One of these spots goes something like this:
“Iowa hospitals are efficient. Efficient is the right care at the right time in the right place. If all hospitals in the US were as efficient as Iowa hospitals, we’d save 100 gazillion dollars.”
Let’s talk about that.
First, is that really a selling point? Come to my hospital, we’re efficient? As I said last night to some friends, do I want the most efficient heart surgeon?
No. I don’t really want efficient in health care. In fact, when I fell in love with our family doctor was some 20 years ago. He owned his own clinic then, and didn’t have to be efficient. Appointments with him lasted 30 minutes, sometimes longer. He talked to us. He listened. We received outstanding care. Now appointments are more wham, bam.
Second, this is exactly what OB patients complain about. Efficiency. OB appointments are like 5 minutes. Yeah, sure, the doctor can see 10 patients an hour that way. After an entire pregnancy’s worth of appointments, that doctor still won’t recognize his own patients at the grocery store. Or at their birth. I’ve had several women report to me that their own OB walked into their room at the hospital while they were in labor and introduced himself as though they’d never met. Hello?
Efficiency in terms of expense is also one of the reasons that American OB care sucks as bad as it does. OBs buy expensive equipment. They need to pay for said expensive equipment. So they use it on everyone, and bill their insurance, and eventually the expensive equipment is paid for. For example, ultrasound machines. U/S machines are SO overused in pregnancy. Some women get scanned at every appointment – for no reason. But, really, this is an efficient use of the machinery and it’s definitely cost-effective for the hospital or doctor’s office.
Also, efficiency might be a reason our C/S and induction rates are so high. OBs don’t like to wait around hospitals while a woman’s in labor. Hospitals don’t want women in labor hanging around to long, either. It’s inefficient. Why let a woman labor for 36 hours in one room, when we could start her on pit or just take her in for a C/S and get at least 2 if not 3 women in those 36 hours? It’s efficient to do it that way, and it definitely increases the hospital’s bottom line.
But is it the best care for the women and their babies??
Third. Let’s look at this. Right care, right time, right place. Perhaps this is true in most areas of Iowa hospitals. Let’s look at the OB area. ICAN recently called every hospital in Iowa, talked to their L&D nurses, to ask if they provided VBAC. Most (overwhelmingly) did not. Many of those, when asked what they’d do if a woman came in in labor, she was a VBAC, and she refused to consent to an unneeded repeat C/S, said they’d make her have one anyway. (let’s ignore the legal ramifications there, shall we? and, anyone from the hospital reading this who is inclined to deny this stuff happens – you’re wrong.)
The right care at the right time in the right place?
Let’s look at Iowa hospital C/S rates. I don’t have them handy, and I’m pressed for time so I’m not going to look them up, but they’re higher than the WHO-recommended rate, by a long shot. About 1/3, I think. 1/3 of Iowa women cannot give birth vaginally? Really?
Or is this the right care at the right time in the right place?
Let’s go beyond statistics to anecdotal evidence. My labor with Wally, in an Iowa hospital. My OB ordered my water broken, and ordered pit started. My labor was progressing just fine (and I declined these needless, but expensive, interventions). In fact, from first contraction to birth was 12 hours, for my first baby, that’s shorter than the average. Was this the right care at the right time in the right place? An acquaintance of mine was threatened by her OB when she refused to schedule a C/S simply because she was past her due date. When she came into the hospital in labor, she had another ugly confrontation with the same doctor. Right care, right time, right place?
Oh, I know, hospitals aren’t responsible for what the OBs do, is that what you’re going to say?
Bull. Hospitals truly interested in the right care, at the right time, in the right place would try to ensure that this kind of crap doesn’t happen.
Hospitals would allow VBAC. Hospitals would encourage OBs to accept VBAC. They’d allow waterbirth. They’d encourage moms in labor to be up on their feet. They wouldn’t read a patient the riot act because she refuses to sign consent papers for surgery she neither wants nor needs. They would do away with their silly hospital policies about length of time a woman’s allowed to labor, about monitors (evidence doesn’t support their use), about drinking and eating in labor.
The right care at the right time in the right place.
It would be funny if it weren’t so sad.