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
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