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Woman Refuses Episiotomy, Gets One Anyway

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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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"This case is not about malpractice. It is about the right of a patient to refuse an intervention. While the doctor stood with scissors in hand, the patient can clearly be heard saying, 'Don’t cut me.'"
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A woman in California is suing her obstetrician because he performed an episiotomy that she had specifically requested not be done. A relative of the patient shot a video of the entire delivery. The portion of the video embedded below begins after the mother had been pushing for about an hour. You can judge for yourself about the bedside manner of the obstetrician. [Emphatically NSFW]

Articles on Yahoo! News and The Daily Beast provide some background to the story.

The incident brings up some issues.

According to Yahoo, more than 80 lawyers turned down the case before a civil rights attorney agreed to handle it. People who commented cited this as proof that the patient did not have a strong case for malpractice.

The reason it is not a good malpractice case has nothing to do with whether the doctor was negligent or wrong. In order to successfully sue for malpractice, there must also be damages. In this case, the episiotomy apparently did not cause harm. Therefore, a malpractice lawyer would decline the case because, absent damages, there is no money to be made.

This case is not about malpractice. It is about the right of a patient to refuse an intervention. While the doctor stood with scissors in hand, the patient can clearly be heard saying, “Don’t cut me.”

Many other comments centered on the misconception that episiotomies lead to better outcomes of deliveries.

To quote The Daily Beast, “Though episiotomies were once common in the U.S.—in 1979 they were performed in 61 percent of vaginal deliveries compared to 14 percent today—the American College of Obstetricians and Gynecologists (ACOG) released a statement in 2006 discouraging their routine or preventive use, finding that it benefited neither mother nor baby. ACOG also noted there were consequences to the procedure, including severe tears, infections, anal sphincter dysfunction, as well as painful sex.”

On the Daily Beast website, the behavior of the obstetrician and his insistence on doing the episiotomy were supported by many of those who commented.

Apparently they did not read that paragraph. That is no surprise, since it has been shown that most people who read articles on the Internet have the attention span of a gnat. [See my previous blog post on this subject.]

In early May of this year, I blogged about a bill introduced in the Wisconsin legislature that would mandate that every operation be video recorded. I discussed a number of reasons why I thought it should not pass.

But after watching this, I am seriously rethinking my position on video recording of procedures. Maybe it’s not such a bad idea.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

 

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