Monday, January 13, 2014

When Nurses make Medical Decisions Instead of Doctors and Patients...

I think I know what really happened in my case. It is disturbing.

The head nurse at Victoria General decided that elective cesarean for whatever reason deserved to have the lowest priority and to never actually get on the slate.

A health professional who I had never met, who I had never discussed my pregnancy with, who decided in her judgement that I was not deserving of respect for my medical wishes.

Where have I come up with this theory?

From an OBGYN nurse who frequents an online discussion forum who decided to comment on a thread I started for Cesarean by Choice Mothers. She declared that there was no way that an elective cesarean was available in Victoria and then indicated why.

According to Tikitorch at Kids in Victoria:

oh yeah who? i am an obgyn nurse and yes i have been on mat leave for the last 4 months but im sure nothing has changed... even if there was elective c sections, theres no way they would make it onto the slate that the head nurse puts in order of priority for the OR, anyone with any medical condition would be above that person.

BC medical does not pay for an elective ceseran section (*unless you had a previous c section, or a medical reason for it, for example active herpes, diabetes, macrosoma etc), so if in fact you found a doctor to do it for you, and the moon and sun aligned and you got on the OR slate, you would be financial responsible for it,.,

This should provide as a warning to mothers planning cesareans by choice at Victoria General - the head nurse will substitute her judgement for yours and your doctors.


  1. The Head Nurse is doing the job she was educated to do. Bottom line is that your pregnancy did not warrant surgery to deliver. In the years since having my children and exchanging birth stories with other women I have never once heard of a woman requesting a C-section to preserve her vagina. The fact that you have been "traumatized" from a successful vaginal delivery of a healthy baby is ridiculous. Stop bashing VGH's nurses and doctors because they chose your baby's health over keeping your sex life as it was before baby.

    1. Nurses are not educated to override the decisions of doctors. The fact that you think it's okay for a nurse to decide that a pregnancy "did not warrant surgery" when A DOCTOR has already decided that it did is ridiculous. You have no idea what you're talking about if you think they prevented a c-section for the baby's health. C-sections are much safer for babies and any woman who wants one should be able to have one on that merit alone.

    2. Anonymous nurse,

      In fact this particular Head Nurse was a sadistic and misogynistic excuse for a human being. I hate all midwives and their like with all my heart and I really hope their sorry profession gets abolished soon. I certainly won't let any of them come within 5 meters of me, when I give birth by cesarean section in a private hospital.

  2. Violating a patient's autonomy and clearly stated wishes to the detriment of their health and well being in order to serve some ideology?? I'm sorry but that seems like pretty bash worthy behaviour. And for the record, given that my child wasn't born breathing, with the cord around her neck and a cord blood pH of 7 - if they were truly concerned about my child's health, she would have been better off with the cesarean. What happened deserves to be bashed!

  3. Mrs. W.
    After following your blog for some time a couple of points have come to mind and I wondered if I could ask?

    1) If you request a C-Section as your choice of birthing option in BC are you required to pay for it out of your own pocket? OBGYN Nurse's comment got me thinking.

    2) You had a C-Section second time around. Was your new doctor considerate of your choice or did you have to validate your reasons?

    3) Were your reasons with Baby Boy the birth trauma you experienced with Baby Girl, your concern for your physical state post delivery or a combination of both?

    4) I'm curious what the hospital bill is for a "natural birth" vs. c-section. I've had American friends ask me when I told them I didn't get a bill when I left the hospital.

    Thank you.

  4. 1. No. There is no private pay option for birth in British Columbia. Expect to spend some time hunting for the right OB though - and be wary of hospital policies, some of which (like that at Victoria General) might be less accommodating than others.
    2. The second time around my OB was very clear "how I birth my baby was my choice." - he was far more considerate and far more respectful of the choice. That being said I refused to go for a shared care model the second time around and had all of my prenatal care with an OB. In Victoria, this generally doesn't happen, however, given that I had a strong inclination to avoid Victoria General anyways I accessed care in Vancouver.
    3. A combination - I never wanted to experience a vaginal birth in the first place, I found the experience traumatic, and I see birth as a risky endeavour that can have devastating results. I will willingly trade the risks of cesarean for the risks of vaginal delivery - as things like HIE, brachial plexus injuries, shoulder dystocia, etc. really scare the crap out of me.
    4. There's not an easy answer on that - a significant number of planned vaginal deliveries result in emergent cesarean surgeries, also a number of "natural births" include things like epidurals, and are you including the cost of surgeries to repair damage from vaginal deliveries or not? Research out of the UK done by the National Institutes for Clinical Effectiveness (whose guidelines permit elective cesareans) determined the cost difference was less than 100 pounds (less than $200) when just one downstream impact was taken into consideration (urinary incontinence). A back of the envelope calculation I did a while back (using CIHI data) concluded the difference between planned vaginal and planned cesarean was likely less than $500. When I was uncertain I could secure a cesarean here - I looked into going to the US and had a cost estimate of $14,100. Again, I've never got a bill for either of my deliveries, nor do I expect to.

  5. I think CS should be a woman's choice. But elective CS should be the lowest priority. So should any elective surgery. It should remain on the slate - a nurse should never simply remove someone from that list - but it is the professional responsibility of the nurse to triage the most important. Ruptured appendix, internal bleeding, breech diagnosed during labour - these all should (and usually do) take priority over an elective CS. If a woman ends up delivering vaginally after requesting a CS due to lack of OR space re: other emergencies, then that is an entirely different issue that healthcare would need to assess - the need for more OR resources.

    1. I agree. It should be the choice of the Mother. However it is almost like it should be a private clinic kind of thing so you can avoid being bumped by more urgent cases. I know Mrs. W. used a hysterectomy as an example but if you were the woman waiting for this surgery you are probably in a lot of pain and it is a serious issue. I wouldn't want to wait one more day to have my uterus removed knowing it was because another woman wanted to avoid vaginally delivering her baby.

    2. The woman wanting the planned CS is also trying to avoid significant pain and other trauma. It is also a significant and serious issue.

    3. Anonymous - would I wait one more day - even a day in pain, so that someone else's right to determine what to do with their body could be preserved because they cannot wait one more day. Absolutely. Because I know that not being able to choose what you do with your own body is a kind of violation that a person has a very hard time getting over (if ever). One more day for me - but for them it avoids dealing with the impact of birth trauma. That is the distinguishing difference - it's one day to those for whom surgery will happen just later, whereas the impact of not being able to have the cesarean in a timely way is cannot be reversed.

  6. I absolutely agree that "life or limb" emergencies should take precedence - however, an elective cesarean, given its time sensitive nature should not be bumped behind things that are not time sensitive. It should not be on the absolute bottom of the priority list, because doing so removes a woman's right to decide what to do with her own body and to expect that right to be respected. Will the person having a hysterectomy have any real impact on their quality of life going forward if they have to wait an additional day for a woman to have an elective cesarean? No. But the woman having the elective cesarean might be forced to undergo a procedure that she does not want if her surgery does not at least merit some priority in accessing the resources simply because she cannot wait an infinite amount of time for it to happen. Simply put these patients and doctors are just as deserving of having their needs met as other patients who must rely on the system.

    Patients need to speak up when they cannot access the services they need, when they need them - because otherwise the problem never gets identified, and nothing happens to fix it.