Something that countries with low infant mortality rates and good mother outcomes have in common are: midwives are the primary caregiver, doctors are secondary, and home births or small-clinic births are the rule, not the exception.
Don’t take this as being completely anti-medicine, but hospitals are in many ways dangerous. They have been from the beginning when sterile technique was heresy and women often died from infections contracted from their doctors during childbirth. Hospitals remain dangerous to this day. You go to a hospital when you need to, i.e.: when the risk of not getting treatment outweighs the risk of being exposed to a nice big petri dish of exotic microbes.
Doctors themselves acknowledge that many, if not most, medical treatments are not risk-free propositions. There is a non-zero chance of you dying on the table every time you’re anesthetized. That risk is obviously balanced by the real benefits of the treatment, in many cases, which is why it’s worth it to have hospitals and doctors.
In the case of childbirth, a midwife’s clinic or a home delivery are actually safer places to give birth than almost any hospital. Several years ago, I did a bit of research into midwives, expecting to find that the benefits were overblown, only to be convinced that midwives have consistently better outcomes for the mother and child than hospitals do.
There is NO such thing as a risk free medical procedure.
The micro organisms present in a hosital are the ones that have survived multiple attempts to kill them.
We all have plenty of deadly organisims colonized on/in our bodies, so long as they stay where they belong we’re fine, but if your appendix ruptures, say, and gut bacteria get into the periteneum rapid septic infection ensuses. Normal skin flora gets in a wound and it can really take off.
My personal nemesis is menigoccocemia, colonized in the nasopharyngeal space of as much as 10% of the population, if it gets a foothold on the “inside” it can kill you or leave you limbless faster than you can believe.
None of this is meant to suggest that someone didn’t screw up in the Fla womens’ case, I hve no idea.
Since the vast majority of people have staph and strep as commensals, I don’t see how showing that somone on the same floor or in the same room had strep is going to show anything. Unless every single patient is barrier nursed in a positive pressure room, people are going to pass on their bacteria to each other, there isn’t even a way to show that this lady had strep as a commensal when she came in, and that stress/antibiotics etc didn’t cause an overgrowth leading to the infection.
There are some possible scenarios where the hospital might be negligent, but nobody amputates unless it is life-threatening, so I would imagine that the decision to do so was probably the right one.
There are some possible scenarios where the hospital is negligent, but this is probably (horrible as it seems) just one of those things.
The hospital would be at fault if:
All pregnant women are routinely screened for group B strep, and this lady’s results were switched with another patient’s so that she was not given prophylactic antibotics prior to the birth.
If her diagnosis or treatment was delayed to the point where amputation was the only option, but this is only relevant if more prompt treatment would realistically be expected to change the outcome.
If the TSS and strep infection was caused by a retained vaginal swab or some other piece of medical carelessness.
Cite? Not to be confrontational - I’m honestly interested.
Would that have anything to do with the fact that “high risk pregnancies” almost exclusively are pre-planned to be hospital births?
I’d think it’s common sense that even if you postulate that midwife deliveries and hospital deliveries have the exact same level of care for routine deliveries, if hospitals do all the high risk deliveries this would make the hospital outcomes “worse” on average.
What the heck is this Global News Matrix? Does anyone have a more reputable source for this story? Has anyone noticed that the people who operate this site (and give only their first names) are college students whose judgment and gullibility might be suspect?
The person I really feel sorry for is the infant. If I knew that my birth had caused my mother to become so horribly disabled and thus made life worse for my older brother and father (not to even mention the mother herself), I would kill myself. Only you couldn’t, because to do that would mean that your mother lost her limbs for nothing. You would have no choice but to surrender your entire life to guilt and to caring for your mother. Anything else would be selfish. To not do whatever your parents want and not live up to their expectations would also be selfish, since after all, you’re the kid she lost her arms and legs for. I foresee a lot of problems for this kid.
And I disagree with people who say this is just a risk of giving birth and she shouldn’t get into the medical records. If the hospital is truly innocent, then they have nothing to fear from a search, right? The fact that they’re holding back information proves that they know they’re in the wrong.
Ugh, I literally had a nightmare about this last night. Whatever you think about a lawsuit in this case, I have nothing but sympathy for that woman.
How does an infection lead to amputation, anyway? I can imagine that if there’s a pre-existing wound that gets severely infected, but a general ‘infection’ is treated by cutting off arms and legs?
Wouldn’t the woman have had to consent to the procedure? <hijack>That’s something the morbid side of me has always wondered about, btw. You hear about people being in serious car accidents or so on, and the ‘only way to save their life’ is to cut something off. If someone’s in bad enough shape for that to even be considered, how can they give consent to it? Is the decision left up to any family/spouses/etc present?
She did consent to the amputation. See this article. Her husband is quoted as saying, “They gave her a choice of either dying or getting her limbs amputated.”
In the case of antibiotic-resistant staph, it’s the only way. Once the infection has hold, it’s not possible to treat it with antibiotics–any type of chemical attack strong enough to kill the bacteria will more than likely kill the host, as well. You can try cutting it out topically, but chances are good to excellent that by the time you’ve done that, the infection has already spread beyond the area you’ve excised, anyway. The only way to be sure you got it all is to amputate well above the infected area. Nasty, nasty stuff.
Damn, davenport, that’s a bit harsh, don’t you think? Unless the parents make the child feel guilty (for something completely beyond its control? Please. :rolleyes: ) I don’t see any problems for this child. Let’s not assume the kid already has two strikes against it because of complications its mother suffered. Yeesh.
On a lesser note, I landed in the hospital two weeks after my son was born with acute appendicitis. At one point my son thought it was his fault, because we had told him how he was pushing on my tummy with his feet when he was a newborn. We quickly put paid to that nonsense. Unless the parents are complete and utter monsters, I can’t see them blaming their child for this, so let’s not assume the kid is in for a lifetime of woe and misery.
If they are looking for info about other patients, the hospital is barred by law from releasing those records. It’s a PR nightmare but that is the current law.
When my mom had breast surgery this is exactly what the doctor did. He checked with her to make sure they both knew which breast he was working on, and then he magic markered all over her. Great big arrows going “THIS BREAST”. (I exaggerate, but only slightly.
Unfortunately, this was in 1997 or 1998, in the early days of the WWW, and I used mostly printed sources, none of which I can remember offhand. I did a quick search and turned up thesetwo articles, the first being a critique of a study on home births that was unfairly biased against them. It gives pertinent information in the refutations. The second is a run-down on good reasons to choose a midwife over a hospital birth. I just skimmed these, so if I contradict something those sites say, don’t shoot me, please.
The second part of your post is taken into account by any but the most rabid pro-midwife sources. Even comparing apples to apples – low-risk pregnancies delivered in hospital to low-risk pregnancies delivered at home – outcomes for home births are slightly to significantly better. Basically, unless you are very likely to have complications, your chances of having a good outcome are no worse at home than at the hospital and might be even better.
There are other factors besides the raw rate of complications to consider. Average labor time for first-time mothers is much shorter for home births than hospital births and recovery time for the mother is shorter on average due to the lower rates of surgical intervention. Hospitals are much more likely to intervene. C-sections, induced labor, episiotomies, and epidurals, for example, are performed in many more hospital births than home births, and as a few people besides me have pointed out now, there is no medical procedure that is without risk. Considering that outcomes are similar with fewer interventions on the midwife side, some of those hospital interventions were likely unnecessary.
Really, all it takes is a glance at worldwide infant and mother mortality rates to conclude that the US is doing something wrong when it comes to obstetrics. It’s not that the US is doing really poorly but, “better than Croatia, only slightly worse than Cuba,” is not a ringing endorsement of American medicine. As a nation with the highest average level of wealth in the world, I think we should be shooting a bit higher than somewhere in the top 20-30 nations in the world.
The reason some infections lead to remote amputations is due to toxins. Say the bad bacteria are growing in a tear in your vaginal wall. You may decide how they got there. The bacteria metabolise nutrients in your cells and make toxins. Toxins soak into your lymph and are recycled into your blood, or enter your blood directly. The toxins cause tissue edema and edema leads to decreased circulation to the remote areas of the body. As a diabetic will tell you, decreased circulation is a recipe for amputation since lack of nutrients and oxygen cause tissue to die and dead tissue can’t keep bacteria at bay.
If the infected wound is on an extremity, you can usually see a red streak coming from the infected wound towards the trunk of the body. People usually call this blood poisoning.
I am not saying the hospital is innocent, but I concur that if I were the hospital administration, I would wait for a court order before making any patient’s record a part of public record.
Sorry for resurrecting, I wanted to say two quick things.
The lady had Streptococcus, not Staph.
It is also quite possible that she developed DIC (Disseminated Intravascular Coagulopathy) as a result of the infection. This causes bleeding and clots at the same time. If the clots in the vessels of your arms and legs are large enough to cut off the cirulation then the limb or digits become ischaemic and gangrene and necrosis will eventually set in, leaving amputation as the only solution to halt the spread. DIC can be caused by sepsis, major injury or following almost any kind of major illness and develops as part of SIRS (Systemic Inflammatory Response Syndrome), which is basically when your body’s own defences work too well and start to do more harm than good. DIC is also a better explanation of why all 4 of her limbs were involved as necrotising fasciitis usually only affects one or two limbs.
In the UK, Ireland and most other countries (I’m not 100% sure about the USA, but I would imagine it is the same) common law allows a doctor to perform lifesaving treatment of any kind on an unconscious or incompetant patient without a court order or family consent. This is on the basis that if the patient were awake or competant a reasonable person would always choose life over death.
It’s why attempted suicides can be resuscitated, but if the person wakes up, refuses treatment and is found to be legally competant the treatment has to stop. If they are found to be incompetant, the treatment continues.
So basically, whether or not this lady or her husband consented is slightly irrelevant, the surgery would probably have been performed anyway over his objections, and very few people would consider someone in her condition competant to refuse the only medical treatment that would save her life.