Saturday, October 4, 2008

Dr. Diabolic and the God Complex

Recently, I happened upon a heated discussion (or rant) by a physician [and I do use the term loosely] on the "unfortunate" occurrence of women having a say in their childbirth choices. His post and the comments of fellow physicians crystallize the flaws in our current system and its misogynistic treatment of women.

My response to their litany appears below:

Yes, there is plenty of clinical research going on....but what good is research if OBs don't follow the evidence in their practice.

All of the following procedures/routines have been shown to be at best, unnecessary, and at worst, harmful, to birthing women, yet they are still standard practice for much of the OB community:

  • Episiotomy

  • Pushing in Lithotomy position

  • Cytotec for Induction or PPH

  • Continuous Electronic Fetal Monitoring

  • Routine Induction before 42 wks

  • Manual Cord Traction

  • Early Cord Clamping

  • C-section for "Big Babies"

  • Late Term Ultrasound for Fetal Weight Estimates

to name a very few. I have to wonder how the physicians above can claim to practice "science based medicine" when standard practice is rife with such non-evidence based procedures.

By even referencing the first example of the woman whose baby was "too big to fit" as a defense of their position that women should just shut-up-and-listen-to-everything-the-big-smart-doctor-says, these medical professionals have proven how fallible they truly are.

There is no evidence to support that suspected fetal macrosomia can reliably be diagnosed without a trial of labor [and one that does not have a woman flat down on her back tethered to an IV with an EFM belt strapped to her abdomen]. Furthermore, there is no evidence to support that weight is a predictor of which babies will fit, as the circumference of the head and shoulders is a more accurate indication than weight alone.

As posted above, the indication would have been shoulder dystocia, which most appropriately could have been resolved with use of the Gaskin maneuver (gasp! an evidence-based procedure from midwife Ina May Gaskin), which could have prevented the baby from being born floppy and requiring resuscitation.

But rather than employ evidence-based medicine, the physician in question had a tantrum about the patient delaying/refusing a [non-evidence based] c-section. He did not attempt to employ any other methods to prevent problems from occuring since he had already [inaccurately] determined a c-section to be the fast, easy and sole solution, the only one acceptable to him. Rather than acknowledging his own errors in judgment, he then blamed the patient for wanting a certain "experience" over a healthy baby.

The plain truth is that her motivations most likely did not arise from any desire for a certain experience, but in a desire to escape non evidence-based interventions.

With evidence-based care, she could have had both a positive experience and a healthy baby.


Contrary to expecting perfection, it is my realization that doctors and specifically to this discussion, OBs, are mere mortals - as human as the next person - which makes me question their recommendations, just as any good consumer would do.

They are just as prone to make decisions based on their own comfort and agenda as the rest of us. There is no higher standard to which they hold themselves, nor should we. They lie to get want they want and to force an outcome in their best interest, which is something all humans are guilty of at one point or another.

It is this realization, that OBs don't always provide care based on the best interests of the patient [because they are fallible humans by nature] nor that their advice is always based on the evidence, whether intentional or not, which makes me question their judgment and motives when providing maternity care.

Women cannot accept their doctor's advice at face value, which is something doctors should acknowledge and accept of them as consumers. In no other arena would people be expected to take what is said as the gospel truth, infallible and without question.

However, physicians are creating a double standard by arguing their humanity while condemning women for questioning their judgment. These two principles are mutually exclusive. One cannot claim infallibility while professing humanity.


To address the issue of litigiousness and liability, I can't help but think physicians have spawned this monster. By perpetuating the use of non evidence-based practices [some of which are proven to cause harm], they create complications that wouldn't have presented otherwise, including failure to progress, fetal distress by aggressive induction, PPH by manual cord traction, and the list goes on.

By asserting that women are not capable of fully understanding and making their own healthcare decisions, they are by extension saying that a doctor's judgment is paramount. Thus, any and all bad outcomes would be the doctor's responsibility, as they are claiming women don't have the ability to make these informed decisions.

In actuality, it is the doctor's responsibility to obtain true informed consent from his patients before any and all procedures by explaining the risks and benefits in a way she can understand. If a woman does not understand her options, it is because the doctor has not done his job.

In either case, the physician is responsible, for either taking the decision out of her hands, ingnoring her decision when it conflicts with his own, or denying true access to informed consent so that an informed decision can be made, even one that is contrary to the physican's determination of "doctor knows best".


Until the system is changed to give the locus of control back to birthing women, we will continue to see this downward spiral in the quality of our maternity care, of excessive infant mortality rates, increasing maternal mortality rates and skyrocketing rates of interventions as standard practice.

For a country that spends in excess of $50 billion per annum on maternity care, more than any other nation in the world, we have pathetic outcomes to show for it.


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