post midterm medical interventions and medicolegal stuff

Question 1

the pennsylvania case

Answer 1

ultrasound at base of another case like the Georgia case that didn’t involve belief in faith healing!
- doctors said that the baby was too big to deliver vaginally, needed C-section
- but she had already given birth to 6 big babies vaginally
- meanwhile, the hospital’s lawyers obtained legal guardianship of her unborn child
- court allowed the hospital to force Amber into surgery if she returned

Question 2

attentional bias in childbirth

Answer 2

• There are big legal and ethical problems with forced interventions during pregnancy. We tend to focus on them.
• But there are also big problems with the reliability of evidence and testimony presented in courts. We tend to not focus on them.

Question 3

electronic Fetal monitoring (EFM)

Answer 3

monitors heartbeat and contraction strength

Question 4

when and why was Electronic Fetal Monitoring introduced

Answer 4

Introduced in the last 1960s w/ promise that it will
reduce (by half) the incidence of:
- a cerebral palsy
- mental retardation
- Perinatal mortality

Question 5

issues with using Electronic Fetal monitoring as a fetal surveillance technology

Answer 5

• interpretations of fetal heart tracings are highly subjecting
• very little agreement among experts as to the interpretation of “non-reassuring reading” tracing
• false positive predictions of fetal distress area. given (>99%)
• using it increases C-section rates, without improving outcomes for babies

Question 6

why is EFM still used?

Answer 6

• makes nurse’s job’s easier
  - justify interventions
  - monitor several babies at once
• already invested money into equipment
• physicians can bill for the use of EFM

Question 7

EFM IN COURTS

Answer 7

• is heavily relied upon in courts to support counterfactual claims that a poor outcome (e.g., brain injury) could have been avoided
• is the main ‘tool of blame’ in birth injury litigation
• produces recordings used in court, based on which expert witnesses testify as to the exact moment (based on the tracings) when the baby sustained irreversible neurological injury
• fuelled and still maintains the international obstetric malpractice crisis

Question 8

correlation of Cerebral palsy with C-section rates

Answer 8

NO correlation rates!

Question 9

what is The most common obstetric intervention

Answer 9

Electronic fetal monitoring
(~85% of hospital births are EFM monitored)