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How does your doctor talk to you?

8/7/2012

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Just recently one of the moms in my class related what her doctor told her when she asked if her baby could delay getting a Vitamin K shot at birth. The doctor told a story of a mom under his care who refused to immunize her newborn with Vitamin K and the child suffered brain hemorrhage as a result, and his skull had to be drilled into for operative surgery. 
I was surprised at this, not of the story, but of the fact that her doctor told it to this mother with such vividness and detail. 

For all intents and purposes, the mother was trying to make an informed decision about her baby's well-being. By telling her the story the doctor was not helping her make an informed decision. In fact, he was scaring her into complying with hospital practices. What he should have done was given her information about the benefits and risks of Vitamin K injection at birth, (This is a good one for example http://drbenkim.com/vitamin-K-shot-baby.html) and if he really needed, he could have mentioned he had seen cases of brain hemorrhage before. But to tell the story the way he did, it was clear he was trying to scare her. It is downright unprofessional, and something no doctor should do. In any case, it would be the pediatrician's jurisdiction when it comes to newborn immunization, not an ObGyn. 

When I was pregnant with my first, I would be ready with a long list of questions to ask my ObGyn at each antenatal appointment- about whether I could birth in different positions, about whether I'd be given enemas, episiotomies on routine, about her induction practices, etc.. But every time I tried to bring up the topic with her, she'd hush me with a wave of her hand and start throwing me statistics about deaths in births. She'd say things like "Did you know, every year, 7 babies die in childbirth?" ... and I would be left re-considering what I was asking of her, whether it really was too much to ask. I have since learned that it is definitely not too much to ask. In fact, I didn't ask enough. I should have insisted she make known her c-section rates (she also waved this question off with a vague "well it depends, sometimes 20%, sometimes 50%" ??!?), her induction rates, her episiotomy rates, and many more. And I was also in a system that supported this kind of disclosure (in Australia its mandatory that doctors and hospitals be transparent about these data).

My point is, scaring pregnant women by telling them stories of maternal or infant death or injury is an extremely unprofessional and irresponsible way for doctors to get women to do what they want you to do. Under no circumstances should a doctor resort to these scare tactics if he is a true professional... because this can have devastating effects on the psyche of the mother. In many cases the mother is left feeling unsure and insecure about her body's ability to birth naturally.

Families have a right to make informed decisions about their baby's births and care in the immediate post partum period. Sadly this is NOT supported in many hospitals or with many doctors in Malaysia today. Many doctors will order prenatal tests, prescribe drugs without bothering to explain to parents about why they think this is needed or bother even getting their consent.

Before families make decisions, remember you have the right to know "BRAIN": - 
 B - What are the benefits of a particular procedure?
 R - What are the risks involved?
 A - Are there any alternative courses of action/ options that we can explore / consider?
 I - What is my gut instinct?
 N - What if I don't do anything and let nature take its course?

And you also have the right to a second opinion. 

The more families make known their request for less biased, more accurate, evidence-based and complete information, the more the maternal health community will take note and perhaps some improvement can come about. 

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    A self-confessed birth junkie, I love all things birth and breastfeeding.. I'm so lucky to be able to work with expectant families and share this very special time in their lives with them :)

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