Saturday, August 7, 2010

Dear OB Who Handled her ER Miscarriage ...

Dear Cedar O.B.,

I came into the Emergency Room on August 5th, 2010 to be with a friend who was losing her baby. When I arrived, you were in the middle of explaining to her the options that she had. As you continued talking, you were unaware that you had a Midwife in the room. You were unaware as well, that you were speaking to a student Midwife who knows much more about pregnancy and childbirth than your average patient.

I listened as you used scare tactic and coercive wording to try to get her to agree to a Dilation and Curettage procedure, which even she knew was completely unnecessary at that point in time. I listened as you continued to call it her “pregnancy”, rather than her baby. You may have some women who walk in who aren’t fully excited about being pregnant in the first place, but I can almost guarantee you that when you have a woman walk into the ER in hopes of preventing the loss of her baby, you are dealing with a mom who is emotionally distraught. Calling it a “pregnancy” rather than a baby, is offensive to a mother who is facing losing a child.

You told her several times that whatever she decided was completely up to her. However, you continued to go back to surgery and scare tactic. You told her that she could do expectant management, and be sent home to await the “loss of the pregnancy” (again, offensive), but that she could hemorrhage very quickly and need emergency surgery anyway. You told her that she could be admitted, but that they couldn’t “keep her forever”. Believe me, the hospital was the last place that this mother wanted to be. She has been planning a home birth since finding out that she was pregnant. At one point, you told her that some women chose the Dilation and Curettage “to get it over with faster”. What a lovely way to put it. I’m sure that you could have chosen a different set of words to be more compassionate. However, your motivation was clear to both her and me.

There were also a few things that were said, that were extremely inaccurate. The only two reasons that would fit for saying such things would be that either you were hoping to scare her into surgery, or you were uneducated as to the things you spoke about. Either scenario is distressing.

1) You told her that her white blood cell count was elevated. You did not give her a quantity. The Emergency Room doctor the night before had told her that there can be several reasons for white blood cell count being elevated, and in her case it was probably due to pain and/or the emotional distress that she was experiencing. Doctor, both you and I know from basic medical knowledge that a white blood cell count can be elevated for more reasons than just infection. Yet, this is the reason you gave her. You told her that she may have Chorioamnionitis, and that if she chose expectant management if this was the case, it could quickly turn into a “septic abortion”. Here is the problem with this diagnosis – she had no symptoms of chorioamnionitis. She had been tested for bacterial infection, which as far as we know came back clear. She had no fever. Her abdomen was not tender to the touch. She had no foul smelling discharge. The baby did not have an elevated heartrate, rather the opposite. I understand that not always are symptoms present in the case of chorioamnionitis. However, when you are speaking of something that occurs in less than 2% of pregnancies, and there are zero signs or symptoms of this, the diagnosis would not be plausible.

2) After speaking to her of possibly having Chorioamnionitis, you mentioned that while she had been given IV antibiotics, they don’t tend to work for 24 hours after administration. Doctor, is it not OB and Hospital protocol to give women in labor who test positive for GBS, IV antibiotics roughly four hours before birth to prevent infection in the newborn and mother? Do you not administer a prophylaxis antibiotic one hour prior to most surgeries? So I ask you – which one is correct? I understand that you probably rely on most of your patients to be uneducated to these things, and not question what you are saying. People come in and rely on you to know much more than they do about their condition, which is why they see a doctor in the first place. However, regardless of whether or not a patient is informed to certain medical conditions and treatments, it is inexcusable to use coercion through scare tactic to obtain consent for a treatment or procedure that you are obviously pushing for.

3) My main contention is when you flat out lied to Mrs. P. When speaking yet again of surgery you told her that her baby, at 13/14 weeks, was only about an inch and a half long. You used your finger for reference, stopping at the middle knuckle. Did you think that by lying about the baby’s size, she would agree to surgery because it made her baby less of a baby? With all of the development sites that pregnant women keep up with now, I know that most women know a rough estimate of how big their baby is at any given point in pregnancy. Had you forgotten that Mrs. P. had several ultrasounds up to that point to follow her diagnosis of Subchorionic Hemorrhage? She had just seen her baby on the monitor earlier that day. She knew that he was perfectly formed, and she knew how big he was. She had already begun to feel him move and kick. What really appalled me was that when you found her son to be in the vaginal canal, you told her that by the look and size of him, she was right on in her estimate of being between 13 and 14 weeks. He was roughly 4 inches long from head to rump, and perfectly formed.

I was also deeply disturbed that you were recommending Cytotec (Misoprostol) to a woman with prior uterine surgery. I understand that Cytotec is less of a risk in first and second trimester use, but is nonetheless not approved by the FDA for this use.

When you did the sterile pap exam and found her baby to be in the vaginal canal, you didn’t explain anything that you were doing from that point on. You did not explain to her that you were going to do a manual exploration of her uterus. You simply told her that you were going to “touch” her uterus to make sure that it was firm. I’m sure that some women may not want to know what is being done to them. Sadly, this is the result that we have from people viewing medical personnel as infallible and completely scrupulous.

I understand that you are brand new to the hospital and area. I am saddened that I will be reluctant to refer to you in any way as a care giver to women that I come across. It’s a shame to not have more reliable Obstetricians in Southern Utah. This letter is not to say that there is any legal action being taken, but rather in hopes of making you more aware of some of the women that you may serve. Doctor, please be very careful with your wording and please keep a check on your motives when you are dealing with patients. It would have made my dear friend’s experience a little more bearable had you been more compassionate, and less self-serving. I’m sure somewhere in training there must be sensitivity sessions in situations as hers. Sadly, I have come across many more in the healthcare field that lack this basic of human capabilities, and there’s just no reason for it.

Hopefully from this point forward, you will take my words to heart. You never know how educated a person will be that walks into your office or hospital. I would personally recommend making sure that you are careful to issue advice without bias, in order to avoid any issues in the future.


Christine Fiscer, Traditional Midwife


Jessica said...

I sincerely hope that doctor heeds your words. :-( The first time I encountered that sort of behavior from an ER doc I was so shocked that I couldn't respond. I did complain to him and the hospital later. However, if I should ever be so unfortunate to witness it again I'm quite sure I will not be able to hold my tongue. *hugs* to you both!

Erin said...

Sadly we know first hand how wrong doctors can be when they want to perform a surgery and take the easy option instead of listening to the patient and waiting for lab results to come back. Today is my sons third stroke survivor anniversary. He was two when the ER doctor told me he had appendacitis and demanded to do surgery immediately. What he really had and should have been immediately diagnosed with was E.coli posioning which lead to Hemolytic Uremic Syndrome with a resulting stroke. It's sad that I no longer have much faith in traditional doctors because they do have a place but we've been through far to many bad experiences to not be jaded anymore.

natalie said...

I recently had a bad ER experience, but nothing like this. I merely ran into multiple people unaware that breastmilk is better than Pedialyte or Sprite for a sick toddler. I am definitely planning on writing the hospital administrator, especially since my child had Hemolytic Uremic Syndrome and I was told later by multiple doctors and ICU nurses, as well as the kidney specialist, that breastmilk was absolutely the best thing for him as his body dealt with acute renal failure.

I am so sorry that this mamas loss wasn't handled in a compassionate way by the OB.

Ashley said...

I love how you handled this. When she told us the story of the ER experience yesterday, I was appalled! I am so glad you have confronted this OB about it. You are truly a blessing to the medical field.

Claire said...

Well written letter, what awful experience! I hope something comes from it.

Something I picked up that you didn't mention was the use of "abortion". I know when I was losing my babies I hated hearing that word, not because I didn't know why they were using it but because I didn't want to be reminded of such things then. Not all women understand why it's used and it can cause upset.

Did you get "Product of conception" too?

When I miscarried they did an internal to see if my cervix was open and he took out one of the babies (triplets). For some reason he then said to Mum (who was comforting me) "If I can just show you this tissue"!!! Mum looked not realising what he had in his hand... She had nightmares for weeks :-(

I have lost four babies over two pregnancies and I could write reams on how they handled my losses. I don't get doctors and even MWs to some extent, where's the compassion?

BeaDandelion said...

thank you. that was very touching and enlightening. SO sorry you had to witness such, thankful you are willing to share.

Gombojav Tribe said...

You did send this letter to the doctor and the head of the hospital didn't you? If not, YOU SHOULD!

Karen Joy said...

Echoing Gombojav Tribe -- I hope you truly did send this letter to the doctor, and to the hospital itself.

The Deranged Housewife said...

I really hope you DID send this letter. I know it's hard for us to say what you should or shouldn't have done, since none of us were there and weren't or haven't experienced a loss like that. But sometimes I think it's important that these people get called to the carpet once in a while and put in their place - gently taking this doctor aside later and saying, "By the way, I am a midwife and realize most of what you told this patient was false." The best thing, though, was that you were there to support your friend, which I'm sure she found invaluable.

I will say that using the term "pregnancy" is much better than "fetus." I can't stand that - as if it's an inanimate object that doesn't feel or even remotely resemble a baby (which we all know it certainly does). My father-in-law, a retired physician himself, had the gall to call it a "ball of cells" when his own daughter miscarried early on in a pregnancy. Yes, a "ball of cells" that just happens to look like a baby already and have a heartbeat.

My heart goes out to you and to this mama.

Nicole D said...

Good for you! So sorry for you and your dear friend!

Mandy said...

i'm so sorry for your friend's loss. unfortunately dr's like that are all too common. i had to have a perinatal consult after losing my precious daughter this summer, and when i just wanted to ask a simple question about one of his reccommendations, the dr YELLED at me "do you want a live baby this time?!" he later went on to have a debate with me on why i should get an epidural, when i wouldn't get one if you paid me, and it was clear he was either lying to make his point, or seriously uneducated. why don't dr's have more training on how to be compassionate to their patients? why are they so angered when the patient is educated about pregnancy? i am glad your friend has you to stand up for her. i hope you really did send that letter to the dr, and the hospital he works for.