This Sucks

Assuming all the facts are as they are presented, this sucks big time:

A Smithsburg woman is speaking out after she says she was dropped by her obstetrician when she was more than eight months pregnant, all because she refused to have a caesarean section.

"It is major surgery and you do have risks, not only during the birth, but down the road,” says expectant mother Lara Ecker.

Ecker says she knows how risky a c-section can be, after having her first two kids that way. So when she became pregnant with her third child, she told her doctor she wanted to do it naturally, or VBAC (Vaginal Birth After Caesarean).

“I was getting so close to my due date, I thought "certainly they'll help me try to do this',” she says.

But she says she was shocked when at eight months pregnant, her doctor's office, Simmonds and Simmonds in Frederick, gave her a letter telling her they were letting her go. They said it was because she challenged the use of a fetal heart monitor during labor and insisted on having a VBAC, a somewhat controversial procedure that some doctors say carries a higher risk of uterine rupture.

"The tactic I felt she was using was a fear tactic; it was like I was choosing between the life and death of my child, not the type of birth I was choosing,” says Ecker.

Simmonds and Simmonds did not return NBC25’s call for an interview, but officials with Frederick Memorial Hospital, where Ecker planned to have the baby, say the decision to perform a VBAC depends on the situation.

"If the patient comes to the physician with unreasonable demands, and will not allow him to deliver them in a safe manner, then the physician has the right to discharge the patient from his practice,” says Dr. Chet Wyman, vice president of medical affairs at FMH.

According to an opinion issued in July by the Maryland Attorney General's Office, a doctor cannot force a woman to have a c-section against her will unless the baby's health is in jeopardy, and ultimately the decision lies in the hands of the patient. It’s a notion shared by many women who have been down the same road before.

"Even though at that point, she could go into labor at any minute, her doctor only agreed to provide on-going care for the next seven days, we feel that constitutes patient abandonment,” says Barbara Stratton, Baltimore chapter leader of ICAN (International Caesarean Awareness Network).

Ecker says in the letter, her doctor gave her a list of three alternative options for other doctors, one which her insurance did not accept and two others who would not take her in at 38 weeks.

I began with the caveat "if these facts are correct":

• Did the patient wait until the third trimester to bring up her concerns about delivery? If so, shame on her.
• Did the physicians (or the allied practitioners) rush her through the regular office visits without allowing her time to discuss her delivery concerns, perhaps telling her, "We can discuss that later." If so, shame on them.
• Did the docs spend each and every visit patiently trying to explain to her why they felt the hazards of VBAC outweighed the risk of another c-section, failed to convince her and gently warned her that they could not in good conscience abide by her wishes and would have to discharge her as a patient? If so, shame on her for misrepresenting the situation.
  

That said, assuming the facts are as stated, waiting until 38 weeks and then dismissing a pregnant patient without warning is outrageous. This kind of discussion should begin at the first prenatal visit, and if by the beginning of the third trimester doctor and patient remain at an impasse, the transfer should occur then. Certainly patients deserve the opportunity to discuss things like fetal monitoring and other labor interventions ahead of time. I've known people to change OBs, albeit earlier in the pregnancy, when they felt their wishes weren't going to be respected.

I agree completely that, in effect, by waiting to this point in a pregnancy, this constitutes patient abandonment. The OBs involved knew or certainly should have known that at 38 weeks, the patient would not have any other realistic options for delivery.

I'd love to hear the opinions of my OBG colleague/readers on this issue, but in my humble opinion, this sucks.