What NOT to expect when you’re expecting, #7: Don’t expect your provider to be interested in evidence

Anyone still practicing flat earth obstetrics?

In What To Expect When You’re Expecting, the author warns readers not to risk being sued by their OB doctor.  Jill, at The Unnecesarean, described this scenario eloquently in a recent blog post.

It’s difficult to imagine a doctor suing a patient simply because she exercises her right to autonomy over her body.  Yet doctors–and unfortunately, midwives too–daily use their medical knowledge to manipulate and intimidate patients into consenting to things they don’t want to do.  Most practitioners know very well how to phrase the “truth”, to slant their words in such a ways as to persuade the patient to give “informed” consent.

Today, I had to call a client about an abnormal quad screen.  Her test indicated she is at higher than average risk for Down syndrome.  I was not the provider who obtained consent for the test from this woman, and she was very upset when she learned that in order to find out if the test results were accurate, she would need to have an amniocentesis.  I sat there, trying to explain to the woman what her options were:

1. Do nothing, and continue the pregnancy as is.
2. Have a screening ultrasound first, look for “soft signs” of Down syndrome, then decide on further testing.
3. Have an amniocentesis now.

She was upset and asked me, “Doesn’t the amniocentesis hurt?”  It was clear that no one had truly obtained informed consent from her about the Quad screen and the implications of a positive result.  No one had told her what type of follow-up is required.  Someone just said, “It’s time for your Quad screen today. . .” and that was that.

Another of my clients today wanted to discuss the three hour glucose test.  She was upset that someone had called, told her she “failed” her one hour test, and would have to take a three hour test.  During the test, she was to remain seated in the lab waiting area.  She would not be allowed to walk across the street to her house, because even that small amount of exercise could help her body metabolize the huge sugar load more quickly, causing concern about inaccurate test results.   “Why do I need this test?” she asked.  “I don’t eat 100 grams of sugar and then sit around for three hours!  I’m up moving around all day long!  Why don’t they do a test that looks at what I normally eat and what my activity level is?”  She had not received informed consent about the process of glucose testing, but had simply been told to show up at her appointment for the test.  We discussed options and agreed that she would do several finger sticks at home at various times of the day, while keeping a food diary, so we could get a clear picture of what her body does under normal conditions.

My last experience of the day was while attending a birth at the hospital.  My client was napping, and I was at the desk charting, when I noticed a large sign on the bulletin board above my head:  “Home Delivery is for Pizza!”  I immediately wondered if the person who posted the sign, undoubtedly thinking it cute and clever, had given any thought to the evidence for home birth safety?  Had they even stopped to question their cherished belief that hospital births are the gold standard?

I went to a private computer, and printed off several studies on home birth safety.  I highlighted the sources–Cochrane Review, British Medical Journal, Canadian Medical Journal, and so on.  I highlighted the conclusions, all stating that home birth was found to have equivalent perinatal mortality rates when compared to hospital birth, and better morbidity rates, along with lower rates of medical intervention.  I printed a list of all recent studies on home birth safety, including studies that do not agree with my opinion that home birth is safe for low risk women with trained attendants. Then I posted an addendum to the “Home Delivery is for Pizza” sign, which simply read,  “What does the evidence say?”, with the studies attached to the board next to the sign.

I then went to check on my still-sleeping client, and when I came back, not five minutes later, my sign and my articles had all been removed from the bulletin board.  WHY?  What are medical professionals so afraid of?  If they have the best care, they need not be afraid to examine the evidence.  What good is it to conduct research if we refuse to examine the results, particularly if they contradict our cherished beliefs?  While I did not expect to change minds by posting my articles, I had hoped that it would, at the least, open a dialogue about the evidence and why some women feel safe giving birth at home.

Unfortunately, this is not the norm in modern obstetric care.  Do not expect your provider to be interested in whatever evidence you may gather about a pet procedure or favorite test.  Do not expect to receive a truly informed consent, for that would require presenting the evidence fairly.  Don’t confuse modern obstetric caregivers with the facts.

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