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Saturday
Mar172012

The Case for Not Using One Personal Anecdote as a Global Case

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Massachusetts cesarean rate history and VBAC bans  |  Massachusetts cesarean rates by hospital, 2009

 

Dr. Adam Wolfberg of Tufts Medical Center in Boston seems like a nice guy and a concerned medical professional. In his piece in The Atlantic, The Case for Hospital Births, he readily expresses his fear and perceived vulnerability by saying that he felt “set up for a calamity” with the out-of-hospital transfer he had to deal with. I don’t read a lot of ER physicians discussing how they feel scared when patients present with emergent complications and think they can prevent every out-of-hospital emergency with their skills, but maybe I am not reading the right material.

Wolfberg shows that he is dripping wet behind this ears in his home birth vs. hospital birth rhetoric, but that’s okay. Everyone starts somewhere and one good place to begin is stepping back from the operating table and looking at the big picture. Could there be a reason why women in Boston might want to avoid hospitals? Has he considered that the concept of harm reduction involves exploring the risks that can occur in all birth settings under the care of the gamut of professionals (and non-professionals, as anyone in Massachusetts can hang out a shingle that says “MIDWIFE” under the current lack of regulation)? People, including pregnant women as people, weigh risk differently and bring their own personal and cultural values to the table. I think it is commendable to say, “I felt scared when this patient presented in labor” and to own that. I think it’s is interesting to take it straight to “…and to process this fear and prevent feeling vulnerable again, I will announce to the women of the world that they should have come to me in the first place.”

I don’t think I have ever written this but if we all take three giant steps back and look at the value in ensuring that women have OPTIONS in place of birth and provider, we might have an answer to the so-called liability crisis (which stems largely from physicians feeling vulnerable to attack via litigation and is something that needs to be addressed with a lot of sensitivity, in my opinion, because of the devastating effect a lawsuit can have on someone’s life). By running to The Atlantic with a call to take home birth off the table in favor of making hospital birth the only option, Wolfberg builds a case for a health system in which patients are essentially deprived of the opportunity to freely CHOOSE hospital birth. When I freely choose something, I accept responsibility for my decision and all that went into making it and all that results from it. If I have no other option, I believe I would be more likely to fault “the system” if something goes wrong. Why? Because I had no other choice.

As my childbearing window comes to a close (I have a few years left in me to pop out a kid and enjoy advanced maternal age standing), I could go either way on home, birth center or hospital birth. It all depends on a lot of things. Who is the midwife or doctor? How is my health? Is the fetus being a sweet, cooperative little vertex angel or breakdancing with head flexed ridiculously and limbs all akimbo? What can I afford on my crappy insurance that I pay for out of pocket?

Then there is what I am willing to tolerate in each situation. Can I put up with the headaches of dealing with a hospital like Tufts with a near 40% cesarean rate and the medical narcissism associated with that? Do I want to be in a birth center a mile away from a hospital even if it has a seamless transfer relationship? Do I want to be a mile away from a hospital in the privacy of my own home if I have a highly skilled provider? The prospect of eating burritos in labor is certainly enticing, but this raises the question of WHEN eating burritos ISN’T enticing.

I don’t know. I do know that Dr. Wolfberg should keep on making his case because those aren’t my fears to share with the world and I think everyone should listen to his experience of being on the receiving end of a transfer. However, I would much rather sit and the table with those making a case for options of birth setting and provider. If Dr. Wolfberg wants a monopoly to assuage his annoyance with an occasional transfer, then he can personally accept responsibility for his role in fueling unwarranted litigious attacks on doctors and hospitals (not including the jackpot justice scumbags out there who will sue anyone for anything, anywhere). So turn that scowl you mention upside down, Dr. Wolfberg! There are a lot of OB-GYNs like yourself working on collaborative models and envisioning a health system without an obstetrical monoculture that allows for patient choice, shared decision making and preference-sensitive care. Good luck promoting your new book… it looks great.

 

 

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