Patient Choice Cesarean, Urgent/Emergent Cesarean or Forced Vaginal Delivery - Is it Really That Hard to Choose?

There's a phrase I hear from healthcare providers and others who oppose patient choice cesarean, "No physician is obligated to perform a procedure that he or she thinks is not medically indicated."

They see the denial of choice as being justified. Perhaps they think that they are saving the healthcare system resources by denying the choice. Perhaps they worry that women are unable to make an informed decision in this regard. Perhaps they see performing a cesarean without medical indication as causing harm, to either the woman or the child.

For whatever reason, there are those, who when faced with performing a patient choice cesarean, will outrightly refuse to undertake the procedure.

This would not be problematic if timely access to an alternate provider who is willing and able to undertake the cesarean can be realized. Unfortunately, under the current system - this is often not possible.

So if a woman cannot access patient choice cesarean when it is needed (either planned at 39 weeks or done urgently after the commencement of labour) - what will happen to the patient?

Perhaps care providers simply haven't thought about this in full - what happens to the woman, pregnant and desiring of a cesarean who is not provided timely access to one? What really happens?

Nature is a cruel wench - she isn't particularly patient, and the woman cannot just delay delivery until she finds a provider and a facility who can accommodate. The woman will eventually go into labour - this is nearly guaranteed. Either a medical need will then arise for a cesarean - in which case an urgent/emergent one will hopefully be provided - or medical need won't arise and at some point the woman will be fully dilated, and given no choice as to what she will have to do whether she wants to or not. She will deliver vaginally. The experience of which is foreseeably traumatic - or at least should be - as the patient will have been subjected to what can only be considered a Forced Vaginal Delivery or an urgent/emergent cesarean where either her life or her baby's is put at risk.

And the thing with traumatic experiences is that they don't just go away - and sometimes they don't ever go away. The physician will have avoided doing what he/she saw as a medically unneccessary procedure - but in so doing will have likely inflicted a rather large emotional toll on a woman as she is entering a very significant life transition.

I can speak to the experience of forced vaginal delivery as it is my own lived experience. I can speak to the toll it has taken on me, and how it has changed me and how having had that lived experience - I would not wish it on any other woman because it is it's own kind of hell.

That is the real choice facing health care providers when women come to them asking for a patient choice cesarean: Do you facilitate the request after having provided informed consent, or do you subject your patient to a Forced Vaginal Delivery or an urgent/emergent cesarean after medical need arises?

A Doctor who Listens: Worth Their Weight in Gold

I appreciate that my experience with the medical system has changed what I expect of it, and has sensitized me to certain things. In particular, I blame part of what happened with my pregnancy and birth of my daughter as a failure of my health care providers to listen and understand what my needs were as a patient, and to facilitate those needs as best they could. I communicated my wishes clearly, and expected them to be respected.

As I've blogged about before, also as a result of what happened, I needed to find a new family doctor. It took nearly a year, but I found one. It is a new relationship - and like any new realationship, it is particularly fragile. We've had a few encounters - and while I think the new Dr. is a good person, I think that it just is not going to work out.

Advocating for oneself in the health system is already a challenge. Recently (now a month ago), I had some female oddness happen - I emailed an OB I knew and asked what I should do about it. I made an appointment with the GP - and the GP's answer was basically to just do another appointment for a pap (no physical was done at that time). I asked for a referral to an OB and that it seemed like a good idea for a pelvic ultrasound to be done. He ordered the ultrasound but refused to do the referral at that time. We did the ultrasound, and I had another appointment with him to discuss the results. My Mirena is partially imbedded in my myometrium. I decided to ask for the referral to the OB I prefer to determine what should be done. My GP is refusing to refer and insists on removing the Mirena himself (a. I'm not sure removal is fully neccessary and I'd like a second opinion on that, and b. if it does need to be removed, I'd prefer to have an OB (and preferably the OB in Vancouver) remove it because if there are any complications the last place in the world, I want to go is Victoria General Hospital). Last Monday his receptionist called - and told me that he'd prefer to remove it - I reiterated the request for the referral. I called today (10 days later) to see if the referral had been put through. It hasn't. This is the last time I'm asking for it - and frankly, this experience has demonstrated that he is not listening to me and makes me question whether or not he would listen to me in the future with any issues that may arise. I am frustrated and annoyed.

I think the hunt for a family physician for the W family is back on - and I foresee going to a walk-in clinic in the interim to get the referral I need to access the care I need.

If anyone knows of (or is!) a family physician in Victoria who is accepting new patients and who listens to their patients - I promise a low-maintenance and grateful young family.