Should we blame women or doctors?

Should we blame women or doctors?

This post on a pregnancy message board under the subject “Inducing at 38 weeks” was the catalyst of a discussion on the ICAN email list (emphasis mine):

I’m for it! There is NOTHING wrong with me, actually not even THAT uncomfortable (knock on wood!), and my Dr. is inducing me at 38 1/2 weeks! The group induces all of their patients! He said by 38 weeks the baby is ready – so why not get them out in the real world! I know it’s REALLY because they are 3 men, who just don’t want to get called out in the middle of the night all of the time, but they wouldn’t do it if there was a risk! I think it’s becoming more common these days – I’m just so anxious to meet her, they can take her whenever they want!! I trust them, they did go to med school and have been in practice for YEARS!

Whose fault is it that this woman doesn’t think there is any risk to inducing at 38.5 weeks?  Is it her fault since she didn’t educate herself?  Or is it her OB’s fault that they didn’t inform their patient on the risks, benefits, and options of induction?  Is it unreasonable to blame the OB since prenatals with an OB are typically 3 minutes after an hour wait?  Or is it unreasonable to blame the patient since she hires the OB for their expertise and education?  But what about the fact that we are dealing with this patient’s health as well as her baby’s?  Isn’t the OB’s oath to first “do no harm?”  But shouldn’t the mom have a vested interest in her health and shouldn’t she care more about her outcome than her OB?  This is a complicated topic…

But, in case you are reading and wondering, “What’s the big deal?  What are the risks of induction?”  A quick google search of “induction risks” lists a ton of sites, here is a quick run down:

What You Should Know: Risks of Labor Induction

  • Contractions are more painful because you are forcing your body to contract with drugs
  • Poor positioning of the baby = longer/more painful labor
  • Longer labor because your body isn’t ready for labor
  • “Longer and stronger contractions can interrupt blood flow and oxygen to the fetus, which can lead to drops in the heart rate.”
  • More bleeding and infection
  • Longer hospital stay and/or longer length of recovery
  • Higher levels of NICU admissions
  • Hyperstimulation of your uterus
  • Premature separate of the placenta (placental abruption)
  • Uterine rupture
  • Increased risk of abnormal fetal heart rate, shoulder dystocia and other problems with the baby in labor.
  • Increased risk of your baby being admitted to the neonatal intensive care unit (NICU).
  • Increased risk of forceps or vacuum extraction used for birth.
  • Increased risk of cesarean section.
  • Increased risks to the baby of prematurity and jaundice.

For a more complete discussion, and even more risks, please read Elective Induction of Labor by Henci Goer.  For a copy that you can easily print, go here.

I’m sharing with permission this post from the ICAN list that says there is plenty of blame to go around… (medpros = medical professionals)

I don’t think women exactly go out looking to hand the responsibility to
some one else. I think both women and doctors are to blame. Women think
(because no one tells them otherwise) that pregnancy has to be managed, that
they can’t do it on their own, and so they go on doing what they think they
are supposed to do, and right there waiting are the medpros waiting to offer
their “help”. Almost all women that walk into and Ob’s office think they are
doing the responsible thing. They think they ARE taking responsibility and
are getting the “care” they have been taught to get. The medpros gladly take
the responsibility from women more than I feel that women are looking to
hand it over.

It’s hard *because* women are not informed and they *don’t know* they are
missing information. They think they ARE informed. Once a person starts down
that path it’s hard to become truly informed because the new information
contradicts what they have always known AND it makes them feel like a fool
for not knowing before. I know we try to education women who just seem like
they don’t want to be educated, but it’s more than that. They have their
past decisions to protect. It’s not easy to realize you made mistakes. It’s
even harder when you made mistakes built on trust.

If women are failing we are failing each other more than we are failing our
individual selves. There is a reason there is such an emphasis on avoiding
that first cut. Women need to know BEFORE it’s too late, but those in “the
know” are not the majority and are certainly not the major influence on most
women today. Once you have been cut your further education is
forever limited by your experience and a women feels a need to rationalize,
justify, and remain in line with her former choices. (Some of us get past
it, many of us here, but we are a minority.) No one likes to hear that there
is a better way when they whole heartedly believed in the way they first
chose. It’d be like finding out you have been buying premium gas at a higher
price only to find out the cheaper gas is actually better for your
car. It would feel awful and your instinct would be to find a way that the
premium gas IS better so that you don’t feel as though you have wasted all
that money for nothing. However if when you get your first car some one
tells you the truth about what gas is best then you are just going to buy
the right gas and never make that mistake. And further more while you are
buying that premium gas and paying the higher price you might even brag to
your friends about how you can afford the better gas and how much better
your car is running, while there might be those around you thinking “you
idiot, that gas isn’t any better”, but NO one told you and if you are told
now, it’s too late, you’re invested. You might come around, but not everyone
would. Some people have to hold on to the bad decision they made being right
because if they admit they were wrong it would be devastating to them. Some
people can not handle that kind of truth or education. They have to remain
blind for their own sanity.

I know I learned nothing about pregnancy and birth from my mom. I know I
didn’t learn it from women I was friends with that were older than me and
had walked that path. I know I didn’t learn anything from my grandma or my
mother-in-law, or my sister-in-laws. What I learned was from movies and tv
where you go to an OB and they “help” you. Is it my fault that no one taught
me what I didn’t know I needed to know?

Sarah Taylor, New York

What do you think? Leave a comment.

Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

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