Home birth gone bad.

Started by cittykat
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cittykat said:
Craziest OB story I’ve ever heard is Act 1.



www.thisamericanlife.org

I Couldn't Help but Notice - This American Life

People dealing with new, glaring, massive changes happening right where they live.
www.thisamericanlife.org www.thisamericanlife.org
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It's financially difficult to run a labor and delivery unit when doing only 1 to 2 deliveries a day. Doing even less is not sustainable.

Your nurses are not going to be as well trained. Your OB coverage will be difficult. Anesthesia services will be difficult to consistently get.

The liability is already through the roof while OB reimbursement constantly gets cut.

The American public got what they wanted. OB is one of the most litigated specialties where a lot of hospitals would rather close the service line then deal with the declining reimbursement and liability.

The sad part is it's going to get worse. I know several OBGYNs who have completely given up doing deliveries. And they are only 40 years old. I still take some occasional call out of some sense of duty (feel a little bad about giving up obstetric skills and what it means for the community/society in general).

And I only have to talk to the guys in the local anesthesia group and read this board to know how many docs give up that part of their practice.

Couple that with smaller hospitals shutting down their Labor and delivery units (this is even in Southern California) and it will not be good in the next 10 or 20 years.
 
anonperson said:
It's financially difficult to run a labor and delivery unit when doing only 1 to 2 deliveries a day. Doing even less is not sustainable.

Your nurses are not going to be as well trained. Your OB coverage will be difficult. Anesthesia services will be difficult to consistently get.

The liability is already through the roof while OB reimbursement constantly gets cut.

The American public got what they wanted. OB is one of the most litigated specialties where a lot of hospitals would rather close the service line then deal with the declining reimbursement and liability.

The sad part is it's going to get worse. I know several OBGYNs who have completely given up doing deliveries. And they are only 40 years old. I still take some occasional call out of some sense of duty (feel a little bad about giving up obstetric skills and what it means for the community/society in general).

And I only have to talk to the guys in the local anesthesia group and read this board to know how many docs give up that part of their practice.

Couple that with smaller hospitals shutting down their Labor and delivery units (this is even in Southern California) and it will not be good in the next 10 or 20 years.
Click to expand...
Its going to consolidate for sure.

Very challenging for rural communities
 
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anonperson said:
The American public got what they wanted. OB is one of the most litigated specialties where a lot of hospitals would rather close the service line then deal with the declining reimbursement and liability.
Click to expand...

No, they didn’t. They protested the closure of a needed service at a hospital which closed OB for financial reasons. Your post is overall good, but if a hospital closes service and the next closest is an hour and a half away, then bad outcomes are absolutely inevitable. You know it. I know it.

The American public, in rural Maine, demanded better. The hospital didn’t listen. Apparently their elected public officials let it fly. A town board? County board? State reps? Congressmen and Senators?

If this is occurring across the country then we sit here and acknowledge the bad outcomes and deaths that are inevitable.

I’m not saying I have an answer. I don’t. But I don’t believe this is what ‘the American public wanted’. No more than I believe the American public wanted the corruption and fraud by Trump and outright dismissal of the needs of the American public.

I’m not gonna make this political, but there’s a clear relation. If Maine wants rural OB care, and they do need it, then their elected public officials and their citizens must demand it.

And if they don’t then they accept as a byproduct the rare but certain abruption or prolapsed cord that threatens lives.
 
Southpaw said:
No, they didn’t. They protested the closure of a needed service at a hospital which closed OB for financial reasons. Your post is overall good, but if a hospital closes service and the next closest is an hour and a half away, then bad outcomes are absolutely inevitable. You know it. I know it.

The American public, in rural Maine, demanded better. The hospital didn’t listen. Apparently their elected public officials let it fly. A town board? County board? State reps? Congressmen and Senators?

If this is occurring across the country then we sit here and acknowledge the bad outcomes and deaths that are inevitable.

I’m not saying I have an answer. I don’t. But I don’t believe this is what ‘the American public wanted’. No more than I believe the American public wanted the corruption and fraud by Trump and outright dismissal of the needs of the American public.

I’m not gonna make this political, but there’s a clear relation. If Maine wants rural OB care, and they do need it, then their elected public officials and their citizens must demand it.

And if they don’t then they accept as a byproduct the rare but certain abruption or prolapsed cord that threatens lives.
Click to expand...


To your point here is the article on which the podcast is based. Look at that map. Definitely a healthcare desert.

themainemonitor.org

Her labor turned dangerous. Her hospital stopped delivering babies.

Paramedics asked the rural Aroostook County hospital for help with the dangerous labor. Its initial answer was no.
themainemonitor.org themainemonitor.org



IMG_2441.jpeg
 
dannyboy1 said:
Here’s a thought. There is no way for comprehensive services to be available in every corner of the country. If you live there maybe spend your ninth month close to a hospital. This would of course require foresight and personal responsibility so of course will not go over well with the general public.
Click to expand...


Yeah some patients travel 2 hours to get induced while others take their chances.
 
Southpaw said:
No, they didn’t. They protested the closure of a needed service at a hospital which closed OB for financial reasons. Your post is overall good, but if a hospital closes service and the next closest is an hour and a half away, then bad outcomes are absolutely inevitable. You know it. I know it.

The American public, in rural Maine, demanded better. The hospital didn’t listen. Apparently their elected public officials let it fly. A town board? County board? State reps? Congressmen and Senators?

If this is occurring across the country then we sit here and acknowledge the bad outcomes and deaths that are inevitable.

I’m not saying I have an answer. I don’t. But I don’t believe this is what ‘the American public wanted’. No more than I believe the American public wanted the corruption and fraud by Trump and outright dismissal of the needs of the American public.

I’m not gonna make this political, but there’s a clear relation. If Maine wants rural OB care, and they do need it, then their elected public officials and their citizens must demand it.

And if they don’t then they accept as a byproduct the rare but certain abruption or prolapsed cord that threatens lives.
Click to expand...

Every system is perfectly designed to get the result that it does.
 
Southpaw said:
No, they didn’t. They protested the closure of a needed service at a hospital which closed OB for financial reasons. Your post is overall good, but if a hospital closes service and the next closest is an hour and a half away, then bad outcomes are absolutely inevitable. You know it. I know it.

The American public, in rural Maine, demanded better. The hospital didn’t listen. Apparently their elected public officials let it fly. A town board? County board? State reps? Congressmen and Senators?

If this is occurring across the country then we sit here and acknowledge the bad outcomes and deaths that are inevitable.

I’m not saying I have an answer. I don’t. But I don’t believe this is what ‘the American public wanted’. No more than I believe the American public wanted the corruption and fraud by Trump and outright dismissal of the needs of the American public.

I’m not gonna make this political, but there’s a clear relation. If Maine wants rural OB care, and they do need it, then their elected public officials and their citizens must demand it.

And if they don’t then they accept as a byproduct the rare but certain abruption or prolapsed cord that threatens lives.
Click to expand...
They may not have wanted it, but they voted for it. Doubly so since Maine's 2 house-seat electoral votes were split. The area where this happened went for Trump.
 
VA Hopeful Dr said:
They may not have wanted it, but they voted for it. Doubly so since Maine's 2 house-seat electoral votes were split. The area where this happened went for Trump.
Click to expand...

Per the article, the community stood firmly against the hospital’s decision to shut down OB. The hospital let the state know one day before they announced publicly the decision.

Apparently hospitals are required to let DHHS know 120 days before a change such as shutting down OB care. If the argument is that the Trump admin has shuttered DHHS such that they couldn’t monitor changes across rural Maine after the hospital shut down OB care I could get on board w that. It’s probably true though I don’t know for sure. It does track for this admin though w their DOGE crap.

If your point is that they deserved this bc they voted Trump, I also can sort of get on board w that (you get what you ask for), though in this situation it’s said the lady who suffered the prolapsed cord wanted hospital services were they available. And so did the physician. Like is most often the case, they’re innocents in a system that turned against them.
 
Southpaw said:
Per the article, the community stood firmly against the hospital’s decision to shut down OB. The hospital let the state know one day before they announced publicly the decision.

Apparently hospitals are required to let DHHS know 120 days before a change such as shutting down OB care. If the argument is that the Trump admin has shuttered DHHS such that they couldn’t monitor changes across rural Maine after the hospital shut down OB care I could get on board w that. It’s probably true though I don’t know for sure. It does track for this admin though w their DOGE crap.

If your point is that they deserved this bc they voted Trump, I also can sort of get on board w that (you get what you ask for), though in this situation it’s said the lady who suffered the prolapsed cord wanted hospital services were they available. And so did the physician. Like is most often the case, they’re innocents in a system that turned against them.
Click to expand...
Thats the inherent problem with whole "question the experts" anti health/anti science maga movement.

The anti science maga leaders convince the uninformed public to go against well established scientific and health guidelines... despite all available evidence. Then when **** hits the fan, the uninformed public clamors for the experts to clean up their self inflicted messes.

And thats how measles comes back.

But since maga is so hard core on personal responsibility..should we turn away all those measles infected magas at the door? Sounds like 2000+ cases with a 7% hospitalization rate so far.

So far, estimated economic burden of each measles case is about 100k. Cost of a single dose of vaccine? $90

Maga math for ya
 
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UscGhost said:
Thats the inherent problem with whole "question the experts" anti health/anti science maga movement.

The anti science maga leaders convince the uninformed public to go against well established scientific and health guidelines... despite all available evidence. Then when **** hits the fan, the uninformed public clamors for the experts to clean up their self inflicted messes.

And thats how measles comes back.

But since maga is so hard core on personal responsibility..should we turn away all those measles infected magas at the door? Sounds like 2000+ cases with a 7% hospitalization rate so far.

So far, estimated economic burden of each measles case is about 100k. Cost of a single dose of vaccine? $90

Maga math for ya
Click to expand...


thefederalist.com

The Death Of Expertise

To reject the notion of expertise, and to replace it with a sanctimonious insistence that every person has a right to his or her own opinion, is silly.
thefederalist.com thefederalist.com
 
cittykat said:
To your point here is the article on which the podcast is based. Look at that map. Definitely a healthcare desert.

themainemonitor.org

Her labor turned dangerous. Her hospital stopped delivering babies.

Paramedics asked the rural Aroostook County hospital for help with the dangerous labor. Its initial answer was no.
themainemonitor.org themainemonitor.org



View attachment 422836
Click to expand...


If you look at that map the northwestern corner of Maine has absolutely no hospitals and it corresponds to the North Maine Woods. The NMW is a mix of state and private timber land and it is sparsely populated and very very rural. Some of the private lands date back to a family land grant from before the state was formed. The area requires 4x4 and you need to sign into the access points and pay a permit fee. It’s not for the faint of heart.
 
Last edited:
Southpaw said:
No, they didn’t. They protested the closure of a needed service at a hospital which closed OB for financial reasons. Your post is overall good, but if a hospital closes service and the next closest is an hour and a half away, then bad outcomes are absolutely inevitable. You know it. I know it.

The American public, in rural Maine, demanded better. The hospital didn’t listen. Apparently their elected public officials let it fly. A town board? County board? State reps? Congressmen and Senators?

If this is occurring across the country then we sit here and acknowledge the bad outcomes and deaths that are inevitable.

I’m not saying I have an answer. I don’t. But I don’t believe this is what ‘the American public wanted’. No more than I believe the American public wanted the corruption and fraud by Trump and outright dismissal of the needs of the American public.

I’m not gonna make this political, but there’s a clear relation. If Maine wants rural OB care, and they do need it, then their elected public officials and their citizens must demand it.

And if they don’t then they accept as a byproduct the rare but certain abruption or prolapsed cord that threatens lives.
Click to expand...

They may have protested but did they put their money where there mouth is?

No.

There is no malpractice reform. There are only larger and larger jackpot verdicts. Reimbursement, especially for obstetrics, is already poor.

Running labor and delivery is expensive and high risk.

If their political leaders really cared, they would pony up money and reduce liability for everyone inclined. But this costs $$$$ that no one wants to spend.
 
cittykat said:
thefederalist.com

The Death Of Expertise

To reject the notion of expertise, and to replace it with a sanctimonious insistence that every person has a right to his or her own opinion, is silly.
thefederalist.com thefederalist.com
Click to expand...
Yup.

Its quite ironic too. Any given productive individual is going to be knowledgeable and some degree of expert in their area of work.

Those folks would also be the first to roll their eyes and express disbelief anytime a person without such knowledge (the average citizen) declares themselves to be expert enough to argue and question with the certainty that is displayed within the maga movement.

Somehow, maga has championed the art of being an idiot with absolute confidence.

Poor leadership only amplifies it. The ideal leader would assemble the best experts, construct a well informed opion, and encourage the public to support such opinion. Maga prefers to clamor for support without a shred of evidence or expert guidance
 
anonperson said:
They may have protested but did they put their money where there mouth is?

No.

There is no malpractice reform. There are only larger and larger jackpot verdicts. Reimbursement, especially for obstetrics, is already poor.

Running labor and delivery is expensive and high risk.

If their political leaders really cared, they would pony up money and reduce liability for everyone inclined. But this costs $$$$ that no one wants to spend.
Click to expand...

That’s correct. If it mattered enough to Mainers they’d ensure their elected leaders heard about it and voted for people that support malpractice reform and kept ob services operational.
 
Southpaw said:
That’s correct. If it mattered enough to Mainers they’d ensure their elected leaders heard about it and voted for people that support malpractice reform and kept ob services operational.
Click to expand...
Its a result of poor leadership.

It would be like having patients watch commercials and then vote on what treatment they need. Mainers were convinced by lobbyists that it was a good idea and their leaders didn't educate them on the downstream effects
 
Southpaw said:
How? I don’t really understand that viewpoint
Click to expand...
I meant it in the sense of:
anonperson said:
They may have protested but did they put their money where there mouth is?

No.

There is no malpractice reform. There are only larger and larger jackpot verdicts. Reimbursement, especially for obstetrics, is already poor.

Running labor and delivery is expensive and high risk.

If their political leaders really cared, they would pony up money and reduce liability for everyone inclined. But this costs $$$$ that no one wants to spend.
Click to expand...
 
anonperson said:
They may have protested but did they put their money where there mouth is?

No.

There is no malpractice reform. There are only larger and larger jackpot verdicts. Reimbursement, especially for obstetrics, is already poor.

Running labor and delivery is expensive and high risk.

If their political leaders really cared, they would pony up money and reduce liability for everyone inclined. But this costs $$$$ that no one wants to spend.
Click to expand...
My father in law was an OB (retired 2 months ago).

Back in the 90s SC tried to massively cut Medicaid reimbursement for deliveries. Every non-academic OB stopped taking Medicaid within 2 months.

4 months later the government folded. Medicaid still pays more than most private insurance for deliveries in SC.
 
dannyboy1 said:
Here’s a thought. There is no way for comprehensive services to be available in every corner of the country. If you live there maybe spend your ninth month close to a hospital. This would of course require foresight and personal responsibility so of course will not go over well with the general public.
Click to expand...
You act like we live in a third world country. I find it hard to believe that anyone can look at government spending/foreign aid and come to the conclusion that some parts of the country will require citizens to drive 3+ hours for OB services because we can't afford it.
 
DG51 said:
You act like we live in a third world country. I find it hard to believe that anyone can look at government spending/foreign aid and come to the conclusion that some parts of the country will require citizens to drive 3+ hours for OB services because we can't afford it.
Click to expand...
This is a huge country. As a poster earlier mentioned the area is an extremely rural area which probably dosent even have roads (need 4x4). It’s basically a logging area adjacent to a national park. Probably dosent have cell phone service either. That’s life in the backcountry. The risk is always there that you may need something emergently and it will be unavailable in time. with pregnancy you have 9 months to plan…
 
DG51 said:
You act like we live in a third world country. I find it hard to believe that anyone can look at government spending/foreign aid and come to the conclusion that some parts of the country will require citizens to drive 3+ hours for OB services because we can't afford it.
Click to expand...
Probably also cant find an emergent cath lab or stroke center that close by either.
 
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DG51 said:
You act like we live in a third world country. I find it hard to believe that anyone can look at government spending/foreign aid and come to the conclusion that some parts of the country will require citizens to drive 3+ hours for OB services because we can't afford it.
Click to expand...

We don't live in a third world country but the United States is massive. You cannot have everything in every little corner of the country.

Labor and delivery care means you need the capability to manage the following:

Hemorrhage - adequately supplied blood bank that can handle a massive transfusion situation
Pre eclampsia and eclampsia
obstetrician 24/7
Anesthesiologist 24/7
A pediatrician who can manage/stabilize a newborn
24 hour cesarean ability which means an OR that can be ready to go technically within 30n minutes but realistically much quicker
Labor and delivery nurses
An actual triage

And that's just the basics.
 
dannyboy1 said:
This is a huge country. As a poster earlier mentioned the area is an extremely rural area which probably dosent even have roads (need 4x4). It’s basically a logging area adjacent to a national park. Probably dosent have cell phone service either. That’s life in the backcountry. The risk is always there that you may need something emergently and it will be unavailable in time. with pregnancy you have 9 months to plan…
Click to expand...
There was a hospital 40 minutes away that recently stopped providing labor and delivery services. I'm not sure what your point is.
 
anonperson said:
We don't live in a third world country but the United States is massive. You cannot have everything in every little corner of the country.

Labor and delivery care means you need the capability to manage the following:

Hemorrhage - adequately supplied blood bank that can handle a massive transfusion situation
Pre eclampsia and eclampsia
obstetrician 24/7
Anesthesiologist 24/7
A pediatrician who can manage/stabilize a newborn
24 hour cesarean ability which means an OR that can be ready to go technically within 30n minutes but realistically much quicker
Labor and delivery nurses
An actual triage

And that's just the basics.
Click to expand...
Yes, and the community did have these resources at a hospital 40 minutes away. Our government has the resources to keep these hospitals open, but would rather send billions to foreign governments 🤷
 
DG51 said:
You act like we live in a third world country. I find it hard to believe that anyone can look at government spending/foreign aid and come to the conclusion that some parts of the country will require citizens to drive 3+ hours for OB services because we can't afford it.
Click to expand...
I don't know, lots of people choose to live really far away from stroke centers and 24-hour cath labs with low door-to-needle times. Those are, after all, choices that individuals make, presumably with a reasonable understanding that if groceries are harder to get, then good medical care during time-sensitive emergency might also be harder to get.
 
cchoukal said:
I don't know, lots of people choose to live really far away from stroke centers and 24-hour cath labs with low door-to-needle times. Those are, after all, choices that individuals make, presumably with a reasonable understanding that if groceries are harder to get, then good medical care during time-sensitive emergency might also be harder to get.
Click to expand...
Did you read the article? there is a hospital 40 minutes away that had been offering labor and delivery services up until very recently. Your comment about choosing to live far away from a capable hospital is a moot point.
 
DG51 said:
Did you read the article? there is a hospital 40 minutes away that had been offering labor and delivery services up until very recently. Your comment about choosing to live far away from a capable hospital is a moot point.
Click to expand...

They said they did 83 deliveries in 2024.

That's 7 deliveries a month.

It becomes hard to run a functional unit with this type of volume.
 
I’ve been to that part of Maine a few times. Pretty sure I stayed at the “resort” mentioned. It is very very rural. That midwife turned PCP is a hero.

I do a fair amount of OB at a suburban hospital. That story gives me goosebumps. The best part for me was when the parturient asked the doc to speak on her behalf for the reporter, “I trust her with… everything”
 
anonperson said:
Just curious what a locum anesthesiologist would charge to even cover this place. It's not busy but you would still need to be available 24/7.
Click to expand...


There was an anesthesiologist there presumably to cover the operating room. They could have been a locums. Sounds like the gynecologist who did the c-section was a locums since she was staying at a motel. No idea what either were paid.

Edit:

Checked the hospital website.

On staff they have:

2 general surgeons
1 urologist
1 podiatrist
1 pain doc
1 CRNA

I imagine the general surgeons, the urologist, and the CRNA take a lot of call.
 
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anonperson said:
Just curious what a locum anesthesiologist would charge to even cover this place. It's not busy but you would still need to be available 24/7.
Click to expand...
A few years ago, I covered a rural hospital where I might do 0-2 cases per day or nothing the whole week if the surgeon wasn’t in town. The hospital did about 60 deliveries per year. Knowing they were paying me for 24 hr. availability most days with little to no work to be done, I got a guaranteed 8 hrs per day @300/hr. For so little work that I did, it felt like theft.
 
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