Thursday, September 22, 2011

Brilliant Repeat Cesarean Patient Plan

Step 1:

Convince first time moms that pregnancy and childbirth is so dangerous and so scary that they need to hire a trained surgeon (OB) to care for them. Even though pregnancy and childbirth are physiologic events. After all, things can go wrong at ANY MINUTE, right?

Step 2:

Convince women that heavy monitoring and/or induction and/or epidural and/or cesarean is going to be necessary. Small pelvis. Past due date. Low fluid. Big baby. Small baby. One or two higher blood pressure readings. Water broke without labor.

Step 3:

If women refuse labor induction, find a reason to scare the shit out of them. Most often? "YOUR BABY WILL DIE IF YOU DON'T ACQUIESCE!" Your baby will be too big, and will get stuck in the birth canal. Your baby is in distress because we found meconium on the bio-physical profile at 41 weeks. Your baby has little to no fluid left, and can die. Your pelvis is just too narrow...we'll LET YOU TRY, but you will probably need a cesarean. If you attempt a vaginal birth with a breech baby, you will kill/harm/damage him. If you attempt a vaginal birth with twins, you will kill/harm/damage them.

Step 4:

Begin induction on a woman whose Bishops Score is unfavorable. Crank up the pitocin, even though the woman's cervix is not low, soft, or dilated. (Or barely so) Recommend an epidural so that the pain of the unnaturally strong (and unnaturally occurring) contractions can be taken away. Break her water artificially. Do internal exams every 2-4 hours.

Step 5:

As soon as the baby goes into distress as planned as you knew he would unexpectedly/mom gets a fever/placenta abrupts, explain to woman that she needs an emergency cesarean NOW, otherwise baby will die/be harmed. You DO WANT WHAT'S BEST FOR BABY, DON'T YOU?

Step 6:

Do not share with woman that according to evidence based research, it was a failed induction because her baby was not ready to be born. Or that inducing for "suspected macrosomia" is going against evidence based protocols. Or that inducing at 12/18/24 hours after water breaks is not evidence based. Or that inducing with a low Bishops Score is formula for cesarean. Or that inducing for low/no fluid is not evidence based.

Step 7:

Convince the woman that it was her body's fault, or baby's fault, that she had a cesarean. Your pelvis wasn't large enough. Your labor wasn't fast enough. Your body didn't create enough fluid at the end. Your baby didn't tolerate labor well. Your baby was too big. Your baby didn't come out when he was supposed to. Your baby wasn't in the right position.

End result?

Scenario 1:

A woman who is now even more scare of pregnancy, labor, and birth. A woman who believes that her body is broken, and that her body put her baby in danger. A woman who will be far too terrified to plan for a normal birth with the next baby. Who will plan her repeat cesarean for 39 weeks, since her body is too dangerous to try again.

Scenario 2:

A woman who will ask her "wonderful, natural friendly" OB (surgeon) if she can "try" for a VBAC, and will not do so because her OB (surgeon) reminds her that her body didn't do well the first time around, and it's safer to have repeat surgery.

Scenario 3:

A woman who will plan a VBAC, but will once again hire a trained surgeon (even though she's trying to AVOID surgery) and most likely will allow interventions in a normal pregnancy and/or labor (VBAC is still normal!) for the same reasons listed above.

Obstetrics, even though 2/3 of their protocols are NOT based on scientific evidence (according to the latest research), continues to claim 99% of women as "patients". Some people wonder why our cesarean rate is so high nationally, and our infant mortality rates are inexcusable. It's really pretty simple. Take healthy, low risk women with healthy, low-risk babies and convince them that they need Obstetric (surgical) care. Add this to the above formula, and you have almost guaranteed repeat cesarean clients. Higher revenue for doctors, insurance companies, and hospitals. (Let's not forget that with cesareans comes a higher rate of NICU admission - even more revenue)

Women - start thinking wisely. Research your options more carefully than you research the car seat, crib, diaper bag, or latest accessories. Childbirth is nothing to fear. Really.

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