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Sunday
Mar202005

If It's So Bad, Why Do They Do It?

Also from my Doula list. The question above is regarding physicians and hospitals.

I answer:

Three major reasons:

Liability - doctors are sued for NOT doing cesareans, not do-ing them. Their liability insurance guides much of what they can and cannot do; the current atmosphere for VBACs as an example. Vaginal twins? Vaginal breeches? Not if insurance has anything to say about it. If there is the *slightest* chance that something might be going wrong, do EVERYTHING to document that you tried everything.

Time - scheduling inductions and cesareans and even doing epidurals with augmentations of pitocin dramatically shorten doctor's days and nights and limit the call time away from their families and other parts of their practice, including doing other GYN surgeries. Scheduling options has lightened the burden for OBs so dramatically in the last 10 years, I have heard docs quietly congratulating each other for not having been called out at all during a week-long night call schedule. Most of us know the not-so-subtle brainwashing that begins in early, early pregnancy to attend to "due dates" and "large babies" (and small babies and low fluid or too much fluid, or Or OR...) so that when scheduling becomes the "requirement" later on, the groundwork has already been firmly laid.

Money - No one likes talking about this part, but its reality must be addressed. Docs *do* make buckets more money for a LOT LOT LOT less time with cesareans. The average vaginal birth hospital cost, without prenatal care, without an epidural, is $10,000. A cesarean, without paying the anesthesiologist, is $25,000. Medi-Cal here in CA pays $800 for a vaginal birth. Around $3000 for a cesarean. Now, of course that is still peanuts compared to insurance payments, but you can see the dramatic difference and with FAR less time invested.

Wrapping all three of these reasons into one ugly package, it's incredible any woman gets an unmedicated vaginal birth out of a hospital doctor. I am always amazed and my mouth hanging open when I hear stories of patient docs and long labors allowed to continue. I send prayers of thanks to those docs that are actively bucking a system designed to bring them to their greedy knees asking for more and more money.

And I hate the insurance companies that schmooze the docs and bribe them with trips, things, and incentives to cut women. It disgusts me, the underbelly of the OB World. Not that I wouldn't be seriously tempted if I were in their shoes, believe me. It feels much easier and safer for me sitting here, as a homebirth midwife, to say these things to my clients and my childbirth classes. And of course, their picture (the doc's) is very different than my own, though liability is most often cited as THE reason for the cesarean rate, induction rate, etc. Not safety.

Long and convoluted.

Thanks for the patience as I ranted.

end post

I add:

Another poster brought up a wonderful point about fear and how people in this culture go to docs all the time to be fixed and cured and that many see birth as something to be fixed, too. That women are subtly promised that all will be well if they see docs and that fear continues to drive them to the hospital and docs in droves. I must remember to keep "fear" in the equation when asked this question. This will be a great point at ICAN meetings.

Made me think, that's for sure.

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    - Navelgazing Midwife Blog - If It's So Bad, Why Do They Do It?

Reader Comments (1)

I agree with so much of what you say here and yet, I do feel the need to speak up on behalf of the doctors just a bit. Before deciding to attend medical school, I spent years working in medical billing & then as an administrator in a pediatrics department at a large university medical center. As far as the physicians were concerned, the vast majority did their best to be present for their patients and to help them/advocate for them wholeheartedly. What didn't help them? Administration. It's the hospital administrators--the ones without the medical knowledge--who think that doctors should be pushed into seeing more patients so that the reimbursement rates and profits go up. I ended up siding with the doctors so often that my bosses hated me--hence my decision to go back to school and become a physician myself. I'm in my first year at a D.O. program--one I thought would be more open to holistic care--and I don't even know how to begin to tell you how bassackwards our education is. We learn in a problem-based format (i.e. from actual cases) and, in the first few weeks here, when we had cases involving pregnant women, the ignorance of the men in the room was unfathomable. And these guys are going to become doctors! Do our professors do anything to change this? No, because they're almost all old men. (Seriously, we have maybe three female physicians and/or ph.d.s on the faculty.) All they emphasize here is the "basic medical science." Granted, it's important...but I would have expected equal weight to be given to how to *care* for patients. No such luck. In all honesty, the way the program is designed is like boot camp. We're treated like peons, belittled, and basically given very little (if any) room to create healthy lives for ourselves. How can we become good health-care providers if we don't know how to take care of ourselves? How to we stop the cycle of abuse that keeps getting passed down to each generation of medical students? Add that to the fact that we're amassing more than $250K in student loans *each* for this "opportunity" to be tortured...plus GW's increase of the cap interest rate on student loans to 8%...and, well, I could see how some docs could end up bitter and struggling financially. I don't mean that to sound like an excuse for physicians doing more c-sections than necessary (that's criminal, in my opinion), but I guess this is all to say that the latest generations of student physicians are under stressors that the older guys never had to face. So if you see ordinarily compassionate people do ogre-like things under pressure, just keep in mind--doctors are human, too. Again, not an excuse for bad behavior--just some background context to add to the food for thought.

April 25, 2007 | Unregistered Commenterstudent dr. blaze

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