Vaginal birth after Caesarean (VBAC) can have risks, including uterine rupture. Because of this malpractice risk, some OBs refuse to do them:
But she says she was shocked when at eight months pregnant, her doctor’s office, Simmonds and Simmonds in Frederick, gave her a letter telling her they were letting her go. They said it was because she challenged the use of a fetal heart monitor during labor and insisted on having a VBAC, a somewhat controversial procedure that some doctors say carries a higher risk of uterine rupture . . .. . . “If the patient comes to the physician with unreasonable demands, and will not allow him to deliver them in a safe manner, then the physician has the right to discharge the patient from his practice,” says Dr. Chet Wyman, vice president of medical affairs at FMH.
Update:
#1 Dinosaur says the situation sucks.
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{ 22 comments }
What she wanted, was a vaginal birth after two cesarean sections. The risk of uterine rupture is then around 2 %.
I have done this kind of VBAC several times, but never without internal FHR and fetal ECG monitoring. If I did, and something slightly untowards happened, the medical authorities would demand (and probably also get) my head on a platter. So I would refuse such a patient if I legally could (which I probably can’t, refusing a patient is illegal here).
Of course, it is every woman’s choice what to do with her womb and her life, but someone but tell the general public that “taking responsibility of one’s own life and health” also includes personally shouldering the risks inherent therein, accepting the downside as well as the upside and not blaming anyone else.
If she will not have an operation, and not use FHR, why would she need an OB at all? Given those restrictions, she could just as well give birth at home or under a tree in the garden.
But then there would be nobody to sue, would there? No hostages…
Good for the OB. If a patient asks a physician to be complicit in a care decision he/she feels is totally inappropriate, then the physician should absolutely take this step. The odds are that this patient will do ok, but physicians must make treatment decisions based upon all potential outcomes.
But why did the MD wait 8 months before dropping the patient?
maybe the patient didn’t decide what she knows is best for her baby until then, or changed her mind in the 8th month.
A refusal to allow any monitoring of fetal heart rate and fetal electrocardiogram is outrageous and exceedingly dangerous to both mother and baby. The comments by Barbara Stratton, Baltimore chapter leader of “ICAN (International Caesarean Awareness Network)” are exceedingly irresponsible, and fail to address the issues in this case.
I suspect that Ms. Stratton only heard the headline. A critical analysis on the papers against VBAC allows enough wiggle room that outright VBAC refusal is inappropriate. But how often are the details lost in the headline:
double sections –> pretty risky
refusal to have monitoring –> foolhardy
If a physician is not comfortable providing the care requested, it should be clear the patient needs to go somewhere else.
Kevin, there was no reference to malpractice in the link. It appeared to just be a professional refusing to act in a manner they didn’t feel was safe for their patient, and advising the patient as such. No different than what professionals of all kind do every day.
Is there something else in the article or are you just reading minds?
And if malpractice risk was the reason, do you believe that’s a bad thing?
Anon 12:07 –
just like the woman – insisting on what she knows “best”- more than the professional that she went to for aid in her delivery, you are questioning Kevin’s editorial prerogatives!
Get a grip: this is his blog! As long as he does not put out 100%factually wrong information, he can editorialize as he wishes. The readers and visitors to the blog can decide for themselves whether to keep on visiting or not.
Just like this woman, who has the freedom to find a provider [perhaps she can go to a high ranking midwife officer in Annapolis] who will carry out her wishes – based on her “better” judgment than the professional delivering her. Talk about putting the cart before the horse…lol.
Its only a success story when both parties decide to move on as they should.
Not when there’s rancor -magnified in the media – like in the part of this patient. Unfortunately…
“Get a grip: this is his blog! As long as he does not put out 100%factually wrong information, he can editorialize as he wishes. The readers and visitors to the blog can decide for themselves whether to keep on visiting or not.”
Settle down hall monitor. Kevin’s a big boy, and doesn’t need you making his points. If he was afraid of people questioning his editorials, he’d disable comments.
“Get a grip: this is his blog! As long as he does not put out 100%factually wrong information, he can editorialize as he wishes. “
And people can disagree with his editorial position, even if it is only 1% factually wrong. (BTW, you have a really low standard for facts…)
People should assume the risks they want to. Fetal monitoring is associated with higher rates of intervention (and slightly lower rates of perinatal death). She wanted a normal birth; it’s her body. What’s the big deal?
i know there have been posts on this very blog where you guys have complained and argued for the exact opposite. How many times have you said that there is no reason why a woman cant have a vaginal birth after having a c-section? You just agree with whomever happens to be the MD and what he is saying. You flip flop more than John Kerry.
i know there have been posts on this very blog where you guys have complained and argued for the exact opposite. How many times have you said that there is no reason why a woman cant have a vaginal birth after having a c-section? You just agree with whomever happens to be the MD and what he is saying. You flip flop more than John Kerry.
# posted by Anonymous : 4:43 PM
Anon 4:43
Your post is complete garbage in my opinion. Many HOSPITALS DO NOT ALLOW VBACS due to the liability.
Please cite ONE example where a physician on this site advocated for the use of VBAC
FP MD
Your wasting your time. He doesn’t have the knowledge base in our field to know what you are talking about.
If he lets her VBAC (TOTALLY against ACOG recommendations as she has 2 prior CS and no vaginal births) and she has a bad outcome, the lawyer will say that he should have “tried harder” to talk her out of it. Since the max insurance the doc can buy is a million, and that would be way less than the usual award in these cases, the doc is stuck. ICAN should understand that it’s not the docs who are taking away women’s autonomy – it’s the trial lawyers and juries who will say, years later, that the woman “didn’t realize” what the risks were if something goes wrong, and the doc should have “made” her do the CS. In other words, juries have taken away women’s right to refuse CS, by holding the docs liable when they do.
Although a physician cannot force a woman to have a C-section if she does not want to, a woman cannot force a physician to perform a C-section if the physican does not want to. That’s really what this boils down to, but the patient in this case was shocked when the physician stuck to his/her position. I understand the patient being frustrated but it seems she does have another doctor lined up to do the VBAC at another hospital.
Dominic A. Carone, Ph.D.
Founder and Webmaster of MedFriendly.com and The MedFriendly blog.
“In other words, juries have taken away women’s right to refuse CS, by holding the docs liable when they do.”
Please point us to a case like the one Kevin posted where the jury ultimately held the doc liable.
Just the state and case name will be sufficient.
Anon 10:25.. yes, we had better find such a case, otherwise it will never proceed right?
Use your imagination, as I am sure her future lawyer will. CAn common sense prevail just once on these posts? Would ANY non physician here like to be put in such a bind when you spent YEARS training and getting competent and paying all these fees, just to get a patient like this who gets you in a catch 22???
So in other words you can’t think of a case. Keep us posted.
And how is anyone in a Catch-22? He discharged her – end of story.
Yes, but now he will fear the potential lawsuit over some silliness like “discrimination” or “abandonment” or some garbage. Even if it never comes to pass, it stalks him. And I’m sure it was led up to by long, lengthy and painful discussions, all the while knowing he was right. So frustrating.
Why will he fear that? How likely is that to happen? Do you know of any similar cases?
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