Reply turned post, second verse, same as the first

Dr. Dangerpartum Von Deathtrap (ha ha ha ha, Jill!) is at it again at The Unnecesarean.

The replies are flying quickly, and the manure is flying even more quickly. Dr. Amy is in poor form, misquoting abstracts and using the death due to shoulder dystocia baby card for babies within normal weight range. Huh?

Anyway, I can’t reproduce all my replies, because they are flying too fast and furious to keep up with.

When I told of a personal experience of being at a frustrating delivery that involved a protracted labor due to an induction in a first time mom, I pointed out that her normally sized baby (8 lb 11 oz) had no shoulder dystocia problems. And, evidence on the subject, including UpToDate, agrees that fetal weight below 4500g (that baby was below 4000g) is not associated with shoulder dystocia.

Dr. Amy’s response:

MomTFH:

“He ended up being 8 lb 11 oz, and there was no problems delivering the shoulders.”

So what? Do you think that’s a defense suitable for court: “the last woman with a big baby didn’t have a shoulder dystocia”?

What would you do if you were RESPONSIBLE in the event that a baby died because you didn’t do everything you could to prevent it? Would you shrug it off? Would you tell the mother, “Too bad things didn’t work out, but it’s more important that fewer women have C-sections than that you have a live baby?” How well do you think that would go over?

Oh, OK, because when I say he didn’t have any shoulder delivery problems at all, what I meant was, the baby died and I shrugged it off, and all I care about is practice patterns, not live and healthy babies.

Here is my reply

Wow, I guess that’s what happens when I comment without reading the other comments.

Dr. Amy – She had NO risk factors or indications for a macrosomic baby and the baby did not have macrosomia. Are you proposing if, in 3 years when I am a practicing obstetrician, I do not section all similar patients, I am risking killing their babies?

Here is a quote from Up to Date:

Fetal macrosomia — Studies have consistently shown that macrosomia is a major risk factor for shoulder dystocia [2,3]. Fetal macrosomia is best defined as an estimated fetal weight (EFW) of greater than or equal to 4500 grams, as morbidity and mortality increase above this level [4,5]. The overall prevalence of birth weight over 4000 grams in the general obstetric population of the United States is 10 percent [6], but falls to 1.5 percent for birth weight over 4500 grams [4].

Her baby was more than 500 g below this threshold, and did not have an EFW above that threshold.

What do you think of the idea of doing an induction at 39 weeks with a Bishop’s score of 2 on this low risk patient? Based on ACOG Practice Bulletins and other online materials on quality care, my interpretation of the risks and treatment decision tree is pretty spot on. How much more do you think the baby would have grown if her physician waited for her due date at least, and how much would that increase her risk of shoulder dystocia?…

Have you read this article yet? The Obstetrics and Gynecology Risk Research Group still thinks obstetricians are misrepresenting risk to patients, to the detriment of women and their babies. You do it also, repeatedly. You have this citation from the thread from more than a week ago. You proceeded to cite a study from the same group the very next day, so you must think it is a good source.

Then the good doctor wanted to set some baseline “facts” about defensive medicine:

Let’s go back to the facts that I set out.

1. Most parents of a baby who dies will contemplate suing the doctor.
2. Many parents will consult a lawyer.
3. The ONLY way to prevent a lawyer from filing a lawsuit is to convince him that he can’t win.
4. The ONLY way to convince a lawyer that he can’t win is to demonstrate that everything possible has been done.

Do you agree?

I responded (in a tag team with hostess Jill):

Right, because obstetric litigation is actually due to substandard care (note the use of citations, Dr. Amy).

One documented way to decrease obstetrics litigation is to DECREASE unnecessary interventions by following evidence based protocols. Funny, one of those protocols was on induction, which is what I was complaining about upthread. Not only did these evidence based algorithms decrease interventions, including cesarean sections, and improve outcomes (preventing those preventable deaths), but they also reduced litigation. Imagine that. With a citation.

Watch Dr. Amy completely invent imaginary conclusions contrary to the actual studies I posted, and then dig her heels in when I present her with the actual conclusions of the studies, and she can’t provide any quotes.

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20 Comments

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20 responses to “Reply turned post, second verse, same as the first

  1. I gave up on that one as soon as she said, “All Cesareans are necessary, or we wouldn’t do them.” Yup. Reasoning with that kind of crazy is a losing battle.

  2. infamousqbert

    good gawd almighty that doctor lady makes me want to claw some eyeballs out. not sure whose, but someone’s. again, i give thanks for being relatively privileged and knowing AND having options. i just hope i still have those options when i’m actually pregnant.

    • MomTFH

      You are so ahead of the game. I was clueless when I was pregnant the first time, and am so happy my outcome was as good as it was.

  3. April

    Ladies, thank you for keeping Amy on the internet and away from real-life pregnant women.

  4. Lindsay

    Lurker, popping in here. As amusing as it is to read all of these arguments (if I can even call them that when the person you’re arguing with is SO illogical and out there), is it maybe time to treat the good doctor like a troll and stop feeding her? I wonder what would happen if everyone just started ignoring her,would she go away? Or is that too much to hope for and she would continue to spew her nonsense unchallenged and then you risk the odd reader actually buying into it,thereby spreading the nonsense even further.

    • MomTFH

      I alternated arguing and staying away. Luckily, another physician showed up to the last thread, and Dr. Amy left in a huff, flinging insults over her shoulder as she left.

      At least, last time I checked. I am in a staying away phase so far today.

  5. Im Henery the 8th I am. I’m Henery the 8th I am I am….Oh sorry.

  6. OK, now I read it. Mom’s TFH. Have you ever been in a shoulder dytocia that caused death? Now this is important. Because we are more than the sum of our parts. Doctors are humans too. I have seen some nasty shoulders. Does that mean I will section everyone when I am a midwife. NO I will not but I will give eveyone information regarding shoulder dystocia and fetal ttn. Because folks need to choose. Birth is not without trauma. It will happen. Does not have to happen to a big baby. The baby can be 6 lbs. What needs to be done? Well I like to jump on the bed and put my fist into the pubic area to dislodge the shoulder. I have found, that I get good results with this and after speaking with midwifes and docs they have told me it was effective.

    However, Doctor Amy has a lot of good experience and I sincerely think she wants all practitioners to understand the pitfalls. I don’t think she puts herself out there just to win the goal of ass hole. I really don’t. I think she is blunt that is her problem. But I think behind it is a good human being. That is just my experience. But I wanted to share that with you.

    You have to remember, you don’t have any Doctor experience yet, so you don’t really know what kinds of decisions you make till you get there. I know your heart is in the right place but you ideas do change as time goes on. I know that after doing foot prints on dead babies, my ideas changed.

    • MomTFH

      Well, I am going to have to disagree with you on this one. I think there were many more problems with her interactions on that post, and others, than being blunt.

      Also, the birth I was discussing was of a normally sized baby. So, why the additional lecture on shoulder dystocias and dead babies? That baby was at more risk due to the nonmedically indicated induction (and its subsequent repeated nonreassuring heart tones due to pitocin) than it was at risk from a shoulder dystocia.

      Not following evidence based medicine = pitfalls. She was repeatedly arguing against evidence based medicine on the thread. I am not interested in worse outcomes by recklessly doing interventions, and research does not show that doing such interventions reduces dead babies who need footprints done, or malpractice suits. Especially when they are done on low risk mothers.

  7. KJ

    MomTFH I sparkley-heart you. You’re one of the only ppl that seems to have enough time and energy to really call her out on the egregious stuff and FOOTNOTE it, and not stoop to ad hominem stuff a la her usual level of discourse.

  8. Speaking of “keeping (her) on the internet and away from real-life pregnant women”, does anyone else wonder: if she has so much time for online shenanigans, why is she not practicing medicine again?

    • MomTFH

      I am going to refrain from discussing her any more on my blog, since I have told her to refrain from posting on here unless she follows through with my requests for a civil, moderated debate.

      But, I will say I think her choice not to practice is completely hers to make and I, in no way, judge her for that. She says on her bio on her site she did it to raise her four children. I don’t need to go all mommy wars on anyone. One has to keep in mind, though, that her point of view is now from an obstetrician who has left practice, which is a specific point of view from someone who the benefits of not practicing and the risks of practicing were balanced in the favor of not practicing.

  9. The sad thing is that there’s just no logic to be had in the medical liability world. Trying to make it sense just doesn’t work. Part of the issue is that lawyers operate on a different ethical scale. I don’t mean this to talk shit about lawyers. What I mean is that they will represent their clients interests, irrespective of the justice of those interests. They are not bound to consider the other side of the story, because the other side will have their own lawyer to do that.

    Personally, I don’t think defensive medicine works. I think we should focus on just making the best decisions we can, and more importantly, having good and open relationships with our patients. Hopefully in that case if we do have a bad outcome we can all understand what happen and take responsibility together.

    I think in some ways the natural birth community has less medicolegal risk because they spend a great deal more time with their clients, thus building a much tighter relationship. Suing somebody is such a violation that it rarely would happen between parties that feel some sort of closeness.

    Physicians are often taught to be friendly with their patients but to maintain enough emotional distance to be able to make vital decisions without emotional influence when it is required. While this may be necessary in some cases, it probably does decrease the intimacy of relationships and may increase the risks of lawsuit in bad outcomes.

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