Uninformed Consent: A Public Service Announcement

    In preparation for the birth of my son Kali Ra, I was convinced I had assembled the obstetric dream team.  Yet, when complications arose, my bubble didn’t just burst, it was obliterated. I learned the hard way that many Western New York families are at great risk because of some uncomfortable truths and shortfalls in competent care.  When providers deny transparency and children are injured because of it, parents are often left with a grim choice—To move on with empty arms and a heart burdened by unanswered questions, or forge forward to get answers and share them with the world.  For many, the latter seems an insurmountable task. I know well the debilitating sense of betrayal that can silence us to surrender.  I appreciate why so many of my sisters who have suffered obstetric violence choose not to share their stories.  And for all of us, and our beloved children, I will speak louder.

    Please be aware that there is a significant difference between having "admission privileges" at area hospitals and having "surgical privileges," wherein a physician is legally credentialed to act in the capacity of surgeon at a particular hospital.   The fact of the matter is, many of our private practice homebirth midwives in the Western New York area not associated with a credentialed obstetrician (OB) with surgical privileges.

    This is an extremely critical difference that is often overlooked and/or purposely not mentioned during initial meetings and intake interviews.  Very few anticipate needing surgical intervention, but I implore mothers and birth workers to use due diligence and make sure you are working with (or have immediate access to) an OB able to perform surgery in the case of emergency.  My Sun Kali Ra lost his life in part because I was not informed that my OB was not credentialed as a surgeon at the hospital I ended up needing to be transferred to after multiple complications arose from my home birth attempt.  No one else should be made to endure such a tragedy, that could have so easily been avoided if care providers had simply offered my family the transparency and full disclosure we deserved... 

    After laboring at home for 36 hours, I demanded hospital transfer for the express reason of receiving an "emergency cesarean."  After being admitted I was left to linger for TWELVE hours until my Sun's heart stopped inside of me. 

    Despite my multiple requests for cesarean, the attending OB (a close colleague of my contracted midwives) tried her damnedest to force me to birth vaginally, telling me "there is only one way to birth a baby and that is to push."  She continued to deny my Sun and I this life-saving procedure, despite a myriad of cascading complications, including (but not limited to) full-blown chorioamnionitis, fever, meconium aspirate and multiple instances of fetal heart rate abnormality. 

    Only after my Sun's heart stopped inside me was I finally granted the cesarean I had been begging for for so long.  As I lay strapped to the operating table, I was dumbfounded how so many signs had been plainly ignored. I endured the cesarean without anesthesia, able to feel every ounce of pressure and stab of pain, from what felt like a mac truck crushing down on my abdomen to the arm of a stranger forcing its way into my womb from below.  One year on and I still suffer near nightly terrors as I close my eyes to sleep, and all the bells and whistles of Post Traumatic Stress in my waking life. Every moment of my agony could have and should have been avoided, if only my birth team had informed me of the attending OB's defunct surgical privilege status.  If I had known this OB was not credentialed, I would have politely declined signing the consent form allowing her to attend me and instead requested a privileged surgeon to oversee my Sun and I.

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    My Sun is no longer here because I wasn't given all the facts.  I was led to believe that the OB attending me in hospital was privileged as a surgeon and willing to provide this life saving surgery when she was not. 

    Some birth workers claim that an "in-person" meeting with a potential provider will clear up any and all questions or concerns.  Ideally, yes.  However, I had multiple "in-person" meetings with every member of my birth team (including doulas, midwives and the infamous OB) prior to the birth of my Sun and no one voluntarily offered to inform me that the OB who would be called in in the event of an emergency was not a privileged surgeon. Despite all my attempts to be as informed and prepared as possible, I began laboring wholly uninformed about what would prove to be the most critical detail. 

    I had no idea how important it was to ask my birth team specifically about surgical privileging status.  To my satisfaction, my midwives assured me that, in the event of hospital transfer, they had "admission privileges" and that a local OB would be called in to attend, if need be.  I fatefully assumed that any emergency situation requiring the oversight of an OB would be attended by an OB with surgical privileges.  Never in a million years would I have imagined a scenario wherein I would find myself begging for surgery amid cascading critical complications, with an OB standing over my bed shaking her head and refusing to operate.  My Sun was a 9lb 13oz bruiser of a baby.  It took a whole hell of a lot of negligence to get his powerful little heart to stop beating.

    Only after requesting and receiving my medical records did I even learn that the OB attending me was not the surgeon in my Sun's birth.  The operative notes clearly state a completely different physician as surgeon.  The OB I gave my consent to perform the surgery was only mentioned as "second assistant."  So what was her actual role in the surgery?  The operative notes reveal that she was the mystery person who forced her arm inside me.  A far cry from the role I had been erroneously informed she would perform in the case of emergency.

    I've written to both the midwives and hospital, in an effort to gain clarity about the attending OB's surgical privilege status and how things could have gone so horribly wrong when I made every effort to keep my birth team informed of my concerns and shifting desire to birth my son via cesarean. Despite all the pie in the sky claims to honor the autonomy of the birthing mother and keep clients informed, I have experienced the exact opposite and been stonewalled at every turn.  In addition to the other lines of inquiry, I also reached out to the attending OB and received a letter in return that stated, in no uncertain terms, that she was under no obligation to discuss my concerns and that I should refrain from further inquiry unless my concerns were directed through an attorney.  No one should be treated so callously-- Certainly not a grieving parent.

    So again, I learned the hard way that, believe it or not, patients are not legally entitled to a physician's credentialing and privileging information.  Not even when a child dies under the care of that same physician.  The medical industrial complex is built to protect its own.  And, as much as some would like to think of themselves as operating outside of this system, I have found that the "cover your ass" and "circle the wagons" mentality runs rampant throughout every chasm of birth work, even the crunchy bits. 

    At the end of the day, any provider without something to hide ought to be happy to disclose such basic information, whether they are legally obligated to or not.  A provider either has surgical privileges or they don't-- It's as straightforward as that.  Any inquiry about surgical privileges ought to be met with a simple "yes" or "no," and red flags should go up whenever our inquiries are not met with full transparency. 

    I believe wholeheartedly that the stars aligned for the birth of Kali Ra to reveal the darkest recesses of the feminine wound and draw my attention directly to this fatal discrepancy in our local birth work community.  What I am sharing may not be comfortable for many, but it is truth just the same.  Facts exist independently of our hopes and dreams, and a birthing woman ought to be honored enough to be provided each and every one of those facts, no matter how cold or hard they come. 

Being informed is our right and the duty of all those who consider themselves space holders during such a critical time.

    So much has changed about how I understand birth and the role of the birth worker.  Yet, if I know one thing in this world, it’s that birth is wilderness. And, just as we would prepare ourselves before stepping into the beauty and mystery of the final frontier, I implore my sisters to take extra caution to protect their families by inquiring *specifically* about the SURGICAL PRIVILEGE STATUS of any OB's who may be called in to be a part of the birth team. In honoring my beloved Kali Ra I will continue to do all I can to share our story and help others avoid the unnecessary tragedy my family was made to endure.  Blessings of protection to each and every child yet to come.

Kali Ra Iman

August 11, 2016 - August 15, 2016