How to answer questions about doctors and delivery preferences

studentmom2007 · Apr 5, 2008

Do you teach a specific type of method of childbirth classes? I took Bradley Method Classes and I hope to be certified to teach the same classes sometime soon. I'm not sure what you teach, but the Bradley Method claims a 3% c/s rate. It advocates no epidurals, no narcotics, no pitocin, all very low intervention. I had both my kids in the hospital and had an OB. I was very open with him about my decision and he and the nurses were all supportive. I was able to have a very low intervention birth in a hospital setting.

Their website is www.bradleybirth.com

CEG · Apr 5, 2008

It does seem to be a tough line to walk. I have a friend (L & D nurse)who when asked will say "I usually recommend Dr So and So to anyone who wants a lady partsl/natural/c-section/whatever". That way they haven't deliberately said anything bad about the patient's doctor but make it pretty clear that they are not recommending that doctor to the patients. You could even follow up with "some of our docs have a higher c-section rate than others. Dr A and B are the lowest."

It's tough because you don't want it to get back to the doctor that you are saying negative things about them (of course if it is a FACT then I guess they cannot be that offended), but at the same time you hate to see the lady with an unnecessary section. Good luck!

beckinben, CNM · Apr 5, 2008

Another thing do you guys have some specific websites where these moms can look at risks of C/S vs. lady partsl deliveries? The march of dimes had a good site, but how about some others.

http://www.childbirthconnection.org/

Great evidence-based site with PDF files you can download and print out for your students. Lots on cesarean sections - very supportive of VBAC.

diosadelsol, ADN, BSN, MSN, RN, APRN, CRNA · Apr 8, 2008

Thank you for this website. Our OB told us last week, at our 28th week appt., that our baby was rather large - weighing in at 3lbs 4oz - and that if he is 9lbs or greater at full term we need to consider a cesarean. I have serious reservations regarding a c-section and I only desire one if it is medically necessary! I don't consider a 9lb baby medically necessary - not with my wide hips and a long line of women in my family able to lady partslly deliver 9lb or greater babies without complications. This was just the site I needed to arm myself for our next appt.

mombabyrn · Apr 8, 2008

I don't think it is ethical for you to answer a question by a patient that is essentially a comparison of competing physicians. You hope patients do these things on their own, and long before they are near term. Citing the hospital's CS rate is appropriate. Citing nat'l rates as well. But as far as infering that their physician is going to push them into an "unnecessary section", you are walking a dangerous line there. It's sounds like you already know this and you are being careful not to cross the line.

I had a bunch of stuff for the class I taught, but it's been a few years and I'm sure it's outdated. OB is ever-changing, and it seems the swing lately, and unfortunately, is that primary electives are becoming more popluar. I think there is a lot of talk in the media and hollywood, and I think this is (unfortunately) affecting deliveries. Be a patient advocate- explain the benefits and risks of lady partsl and cesarean deliveries. Put the information out there. But after that, it's up to the woman, and the doc she has chosen to see for care. I think eventually the pendulum will come back to center; it usually does.

mombabyrn · Apr 8, 2008

This is the NIH position statement on cesarean delivery on maternal request:

http://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf

CEG · Apr 8, 2008

Thank you for this website. Our OB told us last week, at our 28th week appt., that our baby was rather large - weighing in at 3lbs 4oz - and that if he is 9lbs or greater at full term we need to consider a cesarean. I have serious reservations regarding a c-section and I only desire one if it is medically necessary! I don't consider a 9lb baby medically necessary - not with my wide hips and a long line of women in my family able to lady partslly deliver 9lb or greater babies without complications. This was just the site I needed to arm myself for our next appt.

Keep in mind that ultrasound estimates of fetal weight are very inaccurate- about +/- 25% at term. I believe ACOG recommends considering a section for a baby above 9 lb 7 oz at term. The outside diameter of your hips has nothing to do with your ability to have a baby, it's all about the inside.

OzMW · Apr 12, 2008

I don't think it is ethical for you to answer a question by a patient that is essentially a comparison of competing physicians. You hope patients do these things on their own, and long before they are near term. Citing the hospital's CS rate is appropriate. Citing nat'l rates as well. But as far as infering that their physician is going to push them into an "unnecessary section", you are walking a dangerous line there. It's sounds like you already know this and you are being careful not to cross the line.quote]
Is it ethical though to be supporting a woman who is facing an unnecessary major surgical procedure, which is proven to be bad for her and her babys health if there is no medical indication? It is a fine line but as far as my practice is concerned my accountability's lie first and foremost to the women I care for. The trouble is women are ambushed by these doctors usually when they are at their most vulnerable, and that to me is unethical!

mombabyrn · Apr 12, 2008

OzMW~ Of course it is ethical to support a woman who faces a cs. I don't believe that was pirap's question. The question was specifically regarding when pts ask how their doctor compares with other doctors at that institution. I taught for many years. And I also dealt with physicians who advocated elective pcs. It raised a lot of hairs at my hospital as well. As the childbirth educator, it is your duty to give your pts the best and most up to date information that is available. Of course this also mean YOU must be up to date. It is your duty to make them feel as prepared as possible for their birth. The childbirth educator's job is to be informative, understandable to the lay person, supportive, and make sure when the mom leaves her class, she is as ready as she can be for her birth. It is not her job to play one physician against another. It is not her job to give her own personal feelings about a particular doctor. If there is an issue with a particular physician, there are certainly places to take those concerns. That is why the chain of command or chain of communication (or whatever you institution has named it) exists. The place to vent about your feelings about a physician's practices is NOT in front of the patient. THAT is unethical. If you want to make a difference for that physician's patients, then follow the appropriate routes to do that. It is certainly our job to be our patients' advocate. It is also our job to know the appropriate and best way to do that. I suggest you ask your manager what she/he thinks the appropriate action is if you feel your patient is being "ambushed" into a cs.

OzMW · Apr 13, 2008

OzMW~ Of course it is ethical to support a woman who faces a cs. I don't believe that was pirap's question. The question was specifically regarding when pts ask how their doctor compares with other doctors at that institution. I taught for many years. And I also dealt with physicians who advocated elective pcs. It raised a lot of hairs at my hospital as well. As the childbirth educator, it is your duty to give your pts the best and most up to date information that is available. Of course this also mean YOU must be up to date. It is your duty to make them feel as prepared as possible for their birth. The childbirth educator's job is to be informative, understandable to the lay person, supportive, and make sure when the mom leaves her class, she is as ready as she can be for her birth. It is not her job to play one physician against another. It is not her job to give her own personal feelings about a particular doctor. If there is an issue with a particular physician, there are certainly places to take those concerns. That is why the chain of command or chain of communication (or whatever you institution has named it) exists. The place to vent about your feelings about a physician's practices is NOT in front of the patient. THAT is unethical. If you want to make a difference for that physician's patients, then follow the appropriate routes to do that. It is certainly our job to be our patients' advocate. It is also our job to know the appropriate and best way to do that. I suggest you ask your manager what she/he thinks the appropriate action is if you feel your patient is being "ambushed" into a cs.

No issue with any of that, my post was unclear obviously. My concern was with the ethics of knowing a woman faces a likely CS (which she doesnt need or maybe want) after her Dr railroads her into it; and how do you manage that question in relation to that.

Management wouldn't give two hoots and of course I'm not going to slag him off. But is it ethical to sit back and be wishy washy about that situation? What if she ends up with a caesarean hysterectomy due to PPH intraop?

As much as we hope women get there own information and make their own decisions the fact is some drs push certain procedures, and as long as we continue to be wishy washy about that; CS rates will continue to rise. As health professionals we play a role in that!

OzMW · Apr 13, 2008

patient choice cs is such a interesting term. here's some research on the subject. health professionals have such an influence on this and then turn around and say "pt choice" and when i say hps i mean all of us, not just drs. apologies for double posting....

a critique of the literature on women's request for cesarean section.

gamble j, creedy dk, mccourt c, weaver j, beake s.

research centre for clinical and community practice innovation, griffith university, brisbane, australia.

background: the influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. this review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and political-economic contexts of maternity care and decision making. method: a search of major databases was undertaken using the following terms: "c(a)esarean section" with "maternal request,""decision-making,""patient participation,""decision-making-patient,""patient satisfaction,""patient preference,""maternal choice,""on demand," and "consumer demand." seventeen papers examining women's preferred type of birth were retrieved. results: no studies systematically examined information provided to women by health professionals to inform their decision. some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. other potential influences were poorly addressed, including whether or not the doctor advised a lady partsl birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues. discussion: the psychosocial context of obstetric care reveals a power imbalance in favor of physicians. research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution.

and another.....

women's preference for a cesarean section: incidence and associated factors.

gamble ja, creedy dk.

faculty of nursing and health, griffith university, logan campus, university drive, meadowbrook, queensland 4131, australia.

background: few studies have examined women's preferences for birth. the object of this study was to determine the incidence of women's preferred type of birth, and the reasons and factors associated with their preference. methods: three hundred and ten women between 36 and 40 weeks' gestation were recruited from the antenatal clinic of a major metropolitan teaching hospital and the consulting rooms of six private obstetricians in brisbane, australia. participants completed a questionnaire asking about their preferred type of birth, reasons for their preference, preparation for childbirth, level of anxiety and concerns, and the influence of the primary caregiver. results: two hundred and ninety women (93.5%) preferred a spontaneous lady partsl birth; 20 women (6.4%) preferred a cesarean section. of the latter group, most had a current obstetric complication or experienced a previously complicated delivery (p