Doctor's Pronouncements
Condition means C-section?
©1995 Beth Weiss, Posted to misc.kids Usenet newsgroup, May 12, 1995
Disclaimer: I am not a doctor, and I don't have all the answers on any
topics, let alone medical ones.
In the last couple of weeks, I've seen several women posting (including
someone on this thread) that their doctor said they had to have a c-section/be
induced, whatever, based on a medical condition. However, those medical
conditions don't necessarily require the intervention that the doctor has said
is required. I am not saying that the individual's medical
situation might not require the intervention, but rather that the condition
itself is not sufficient to require the intervention.
Here's an example. I have pregnancy-related ITP (I create antibodies
that kill my platelets). With my first pregnancy, the hematologist told me
I'd need to deliver by c-section due to risks of the baby's head being
compressed and hemorrhaging due to low platelet counts. That took a while
to adjust to, but after all, like all of us, I wanted a healthy baby, and I
started to accept the idea--what choice did I have?
So what was the problem? The hematologist was wrong. Women
with pregnancy-related ITP don't necessarily need c-sections, and in fact, in my
particular case, a vaginal birth was preferable, if it was possible (and it
was). How do I know that? Because at 38 weeks pregnant, I saw a
perinatologist who was up on the current research, and told us about study after
study that showed c-sections did not change the outcome in women with
pregnancy-related ITP, and that there were definite risks associated with
c-sections and moms with ITP.
On this group in the last month or two, I've had contact with several women
with ITP (not all pregnancy-related), and two have been told, by at least one
physician, that a c-section is required. I think those women need to be
told that they should question their doctors closely about this.
I am not saying that their doctors are wrong, or that what was
appropriate for me and my medical situation is appropriate for them. I am
saying that they should ensure that their doctor is up-to-date on current
research and findings in this area. Why? Because current research
and findings indicate that labor/delivery and ITP should be handled on a
case-by-case basis, and not by a set policy for all ITP patients.
I think people are trying to make the same point with regards to automatic
induction at 38 weeks due to gestational diabetes. I also have GD (mostly
controlled by diet, but barely), and my doctor brought up the idea of inducing
at 38 weeks. I told him I didn't want to be induced--but could be
convinced, if it was medically necessary. What's our current plan? A
sonogram at 38.5 weeks to estimate fetal
weight, and then a decision at that point.
In other words, more of a "let's be sure that this particular situation calls
for an induced labor". If my baby is large at 38.5 weeks, I'll know that
the induced labor is in our best interests. (I suspect that's what's going
to happen) If the baby is still reasonably sized (say 7-7.5 pounds), then
we'll wait until 40 weeks, and re-assess.
I feel comfortable with this, because the decisions are being made based on
my body, and my medical situation, and not the fact that I belong
to some broad category.
And I think that's the point that so many women have been trying to make
about "why all these inductions?" and "is this necessary?". Posters are trying
to point out that some of these "absolutes" don't have to be taken as
absolutes--they're really not always necessary.
When a doctor makes a pronouncement, many patients just go along--when they
should be asking "why does this apply to me?" and "what other options do we
have?" so that they're sure that what is happening is what _should_ be
happening, and that they're getting the best possible medical care.
              
|
