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Thread: Pregnant Women Warned: Consent to Surgical Birth or Else

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by Deuce View Post
    What if the doctor had concluded a natural birth would kill her and the baby?
    Then the Dr shouldn't agree to do it.
    Quote Originally Posted by matchlight View Post
    Justice Thomas' opinions consistently contain precise, detailed constitutional analyses.
    Quote Originally Posted by jaeger19 View Post
    the vast majority of folks that need healthcare are on Medicare.. both rich and poor..

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by US Conservative View Post
    I can show evidence, its current best practice as stated by acog. But you need to understand what you are reading-ACOG-in your link does NOT say they oppose u/s in abortive procedures-they say they oppose govt mandates for diagnosis (as do I). Because its already the standard of care, and because of its benefits they support the technique. The issue, is politicisation of terms like transvaginal (calling it rape, and disregarding its better sensitivity and lower pain for many patients). There are publications from acog and pubmed that I can't post here, but that recommend the same, as do other groups (ACOG is not the sole "authority" for the issue, family practice and radiology are prominent as well. I work internal medicine and we listen to ACOG and ACR.
    http://www.acog.org/~/media/Departme...709T0142491575
    National Guideline Clearinghouse | Ultrasonography in pregnancy.
    ACOG Practice Bulletin No. 101: Ultrasonograp... [Obstet Gynecol. 2009] - PubMed - NCBI
    http://www.acr.org/~/media/a79db56d3...8250a67a5a.pdf
    I don't see where it says what you claim it says. Can you quote from one of those links showing that the OK requirement is consistent with current best practice?

    The last link does say this, which seems to contradict your claim
    This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for
    patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not
    intended, nor should they be used, to establish a legal standard of care1. For these reasons and those set forth below,
    the American College of Radiology and our collaborating medical specialty societies caution against the use of these
    documents in litigation in which the clinical decisions of a practitioner are called into question.

    The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the
    practitioner in light of all the circumstances presented.
    Thus, an approach that differs from the guidance in this
    document, standing alone, does not necessarily imply that the approach was below the standard of care. To the
    contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in this
    document when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of
    the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of
    this document. However, a practitioner who employs an approach substantially different from the guidance in this
    document is advised to document in the patient record information sufficient to explain the approach taken.
    Quote Originally Posted by matchlight View Post
    Justice Thomas' opinions consistently contain precise, detailed constitutional analyses.
    Quote Originally Posted by jaeger19 View Post
    the vast majority of folks that need healthcare are on Medicare.. both rich and poor..

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by US Conservative View Post
    I can show evidence, its current best practice as stated by acog. But you need to understand what you are reading-ACOG-in your link does NOT say they oppose u/s in abortive procedures-they say they oppose govt mandates for diagnosis (as do I). Because its already the standard of care, and because of its benefits they support the technique. The issue, is politicisation of terms like transvaginal (calling it rape, and disregarding its better sensitivity and lower pain for many patients). There are publications from acog and pubmed that I can't post here, but that recommend the same, as do other groups (ACOG is not the sole "authority" for the issue, family practice and radiology are prominent as well. I work internal medicine and we listen to ACOG and ACR.
    http://www.acog.org/~/media/Departme...709T0142491575
    National Guideline Clearinghouse | Ultrasonography in pregnancy.
    ACOG Practice Bulletin No. 101: Ultrasonograp... [Obstet Gynecol. 2009] - PubMed - NCBI
    http://www.acr.org/~/media/a79db56d3...8250a67a5a.pdf

    As for your second q, Im not here to teach you and this is not a superficial medical discussion, but I will hit the highlights anything that impacts maternal bleeding in significant quantities (hypovolemia/exsanguination) means the child has tops several minutes-the first thing compromised will be fetal/placental blood flow. We dont use the term "crash c-section", but an OB wont attempt to ligate or repair anything without at least a general, and possibly a vascular surgeon-these specialists are NOT a normal presence in the OB theater, and thats time the child wont have. OB's ARE trained in perimortem CS but thats not going to be done here.
    The first thing to remember is we aren't getting the entire story-we dont know this patients history or risk factors, we know what a media source says-this alone makes it highly unlikely we have the full picture. As I stated earlier in the thread this is a high risk procedure, and this woman has had 2 prior CS's-so the uterine scarring and surgical adhesions are more likely to lead to complications. The ACA did very little to address tort and has made high risk specialties MORE defensive. This is the result. The other issue is so many vbacs lead to failure to progress, leading to increase risks of fetal anoxia, erbs palsy, etc. When you say things like "the infant would stand a good chance of being fine" without the data what you are saying is you'd like this to be the case, and hope its true. Some reading, but your best bet would be to admit you dont know.
    Practice Guidelines: ACOG Updates Recommendations on Vaginal Birth After Previous Cesarean Delivery - American Family Physician
    Ob Gyns Issue Less Restrictive VBAC Guidelines - ACOG
    Vaginal Birth After Cesarean and Uterine Rupture Rates in Ca... : Obstetrics & Gynecology
    Can you quote actual points that state the ACOG recommends ultrasound. In your links I see references to unnecessary testing (referencing ultrasound with abortion). One of your links did not work for me and another was to a publication that I was able to open.

    In terms of the uterine rupture....first of all, the available literature seems to totally discourage VBAC if the woman has had more than 2 C-sections. She has had three.

    In terms of making her have the child C-section.....C-sections have not just anesthesia and surgical risks, they have risk of post operative complications.

    She has to sign a consent for surgery for a reason. It is inherently a potentially dangerous process.

    I see more risk to her than the baby. If she is already in the hospital with her OBGYN there for the delivery, a crash C-section can occur in minutes - especially when the mother is already in a place that can manage this.

    I see this as a risk to benefit issue. Just like any other person having a procedure, they get to choose what risks they are willing to take for whatever benefit. Every day in this country, patients do not chose the path medically or surgically that their MD thinks is best. Not unusual. It is choice. Not so sure why this situation would be any different.

    Now, if the facility is unable to manage a patient that needs a crash C-section, that needs to be known to all pregnant patients who are considering delivering their baby that facility.

    But like I said, VBAC is usual, but it seems that it is acknowledged that usually discouraged after 2 C-sections. But as a CPS issue. Please. Forcing a woman to have a surgery - way to go medival on her.....

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by sangha View Post
    I don't see where it says what you claim it says. Can you quote from one of those links showing that the OK requirement is consistent with current best practice?

    The last link does say this, which seems to contradict your claim
    And the first link clearly speaks to unnecessary procedures!

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by Deuce View Post
    What if the doctor had concluded a natural birth would kill her and the baby?
    A possibility or an absolute certainty?

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by sangha View Post
    I don't see where it says what you claim it says. Can you quote from one of those links showing that the OK requirement is consistent with current best practice?

    The last link does say this, which seems to contradict your claim
    I think I've already made clear Im not interested in continuing the discussion with you.

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by year2late View Post
    Can you quote actual points that state the ACOG recommends ultrasound. In your links I see references to unnecessary testing (referencing ultrasound with abortion). One of your links did not work for me and another was to a publication that I was able to open.

    In terms of the uterine rupture....first of all, the available literature seems to totally discourage VBAC if the woman has had more than 2 C-sections. She has had three.

    In terms of making her have the child C-section.....C-sections have not just anesthesia and surgical risks, they have risk of post operative complications.

    She has to sign a consent for surgery for a reason. It is inherently a potentially dangerous process.

    I see more risk to her than the baby. If she is already in the hospital with her OBGYN there for the delivery, a crash C-section can occur in minutes - especially when the mother is already in a place that can manage this.

    I see this as a risk to benefit issue. Just like any other person having a procedure, they get to choose what risks they are willing to take for whatever benefit. Every day in this country, patients do not chose the path medically or surgically that their MD thinks is best. Not unusual. It is choice. Not so sure why this situation would be any different.

    Now, if the facility is unable to manage a patient that needs a crash C-section, that needs to be known to all pregnant patients who are considering delivering their baby that facility.

    But like I said, VBAC is usual, but it seems that it is acknowledged that usually discouraged after 2 C-sections. But as a CPS issue. Please. Forcing a woman to have a surgery - way to go medival on her.....
    On best practice you need to understand what that is-its NOT a policy from the top, its comes from practice-the clinics UP, In my links, ACOG states that most clinics perform this as the standard. THIS is how best practice is determined, and for good reason-as you can see this type of thing is missed by a casual reader.

    As for the rest, you are repeating things as if it changes the issue. OB's are sued even after waivers, etc all the time-all they need is a lawyer to say the pt didn't really understand what the complications meant. They dont want to perform the procedure more because of the much HIGHER incidence of failure to progress (around 1/3 of cases-which often revert to emergent CS, compared to 3-5% chance at the highest risk of uterine rupture-which is of course catastrophic and also much higher than the gen pop.)

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by US Conservative View Post
    I think I've already made clear Im not interested in continuing the discussion with you.
    or backing up your claims

    Quote Originally Posted by US Conservative View Post
    On best practice you need to understand what that is-its NOT a policy from the top, its comes from practice-the clinics UP, In my links, ACOG states that most clinics perform this as the standard. THIS is how best practice is determined, and for good reason-as you can see this type of thing is missed by a casual reader.

    Translation - You can't show that best practice is to perform one every time.
    Quote Originally Posted by matchlight View Post
    Justice Thomas' opinions consistently contain precise, detailed constitutional analyses.
    Quote Originally Posted by jaeger19 View Post
    the vast majority of folks that need healthcare are on Medicare.. both rich and poor..

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by US Conservative View Post
    On best practice you need to understand what that is-its NOT a policy from the top, its comes from practice-the clinics UP, In my links, ACOG states that most clinics perform this as the standard. THIS is how best practice is determined, and for good reason-as you can see this type of thing is missed by a casual reader.

    As for the rest, you are repeating things as if it changes the issue. OB's are sued even after waivers, etc all the time-all they need is a lawyer to say the pt didn't really understand what the complications meant. They dont want to perform the procedure more because of the much HIGHER incidence of failure to progress (around 1/3 of cases-which often revert to emergent CS, compared to 3-5% chance at the highest risk of uterine rupture-which is of course catastrophic and also much higher than the gen pop.)
    YOU asserted that your links showed that ACOG clearly indicated that ultrasounds should be required. Still looking for quotes from the links that state this. Seems you are deflecting to wiggle out of your claims.

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    Re: Pregnant Women Warned: Consent to Surgical Birth or Else

    Quote Originally Posted by Summerwind View Post
    Have you ever been on the receiving end of a report to child protective services? I know a person who was, and you clearly don't have a clue as to how that goes. First things first, they come and take your children, then they decide if they should give them back.
    Bullcrap. CPS are some of the most clueless people on the planet. Its rare for them to take abuse victims when there's no doubt about the matter, much less when there is.

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