Backassward

Ok, let me preface this with the fact that I'm only slightly post-coffee, and so my morning hair-trigger persists a little. But HOLY shit, what is it about the reactions to the Pit to Distress discussions?? Mercifully most of the reactions have been ones of disgust and anger (where I think they should be), but increasingly I'm seeing it spun into two camps: the "this wouldn't be happening if women didn't all ask to be induced so often because they're miserable, or their inlaws are coming, or doc is going on vacation" or the nursing camp which is focussing on the nurses responsibility to decline, or argue unsafe physician orders. It's not even about whether or not the words "pit to distress" or "pit to D or D", or whatever else are written into the chart or are accepted as a reasonable option in any hospital. While the nursing ramifications of these types of orders are very reasonable discussions to be having, NONE of these angles addresses the issue at hand!

Regardless of whether or not a woman is so rediculously miserable with being pregnant, or whether a nurse can use her hospitals protocols as back up to refuse to administer what she feels is an unsafe dose of medication we're talking about a system in which physicians are allowed to practice in a manner which is DANGEROUS and LIFE THREATENING. We MUST NOT blame women for presenting for an induction when they have (usually) been given what they -and probably their physicians - truly believe to be good clinical reasons. We MUST NOT blame the nursing staff for having to act as the safeguards for their patients (or not being able to, as the case may be). We HAVE to call the physicians (ACOG?!) on this particularly vile mismanagement and the medical school programs who teach their students that labors can be 'managed' this way. Where's the accountability?!!

I don't give a rats ass (sorry again, it's the coffee) if some quarters believe that this isn't common and therefore not worth getting worked up about. In the last few days I've heard first hand report after first hand report, in my state (where incidentally the ACOG chair - who is very pro-midwife and homebirth - when asked about this was shocked and appalled too), in other states. When the words "pit to distress" appear in textbooks the case can be fairly made that this is happening too frequently. Honestly I believe that even once would be too many. If you're uncertain if a mom/baby needs a cesarean, then to my mind you have two options: 1. You make the decision that the dyad needs a cesarean (hopefully for a sound clinical indication) or 2. You WAIT and WATCH for a true indication that takes them to the OR. Throwing high dose pit into the equation to accelerate this call is simply reckless and also, I think, cowardly. Asking nursing staff to participate in that process is beyond cowardly. I've stood up and applauded for the nurses who have made it clear to their physicians that "they want the pit turned up, they can do it themselves". The nurses shouldn't have to fight to 'protect' their patients.

As ever rising cesarean section rates are debated in this country I think that we have to very closely examine the reasons which are so commonly brandished by the physician camp: "you don't get sued for doing a c/s, you get sued for not doing one", "The childbearing demographic has changed" (AKA, too old, to fat, too short, too young etc. etc.), and address more closely the MANAGEMENT of pregnancy and labor in this country. Midwives are working largely with the same demographic, and yet through attentive, comprehensive, holistic prenatal care, excellent childbirth education, one on one labor support, and yes, no routine pharmaceutical augmentation of labor, we manage to facilitate vaginal births for many, many more women just as safely. All that, AND midwives are many times less likely to be sued by clients, even after bad outcomes - even in states where professional indemnity insurance is available to midwives. Why? Probably because midwives take the time and work hard to establish solid, trusting relationships with their patients - something which (respectfully) is tricky to do when you only see your physician for short minutes at a time and who (usually) step into the room as your baby crowns. So the "you don't get sued for doing a c/s" thing rings hollow. All too often mother/physician relationships are based on blind faith that your doc has your best interests at heart. Clearly though, as we discuss "pit to distress" that faith is terribly misplaced. That this is happening AT ALL, ANYWHERE, is TOO MUCH.

What we need to figure out is what we have to do to stop it and we have to stop blaming the women for what happens to them when they walk into a hospital.