Dr. Amy's dead baby card

Just like the medical student I quoted in yesterdays' post, I too had an encounter early in my career with a natural childbirth advocate who refused to acknowledge that her baby was experiencing severe distress.

It happened within the first weeks of my obstetrics residency and involved a woman who had been attempting a VBA2C. The mother had received her obstetric care at a large HMO and had been cleared to attempt the VBA2C at the hospital. However, in an effort to give herself the "best chance" to have the longed for vaginal delivery, the mother hired a lay midwife and labored at home until she thought she was close to delivery.

She was only 6 cm and the baby was experiencing deep, prolonged episodes of bradycardia with heart rates down to the 50's (the normal fetal heart rate is 120-160). The patient refused oxygen, she refused an IV and she refused to reposition herself to see if the baby might recover.

It was about 2 AM and I was alone with a nurse who was equally inexperienced. The patient's doctor was in the OR along with the senior resident. We begged the mother in every way we knew how, but the mother was adamant. I distinctly remember her announcing that she would no longer speak to us and that henceforth everything must be negotiated with her lay midwife who kept counseling the patient that we were lying in an effort to ruin her "birth experience."

The young nurse began to cry and that frightened the husband. He started to cry, too and begged his wife to put on the oxygen. Shortly thereafter, her membranes ruptured and thick, pea soup meconium oozed out.

I had called into the OR to alert her doctor to the situation and he finally appeared. He strode into the room, tore the paper strip from the monitor and waved it at the patient and her husband. "You don't have to have a medical degree," he shouted, "to know that a baby's heart rate shouldn't go down to 50 and stay there. Your baby is dying and if you don't consent to a C-section right this minute, your baby will die."

The husband became frantic and the wife acquiesced. The baby was born within 10 minutes with initial Apgars of 1 and 1 due to a massive, nearly complete abruption. The father was appalled and just like the story in yesterday's post insisted that this was OUR fault and that they were going to sue.

They never sued, but I learned a great deal from the episode. I made sure that nothing like that ever happened again and it wasn't really that hard. I simply played my version of the dead baby card. In the rare instances in which patients were so indoctrinated by the NCB and homebirth literature that they would not believe a detailed explanation of the danger of severe fetal distress, I didn't argue. Arguing was what they expected and what they were prepared to defend against.

I drew up a hand written informed consent addendum:

Dr. Tuteur has explained to me that she believes my baby is in imminent danger of dying and needs to be delivered by C-section immediately. I understand that my baby might die without an immediate C-section, but I refuse and I take full responsibility for my baby's death.

No one ever signed. When faced with taking responsibility for the death of her baby, every woman consented to the C-section.

I didn't use that option very often, because frankly there are very few women who are so indoctrinated with NCB and homebirth misinformation that they cannot be reached. But for those who were, this seemed to cut right through the nonsense. When forced to acknowledge in writing that her baby might die, no woman could bring herself to do it.