By Desirre Andrews, President of ICAN
A woman’s pregnancy should be a positive time as she prepares for the birth of her baby. Unfortunately, in this age of defensive medicine, a pregnant woman must arm herself with evidence-based information and self-advocacy skills. She must be willing to act in a self-protective way to be certain she is getting individualized patient care versus the cookie cutter care modern medical practice normally affords.
This phenomenon of defensive medicine may largely be born out a very human response to the expectation of perfection we have in society today, especially with care providers. We have developed a willingness to hand personal authority over to our care providers.
For years, doctors have been deified, treated as being better than everyone else. Perhaps it is in their ability to save lives. We simply expect them to be able to do everything, but they can’t. They are human.
Doctors and patients might be able to see the human face of medicine if the traditional practice style that valued provider-patient relationship came back into use.
Today, with OB appointments being no more than ten minutes each visit, how can a personal, trusting relationship build between the two parties? It cannot. A woman can not be sure she can fully rely on her provider to know her well and help her make decisions that are in the best interest of her and her baby. The provider must rely on what he or she is comfortable with offering and doing to patients instead of taking each mother and baby into consideration individually. It is no surprise the circle of distrust and fear is palpable by all sides.
Prior to ever practicing medicine, the defensive attitude comes with the education a physician receives in medical school and the training in residency. The lesson is that your patients are not as educated as you are, always practice to defend yourself and get the patient to agree to the course of action you want no matter what.
With this attitude, what sort of “care” practices is a woman facing? Higher induction rates to lessen the rare fetal demise that can occur “post dates”. Higher cesarean rates because a physician does not want to incur risk of a VBAC mother going for a vaginal birth, even though catastrophic uterine ruptures are not common place. Viewing all OB patients through a lens of high risk or as an emergency waiting to happen.
All aspects of managed and medicalized birth occur because a physician is not comfortable, has fears, has worries and/or is not willing to practice outside of that mode because tolerate risk has been depleted. The physician desires to create a zero risk environment because of a lowered risk threshold either by training or by an adverse outcome in the years of practice. The humanness of the mother has been left out of the equation, while the ideal of a “healthy” baby is elevated in this physician centered point of view.
We as ICAN believe that every mother has the ability, responsibility and intrinsic right to make medical care decisions for her pregnancy, labor birth and baby. She should be able to obtain true and complete informed consent from her provider. We believe it is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective), to refuse to support VBAC (vaginal birth after cesarean) across the board without individualized assessment, or to skew cesarean as the easier, safer choice as a standard course of practice.
In the big picture no one truly benefits from a defensive medicine practice style. Providers and patients all lose.