Thursday, December 6, 2007

Perinatal Delirium

My husband has a very interesting job. I love to hear the stories of the patients that he encounters. Some stories are sad. Some happy. Some are funny. Some are interesting or intriguing.

And some just really piss me off.

Like today. He's telling me this sad story about a woman who's baby has anencephaly. This baby will die when born. Or he or she will die shortly afterwards. It's a sad story. Definitely one of the sad stories.

But then he tells me that the mother is pregnant with baby number 9. NINE. Babies 1-8 are not with this mother but rather in various stages of CPS involvement. Some are in foster care. Some are with relatives. None of them are with the mother. Then he tells me that this mother just got out of prison and immediately got pregnant. Oh, the plot thickens.

Okay, this pisses me off. What is this woman doing having baby #9? Yes, this pisses me off. But just a little bit.

What really pisses me off is this---

I ask him something like this. "This might sound strange or whatever, but can you, as her doctor, recommend or at least ask if she's interested in sterilization? If she'd be interested in having a tubal while she's there delivering?"

DH: "Oh yeah we can. We do it all the time. We ask. We suggest. But she has to sign the consent within 30 days."

Me: What do you mean by 30 days?

DH: Well, she has to sign the consent for the tubal ligation within 30 days of her expected date of delivery. If she's closer to delivery than that, then apparently, she's not mentally stable or whatever, enough to sign the papers."

Me: WHAT????

DH: It's a federal law. She has to sign the consent papers within 30 days of expected delivery and within no more than 180 days. If she's closer than that, she cannot give consent for the procedure.


DH: No. Of course not. Apparently, there's a lot of litigation surrounding cases where a woman who's "too close" to delivery decides that she wants a tubal and then regrets it afterwards.

Me: Okay, I can understand regretting it afterwards, but why the 30 days?

DH: Because, I guess, your hormones are too out of whack or something and you're not considered mentally competent to make that decision.

Me: WHAT? You're not considered mentally competent to sign a legal medical document when you're perinatal?

DH: Don't yell at me. I didn't make the law. I'm just telling you what the law says and what standard medical practice is. You can't give a tubal if the patient asks for it within 30 days of the expected date of delivery.

Me: You've got to be friggin' kidding me! Could I legally sign for a mortgage at 36 weeks pregnant? Yes! Could I sign for a new credit card? Yes! Could I decide to divorce you? Yes! But I can't sign a medical consent form for a tubal ligation?

DH: No.

Do you see where I'm going with this? Do you see why I'm so pissed off? Oh my stars, this has soooooo many levels.

Don't even get me started.


Katrina said...

I hear ya loud and clear! I don't think it should be law, but I do wish that I had waited until I was out of the hormone wonkiness of pregnancy to make the decision. I was miserable during that pg and thought I never wanted to do that again.

I had my tubes tied after son #3. I had tubal ligation reversal surgery about 4.5 years later...which eventually led to 5 years of trying to get pg again including clomid hell, a mc, a double ectopic and IVF.

I don't understand the 30 day thing though. At 31 days pre-due date we're sane but 29 we're not? That makes no sense.

(sorry for the book)

Family Adventure said...

As much as I feel for Katrina's story -- I agree with you that this is ridiculous. Arbitrary and ridiculous.

Personally, I also feel it smacks of chauvinism, but that's just me...


Mary Alice said...

The precedence for this law was created by the continued litigation brought forth by females who had made a decision in the through of hormonal influence that they later regretted. It can not be said that it smacks of chauvinism, as the law would never have been created in the first place, if it not for the fact of continued lawsuits brought by regretful females against their physicians….further running up malpractice insurance expenses and ruining it for everyone. The law applies to sterilization because there is a direct correlation between the emotions of the woman in her final trimester and her pregnancy or interest in subsequent pregnancies. If there were many wrongful mortgage lawsuits filed by remorseful postnatal women, there would be a law for that as well. Obviously fewer women have thought to file those suits, and even if they did, it would have no effect whatsoever on the insurance prices others pay. Now, whether the state should order this particular woman to be sterilized or if she chooses to continue her reckless procreation, make her fully financially responsible for her children’s care - whether or not they are in her physical custody – that, is another matter entirely. My nickname isn’t Da Judge for nothing.

Fairly Odd Mother said...

I should've gone more crazy for the month before I gave birth three times---at least I could've blamed it on something.

And, that woman with 9 kids---unforgivable. . .

Jen M. said...

Holy cow that is one antiquated piece of legislation.


I can totally hear your voice in this post - ARE YOU FRIGGIN' KIDDING ME? :)

Mrs. G. said...

This is ridiculous. It baffles me how often women are still seen as hormonally unbalanced and unstable.

But I bet the number of people who have sued is equally is equally ridiculous, and this is healthcare's attempt to cover it's ass...and who can blame them there.

This is screwed up on so many levels.

Marie said...

OMG. On so many levels.

Lisa said...

What about long-term birth control? Say an IUD? I don't understand what is so difficult about that. The rest of us make it work!!! What is most sad to me are those nine children that are being swept away in the system. Because of the circumstances they have been dealt, they are likely to go down the same path as their mother. I'm sure if you went back & looked at the upbringing of this woman, her circumstances were similar to the circumstances her children are dealing with. Poverty is so cyclical. This woman needs a tubal, or some sort of long-term birth control, but more than that she needs some help. Something that would help her get her life on track so she isn't seeing your husband in ten months pregnant with baby #10. Very sad.

bermudabluez said...

Oh I agree with you! I hear you LOUD and C L E A #9!!!!!!!!!!!!!

Sue said...

Wow, the original post about the legislation had my blood boiling a little, but Mary Alice's comment was fascinating. Is that really what happened with this law, or was it just an outdated piece of legislation? I'm curious now...

painted maypole said...

ranting with you....

Anonymous said...

Mary Alice is only partially correct, but she is obviously not an attorney so you can't blame her.

But she sure sounds like she thinks she knows what she's saying!