Google+ Authentic Parenting: Medical Diagnosis in Pregnancy

Monday, January 31, 2011

Medical Diagnosis in Pregnancy

Image: Daquella Manera on Flickr
In obstetric care - which is still the main from of care pregnant women in the Western world are getting, and which more and more women in the world are being pushed into - it seems as if a pregnant woman is a disease waiting to happen. Obstetric care for pregnant women is indeed focused on seeking out deviant results in an otherwise symptom-free patient. That's why 'regular' care in pregnancy includes this huge battery of tests (well, that and the fact that these tests mean big business for hospitals).
This is quite different from any other medical speciality. Generally doctors don't seek out illnesses, unless they manifest. Most forms of medicine are diagnostic or curative... seldom is medicine explorative or preventative.
Preventative care can even be refused by your doctor (like taking out a completely healthy appendix, because it might someday get inflamed), and preventative drugs - profylaxia - are mostly given only when the treat of disease is real and the cure is hard or non-existent (at least this is how it should be in an ideal medical situation, but we see that with things like vaccines - big business again - this bird doesn't fly either).

So back to obstetrics. Obstetric care looks for diseases that don't present itself, and uses preventative treatment and procedures and sometimes even surgery, without necessity. ANd most often without informed consent. When necessity does arise, it is most often created by the very profession that cures it - again all very lucrative. All under the motto that "we should think about the baby too". I'm sue if they would ask those babies, most of them would prefer to just be able to gestate at their own pace, and be perfectly well with that.

Image: Euthman on Flickr

So I wonder where this attitude comes from - especially since it has been proven time and again that this approach to pregnancy causes more harm than anything else.
There are two reasons I can see for this approach. One is financial, as you could have guessed from the text above: labour wards are often indeed one of the only wings of a hospital who make a profit (that and radiology or laboratory facilities). The other one is that OB/GYN in fact practice defensive medicine and a diagnosis in pregnancy gives them a sort of 'get out of jail free card' to get out all the possible tests and procedures in the book, and afterwards - if all would fail - leaves them to say "we tried everything we could".

Either one of these reasons seem very unethical to me... Is all this even legal? And who regulates this?


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4 comments:

  1. i completely agree that all of these tests are not needed. my OB didn't. one of the OB's where i was going when i was pregnant kicked me out for refusing the glucose test. he said that i was not going to tell him how to practice medicine and that i either do what he says and all the tests that comes along with pregnancy or i can find somewhere elso to go. i said, "tell me where i can go because i'm not doing it." (i was 32 weeks pregnant... nice to know that he was concerned for the baby...) i am a nurse and i see these same OB's from that practice at work... but they cannot scare me.
    i called around to other docs in the area and they all said glucose test is standard and i would have to do it. i didn't go midwife or homebirth because of my husband's wishes.
    i did find a new doc. he didn't do the glucose test but he did do an a1c. (i would have been fine with no test at all. and... my blood sugar was fine) this doc basically told me that he is different. he will tell me what he thinks but ultimately, i get what i want. i was very happy with my experience with him. others told me that i should pick my battles and just to the test but i was not going to let some dumbass, god-complex MD tell me i needed induced or anything like that...

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  2. Some women find comfort and security in being told what to do and what is 'right'. This is unfortunate, but many people choose not to think for themselves, this is for many reasons. It's easy to blame someone else for any problems if that person is doing all of the 'choosing' for you. Again this is unfortunate because its not a blame and statistics game, this is their life, this is their happiness - when it comes down to it,ultimately every single person is responsible for themselves.

    I rememember educating myself regarding vaccines, learning as much as possible about immunology and germ theory. After learning and reading many research articles and journals, I had thought to myself that i wish i could give this knowledge back - that it was easier just not knowing. And it is easier to rely on someone else.

    But life is not easy.

    If a person loves themselves enough, they will ask questions, they will learn, they will teach others!

    Thank you for this post !!

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  3. I think it depends on the mindset of the practice. It happens that my husband is a medical provider in the army and within that system there is no billing because the care is part of the benefits of being a soldier or a dependent of one. So there is no financial reason to do tests or procedures that are unnecessary.

    I also don't think that performing tests is a way of ensuring a "get out of jail free card". Doctors are required to carry malpractice insurance in the civilian world and those insurance policies often require that certain tests be done as standard in order for the doctors to be covered if the patient tries to sue. Americans are lawsuit-happy in general and frequently bring lawsuits against doctors for things that are not within the doctors' control. Tests get performed to insure that the doctor can prove that s/he did everything possible to prevent any problem that may arise. And there are tons of problems that can arise even from a normal pregnancy. For example: when the father and mother have differing Rh types, rhogam is given to the mother because during delivery the baby's blood mixes with the mother's blood and this can cause the mother severe problems. My husband's grandfather's first wife had this happen back in the years before Rh typing was discovered. She died after her second pregnancy despite transfusions and was lucky that her children didn't have hemolytic disease due to the antibody-antigen incompatibility. Her doctor called my husband's grandfather years later to tell him that Rh incompatibility was the reason she died.
    In the fetus hemolytic disease can cause enlarged organs (liver, spleen, heart) and fluid retention in the abdomen - all things which would require various expensive medical procedures to fix and/or medication for the rest of the child's lifetime. In newborns whose contact occurs during birth, anemia, jaundice and difficulty breathing are common problems. If the mother's death can be prevented, as well as health problems in the baby, by a shot of rhogam - why wouldn't one want to have the shot?

    Personally, I refuse the rhogam, but I'm lucky: my husband and I both have the O- blood type and can only have children with this blood type. I don't need the rhogam. But there are other women who do need it and for whom a doctor might insist they get the shot, specifically those women who are unaware of the partner's blood type (for whatever reason) and, more importantly - for those women who wish to hide the identity of the father of the baby. In fact, when I was pregnant with my first child, I tried to refuse the rhogam, explained why it wasn't necessary and the nurse practitioner turned to the student NP that was with her and said, "Usually we don't take their word for it." I told her off and said that if she felt that way she could tell the student out of my hearing and that I was offended that she basically said that I had probably cheated on my husband without even knowing me. That said, I know specifically of a case where a baby was having problems and the parents took him in to the doctor. The doc walked in and said "So the father is African-American? Have we checked for Rh problems and sickle cell?" to the PA student. The woman's husband was standing there and he was white. Turns out she had been sleeping with his supervisor, who was African-American, and the baby was not her husband's. She knew it but chose to keep it from her husband. Not all people are honest about their medical histories and doctors have to try to take that into account and look for things that may be unknown or kept hidden, so that a potentially preventable medical problem can be found and taken care of. Because if the test is available and it's not performed, then the doc can be sued for malpractice for not doing the test - even when there's no indication that said test should be done.

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  4. Another point about the view that certain things are unnecessary:
    The same thing happens with vaccinations and in areas other than obstetrics. A colonoscopy is standard for someone who is over the age of 50, regardless of whether or not there are symptoms of colon cancer- firstly because symptoms are not always present, but also because often symptoms don't appear until the cancer is in more advanced stages and at that point it could be too late to do anything about. Until recently, breast exams were a standard part of every well-woman doctor visit because it was determined that this helped prevent breast cancer. If you never refused one at your practitioner's office, then you had a test done that wasn't indicated and for which you had no symptoms. It has since been shown that there is no evidence to prove that breast exams help prevent breast cancer in the general population, but doctors do tests because there are potentials for problems that often we just don't know about. Sometimes that means that a test may not have been necessary. But you cannot expect doctors to not perform tests which may have a bearing on the outcome of a pregnancy (or on any other health issue) and then have people not try to hold them liable for problems which result from that decision. It's not how life works. People want to believe that things can be prevented that often can't be. The doctor is often the one who gets blamed - it's damned if you do and damned if you don't. If a doc has been sued before for not doing a test you can bet your ass s/he's going to insist on doing it every time.

    A part of this is genetic testing during pregnancy, which are done even when there are no indications of a problem. Most people think that these tests are necessary, because if there is a problem, they want to be aware of it before the baby is term. Some tests can show that the baby is unlikely to live long after birth, simply because of the birth defects it may have. Some birth defects can be repaired in utero and are discovered because of tests that are done when the mother has no obvious problems with the pregnancy. I had a great pregnancy about 5.5 years ago and had no idea that the baby had died in utero at 21 weeks, until I went into the office and had an ultrasound. This was in Germany and I had an ultrasound at every visit. The previous visit had been fine. There was no test that could have prevented his death but if there had been I would have jumped at it. The way American medicine works, I might not have known that he was dead until later. As it was I had to be induced and have a D&C after delivery. I know someone who had her genetic testing done and found out that the baby had a trisomy disease which meant that he wouldn't live more than a few days. She had time to come to terms with that before she was due, only to find out that he died in utero a few days before she gave birth. Parents need to know if there are special circumstances that will result from the birth of their children so they can be prepared for it.

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