Absurdity of the End Game with Hospital Birth

I don’t know how else to title it.  Perhaps “Being Left at the Altar”  Or “Some OBs Value Weekends More Than Moms & Babies.”  Or “Left to the Tribe: Who Will Catch or Cut?”  Yeah, those are good ones, apt titles.  But I’ll stick with my initial title.

I’m not an OB hater, really I’m not.  There are some awesome docs out there who do wonderful things for women and their babies.  When pregnancies are truly complicated, OBs and perinatologists may be necessary.  When natural birth goes awry and babies need to be delivered by cesarean, OBs are necessary.  Most of the time, though, it’s overkill.

And then there’s someone like me who needs RE assistance for pre-conception (or an OB who’s willing to test progesterone and treat low progesterone) and regular monitoring in early pregnancy to be sure that the babies have a chance at life.  But just because I need interventions in pre-conception and pregnancy does not justify the need for interventions at birth.  I’m deemed high risk for many reasons this time – I’m old, my scarred uterus, twins.

My OB and I have agreed . . . no induction, no augmentation.  That increases my risk of uterine rupture.  My OB and I do not agree . . . I don’t believe that having twins puts my scar at greater risk during labor, mostly because I haven’t found any evidence that supports the claim.  If the risk is there in labor then it’s there just being pregnant.  I reminded him that the composition of the lower uterine segment (mostly fibrous, less contraction) is different from the contracting portions of the uterus.  He had to agree.

But most simply stated: I don’t feel high risk.

So why the title of this blog.  Yes, perhaps I digressed.

I am not assured of getting my OB after hours or especially on weekends.  The call group in this town is large and shared among many practices.  Excuse me . . . but I chose my OB specifically for his track record with lower-interventive birth and “natural” delivery of twins.  I didn’t choose him and the rest of the tribe here in town.

Additionally, if it were to turn surgical . . . I may not know who my surgeon is?  What???  In any other medical specialty this is NOT how it’s done.  This is what is absurd – you spend 30 or so weeks cultivating a relationship with a particular provider only to be left at the altar at week 40?  Only to be cut open by a complete stranger?  Only to be cut open by a complete stranger whose surgical skills are completely unknown to you?  Whereas if you need hand surgery you meet with a surgeon a couple of times, be sure that this is the right surgeon for you, and that surgeon does the surgery!

Why is this acceptable?  How do we put pressure on the tribe to be accountable to their patients.  How do we convince docs to break up into smaller call groups of similar-minded similarly-practicing docs and be sure that women know and have interfaced with these docs at least once during pregnancy?

Tribal obstetrics is selfish.  It’s lazy.  It’s unjustifiable.  Docs, if you didn’t want to serve your patients, you should have chosen another field.

9 responses to “Absurdity of the End Game with Hospital Birth

  1. What you might find even more depressing is that many OBs in the field are now becoming “hospitalists” and as such have no personal interaction with their patients at all in a private practice setting. There is, in fact, some call for all OB care to go this way – you see an OB in a practice for your pregnancy and then get a crapshot “hospitalist” for your birth. Luckily, I know that in my area (IN) this idea is thankfully not catching on (yet), but it is scary, nonetheless.

  2. Mmm, yes I was just reading about “laborists” in Born in the USA. Actually in our town, that may be more adventageous since the call group is SO LARGE. At least I’d maybe have a chance of knowing about the person who is staring into my vagina waiting for my uterus to explode or my babies to need emergency extraction.

  3. On the other hand, if you see that hand surgeon a couple of times and then something happens to make you need the surgery RIGHT NOW THIS VERY MINUTE, then are you assured of getting the same surgeon? Or do you go to the ER to be operated on by a complete stranger?

    Just looking for the apples-to-apples comparison. I fully agree that it would be nice to break OBs into smaller groups of like-minded doctors who would all have some interaction with each patient. But expecting one particular person to be available when your baby decides to come? Not very reasonable, as nice as it would be.

  4. Rini, it’s just not apples to apples. Sure, if I were in a car wreck in the next 10 or so weeks and was taken to the ER, I’d be more than grateful to the doctors that may save my life and my unborn babies.

    Although it is more likely that I will be in a car wreck in the next 10 or so weeks than it is that I would ACTUALLY NEED surgical services, I will be having these babies at the hospital. My birth WILL be monitored by L&D nurses and surgical specialists. It is 97-99.5% likely that these services will be unnecessary.

    If I need an emergency surgery, then it’s a completely different fruit… or perhaps not a fruit at all. Whatever it would be, it would not be an apple.

    We really can’t compare natural birth in the hospital to the home setting. The hospital isn’t trained for natural – it’s trained for exactly what you pointed out: complications and emergencies.

  5. >>But expecting one particular person to be available when
    >>your baby decides to come? Not very reasonable, as nice
    >>as it would be.

    Um, it is totally reasonable for those who practice the Midwifery Model of Care.

    Seriously, if one does not want to get up in the middle of the night & attend births, he or she should not become an OB. At the very least, care providers have a responsibility to their patients to be part of a like-minded group with whom to share call. Providing prenatal care, but then sending your patients to the wolves is as good as no care at all.

    Lisa H.

  6. ITA with Lisa. I know OBs are very busy, I get that. But if they didn’t make it so hard for midwives to practice, OBs wouldn’t need to take on so many patients- in particular patients who are low-risk. It’s overkill to see a trained surgeon who specializes in high-risk pregnancy for those who have a low-risk pregnancy (which is what, like 90% of women?). If OBs didn’t overbook their schedules & take on so many patients, they could give more individualized care instead of having 5 minute prenatal appointments that always run a half hour late.

  7. It’s really sad that it has to be such either/or. Either you get a midwife and do a home birth and risk that you will have a complication and take precious time to be rushed to the hospital (not to mention all the problems with insurance companies refusing to insure home birth services, etc.) or you put yourself into the hands of the hospital overkill machine which is more interested in getting your baby out and getting you out the door than in what is right for you and baby.

    It is a very good point that midwives are expected to show up all hours, small groups of OBs would also help. But what would really be nice is if you could have the best of both worlds. Have a midwife assisted birth on your own time in a comfortable hospital setting, with OB surgeons only there as back up, to be brought in when you and midwife determine it is necessary.

    • Some of it seems to be that OBs don’t want to just be there as “back up.” That was part of the justification given by my OB as to why I couldn’t work with his CNM. Granted I don’t know much about her – she could be just as wonderful as a HBMW or as interventive as an OB…

  8. I am pregnant with twins and I feel the same way a you. In fact, I feel like you wrote my thoughts down exactly. I love my OB, but again she does not work most week nights and weekends- so where does that leave me? So now I am looking into other options.

    What did you end up doing? Staying that that OB or switching to midwife/ homebirth?

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