Wednesday, July 08, 2009

Gosh Darn It: The Continued Admission of Guilt

The Pittsburgh Post-Gazette is rerunning an article you may have seen in 2006.

The article points out several issues we "birth people" have known about for some time. I guess the reason why I am so surprised/appalled/amazed is that they are admitting it!

The following are italicized excerpts from the article. The exclamations are my own.

Driven by soaring liability-insurance premiums for their obstetrics units, hospital groups are adopting policies to discourage or prohibit births induced before the minimum 39 weeks recommended by maternal and child health experts, unless medically necessary. They are curtailing the use of drugs such as the hormone oxytocin to start or speed up contractions, which in too-high doses can lead to ruptures of the uterus, fetal distress and even death of the infant. And they are limiting the use of forceps and vacuums that can help coax babies from the birth canal but also lead to injuries such as bone fractures and nerve damage.

First, why does it take higher insurance premiums/fear of litigation to discourage induction prior to a baby being full term (unless medically necessary)? Why cannot the reason be respect for the growth of the baby? Respect for the mother who may encounter an unplanned cesarean due to a failed induction? And to even use the word coax in talking about forceps and vacuum shows ignorance on the part of the author. The baby is probably trying to stay IN the uterus because he/she knows it is dangerous out here!

With communication breakdowns at the root of 85 percent of all adverse events reported in obstetrics units, hospitals are also taking steps to ensure better teamwork, such as making sure electronic fetal monitors that trace baby's heartbeats are interpreted the same way by both doctors and nurses.

Oh, my....

"The OB is its own little world in a hospital setting, and 99 percent of the time it's a happy and nice place," says Kathy Connolly, assistant vice president of risk management at the insurance-management unit of Premier Inc., an alliance of 1,500 nonprofit hospitals. But obstetricians don't always adhere to guidelines for elective induction set by groups like the American College of Obstetricians and Gynecologists. They often schedule deliveries around their own office hours or travel plans, and don't always take the time to document care in patient records, increasing hospital liability, she says.

The written word is odd. Ms. Connolly might have the voice inflection such as "Those pesky folks, do they need another time out?"

There was good news though.....

Salt Lake City-based Intermountain Healthcare began requiring doctors to obtain special permission to induce delivery earlier than 39 weeks. Intermountain, which operates hospitals in Utah and Idaho, reduced elective inductions at less than 39 weeks to 5 percent of all births today, from 27 percent before the program started in 2001.

Then it is back to the admission of guilt....

"Pitocin is used like candy in the OB world, and that's one of the reasons for medical and legal risk," says Carla Provost, assistant vice president at Baystate Medical Center in Springfield, Massachusetts, who notes that in many hospitals it is common practice to "pit to distress" -- or use the maximum dose of Pitocin to stimulate contractions.

Let's clarify that. Pit to Distress is referring to the practice of increasing the dosage of pitocin until the baby shows distress on the electronic fetal heart monitor and the mother immediately becomes a candidate for an emergent cesarean.

In plain terms, the practices of the physicians cause fetal distress and make operative delivery urgent, life-threatening and painful.

Gary Hankins, professor at the University of Texas Medical Branch at Galveston and chairman of the practice committee of ACOG, says doctors can cite hospital policies in declining to do preterm elective deliveries, which are sometimes requested by mothers tired of being pregnant.

The article ended with the above paragraph. Why do doctors have to use the hospital policies as a crutch to decline early/elective induction? Why don't they tell mothers the truth about the beauty of the uterus and the give they are giving their baby by providing an optimum living and growing environment for them....that with each passing day, they give their baby an even better advantage at life and health.

Not to mention the risk factors with elective induction.

1 comment:

Rae Davies said...

Love your comments - thanks for sharing.