A friend of mine shared this on Facebook today. Take a look at the article first and then come back. For those of you too busy (lazy) to read the whole thing, essentially a mom gave birth on the way to the hospital and the hospital showed very poor judgement in the way they handled her case. They administered medications without discussing it with the patient first, they denied access to the baby postpartum, they bullied her into making medical decisions, and they abused the law to take the baby away from the mom.
Let's back up a bit. First of all, we only have one side of the story and it is written from the perspective of a non-medical person (not that there's anything wrong with being "non-medical" but they have a very different perspective going into this). Second of all, I haven't confirmed that this story is true. The site appears reputable, but it is the Internet, so who knows. For all that, we are just going to assume that this really did happen. Finally, this won't be a discussion (for now) on whether midwives are better than doctors, homebirths are better than hospital births, or natural is better than epidurals. That's for another time.
I am currently on my OB/GYN rotation and we had a very similar patient come in earlier this week. However, the staff here at my hospital handled the situation very differently I'm pleased to say. Now when a woman comes in to the hospital having just given birth in an ambulance, a lot of people are going to rush to the scene to make sure both mom and baby are not only okay for the moment but that they both survive in the long term. With this woman's history of trying to deliver by midwife, it's probably safe to assume that the hospital was working blind. They had no medical records, no history of prenatal care, and no information regarding the patient except what EMS gleaned from the ambulance ride over. The medical staff are going to assume the worst and work from there. They are also going to be working quickly to learn as much as they can and do their best to make sure Mom and baby are stable. So I understand if Mom's questions weren't being answered right away.
As I picture the scene, Mom is being rolled in on a gurney. Baby is crying. Nurses and docs are rushing about trying to check vital signs and asses for any emergent medical issues. And Mom is panicking and saying to anybody she thinks will listen, "What's going on? Where's my baby? Why can't I hold my baby? Why won't anyone tell me what's happening?" I understand her concern. I also understand if it takes a bit for her to get some answers and that to her, it probably feels like hours before someone finally talks to her. But for the medical staff, when seconds count, they are trained to stabilize first and answer questions later. So at this point, I think we do have some miscommunication/ lack of communication between staff and patient. But as a patient, Mom needs to understand that by coming to the hospital she is implying that she trusts the medical staff to make appropriate, standard of care, decisions for her in an emergency.
Let's talk about the Oxytocin. Also called Pitocin, this is a synthetic form of a hormone released by the body to stimulate contractions. In the hospital, it is often given to help moms who are not progressing with labor. In this case, Mom had already delivered the baby. So why the oxytocin? Again, since all I have is the non-medical side, I'm going to have to make some assumptions. When oxytocin is given postpartum, it is usually because there is excessive bleeding. Oxytocin causes the uterus muscles to contract and the thought is that this then squeezes the blood vessels shut responsible for the blood squirting out. This may help answer why nobody was initially responding to Mom, they were worried she was losing too much blood and were working to save her life. (Oxytocin may also be given to help with delivery of the placenta, this may also have been the case but it seems much less likely as the nurses were rushing to give the oxytocin to Mom).
Now as far as Mom, Dad, and Baby not being allowed to leave, this is not cool. A hospital, unlike a jail, is a place where you may leave whenever you wish. Most people wait until they are discharged from the hospital by the doctor. But a person can leave AMA (against medical advice) at any time. Most hospitals require the patient sign a waiver saying they won't sue the hospital if something goes wrong because they left early, but you can almost always leave. It is even possible to leave without telling anyone (this is commonly called elopement) and while hospitals don't like it, you are well within your rights to do it. Medically, I can understand why the staff wanted to keep Mom and Baby around, but they legally can't enforce that without a court order.
Threatening to take the baby away unless Mom agreed to medical procedures is called coercion and, if not illegal, is definitely unethical by all medical standards. Forcing a patient to undergo an invasive medical procedure is also known as assault.
Getting the police involved and taking the baby away is a truly terrible thing that happened. From what I know, without a court order, it can't legally be done. I'm very sorry that the parents had to go through that. I can only imagine how distraught I would be if someone tried to take my son away from me.
So that's my perspective on what happened. I think a lot of it was terrible, but some of it is understandable from the other side. What are your thoughts?
For now, my comment is going by the assumption that the story is true, because I do know and trust the organization behind it. As you stated, there is another side to this story which I am sure will be argued in the court case.
ReplyDeleteYou are absolutely right that this debate has nothing to do with whether a certain license, facility, or procedure is better than another one. It has everything to do with rights.
I have the medical perspective of being a licensed midwife who has transferred care of patients to hospitals. About 50% of the time the woman is treated poorly by at least one of the medical staff because of the choice she made to birth at home.
In most situations, a woman makes an informed choice to have a homebirth as long as her care stays within the realms or normal and low risk. Many times she chooses this because she doesn’t want to have procedures done or medications given that are a standard of care in a medical facility (including pitocin, which is commonly given preventatively and does carry risks). This is her decision, and her right. It has nothing to do with which is better. Either situation can have risks and benefits. If a situation arises in which the women has a abnormal or high risk problem and therefore transfers care, she should be welcomed into a facility that is equipped to treat her. Under the recommendation of her care provider she is there is because she wants the very best for her infant and herself. So instead of hearing “homebirth” and be treated as stupid, she should be applauded for having wisdom and placing herself in a situation that is outside of what she had planned. Usually, most people are trusting and compliant to accept standard of care and not question things that are done to them. Most homebirth transfers will not feel like this, which is why they had planned something alternative in the first place. In my opinion the care provider should always, but especially in these cases, be respectful to communicate what and why they are doing certain procedures. Example: “We are giving you pitocin because you are bleeding heavier than what is normal and we are worried.” Or, “we give everyone a shot of pitocin after the delivery the baby, is that ok?”
The other perspective, taking all medical training out of it: I am a mother and a homebirth transferee. I personally know how I was coerced and mistreated because of the choice I made to refuse a test. I have personally been threatened with custody loss of my child because I wanted to leave AMA under the care of 2 other licensed midwives (not including myself, as I was the patient), in a situation that was under the guidelines of normal postpartum and newborn care under the midwifery laws. I had no risks, and no high care situation going on at that time. But because a pediatrician disagreed with my choice (my right) I was forced to do as he wanted. That is very wrong.
I am very happy that you handled a similar situation differently. I wish that was always the case. Unfortunately, ones like mine and the other or becoming more and more common.