Choice is an interesting concept: if we
truly support choice then surely even 'bad' choices should be
respected? One of our obs has joked about having a sign made for the
ANC saying 'please do not ask for an induction as a refusal often offends'
because the request comes so often.
However, the other obs will often agree to a
woman's request without too much argument. I have seen instances where
the Ob has told the woman - you are not ready to birth, there is no reason
to induce and if we try you will have a lengthy and horrible labour.
The reply was "I DONT CARE- I WANT TO BE INDUCED" How can the ob refuse in
this instance? The reverse is not true - if a woman reaches T+10 she
is booked for IOL - there is little 'choice' within our policy for anyone
who wishes to wait longer - despite the evidence or the individual
circumstances. Occasionally requests for 'social' induction
can be for very valid personal reasons and such instances should also be
respected.
I have discussed with some of
our obs the mentality of agreeing to elective C/S for no other reason
than maternal request, given that we are a public hospital - should we
be wasting taxpayers money on non-essential surgery etc etc.
Again the question of choice. If a woman demands an elective C/S despite
discussion of the pros and cons, the usual route is to go with her wishes -
presumably for fear of litigation if the birth does not go well. I did
challenge one ob who agreed without hesitation to a woman's request for
repeat C/S and asked him what his attitude would have been if she had asked
for VBAC - did not get much in the way of response!
Not saying that I agree with this you
understand but it does cause some tricky moral dilemmas.
I feel the key issue is one of respect and
honest discussion - ah but that is all too often missing within the medical
model of care. That and education - women don't know that they have choices
to challenge the usual practice of whoever their care provider happens to
be, sadly those who do challenge are often seen as 'troublesome radicals' if
their challenge is against 'routine' interventions. (Of course they are not
seen the same way if their challenge is to request unecessary interventions!
:-))
Sue
----- Original Message -----
Sent: Saturday, June 17, 2006 8:49
AM
Subject: Re: Re: [ozmidwifery] ctg
stuff
hi all
i have just finished the 'obstetrics' term of my
course and over the 9 weeks i repetitively brought up my disgust with the
use of CTGs against all the very high quality evidence that is out there
against them, that noone refutes they just ignore. the wonderful
obstetrician who was my supervisor (only one ive ever met that i like)
agreed and said it is only collective inertia and fear that has led to
everyone still using it. the fact that it has sneakily become the best
practice standard. in the big cochrane review on the subject the only
benefit seen was a reduction in neonatal seizures seen in the CTG group.
this was used as evidence that it may reduce the incidence of cerebral palsy
in this group also. actually, there was follow up studies done on all the
studies included in the review some years later and it actually showed no
difference in cerebral palsy rates in most studies. one study amazingly
actually showed a higher rate of cerebral palsy in the CTG group !! this has
been conveniently forgotten. CTGs are still sold to women as being a safety
net to prevent cerebral palsy despite the fact that there is absolutely no
evidence whatesoever of this being the case
all that remains to be the
benefit of CTGs is for care providers. it makes many people feel safe to
have a neat little print off documenting what has been happening. the other
thing is that apparently in the court system, parents can only be
'compensated' if a no fault verdict is made and that requires a CTG.
anyway i wrote a huge article about this titled 'the irony of obstetric
risk analysis' and handed it in with my end of term work. i am waiting
with bated breath to hear the feedback and whether i will fail for being so
blatently anti-obstetrics to my obstetric supervisors!!! but i figured
theres less harm saying it all now, on my way out :)
the reason im
writing this is that the (good) obstetrician wants me to put together my
views on social inductions and social elective caesars and how we should
respond to women who sometimes demand these things and whether it is ethical
to refuse. im really struggling with it because if we all always say inform
and then follow the mothers wishes, what right do we have to refuse this? it
is often for what i see as ridiculous reasons (ie the woman recently who
demanded an induction so she wouldnt birth on 6/6/06 and threatened to kill
herself if we didnt) but who am i to judge women's choices like others judge
non-interventionalist choices?
id love to know everyones thoughts on this
one
love emily
Do you Yahoo!?
Everyone is raving about the all-new
Yahoo! Mail Beta.
No virus found in this incoming message.
Checked by AVG Free
Edition.
Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date:
16/06/2006
