The Good, The Bad and The Ugly…

by Lindsey Wimmer, MSN, CPNP

Over the last few weeks, I’ve read dozens of articles about the evils of a wide variety of topics in obstetrics that include cesarean sections, perinatal testing, medical intervention, birth positions, prescription medications, and more.  These articles all give individual examples of people who had horrible experiences or wish they had done things differently.   But they are all one-sided arguments of people who had horrible experiences or wish they had done things differently.

The part that drives me crazy is that I don’t see ANYTHING about the other side of the coin.  So I feel the need to speak up for the other side of the argument.

I know MANY people (as we all do) who are extremely grateful for the technology or interventions that they utilized in their health care decisions.  For example, they are thankful they had a medical intervention that ultimately saved the life of their child, gave their child a better chance, or allowed their child to have a better outcome.

It is irresponsible to talk about medical interventions without discussing WHY they were used.

I’ve talked to so many stillbirth parents who would have chosen every medical intervention possible if it could have saved their child.  These stories never appear in the magazines or on the television news specials.

In addition, these articles rarely explain WHY the people had the experience they did.  I have yet to see one that dared to say that the alternative to the horrible medical decision or intervention was that their child would have died.  That is ultimately my biggest frustration.  Our society is inundated with information about avoiding pre-term birth, induction, c-section, monitoring, testing, medication and more during a pregnancy.  But those same sources aren’t balanced by the other side of the story because stillbirth is a taboo topic.

The bottom line is – most of these medical decisions/interventions are ultimately trying to avoid the death of the baby or mother.  How many people know and appreciate this?

The half-information that is given to pregnant women leads them to believe that a c-section or an induction or similar intervention is the worst possible outcome.  I agree these things are not the first choice of any mother or the providers involved, but they are far from the worst possible outcome.

Ask any stillbirth mother what the worst possible outcome is and they won’t tell you a c-section or induction — they will tell you it is delivering a stillborn baby that could have been saved.

OBs, midwives, nurses, childbirth educators, and other health care professionals tell me frequently that they don’t usually tell their patients WHY they are recommending certain interventions if the ultimate risk is stillbirth.  They don’t mind telling them it will increase the chance of a longer labor or other non-fatal outcomes.  But they don’t want to scare these mothers by telling them their child could die.  I feel like these families need all of the information to truly be a part of the decision.

One of the articles talks about how some mothers were not given adequate information before making a decision and  they were upset because these mothers weren’t told they could say no to induction of labor, specific birth positions, or medications.  I would guess that these same mothers weren’t told that the interventions were likely being used because the provider feared the mother or baby or both could die if action wasn’t taken.  Why aren’t we talking about that side, too?  How many of these mothers have no idea that the provider they are bad-mouthing may have saved their life?  Would their decision to be angry about induction, c-section or anything else have happened, if they knew it possibly saved their baby’s life?

Another article mentioned that having a cesarean delivery increased the chances of having a stillbirth in a later pregnancy.  The theory was that the scar tissue disrupted blood flow through the uterus and caused the stillbirth.  While this theory merits further investigation, there was a glowing statistic that was glossed over – this increased chance was ONLY present if the mother had previously had an emergency cesarean section.  This tells me that the other theory deserving investigation is if the first child had the same or similar issues as the second child, but the cesarean delivery saved the first child’s life.

Why do we assume the medical intervention is the cause of a horrible outcome?  Why don’t we evaluate why these women needed a specific medical intervention and try to prevent a similar or worse outcome in subsequent pregnancies?  Instead, this article and its headline wanted only to give pregnant women one more reason to fear a cesarean delivery.

And what about the parents who want the medical interventions but aren’t told about the options, allowed to utilize them, or are made to feel inferior for needing or wanting them?  These parents deserve the same amount of information and support as the parents who don’t.  Who is standing up for them?

I ABSOLUTELY believe expectant parents deserve to have all the information available about the health of the mother, the pregnancy, and the baby.  This includes the good, the bad, and the ugly.  Many organizations are worried about the increase in the use of medical interventions, but, to me, the number isn’t significant – the ultimate outcome is.

One of the first things I learned in nursing school is that there are risks and benefits of EVERY medical action (or inaction).  Pregnancy management cannot be done from a cookbook.  Every mother, every baby, every pregnancy is different.  Open communication between the health care provider and the expectant family throughout the entire pregnancy encourages dialogue and discussion.  Any decisions should be based on FULL informed consent – even the parts that may not be popular or easy to hear.  As patients we need to be asking -“what is the worst possible outcome” when considering an intervention/procedure and “will this procedure/intervention improve the chances for a good outcome for mom and baby?”

The kindest thing we can do as a society is to encourage health care providers and expectant families to have open and honest conversations with each other, and to respect the recommendations made by this team.  They may not make the recommendations you feel you would have made, but every situation is unique.  Let’s respect the education, knowledge, and experience of the health care professionals together with the right of a family to do what is best for them without judgment.  If you expect them to tell you the whole story your perspective on their decision making and recommendations may be very different.

When you next see one of these articles – ask yourself……”What is the rest of the story?”

In reality, this communication and teamwork is the best chance we have of encouraging a happy, healthy baby and mom.  Ultimately, that is what we should be concerned about.