Saturday, August 13, 2011

Inherent Risks

I had a very interesting conversation today with a family member.  He has been having an abdominal aortic aneurysm monitored for several months.  Thank goodness his most recent evaluation showed that it had stabilized and hadn't gotten any bigger since his last exam.  He was telling me how he thought he needed to find a new surgeon since the guy he was with was pushing an angioplasty on him, which apparently would have done nothing for the aneurysm.  His doctor said they could check it all out and place stents in if they found any plaque as a preventative measure.  The aneurysm being the main concern, he declined the angioplasty, since any surgery carries with it inherent risks.  If it wasn't going to help the aneurysm, he would just as soon not do anything that might lead to further complications.  Since the aneurysm doesn't yet measure 5 cm (the threshold where they start to really consider the risk of rupture and the need to do surgery), he wanted to continue to monitor it closely instead of do anything of dubious value.  Apparently, angioplasty is a cash cow for heart doctors.  They can make like $10,000 in one 20 minute procedure, so some tend to push it on patients whether or not is is medically indicated.  He was telling me of one case where a patient needed open heart surgery, but they couldn't do it because of all the metal stents he had in his blood vessels from several previous angioplasties.  Oops.  (Now, please understand I have none of this as first hand knowledge, just what my family member was telling me today, but this family member has a vested interest in getting his research from credible sources since his life literally depends upon it). 

He then went on to tell me of his distrust of doctors in general and how he only goes if he has tried everything else and it still isn't working.  So when he goes to a doctor, there is a good reason and he wants help, not more watchful waiting.  So I said, as an off-hand comment, "And that is exactly why I have my babies at home".  He sort of chuckled and said "Well, what you're doing carries some serious risks".  I said "You are walking around with an abdominal aortic aneurysm.  That is neither normal nor healthy!  You just said there is a risk of it rupturing and you bleeding out in a matter of minutes.  I am having a baby - which is both normal and healthy.  How is what I am doing any more risky that what you are doing?"  He didn't really have an answer to that.  Looking back at it, I am slightly offended that his research and ultimate decision not to subject himself to unnecessary procedures - on a decidedly unhealthy condition - was somehow more valid than my research and similar decision, for a perfectly normal and healthy condition.  **Le sigh**  He has never made any negative comments to me previously about my decision to have my babies at home, and didn't even really make a negative comment this time.  He has been respectful of my choice.  Or perhaps he has just been silent - but that is good enough.  But it is interesting to see a little window into his thoughts on the matter. 

On the car ride home, I was thinking - and of course I am speaking in the grossest of general terms - that OBs are trained as surgeons and in the pathology of pregnancy.  They rarely see normal, natural births.  My pregnancy is healthy.  I am healthy.  I don't want to be operated on.  Why would I go to an OB?  My midwives are trained in normal pregnancy and childbirth.  They see it every day.  So if something is deviating, they know it and make sure the I see a doctor.  Why would I take my normal, healthy pregnancy to a place for sick people (the hospital) where it is the standard care to hooked up to an IV and monitored so closely that you can even move around?  Where I can't be sure if they are intervening in the process because it is necessary or because it is more convenient or because it is "standard procedure"?  Why would I subject myself to procedures that carry with them dubious value for a healthy woman within the normal process of labor and also the risk of possible complications?  It seems to me it is the exact same decision that my family member made regarding his heart, but for some reason when I make it about my pregnancy and baby's birth, it is suddenly unwise and unsafe.  All medical procedures carry with them the risk of complications.  I am choosing not to subject myself to them.  If it is absolutely necessary, I am happy to go to the hospital, happy to strapped and poked and monitored and even operated on.  If it is absolutely necessary.  But until then, you can find me at home.

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