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Who Chooses the Choices?

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By emjaybee

Just saw this story over at Birth Sense, and thought it was an interesting peek into the commerce of hospital treatments. The Birth Sense blogger mentions as product called Gynacare Interceed, which is described on the Gynacare website as a lightweight, tissue-like “fabric” adhesion barrier that your doctor can apply to organs to protect and separate them during the healing process. The fabric eventually dissolves as your body heals.

Now there are two interesting things about this product. The first, as Birth Sense points out, is that it is being marketed under the assumption that any woman with one c-section will have another; VBAC is definitely not the expected norm. At the same time, the problems associated with adhesions, such as placenta accreta, are on the rise, but still not moving ACOG to do much to increase the VBAC rate.

The other thing that struck me is that when you go to the Gynacare website, you find that they are marketing directly to you, the patient. You are told to urge your doctor to use their product during your next c-section to prevent adhesions. Which is more than a little odd. Should patients also voice opinions about the type of scrubs, brand of instruments, choice of sponges that their surgeons are going to use? Since when did this fall under our responsibility? And how on earth would we know whether their claims have any validity?

While the manufacturers would no doubt respond in flattering terms about patient choice and autonomy, I can’t help thinking that what we’re dealing with here is the “illusion of choice” phenomena; in other words, being told to choose between lesser options and to ignore the fact that better options are being kept off the table.

This happens a lot in pieces directed at women, who get asked questions like “Will you be a man-hating feminist or perfectly submissive? Do you marry a wimpy nice man or an abusive he-man? Are you a Madonna or a whore?”

The first lesson of resistance is: question the assumptions. Who decides what choices go on the list? Who decides what your possible answers are? Who decides what the questions are? And why should you give them that power, anyway?



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Reader Comments (10)

I haven't read the website's description of this product, but personally, I would've loved for my hospital to use them. It would've spared me the anxiety I'm having this pregnancy worrying about placenta accreta and other complications of previous thoughtless surgeries. Yes that was plural I just used. Those jerk-faces. And for some reason they're so surprised that I'm not seeing them again for this pregnancy.

November 25, 2010 | Unregistered CommenterHeather

Well said!

November 25, 2010 | Unregistered CommenterSarah

When I had an unplanned repeat cesarean 2 years ago, I specifically requested the use of an adhesion barrier. The OB looked at me a little funny and then suggested Interceed over Seprafilm due to the differences in properties of the two. She said that Seprafilm feels like tinfoil and that Interceed is more flexible and cloth-like. I honestly had no idea that Interceed even existed (I was only aware of Seprafilm), but was glad for its availability when I needed it.

I can't help but wonder if my rcs and the use of this product was a corrective experience seeing as when they opened my abdomen my bladder was 100% adhered to my uterus. That being said, I'm pretty sure that I'm the only person I know who had an adhesion barrier used during a cesarean and it was ONLY because I requested it. I'm glad I was informed enough to know about it and even more glad that I was assertive enough to request its use even though it was not a standard of care for my surgeon.

November 25, 2010 | Unregistered CommenterMonkey Mama

A few years back a grand multiparous client of a local midwife showed up at the hospital in labor, 8 cms dialated. The baby was breech.

The OB resident quickly began flurrying around to get a stat c-section--before that baby fell out vaginally, you know (insert eye roll). The midwife had been displaced.

The expectant father asked what their options were. The OB resident said "stitches or staples for the repair." The father said he was talking more like whether vaginal birth was an option. The resident said that he'd never done a vaginal breech, and wasn't willing to try it. The father turned to the midwife and asked her if she had experience with vaginal breech. She did, and she ended up catching the baby.

Of course a lot of other drama went on with that--it wasn't like the resident just graciously ceded control to the midwife.

When the midwife's contract for privileges at the hospital came up for renewal, they were not renewed. Because she "wasn't a team player," as evidenced by her refusal to "support the team" and tell that mom to have a cesarean. Obviously in this situation, the mother is not supposed to be allowed to make choices for vaginal breech.

November 25, 2010 | Unregistered CommenterKnitted in the Womb

"Who chooses the choices?" is an excellent question, and one that is applicable in lots of areas of life, not just medical choices! That being said, I wish I had known that such a product existed when I had both my initial c-section and my second (elective) one.

November 28, 2010 | Unregistered CommenterHeather

Nicely said, emjaybee!

November 29, 2010 | Unregistered CommenterThe WellRounded Mama

When I had a breech c-section, my "choice" was whether to schedule the c-section for 38 weeks or a bit later (I "chose" 40.5 weeks). When I voiced that I meant a vaginal breech delivery instead of a c-section, I was basically told that was ludicrous.

November 29, 2010 | Unregistered CommenterKK

Monkey Mama, what's fascinating about your story is that I'd never even heard of an adhesion barrier before the Birth Sense article...but if I had, I would have assumed they were using them already! If there is resistance to using them, I wonder why? They do sound like good products, but not being a surgeon or privy to the research on them, I have no knowledge of their overall effectiveness. Anything that reduces adhesions without introducing other risks is good, since some % of women will always need c/sections.

November 29, 2010 | Unregistered Commenteremjaybee

The only reason I knew about adhesion barriers was due to my unending quest for knowledge about the actual cesarean procedure and its potential consequences in the aftermath of my total unnecesarean five and half years ago that I was coerced into that resulted in severe PPD and PTSD. When I first heard about adhesions my mind was blown because I had never heard anyone talk about them and I was appalled that this was not part of the informed consent process (which is a joke itself, but that's another story). Then when I found out that there was a way to minimize their formation but that the use of barriers was not standard procedure, THEN my mind was officially blown.

Research on the barriers goes both ways. I've read some that says they are effective, others say that they are only minimally successful at preventing the formation of adhesions. Personally, I didn't care if it was only 2% effective. I wanted (and still want) any fighting chance at a normal internal anatomy after 2 unwanted abdominal surgeries.

I've read more research about cesareans than I care to admit. In fact, I graduate next May, and I'm already plotting how I'm going to get on campus every so often so that I'll have journal access since I won't have it available to me off campus anymore. I'm sure there's plenty of people in my ICAN discussion group who will be relieved when less research is being sent to their inboxes.

November 29, 2010 | Unregistered CommenterAngela

Absolutely LOVE this! I've asked myself the same thing about marketing scams to make people forget that we're dismissing the most important questions (and choices) of all! I'll be linking to this on my blog for sure!

December 1, 2010 | Unregistered CommenterNaomi Kilbreth
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