Responses to Survey on Unnecessary Medical Treatment

The Safe Patient Project is soliciting stories of medical overtreatment and medically unnecessary treatment. The Consumer Union asks:

Have you or a loved one had tests, surgeries, procedures or medications that you thought were unnecessary? If so, we would like to hear your story. We'd also like to know if you declined tests or treatments offered to you that you thought were unnecessary and found a medically appropriate alternative. Thanks for taking the time to do this. Your personal experience can really help us stop unnecessary and inappropriate medical care in the future, and improve the quality of care for patients.

One of the the areas in which medical overtreatment is done most is in maternity care. Its a multi-billion dollar business where each delivery costs almost triple than it otherwise could. There is evidence to suggest that childbirth in a hospital after a low-risk is overtreatment. Midwives are able to safely assist women in birthing their babies in their homes in the vast majority of pregnancies at the fraction of the cost. Choosing to birth without a medical attendant is also a valid option given preparation, planning and access to emergency services.

If you, one of my readers, have a story to tell about unnecessary medical treatment during your child's pregnancy, labor and birth, the Consumer's Union Safe Patient Project is giving you the opportunity to tell about your experiences. If your experiences were traumatic reporting on it may be triggering. There is a chance that your story will make a difference in maternity care and you'll face better and more appropriate treatment the next time you have a baby. You may also be making maternity care better for other mothers and their babies. The URL for the survey is: http://cu.convio.net/site/PageServer?pagename=spp_unnecessary_care

The following is the story I told. I'm including my responses to the question. I tried to explain as clearly as I could that I feel like the admission to the hospital in early labor was medical overtreatment. I recognize that in the big picture and in comparison to other birth experiences I may have had, its a small thing. But as I learned, it can and did have strong consequences.

1. Question - What type of medical overtreatment did you experience?

Answered: Other

2. Question - In what kind of facility did the event occur?

Answered: Hospital

3. Question - Describe your medical overtreatment experience in your own words (the space below allows you to include as much detail as you like):

I was admitted to the hospital in early labor (38 weeks pregnant) where the midwives proceeded to attempt a induction. This strategy is sometimes called a "backdoor induction" because it misleads the pregnant patient into believing that her labor is more progressed than reality and that a hospital admission is warranted. In response to this question, I'm considering the hospital admission medical overtreatment. There was no need to be admitted to the hospital at that time. The result of the admission was stress in response to the coercion used by the midwife on duty who attempted to get me to consent to an induction that was unnecessary. I felt bullied, manipulated and scared for my health and my unborn baby. I experienced PTSD as a result from what I feel like was fighting off a potential rape of my body.

4. Question - Did you report this incident to your state's Medical Board or other licensing agency?

Answered: Yes

5. Question - If yes, what was the Medical Board or Licensing Agency response?

Answered: None

6. Question - Your experience or that of a loved one resulted in:

Answered: minor injury or minor disabling condition

7. Additional Comments:

I explained above that I experienced PTSD as a result of overtreatment in my pregnancy. Often the psychological response is not classed as "morbidity" but considering how debilitating it was for me, I consider it a minor condition that had far reaching effects on my life. I still suffer the effects of the emotional trauma but felt recovered enough to not longer need treatment after 1 year.

8. Question - If you or your loved one experienced medical harm from overuse, how long did it take to fully recover from the incident?

Answered: More than a year


9. Question - Did the medical professional fully inform you of the risks of the procedure or treatment.

Answered: Did not provide full information about the risks

10. Question - Please describe additional information that you received about the risk or found out after the procedure from another source.

I was not informed that the risk of early admission to the hospital was increased intervention that could lead to a hasty attempt at induction which is associated with a higher likelihood of c-section, mortality for mother and baby, respiratory distress for the baby and NICU stay. If I had know that quickly, upon admission to the hospital that an induction of active labor would have been suggested, I would not have consented to being admitted.

It was later that I found out about backdoor induction from a labor and delivery nurse who blogged about it at:http://nursingbirth.com/2009/04/13/don%E2%80%99t-let-this-happen-to-you-24-part-1-of-2-jessica-jason%E2%80%99s-back-door-induction/

11. Question - Were there unanticipated costs associated with the medical procedure or treatment?

Answered: Yes (therapy, an extra day of hospitalization)

12. Question - Did your health insurance company pay for expenses associated with this care?

Answered: No (not the therapy)

13. Question - If you declined medical care you thought was unnecessary, what tests or treatments were offered to you that you declined?

Answered: Other

14. Question - Please describe why you thought the tests or treatment were unnecessary and declined them.

I declined the induction that the midwife attempted to force on me. She lied to me telling that she wanted to augment my labor. I after learned that using pitocin and breaking water before 4 cm dilation (and active labor) is a complete induction.

I also declined the morphine and sleep aids that I was offered. I felt that the midwife was attempting to coerce to me take them and that she did it with the intent of knocking me out so she wouldn't have to deal with me. When a woman is coping well with her established labor pattern and is not expressing any exhaustion or discomfort, the offer for pain relief or sleep aid is unnecessary.

15. Did you seek a second opinion?

Answered: Yes

16. Question - What did you do?

Answered: Pursued another treatment

17. Additional Information:

Because I was told that there was a good reason to be admitted to the hospital, I was very confused why I was then rudely told to leave the hospital when I declined the offered procedures and drugs. I continued laboring and progressed to active labor after being kicked out of the hospital for my lack of cooperation. I was then afraid of going back to the hospital fearing that I would be told to leave again, forced into intervention I knew to be unnecessary or that I would be lied to regarding the health and well-being of my baby.

In the hospital, I considered trying to switch providers to one of the OBs on staff and I learned that the OB supported and was going to sustain the midwife's plan for my labor. When I was told that I would not consent, the OB told me to leave.

At home I considered the options of not seeking further treatment or consulting with another hospital or maternity care provider. Because I was in labor and the baby would be born within hours, I could not bring myself to go to a different hospital and provider that I had not planned on working with. I was very fearful that if I even tried another hospital would not admit me. That left my other option of giving birth at home unattended by a medical professional or calling a homebirth midwife to attend me which I did not think a midwife would be willing to do without a prior working relationship with me. I was worried about the legal implications of birthing unassisted and thought perhaps my child could be taken away from me because of my neglect is obtaining proper medical attendance for his birth. I felt like my only option was to return to the hospital where I had been treated badly and hope for the best in spite of my fear.

Upon returning to the hospital, labor progressed easily and I birthed my baby unmedicated and without further intervention within 6 hours. By that time the midwife who had troubled me the day before was off shift and I didn't have to deal with her anymore. No further attempts to alter my labor were made though AROM was done with my consent. It was unnecessary at the time too but I did consent to it and did not feel pressured to do so.

In effect, the treatment I pursued was "the tincture of time." I knew that a first time labor could be slow to establish an active labor pattern that with the supportive emotional and physical assistance I could bear the labor as it progressed and that in time, the baby would be born without difficulty.

My story does not highlight the most egregious ethical lapses of a maternity care provider but yet, her treatment and tactics still were not right, not in line with the midwifery model of care and unfortunately indicative of the greater obstetric culture where its just fine for providers to withhold and manipulate information to hurry births along. I can only speculate on the motivations for why they do it and even with an explanation, the "care" cannot be excused. I truly hope that my story and others will have an impact on how patients are treated and that they are given the respect they deserve to make completely informed decisions.

Mothers and Fetuses: Whose Rights Trumps Who's?

One of the fears facing homebirthing and unassisted birthing mothers is a transfer to the hospital where their motives and "fitness" as a mother are called into question by hospital staff; sometimes resulting in CPS taking the newborn from its mother and the mother faces criminal charges. Another fear is the court-mandated Cesarean where a women is forced into a surgery that maybe against her wishes.

Lorna A. Turnbull discusses these issues in the article "The Legal Characterization of Pregnancy and Mothering: Does Mother Know Best?" in the Spring/Summer 2001 issue of Journal of the Association for Research on Mothering.

She states that the legal system has historically relied on a medical model of pregnancy that dictates the behavior and decisions made by a women. The state has then attempted to regulate pregnant women's behavior through criminal prosecutions or by allowing civil actions against the mother.

"The medical model removes the power of women with respect to their pregnancies and places it in the hands of doctors, or in some cases, the state. The model allows women to be depicted as self-interested or incompetent. The standards of medicine become the norm against which a pregnant woman's behavior is judged and a woman who decides against the norm of medical science is cast as irrational and selfish. A woman who defies the truth of medical knowledge becomes a bad mother, one who has declined to put the perceived needs of the foetus ahead of her own concerns."

Homebirthing and unassisted birthing mothers know this frame of reference all too well. By choosing to birth a home with or without a professional who is not a doctor, women are considered to be flouting what the medical establishment has deemed proper behavior for birthing women. The American College of Obstetrics and Gynaecologists have repeatedly decried the dangers of homebirth calling mothers "selfish," "irresponsible" and "incompetent." Conversely the vast majority of mothers who do choose to birth their babies at home do so beleiving that it is within the best interests of their baby and themselves; as to not be exposed to the risks attended with hospital birth. Ironically, the evidence based research of the most appropriate care for birth aligns with homebirth practices moreso than hospital births for low-risk women. Yet women are still being framed as unable to understand medical practices and then stupid and irresonsible for choosing to go against those practices. It seems that we still live in a world of "doctor knows best."

Rixa of Stand and Deliver also gave a talk discussing Risk, Responsibility and Safety at the 2008 Trust Birth Conference.

Childhood Vaccines: Questions All Parents Should Ask

Conscious Woman. org sponsors online seminars, called "webinars" on a variety of topics that are relevant to parents and women, particularly in their roles as mothers. They provide easily accessible, affordable information and evidence based research on topics like natural birth, circumscion, breastfeeding, vaccines, midwifery and being an effective advocate. As a stay at home mom, I am able to participate without interfering with my child's schedule as I can use a portable phone and headset to listen to the presentation and view the slide shows on my computer with internet connection.

I first became acquainted with Conscious Woman when I discovered that they were offering a series on Postpartum Mood Disorders, which Post Traumatic Stress Disorder after childbirth is one. I took the two part series to learn about my condition, what I could do to heal and move forward, as well as to learn about the academic research on the topic so I could be an effective advocate for change.

The most recent series I participated in was Childhood Vaccines: Questions All Parents Should Ask I was very glad to participate because, like many other parents, I have been concerned over the rumors about vaccines causing autism, asthma, chronically ill children, even death and other neurological disorders.

From the Conscious Woman website, here is an outline of the material presented in the webinar:

Part I: Myths vs. Realities
This workshop will explore common misconceptions regarding vaccination efficacy, and how tests are conducted to determine vaccine safety. Questions that will be addressed include:

What are the present legal requirements for mandatory vaccinations?
How effective are vaccinations?
Are vaccinated children healthier than non-vaccinated children?
Are vaccines safe? Do the benefits of vaccination outweigh the risks?
How is vaccine research conducted? How thoroughly are vaccines tested? How long are test children observed?
What is congenital rubella syndrome? Does the rubella vaccine prevent it?
Do vaccines cause meningitis?
Tedd will also discuss transplacental immunity and how it relates to current vaccination practices.

Part II: The Shots
Many parents still consent to routine vaccinations - believing that the “removal” of thimerisol (mercury) has taken away the major risks associated with the vaccines - without considering whether vaccines contain other toxic ingredients and what their potential side effects may be. This workshop will focus on the following questions:

What’s in a vaccine?
Are there benefits to infectious diseases of childhood?
What is herd immunity?
This workshop will explore the controversial research on SIDS and vaccinations, the relationship between polio vaccine and cancer, and whether or not polio has disappeared as a result of the vaccine. Epidemiology of childhood diseases, mortality and morbidity, and the Hygienic school of disease will also be addressed.

Part III: Risk and Conflict
This workshop will involve an exploration of Juvenile diabetes, Crohn’s disease, autism, post-encephalitic syndrome and a multitude of other chronic diseases and conditions that are associated with vaccinations. The focus will be on how conflicts of interest have played a significant role in the introduction and proliferation of unnecessary and harmful vaccinations into state immunization requirements and ultimately - into your child’s body.

This workshop will conclude with a discussion of the age old debate between expressive and suppressive healthcare.

The series is being offered again, in three parts starting June 8, with part two on June 22 and part three on July 6. Its a very good way to spend a Sunday morning: learning while in your jammies.

What did I learn from the series?

I learned that there is not enough research to dispute the claims that vaccines cause autism, or death; therefore making putting their safety into question. Until vaccines are proven (by quality, reliable research) to not cause injury to children, I will not feel comfortable following the recommended immunization timetable published by the Centers for Disease Control. It seems to me that pharamceutical companies, doctors and public health officials are not addressing parent's concern about safety and effectiveness, instead are running smear campaigns implying that parents whose children suffer vaccine injury are seeking to blame someone, and those who chose not to vaccinate are irresponsible and neglectful parents.

Educational Guide to Plastic Problems

Here's another topic that as a mother gets my attention. When I hear that plastics (that are used in most all children's toys, feeding utensils, and food packaging) contain dangerous chemicals that lead to adverse health effects, I start listening and finding out what I can because I want my children to be healthy, protected from dangers, especially those that are present (unknowingly) in my home.

I found this guide to be helpful in educating me about what is contained in plastics and what their effects are.

Smart Plastics Guide

I hope that guide is helpful to other parents!