In response to Hudson Hospital's ban on physiological breech birth and denial of informed consent and refusal

This is the letter that I have sent to the Hudson Hospital administration in response to a notice that was sent out March 7, 2013 announcing a ban on physiological breech birth and the denial of fully informed consent to care and fully informed refusal for care.  I have written the letter from the position of being a past patient and not as a care provider.  I chose this point of view as I feel it will be more valuable for them to hear from a consumer and not a practitioner.  It has come to light that the decision was based on attempting to fit into a Triple Aim model and not because of litigation, fear, or even evidence based practice.  

Here is the letter from Hudson as it has been posted on Facebook.

"Hudson Hospital & Clinics is committed to achieving the Triple Aim in our service to patients and families.  We are dedicated to providing excellent patient experiences while delivering quality care at an affordable cost.

We have consistently experienced growth in our Birth Center volumes each year and want to ensure on-going safe patient outcomes for both mothers and newborns.  It has been decided jointly by medical staff leadership and hospital administration to suspend vaginal breech deliveries immediately and these patients will be delivered by cesarean section.

Medical interventions will be employed, when needed on all mothers and newborns, including transfers in, to assure the safety of the mother and newborn.  This practice is in alignment with national medical standards of care and consistent with other hospitals in the region."

So I ask you - do you want your health care based on corporate goals or based on evidence collected in practice and execution of laudable medicine?

Please do let Hudson know what you think and contact them.  This is a link to the Stand and Deliver blog written by Rixa Freeze.  Rixa has laid out a lovely talking points bulletin to help form your letter.  Thank you Rixa!  She is also giving away a lovely baby wrap if you contact Hudson by March 18.

Why is this important?

Because this is a big step back for a woman's right to choose her care.  It is a big step back for women to be able to birth according to evidence based medicine.  It is a violation of human rights.  Please do not sit idly by with this, it is affecting your community and it will eventually effect someone you know.

Have a great day and be well ~ Adrienne

14 March 2013

Dear Robbi,

I am a mother of two beautiful children who were birthed at Hudson Hospital.  I chose Hudson because of the willingness of the hospital to accept my family’s adamant demand for fully informed consent and fully informed refusal for care and interventions.  The nurses and doctors that cared for my babies and me were wonderful, caring, and skilled in their art.  I have since referred many families to your hospital.  I will no longer be referring anyone to your hospital with the current policies in place.  Let me explain why.

First, the decision to suspend vaginal breech delivery is heart breaking.  My first child was delivered vaginally and breech at your hospital.  The most recent studies have shown there is no higher risk for vaginal breech delivery than cesarean section when the baby is presenting in the Frank position.  Especially if the practitioners are skilled in physiological breech birth.  Hudson has the unique situation of having very skilled practitioners in physiological breech birth.  The ACOG recommendation in physiological breech birth in 2006 even states that vaginal breech delivery of a singleton breech should be based on the skill of the practitioner. 

Second, the decision to employ medical interventions on “all mothers and newborns” is a slap in the face to the educated women of this age.  We are not ignorant, helpless nymphs that cannot make a decision for ourselves.  This policy is a violation to women and their partners to make medical decisions for the good of their family, with what they feel comfortable.  The current “national medical standard” is not a good one – the United States has the third highest maternal and infant mortality rates in the developed world.  Not impressive.  This is the equivalent of saying “Johnny jumped off the bridge, so I am going to do it too.”  Hudson’s own Patients Rights and Responsibilities state:

·      “ Except in emergencies the consent of the patient or the patient’s legally authorized representative shall be obtained before treatment is given.”

·      “All patients have the right to be informed concerning their continuing health care needs, course of treatment, prognosis for recovery, and alternatives to meet these needs in terms the patient can understand.”

·      “Any patient may refuse treatment to the extent permitted by law and is informed of the medical consequences of the refusal.”

It literally made me cry to hear the board’s decision for Hudson to become a surgical birth hospital.  I myself have an irrational fear of C-section and was so grateful to find a hospital that would allow physiological breech birth.  I went into my birth knowing that at best my baby would have some respiratory difficulty at first, and at worst death for the both of us.  But isn’t the worse case scenario for any woman giving birth death?  Don’t we all face that when we first discover we are pregnant?  Is it so awful to allow women to educate themselves about the risks and delights of birth that now we just say, “Oh, the doctors know best, let them make the decision for you.”?  Part of the gift in being able to bring a life into this world is the responsibility of the woman and her family to understand that birth does not always end perfectly.  Women hold great responsibility when they become pregnant and taking away the choice of informed consent and refusal is extremely disempowering to all women and their families.  I fear for the future of birth and empowering women to be strong, well informed, and allowed to give birth in the manner that is best for them.  I ask that the Hudson Administration reconsider their decision and perhaps find a different approach to achieve the Triple Aim.

Very Sincerely,

Adrienne C. Caldwell