Births Prompt Alarm

news-apr5_Layout 1 16/03/11 10:48 AM Page 648 News the wheat from the chaff when it comes “everything that seems simple may not Safety Commission’s National Electronic to online advice, videos give people be to everybody.” Injury Surveillance System reveals a who are considering self-treatment a While Canadians are less likely than litany of botched attempts to remove leg better sense of what they’re getting their American counterparts to “rifle casts with paint thinner, moles with nail into, says Zaugg. “You don’t need a lot their own medicine cabinets” rather clippers, dry skin with razors and teeth of medical knowledge to perform cer- than see a doctor for financial reasons, with screwdrivers, among other do-it- tain procedures. In almost all cases, the Goldman says wait times in Canada are yourself medicine failures (www.cpsc main risks you run are infection or cut- motivation enough for some people to .gov /cgibin/NEISSQuery /ExportFile .aspx ting into something you shouldn’t, but shirk professional care. ?FileName=/download/nss20027.tsv). that doesn’t mean the knowledge “A woman I know was scheduled Most common are the “people who should be inaccessible for anyone who for an appointment at an orthopedic have a lump on their skin and are certain wants to put the time and effort into clinic to have surgical pins removed they have an abscess, so they squeeze learning. I think everything a doctor from her foot. She arrived on time for it,” putting themselves at risk of “partic- learns, your average intelligent person her appointment at eight in the morn- ularly serious” blood-borne infections, can learn without a degree.” ing, and was kept waiting until four in says Goldman. Another category of do- It may be “quite reasonable” to train the afternoon. At one point, she decided it-yourself enthusiast that Goldman fre- patients, particularly in remote loca- she couldn’t wait any longer, so she quently comes across in emergency tions, to remove their own stitches, but pulled the pins out right there in the rooms is “the patient who is convinced one should “never underestimate the clinic and walked away. This is a smart they have a foreign body, like a sliver, a ability of people to misinterpret rules or person, and she was willing to do that.” metallic shard or a piece of glass or get them wrong,” says Dr. Brian Gold- A dearth of research tracking compli- wood, which they’ve attempted to man, an emergency room physician at cations among patients who choose to remove themselves. … Sometimes I can Mount Sinai Hospital in Toronto, skip the line and treat themselves at remove it, sometimes I can’t and some- Ontario. “The first thing I’d want home makes it difficult to assess the times there’s nothing there at all.” someone to tell me is how many health impact of open forum access to While such cases are nothing new, stitches they had, because if they pulled videos such as those featured in the the proliferation of medical how-to out eight and are satisfied, when in fact “YouTube Medical School” series. Cre- videos may lend a sense of false security there were nine, they could end up with ated by an orthopedic surgeon to provide to people who might otherwise have an infection.” practical examples of procedures to been on the fence about attempting a The popularity of medical how-to medical students “or anyone else who procedure at home, Goldman fears. videos speaks to the “tremendous wants to study to be a doctor,” the near “Suffice it to say, it happens in Canada, potential” that exists to teach patients to 600 videos in the series have attracted it happens in the United States, and I’d use health care services more appropri- some 1 136 850 views (www.youtube be very surprised if it doesn’t happen in ately, he adds. But in their current .com /user/surgicalgown). other countries, both developed and form, such videos typically fail to men- However, a cursory search of patient developing.” — Lauren Vogel, CMAJ tion “anything about the potential com- narratives accompanying 2009 data complications” or take into account that piled by the US Consumer Product CMAJ 2011. DOI:10.1503/cmaj.109-3812 “Do it yourself” births prompt alarm growing number of women Some 33%, or 8708 out of 26 667 guides and home videos dedicated to are choosing to give birth homebirths in the United States in 2007 freebirth. Popular parenting website A without the assistance of doc- were not attended by a physician or Mothering.com, for example, currently tors or midwives, provoked by dissat- midwife, up from 30% in 2005 and hosts more than 15 000 active discus- isfaction with modern obstetric care, 31% in 2006, according to the US Cen- sions on unassisted childbirth, or what fear of unnecessary medical interven- ters for Disease Control and Prevention members call “UC” (www.mothering tion and a desire to reclaim birth as a (www.cdc .gov/nchs/data/nvsr/nvsr58 .com /community). private, natural act. /nvsr 58 _24.pdf). Two-thirds of those It’s a difficult trend to track with any It’s a choice the professionals say is deliveries attended by someone other certainty, not least because advocates fraught with peril. They fear the fledgling than a physician or midwife in 2006 were of unassisted childbirth aim to avoid “freebirth” movement may undo gains in reported as “planned” (www.cdc .gov interaction with the medical system mother-infant mortality. The women, /nchs /data/nvsr/nvsr58 /nvsr58_11 .pdf). wherever possible. however, believe unassisted childbirth is Canada lacks similar statistics, but a While some women forgo prenatal emotionally and physically the safest cursory search online turns up a surfeit care entirely, others orchestrate a option for themselves and their babies. of websites, forums, chat groups, “planned oops” or “accidental” unas- 648 CMAJ, April 5, 2011, 183(6) © 2011 Canadian Medical Association or its licensors news-apr5_Layout 1 16/03/11 10:48 AM Page 649 News sisted birth to avoid confrontation with health care providers and the law. Many are already mothers, wary after a bad experience with a doctor or midwife. “My first son’s hospital birth left something to be desired. We were both fine, but the doctor I had was terrible. When I became pregnant a second time, I sought out a midwife and while one of the women in the practice was great, the other really talked down to my husband and I, almost like we were children,” explains Andrea Salcedo, a Calgary, Alberta-based mother who has since delivered two children unattended. “I was probably seven months pregnant when I decided I didn’t want [that midwife] at my birth. I didn’t want it to be a guessing game.” 2011 Jupiterimages Corp. Jupiterimages 2011 Others fear being coerced into med- © ical procedures they’re not comfortable Some women prefer to put complete faith in their bodies and refer to complications as with. “variations of normal.” “There are some people who can go into the birthing room and put their foot -fiche-eng .php). Significant variations than a remedy, she adds. “People down, but I know when I go into a doc- in surgical rates among Canadian juris- counting, measuring and managing tor’s office for an appointment, I get dictions suggest some of these proce- birth into this controlled, manipulated overwhelmed, let alone in a case where dures “may not be appropriate or neces- act, it’s no wonder women’s bodies they’re saying your baby might die,” sary,” by recent Canadian Institute for shutdown — the way anybody’s would says Lia Joy Rundle, a Mazomanie, Health Research estimates (www.cihi if someone kept interrupting them Wisconsin-based mother who delivered .ca/cihi-ext-portal /internet/en/document while they were trying to have sex, go all three of her boys unattended. “I /health+system +performance/indicators to the bathroom or go to sleep.” think it’s easier to trust yourself if /performance /release_16dec10). In Intervention should be the last there’s not another voice there. Having 2008–2009, primary c-section rates resort, not a given, says Salcedo. that other set of interests involved ranged from a high of 23% of deliveries “When I went to have my son’s birth makes me uncomfortable.” in Newfoundland and Labrador to a low registered, one of the nurses asked why Doctors and midwives bring their of 14% in Manitoba. we didn’t go to the hospital and my own timelines and expectations about With up to 15% of all births involving husband looked her in the eye and said: how a delivery should proceed, and will potentially fatal complications, however, ‘Because it wasn’t an emergency’.” err on the side of intervening in birth to “the evidence is overwhelmingly in The couple prepared for complica- protect themselves against litigation, favour of giving birth with a skilled atten- tions by reading books for first respon- says Laura Shanley, the Boulder, Col- dant present,” said Dr. Donald Davis, ders on how to deliver babies in emer- orado-based author of the book, Unas- past president of the Society of Obstetri- gency situations. sisted Childbirth, who has delivered cians and Gynaecologists of Canada, in a Others look for such information five babies by herself. “I can see the statement on freebirth (www.sogc .org online. position they’re in, because if you don’t /media /pdf/advisories /Release _freebirth “I had to assess what my personal deliver a perfect baby there’s a chance _final _e.pdf).

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