Cesarean Disasters
Over the years that I’ve been a labor nurse and then a midwife, I have seen more mismanagement associated with cesarean birth than anything else. Women are often treated patronizingly and unkindly if they are reluctant to have a c-section, or dare to ask if there are any alternatives. I wrote about one of my most disappointing experiences in an early blog post, An Unecessary Cesarean.
One of the worst mistakes I’ve experienced was when I was a midwife asked to assist on a c-section for an obstetrician’s patient. We were doing the preparatory scrub prior to surgery, while the woman was being prepared for the delivery. As we entered the operating room after scrubbing, we notice that the woman was completely anesthetized under general anesthetic. The obstetrician asked the anesthesiologist if the woman had gone to sleep. The anesthesiologist looked stunned, then said, “Oh no! I wasn’t thinking and I put her under!” Cesarean deliveries are never done under a general anesthetic unless there is no alternative, because the anesthetic has the same effect on the baby as on the mother, and the baby will be born with breathing difficulties. If a general anesthetic must be used, it is not given until everything is ready so that the surgeon can get the baby out as rapidly as possible once the mother is asleep.
Upon hearing the anesthesiologist’s admission, the surgeon didn’t even bother to put on a gown. He threw on a pair of gloves and yelled at me, “We’ve got to move fast!” He opened the belly with one cut and ordered me, “Put your hands in the incision and PULL!” We pulled the incision open, and he rapidly opened the uterus and pulled the baby out. Fortunately, the baby did well, but this could have had a very different outcome.
Another incident I recall is a woman who came in with a birth plan. This generated the typical response from the staff: “She’ll end up with a c-section for sure”. Eyes rolled as they read the woman’s request for an unmedicated birth and immediate skin-to-skin contact with the baby. I was happy to be assigned to care for this woman, because I love working with woman who want normal birth.
During the course of her labor, the baby began to show some signs that the OB interpreted as fetal distress. I did not agree with the obstetrician, and felt that while the situation bore careful observation, it was not necessary to rush to a c-section at that point. He was eager to be finished because he had a golf game at 5 p.m., and he told Carla (not her real name) that her baby was showing signs of distress and it would be better to do the c-section now than to wait until the baby “crashed”.
Carla and her husband replied that they felt they were close to delivery, and they were comfortable with watching the baby closely for a while. They declined c-section. Angered, Carla’s doctor stated, “I’m going to get a court order for you to have a c-section if you don’t sign the consent! I’m friends with the judge and I can have the order in 20 minutes!”
At that point, other staff began coming in and bombarding Carla with comments such as, “If you don’t sign the consent, and he gets a court order, child protective services will come in and take your baby away!” I was very frustrated with the situation, and tried to support Carla’s desire for watchful waiting, but it became apparent that the physician was determined to deliver the baby by c-section with or without Carla’s permission. At that point, Carla reluctantly signed the consent. The baby was born with Apgar scores of 8 and 9, totally normal scores for a newborn. As I was walking down the hall after the surgery, I overheard the physician say to a nurse, “I wish her baby had died! That would have served her right for being so non-compliant!” He made it to his golf game on time.
Jane (not her real name) had a cesarean delivery, and soon began having complications. She had continual abdominal pain, difficulty moving her bowels normally, and pain with certain movements. For eight months following her surgery, Jane kept returning to her OB with complaints of abdominal pain. He kept reassuring her that some pain is normal following surgery, and she probably just had scar tissue forming inside, a common complication.
Finally, her pain became so severe that her OB re-admitted her to the hospital for exploratory surgery. He discovered a hemostat (surgical clamp) inside her abdominal cavity. Fourteen inches of her intestines had to be removed due to damage from the clamp being left inside her during her c-section. Hospital records showed that the surgeon had been notified by the scrub nurse during surgery that the instrument count was off. At this time, it would be the scrub nurse’s responsibility to call for an x-ray before the surgeon closed the incision. When she told the surgeon she was calling for an x-ray, he threw and instrument at her and cursed at her. “There are no instruments left in the incison!” he yelled. “If you call x-ray, I’ll make sure you are fired!” The nurse was intimidated and backed down.
Following the discovery of the hemostat in Jane’s abdomen, the labor and delivery nurses were called to a meeting and informed that Jane was to be told only that she’d had scar tissue in her abdomen as a result of her c-section, and the OB had surgically corrected the problem. Anyone who dared to tell Jane the truth–that her pain had been caused by a preventable surgical error–would be fired.
These experiences, and others like them, solidified my decision to have my babies at home, even though I was a hospital employee and could have given birth on the unit where I worked. I truly felt safer in a home environment–there would be less chance for error, less chance that my caregivers would rush me to an unecessary c-section, and less chance that mistakes would be made and then covered up. For all who feel the hospital is necessary “just in case”, remember that the hospital may create the very situation you are trying to prepare for.
So sad… so infuriating.
My 1st child was born by cesarean after a “failed” induction. My OBGYN later told me I was just too small to have babies vaginally. She told me I would “fail” at a VBAC attempt.
I had my next baby AT HOME. She was bigger than my c/s born. A much better experience. My MW’s treated me with RESPECT. I will have any future babies also at home with the same MW’s.
Oh, I also wrote my OB a nice letter explaining just how WRONG she was.
It’s so unfortunate that there are OBs whose fear of home birth causes them to say such negative things. I don’t believe they realize the impact that negative comments such as this can have on women. Many women are not comfortable with home birth, and so will have no choice but to return to the hospital and this type of treatment. How sad that those within the hospital cannot make it a welcoming and safe environment for those who need it.
Was Carla me? If the time was different, I would swear it was…
My word…I am sorry for those who bear the consequences of the actions of these medical professionals who took an oath to “do no harm.”
I cry for these women!
So do I. These are women I’ll never forget, and one always questions whether one could have done more to advocate for them.
This is some of the most revolting, disgusting, infuriating BS I have ever read on the topic – and I’ve read a lot.
I really try to not hate on all doctors, and remind myself that there are some good ones out there, but these? EVIL. Simple as that Absolutely evil.
It is infuriating. There are many excellent physicians out there, and I’ve known of midwives who are unethical, so the problem goes both ways. I just believe that the likelihood of encountering a situation like this is dramatically reduced if you only use the hospital for emergencies or complications.
A nurse friend of mine assisted at a tonsillectomy in which the child died. The doc was proud of his perfect track record of never having to use some tool or other (a cauterizer?); anyway, the child was bleeding badly and the nurse begged the doc to use the thing, and he responded that he never had to use it yet and he wasn’t going to use it. The child died because of his arrogance. He intimidated the nurse (and I suppose the rest of the staff) by saying it was going to be her word against his, he was the doctor and therefore going to be the one who was believed; and told the parents it was “one of those things that couldn’t be helped” — one of those rare adverse events, maybe even said it was an allergic reaction? I can’t remember, but he lied to the parents and really got away with murder, when you think of it. He did not intend to kill the child, but by his actions, that is exactly what happened. He could have avoided the death, but for his arrogance.
If people knew how often this type of incident occurs due to arrogance or ego, they would be very shocked. Fortunately, most of the time these attitudes don’t cause the death of a patient, but they are still frustrating and annoying to deal with.
Is it just me, or does it seem like some of the nurses/staff who were intimidated into silence have a responsibility to blow the whistle on such blatant medical malpractice? I would think that a scrub nurse who, for example, noted in the chart that the instrument count was off and then did not subsequently follow protocol by calling x-ray would be a violation that could result in dismissal anyway. I feel terrible that women go through these things. Thank you for sharing.
I do believe that the nurses and staff have a responsibility, too. I can see both sides–the nurse that is intimidated because the doctor can and will use his influence to have her terminated; and the hospital that is reluctant to offend the doctor who provides patients and business for them. It is a vicious circle. Unless and until everyone on staff at a hospital is committed to putting the woman first, patient rights, protecting normal birth, and respecting and supporting individual choice, not much will change. If enough women would refuse to give birth at hospitals, things would change very quickly.
Good grief! It gets worse! Re the court order — an obstetrician once got a court order and c-sectioned a woman against her will, and the case went all the way to the Court of Appeals, where a firm precedent was set: they stated that a woman has the right to refuse medical treatment, even if it means she will die, and even if it means her foetus will die. A baby has no rights until it is born, the judges said. And the woman was awarded substantial damages. In UK, you still have the right to refuse surgery. I am shocked that in “the land of the free”, you don’t! Is this really true, or was it just a threat to get the woman to ‘consent’?
Sadly, it is true that women have been forced to undergo surgery they did not want because the obstetrician got a court order. National Advocates for Pregnant Women details many incidents of forced cesarean section, and of women being prosectued for child abuse/neglect because they did not comply with their physician’s recommendations. This clearly makes no rational sense, when a woman in the US can elect to have an abortion even after her fetus would be able to survive. Why shouldn’t a woman also have the choice to birth where and how she wants?
Re my previous comment — sorry I should have said “an obstetrician in UK once got a court order…”
This just makes me sick. I’m in a position right now where it looks like, due to the laws in this state, I will have no choice but to deliver in a hospital, a teaching hospital no less. I’m fully informed about birth and intervention statistics and fully capable of standing up to the doctor/nurse/staff even while in labor. But I’m horrified by the posibility that the hospital with either a) refuse me care if I don’t consent to something I don’t want/know is not in my/baby’s best interest or b) obtain a court order to force the intervention upon me.
I’m not a high risk pregnancy, but because the doctors in this town are apparently completely freaked out by anyone on long term pain management (I’ve been turned down by general practice doctors because they ‘don’t take high risk patients’), all the OBs insist I’m ‘high risk’, even though the pregnancy is completely normal, so I’m sure I’m going to get a LOT of pressure to consent to interventions, including c-section.
DEMs are not really legal (its kind of a grey area but they can be charged with practicing medicine without a license), and the CNM can’t legally take me because the OBs consider me ‘high risk’. My choices seem to be labor at home by myself until I’m a few minutes away from ready to push or submit to the insanity that is the ‘hospital ride’, neither of which seems safe or sane to me!
Wow. This just underscores why I believe that EVERY person admitted in a health care setting should have the right to have an advocate with them 24/7, INCLUDING in surgery. Someone whose interests are not tied to the hospital needs to be there as a witness. What will it take to get this?
Jespren, I am so sorry at the situation you are in. A friend of mine VBACed just a few months ago at our local hospital. She arrived pushing and had her baby just an hour after she got there. The hospital ride was painful and crazy, for sure, but she is happy that she waited so long. She also fought for about three weeks to refuse/delay the c-section that her OB wanted to do because she “just wouldn’t go into labor” – at 38 weeks!!
I would like to clarify that a hospital CANNOT legally refuse you care. There is a law stating that emergency care must be provided, and a woman in active labor is considered an emergency. What *can* happen is that doctor can refuse to treat you, in which case you would transfer to the emergency on-call doc. That is technically against their code of ethics, which states that a patient must receive 30 day notice before termination of services. It is considered patient abandonment. Also, it is very rare for a hospital to get a court order requiring an intervention, and it usually happens before a mother is in active labor. Typically it just takes too long for a court to make a decision. How you would be treated if you got into a hostile situation is anybody’s guess, but you do have legal rights.
Have you considered hiring a doula to be there during your birth. They have an amazing record for reducing the chances of interventions. A few hundred dollars is a small price to pay for your birth experience. Many will make payment arrangements with you if you need it. If you cannot afford the fee, you may be able to find a doula in-training for her certifications. Some will attend births for reduced or free just to get the number of births they need for their certification.
I hope you find the information you need. I will be praying that your birth is more peaceful than you could have imagined. Best of luck to you and your little one.