK. Then again, maybe that would be better -- if you're going to mess up the management of a labour so that a c-section is needed, you might as well do it quickly rather than hang on for 24 hours first... [bitter and cynical emoticon]

I think a lot of doctors don't even think that their intervention might not be wanted.

My DH did a medical degree (though didn't end up becoming a doctor). I read out something on MN about a woman having a home birth whose labour lasted almost three days. His immediate reaction was 'why was it allowed to last so long? Why didn't the midwives get her into hospital to get things speeded up? She shouldn't have to go through all that pain.' As much as I tried, I couldn't get through to him that some women would rather the pain than the intervention. He just couldn't get his head round it - why would she choose the longer labour when doctors could 'help' and speed it up? It was really interesting to see his honest confusion about the issue, and his complete incomprehension that any woman might find intervention to be a worse scenario than a prolonged labour.

He's incredibly pro-women's choice as well - he's supporting me in wanting a home birth, and his medical school was very strong on the issue of informed consent.

I don't know the answer, I find it very hard to comprehend too - The answer must lie somewhere in between. The fear of 'intervention' is being exaggerated into a meaningless mantra by some but equally intervention is not always needed. Maybe crystal ball designers could help....

Message withdrawn

I had some intervention with DS1, none at with DS2 and I am happy with both outcomes - and I'm not easy to please .

i dont like watching american birth shows, i always end up cross. the way they push ladies legs back whilst flat on their back yelling 'puuuuuuuuuuush' at them.

i like some of the uk ones when women are walking around the room and holding onto their partners.

oh and dd3 was induced due to size (i had gerstional diabetes), but at 38 weeks she is 7lb 13oz. so not huge.

i went to private consultant in london(for first few months of pregnancy) as have NO confidence in nhs where i live for reasons too long to go into now.EXCELLENT care in terms of scans /prenatal stuff from a consultant.however was told as i live far away i could be induced a couple of weeks early (so baby would be a little smaller and easier for him to deliver) or better still book in for elective c section to save any inconvenience on his side and mine.im 26 and this is first baby,when i asked about options for a natural birth with as little intervention as possible he actually asked why any woman would want to do that to her vagina and without an epi ...madness. at this point i found an independent mw locally and booked her for a hwb.

"I don't know the answer, I find it very hard to comprehend too - The answer must lie somewhere in between.

Ooh, I wonder if that was me?

My third labour lasted three days. I was 5cm at 8am on Monday morning and had ds2 at 5pm on Wednesday.

If the question is 'why not intervene in a long labour' the answer is - as long as the mother and baby are in good health and coping with the labour, and as long as the mother is willing to continue then where is the value in intervening?

It's the interventions that need justifying, not the other way around! Letting a labour progress naturally in the event that mother and baby are both well is the default mode - it doesn't need to be justified.

"The fear of 'intervention' is being exaggerated into a meaningless mantra"

It really isn't being exaggerated - normal birth, that is spontaneous labour in which episiotomy, amniotomy, augmentation, epidural anaesthesia, CEFM, forceps, ventouse or c-section, and a managed third stage don't feature, is now vanishingly rare in the UK. How many women do you know who've given birth without any of these interventions, particularly first time mums?

I rest my case!

And yet even the RCOG estimate that 60% of women should be able to have a 'normal' birth. We're a long, long way from that.

The fact that we talk about it so much in the way that we do is a sign of how bloody dire things have got and how powerless so many of us feel to do anything about it.

i felt i had a total lack of choice and absolute loss of control.im no ''earth mother'' but neither do i like the idea of having epi and continuous monitoring laying on my back unless needed...point was he had no way of knowing whether it would be neccessary at that stage so in essence i was advised to have intervention without ascertaining whether it was going to be helpfull.imo that is terrible. i am very scared of giving birth but what this consultant told me during my numerous visits made be doubt myself and my body in every which way possible. to be honest i still feel a bit like that now.

I'm at 40+3 with first DC. When I tried to speak to MW about putting together a birth plan, she just said 'go with your midwives, they know what they're doing'. I'm starting to think this isn't the best advice, as I want a waterbirth, as natural as possible, with intervention ONLY in the event of emergency eg baby going into distress.
But have ot say, I'm so glad not to be having baby in the US. I haven't seen the programme the OP mentions, but I've seen enough TV shows/movies featuring a woman on her back in stirrups being bellowed at by a bunch of people to push. I asked an American lady if this is for real, and she said yes - I was at that. Their babies also get taken away from mum and put in a mass nursery with all the other babies for monitoring - why??
Things may not be perfect in the UK but at least we don't have to put up with THAT!!

Starlight - I think you're right. This particular MW is a bit authoritarian. TO the extent that she keeps booking my appointments for first thing in the morning even though she knows I've got really bad insomnia. She has a bit of a schoolmarm thing to her. The last one I saw seemed really nice. I think I will jot down some things and make sure DP knows what I want - he's very determined that my laour should be what I want it to be, so I'm fairly certain he'll stick up for it.

Agree with Starlight.

OP here.

I'm not trying to compare Us to Uk birth, or the midwifery versus the medical model of care. I was honestly wondering how they can operate the way they do and blame it on fear of litigation, when it seems to me that deviating from professional guidelines the way they do would leave them more open to legal action, not less. Surely interfering to the extent that they do is going to result in worse outcomes more often, and if it can be demonstrated that they were acting in direct opposition to the guidelines of evidence based care then I can't see how they can defend themselves, even with the best lawyers in town. To then put that on the television is madness IMO.

I have read Tina Cassidy's Birth, and Jennfier Block's Pushed, and I have seen The Business of Being Born - in fact it was I that posted a link to that film here months ago when I found it being shown online. I do appreciate the recommendations though.

I am naturally upset for those women on this thread that didn't feel and don't feel listened to in their care in this country or anywhere else. That was part of my point in my original post - women were coming in saying they wanted a natural birth and then being railroaded into inductions, augmentations, epidurals, etc. They weren't being given the slightest chance of getting what they wanted and worse, they weren't being informed of the effects of any of the things being done to them. I really care about informed consent and seeing that really riled me.

I'm not saying that these things can't and don't happen in the UK or any other country. I just don't understand how a highly trained obstetrician can say ON TELEVISION that there are no side effects from an epidural, that synthetic hormone is exactly the same 'as what comes from your head' It's not. It can't be. Either they don't know that which is worrying or they are lying which is unforgivable.

Comparing the era of scopolamine and twilight sleep to the current birth climate in the US in order to argue that today's women have it good is fairly pointless I think. Noone wants to go back to the days of lying-in hospitals. But when you think of what happened in those days - which was doctors drugging women whether they liked it or not and then performing procedures that could be proven to be harmful to mother and child in order to get the baby out - well. How exactly is routine hormone augmentation necessitating anaethesia and confinement to bed, followed by operative or assisted deliveries far more often than would have been needed - how exactly is that dissimilar?

this article nonsensus consensus really gave me the confidence to refuse induction after going over my dates.

it calls into question much of the research which is used to push women into agreeing to inductions, and pretty much suggests that the risks to baby from going over due dates are actually pretty similar to the risks to the baby from intervention. it is focussed on the canadian experience where inductions seem to be routine from 40 +7 but, in scotland anyway, they seem to routinely induce at 40 +10, which isn't that much better.

of 20 odd friends, not one had a natural first birth in my area. i'm so glad i refused my second induction - had a wonderful water birth on the morning after i had been booked in for induction.

p.s. - am new to the site, so sorry if everyone has read this before!!