Meaningless Choices

There is, rightly, a push to ensure informed consent for medical choices. There is also, rightly, a push to ensure the full range of choices is available, of course ensuring that such choices are made with all the facts in mind. Various medical associations have released statements affirming that these options should be available. This sounds well and good, until you realise that, in some cases, these statements are meaningless due to various factors.

For example, The American College of Obstetricians and Gynecologists (ACOG) states that a woman should have the option to have a VBAC, and that this may be appropriate even after two Caesarians. This is something for which some have been campaigning, since the Caesarian rate in the US is rather high. However, in practice I'm not sure how much of a choice this actually gives women. ACOG doesn't have the authority to enforce this. Some doctors continue to have a policy of "once a c-section, always a c-section". In smaller towns, there might not be any doctors willing to oversee a VBAC, meaning that the woman doesn't even have the choice of switching doctors, assuming her insurance would allow that anyway. Speaking of insurance, I suspect, though am not certain, that the doctor's malpractice insurance plays a role in the refusal to attend VBACs. I certainly don't think the doctors are just being mean. But in this case, the statement from ACOG doesn't translate into a true choice for all women in the US.

A similar case is found in the case of vaginal birth of frank breech babies. ACOG states that vaginal delivery of a frank breech baby may be appropriate if the doctor is experienced in such births, the risks have been discussed, and it is carefully monitored. The key here is the doctor having experience. Through no fault of their own, many doctors lack experience delivering breech babies, as the standard protocol was to do a caesarian. As more research has been done, it's again been determined that vaginal birth of frank breech babes may be appropriate, but now fewer doctors have the experience to attend such births. Therefore, it is still a meaningless choice for some women (though hopefully not for long since I would think more medical schools would be training doctors for this given the more recent research).

I am in no way criticizing the doctors, nor do I think they are just keeping women from making these choices. In fact, i imagine some doctors wish to accommodate these choices, but cannot due to lack of experience or other factors. These are complex issues, with many factors coming into play. I simply lament that circumstances are such that, while women have the choice for these things in theory, it is not yet practice everywhere.