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......

You have to sign a disclaimer before getting an epidural in Scotland - I was told about every side effect under the sun and a lot more. They wouldn't have set it up unless I signed on the dotted line. I never know what people mean when they ask about the deliveries - if they were natural or not, you usually have to get a working definition before you can answer. An epidural but no other intervention might rule it out for some. No epi with the second but it was in hospital which isn't my natural environment. I'm sure water births are great but are they natural ? I don't know many other mammals who decide to have them naturally. Would a pregnant cat want to get into a bath?

Message withdrawn

I think a lot of intervention is based on the premise that if you are seen to do something you have a better defence in litigation than if you stood back and did nothing. Therefore, in the litigious American society doctors and midwives may be happier intervening at the first opportunity because they like having control of the situation and their medical insurer likes it that way! Childbirth seems to be pretty inconvenient to most of the medical profession as it can be long and unpredictable. Research shows that a natural birth (where no major problems are occurring) is better for mother and baby in the weeks/months/years after birth but the focus of the consultants and midwives is on the 'here and now' and they want to complete the job with minimal risk of being sued or disciplined for ignoring a hospital protocol.

It is much harder to sue a doctor or midwife for intervening when you think they shouldn't have done as they would cite all sorts of examples of how intervention stopped a particular problem. Much harder for you to come up with tangible examples of how not intervening would have prevented a problem I suspect. I think the UK is going the same way as the US unfortunately, and we also have the issue of stretched resources here which means that micro-managing a birth enables doctors and midwives to be more efficient, free up the beds more quickly for labouring mothers in the waiting room, enable delivery before a shift change etc! I also think that problems caused by intervention are quickly brushed aside with comments such as 'it will be better in a few days/weeks etc' to head off a complaint. Therefore, intervention continues to be the acceptable norm in too many cases and few records are kept of the problems it has caused to balance out the benefits.

Apologies for philosophical rant - got it off my chest now! However, for a first time mum I think its very hard to argue with medical staff unless you really understand a lot of what's going on and have read up on it. Agree with one of the posters here that it is easier to be assertive second time round after you've experienced a birth, had a chance to reflect on what the medical staff told you was necessary and what you found out afterwards. It does take guts to go against medical advice and might be risky if there is a genuine danger so most women will end up doing what they are told.

I'm sure water births are great but are they natural

As they don't interfere with the normal physiological mechanism of birth (unlike all the other interventions I mentioned) then yes - they can be said to be 'natural'.

Re: Midget's post - I think you've also got to take into account that the bar has very much been lowered in relation to what women are prepared to tolerate in labour. If you've read 'Spiritual Midwifery' (thinking of Pruners' comment above) you'll clock that some of the labours in that book which end in normal births are very, very gruelling. I got asked on this thread and have been asked in RL why on earth I didn't ask for intervention in my last labour which was very very long and hard. I can't think of many women that I've met who'd want to put themselves through that for the sake of a normal birth given that as a society we're so........ comfortable with the idea of c-sections and epidurals......

"It does take guts to go against medical advice and might be risky if there is a genuine danger so most women will end up doing what they are told"

I think the problem is that women who want intervention free births find themselves labouring in places where the entire culture is geared against normal births. I don't just mean that staff might sometimes be too quick to jump in with suggesting interventions, but that the whole way women are treated in labour from start to finish militates against the normal hormonal physiology of birth, so making real problems much more likely. In these sorts of circumstances interventions are not only more likely but are perhaps more necessary.

I think that women should be allowed to choose the birth they want. I am the opposite of you all as I was delighted to be induced and have an epidural almost immediately and to have a forcep delivery. I was terrified of giving birth, of the mad rush to the hospital in rush hr London traffic (in central london and we are n london). I always knew I wanted an epidural but the fact that I was induced and got it as soon as I was 3 cm and on the drip was to me, bliss. I didnt have to wait for an anethitist (sp) to be available. I was monitored all the time. Fine by me as I knew how my baby was doing. I had a forcep delivery as they were worried about her heartbeat and had to get her out quickly. For me, that meant about 3 pushes and she was out. I didnt have to push for ages like I thought I would. I had an episiostomy but I was fine after a few days.

For some, this would have been their ideal of a hellish birth but for me, it was an amazing experience. It took 2.5 days to get dd out and most of it was pain free.

My main fear is that everything will go the other way and women won't be allowed the option of epidurals which would make me never have another child.

Most my friends actually feel the same way as me and all but 2 of them have opted for epidurals and all have had positive experiences.

Midget- I think you are completely right about in the US intervention seems an easier outcome to justify. I think for many doctors and nurses if they fear they are going to end up in court it somehow feels easier to go in with a defence of 'I stepped in and tried to help with the birth but it went wrong, rather than I didn't do anything and it went wrong.' That in fact may be medically wrong but in the US I think people are much more expectant that their doctors do something. Its not just when it comes to birth but in all things .. I think they give out more antibiotics and prescriptions and are much more willing to do diagnostic tests. A typical example would be with strep throat (tonsilitis here). According to all my girlfriends with kids they routinely do a throat culture for kids with sore throats during your GP visit which gives a result within 10 to 15 minutes and if you do have the bacterial infection they give out antibiotics right there. My experience with my GP has been they are far more willing to take a wait and see approach-see if the child starts recovering before testing to see what they have or giving antibiotics.
I have mixed feelings on it-sometimes I am glad they don't hand out medicine like candy here, on the other hand a few times my child has been really sick I have felt like I have had to suffer through two weeks of bad illness before getting anything to help them fight the infection.
So a long way of saying there are some strong cultural differences between medical care here and in the states.
Back to the discussion touching on the birth culture here .. I think the midwife model really only works well if there is adequate staffing and resources. Part of the implied midwife experience is that it works when the woman trusts her midwife and the midwife is able to devote attention to her patient to help her have the birth she wants. What makes me so fustrated is that in certain regions that model has totally broken down-they dont have the midwives or beds to provide care. My birth experience (being refused access to the hospital) was completely due to overstretched resources at my hospital. I think if one midwife had even taken one look at me in the 14 hours between being sent home and delivering by myself they would have seen I was in labour. But they were slammed and because I wasn't hitting textbook numbers (i.e. contractions every five minutes for an hour) they kept pushing me to the back of their priority list.
Okay sorry for the rant, I just do get worked up about DS2's birth a bit.

cyberseraphim: i don't know many cats who have baths either, but as i relax in one every night, it felt entirely natural to climb into water after a period of exertion.

it felt natural to me to have an epidural as it got me relaxed enough to enjoy the birth but maybe having a legal background, I am always interested to get down to the level of definition. However a concept such as 'natural' will always have an element of subjectivity that will make definition elusive. Come now now Tiddles, you'll love it once you get in !

glad to hear you enjoyed it.

woops - not finished. when am i ever? i don't think anyone would have an issue with people who want or need interventions such as drugs or surgery. it's when those types of intervention become hospital procedure and the hospital procedure takes precedence over a women's wishes that i become concerned.

i didn't want to be induced when i went over my dates with my first pregnancy, but i was made to feel that i was taking a big risk if i went against the advice of the medical staff. this advice was not specific to my situation, just a blanket procedural policy. and the research the advice is based on may in fact be flawed, if the report i linked above is correct.

in fact, i ended up being in hospital for nine days, 3 days to induce me and 6 days to recover from trauma to my bladder following forceps delivery. compare this with the 24 hours i spent in hospital having my second baby - it just didn't make sense to apply this policy to me in terms of health or finance, and i'm sure that this must be the case for a great many unwanted inductions.

phew.