To Complain or Not?
February 22, 2012 8:10 AM   Subscribe

I gave birth via emergency c-section over the weekend. The baby and I are both fine, but I wouldn't be querying the hivemind if I didn't have a too-long and too-detailed question about what happened.

Let me start by mentioning a few things up front. One, I was a wannabe Bradley Method mom - what I thought of as "sensible hippie" inasmuch as I wanted a natural and intervention-free birth in a hospital setting. Two, I am morbidly obese. This has not (yet) caused any health problems for me, but I am fully aware that I need to lose weight so no need to harp on that. I intend to engage in an aggressive weight loss plan after I recover from surgery. Three, I suffer from mild anxiety (untreated) and a fairly bad medical needle phobia. I also have a family history of anxiety and depression, and am concerned about the possibility of postpartum depression.

Now, what happened - early Saturday morning my water broke before any contractions occurred and showed signs of fetal distress due to the amount of meconium in the amniotic fluid. When I arrived at the hospital, my child's heart rate did not vary with contractions - or at all, really. In addition, the situation just felt wrong, so I agreed to an emergency c-section shortly after admission. This is not something I have a problem with, at least rationally; this was my first pregnancy and I wanted the security of having trained medical professionals around in case of problems. I also did not feel "cheated" out of a natural birth. Complications happen, and I just happened to be one of the people they happened to.

Rather, the issue I have stems from the anesthesiologist who assisted me. I had told my OBGYN that I was concerned my anxiety would interfere with the spinal block I was about to be administered in some way - that it might make me pass out, for example, which has not been an uncommon result for minor procedures such as TB tests and routine blood draws. This short conversation took place while I was in the middle of a panic attack, so I don't know if what I was trying to say really made it through. (The OBGYN also really wanted to get me in ASAP, which I agreed with and attempted not to obstruct even though he made a point of explaining the procedure despite my knowing what it entailed. I thought it was rather endearing, actually.) However, I think the OBGYN might have mentioned it to the anesthesiologist on duty when s/he came to talk to me about the anesthesia s/he would administer. I attempted to tell the anesthesiologist that I was concerned my anxiety would cause problems even though I wanted a spinal block because it was a lower risk procedure. The anesthesiologist basically cut me off, told me I had to do the spinal block (which I agreed with), that I was fat (which I also agreed with), and did not address what I was trying to tell them at all.

When I went back to the OR, the anesthesiologist had difficulty giving me the spinal block. I was very tense and on the verge of losing consciousness the entire time which couldn't have helped, and it took the anesthesiologist a few tries to find a good place for the block. After the block was administered, I started to lose consciousness along with feeling in my extremities and had difficulty in assisting the medical staff with moving me to the operating table. Then the numbness began to creep up into my arms and eventually up to my neck. I don't know if I couldn't breathe at that point or if I just couldn't feel myself breathe; I think I might have been hyperventilating. I tried talking and saying the alphabet because I really didn't want to go under, but I was obviously worrisome enough that my attempts to calm down didn't convince the anesthesiologist to keep me awake. The anesthesiologist quickly administered general anesthesia, and the operation proceeded smoothly.

After the operation, there were various nurses and doctors who came by the room to talk to me about what happened. The hospital I went to has a reputation for being very friendly to natural births and new parents, and for the most part the reputation was earned. However, I was not happy with my post-op conversation with the anesthesiologist. At that point my birth plan had been completely obliterated and I hadn't seen my child, but I knew the birth was extremely traumatic and that they were in the nursery (or maybe the NICU at that point; I don't quite remember). The anesthesiologist was not at all compassionate, and they functionally told me that the problems were my fault because my weight pushed the block higher than it should have gone, and also I was functionally being negligent and a terrible mom because I was obese. Most of the post-op conversation was actually about getting lap band surgery and the anesthesiologist's own experience with it. I didn't really say anything at the time because I was medicated and shell-shocked, but I did later confirm with my husband later that the conversation did happen as I remembered it. I promptly forgot about myself anyway since I was worried about my child - who is OK, but only due to the quick work and care given by the medical staff.

This morning, I woke up sobbing and convinced that I had nearly killed my child or given them brain damage by daring to be overweight and pregnant. (Not the case, according to pretty much everybody else at the hospital I talked to who was involved in prenatal and pediatric care.) I also had a really vivid memory of that conversation. I am now concerned that this might be a sign of some sort of mental trauma caused by a callous conversation during a stressful time. I already know to contact a physician if there are further emotional issues and I have reached out to ICAN, but should I do anything else or say anything to the hospital about what happened? My issue is entirely with the anesthesiologist's bedside manner, not with the work they did, and I mostly want to spare other people in a similar position that same kind of conversation. Because really, a conversation that boils down to "you are a fat fatty who caused all of the problems in this pregnancy and operation, now let me lecture you about ANOTHER surgery and how to convince your insurance to give it to you while your kid who you haven't even met is in the NICU with concerning symptoms" is probably less than helpful under the best of circumstances. Alternately, if I am overreacting, let me have it.

***Or, just skip to the TL:DR - successful emergency medical care, terrible bedside manner that might be provoking or exacerbating mental issues. Should I complain to the hospital or suck it up?***
posted by anonymous to Health & Fitness (41 answers total) 3 users marked this as a favorite
People will alternately criticize and praise your decisions in child-raising for the rest of your career as a parent. I would take this opportunity to begin the practice of letting it go.
posted by These Premises Are Alarmed at 8:27 AM on February 22, 2012 [21 favorites]

First, congratulations on becoming a mother! I know your question isn't focused on this aspect specifically, but don't lose sight of that. You brought a baby into the world with the help of some talented doctors, and you should be happy about this.

Second, my wife just had a baby via emergency c-section, and I remember being conflicted between unfiltered, heretofore uncharted levels of joy... and feelings of anger/resentment at the doctor/nurses who I think really screwed up my wife's epidural (while she was in the midst of a 3-hour pushing session) to the point that she was crying in pain and looking at me to help her (which I wasn't able to do). I always meant to say something, but didn't at the time because I didn't want to add to my wife's stress... and afterwards I was so busy with being a new father that I lost the motivation/edge to my anger (the baby and my wife were perfectly healthy after all).

But just last week we received a survey in the mail, and I was able to communicate back to the hospital about exactly what we liked and what we didn't like about the hospital experience. It felt good to be on record about what didn't work (the pain management) while appreciating the work of the folks who did the C-section and protected the health of my wife and new baby boy.

Finally, since you're still obese and just went through what must have been a fairly risky pregnancy, maybe the doctors were right to tell you -- at that moment -- that you need to do something serious about your weight problem, for your sake and now for your family's sake. I'm not able to judge their bedside manner, and frankly, with all the conflicting emotions (and medications) coursing through your system, you might not be the best witness either.

I'm sorry you have hurt feelings, but in dealing with them, please keep them in proper perspective. Maybe you can, as a first step, ask the hospital if they have a survey so you can communicate your thoughts back to the hospital. They are in business after all, and need to have satisfied customers!
posted by BobbyVan at 8:29 AM on February 22, 2012 [3 favorites]

Complain to the hospital. And don't let them or the anesthesiologist brush you off. There's no excuse for the type of behavior exhibited by the anesthesiologist. You absolutely don't deserve to have your body image policed while you're in the freaking recovery room after an emergency surgery. I cannot fathom why she/he thought that was appropriate.

You are not overreacting. You had so many other things to be worried about and the anesthesiologist was completely unprofessional to be droning on instead of actually addressing your atypical reaction to the anesthesia. On top of that - had you even given permission for general anesthesia? Did he/she do it without your consent? If so, that's also something you'll want to address.

Good luck and congrats on the new baby.
posted by i feel possessed at 8:30 AM on February 22, 2012 [28 favorites]

Definitely talk to the hospital, if only for your own peace of mind in having your valid complaints be heard. You were unsatisfied with a major aspect of your care; that deserves a complaint. Once you've done that, then move on. This is not a bystander judging your stroller choice. This is a medical professional from whom you paid to receive care.

Congrats new mom! Hope you have a swift recovery.
posted by Katine at 8:30 AM on February 22, 2012 [1 favorite]

I have not had children, so I cannot speak to how the C-section went. I have had minor surgery on my foot that required me to be "put under" but not intubated, and a nerve block on my ankle, so I'm going to guess that the anesthesiologist used a similar med for you as he did me. Based on my experience, the meds used for anesthesia screwed me up emotionally but it didn't really hit me until a couple of days afterwards (I was pretty cheerful for the first two days). Ask Metafilter helped me understand it was most likely the anesthesia and having my meds messed up that turned me into a big ball of anxiety. Add the changing hormones after childbirth and it's quite understandable how you could have woken up sobbing this morning.

Bottom line is this: YOU DID NOT HARM YOUR CHILD!! It sounds like wee one is fine, so you did nothing wrong. In my opinion, the anesthesiologist was OUT OF LINE for having the obesity discussion with you at that particular time, or even at all. He/She should know that patients have a hard time processing information right after surgery. In any case, if your OBGYN was that concerned about your obesity, they would have been having that discussion with you all throughout your pregnancy.

So....RELAX, your body has been on a major roller coaster ride the past few days so just let yourself feel what you're feeling. Things will settle down for you and you will get into a new routine of loving and caring for your little one. Give yourself some time, and know that it's OK to still be processing some intense feelings. Journal what's going through your mind if you want. Once you feel a little more settled, then look back at your journal and formulate what you want to say to the hospital (if you choose to do so). I think that will help clarify your thoughts.

If it were me, I'd have that conversation with someone, but I'd give myself a week or so to calm down and get my thoughts together.

Congratulations on your baby, and good luck!
posted by MultiFaceted at 8:31 AM on February 22, 2012 [3 favorites]

You most certainly are not overreacting and should complain to the Administrator of the hospital. Keep in mind they will probably see "law suit" above your head, so it would benefit you to clarify your concerns are surrounding the poor behavior and you're making it known to help others (hopefully) avoid this treatment in the future. Of course, this is assuming you aren't interested in suing.

I'm sorry you had to put up with this stress-inducing and callous behavior and hope things go well for you and your new family. Regardless of how you handle the complaint to the hospital, please consider speaking with your OB/GYN regarding your untreated anxiety and fear of postpartum depression so they can assist you. Congrats on being a new mother!
posted by cyniczny at 8:33 AM on February 22, 2012 [3 favorites]

I think it's worth a letter. It may go on top of a pile of letters - anesthesiologists do not have a reputation for being people-persons - but I think it's worth registering the complaint about the post-op conversation in particular. That person is probably not qualified by your state or the hospital to diagnose obstetrical problems, nor is it an appropriate time for a sales pitch, and I think you should make both points very strongly. It's ethically questionable behavior even if you hadn't just been unconscious.

You can follow that point up with a word about post-partum depression and how you're at high risk already because of an existing anxiety condition, and make sure they understand you're writing the letter, in part, as documentation in case you need it later.

For legal reasons, you will probably get no response or apology, but you will have done it. I hope that the behavior of the rest of the staff along with support from your pediatrician/neonatologist helps you get some peace.
posted by Lyn Never at 8:33 AM on February 22, 2012 [5 favorites]

Congratulations! You have just had a baby and you are in a state of preternatural high alert which will last for several days after coming home. You are also right on schedule for waking up and sobbing (or indeed for spending your entire day sobbing) and being convinced you are The World's Most Incompetent Mother. Your estrogen is literally falling through the basement and it does an epic number on your emotions.

I am in no way trying to trivialise your birth experience - I would never do that to any woman ever. I am however suggesting as gently as possible that this is the absolute worst moment to make decisions about how you definitively feel about events or what you would like to do about them. I would wait a few weeks until you are on a more even keel and then look at it again. In the interim, I would hope you could turn to your midwife, doula or other experienced care provider for a sympathetic ear and some advice.

But don't let anyone tell you "you have a healthy baby, that's all that matters." Your experience matters, profoundly.
posted by DarlingBri at 8:35 AM on February 22, 2012 [23 favorites]

While it's true that it can be difficult to do a spinal on a morbidly obese person (my mother had two last year due to uterine cancer related surgery, and the anesthesiologist was upfront with us about how he sweated it out until he managed to get her in a good spot) the non-anesthesia related comments were totally inappropriate and in your position I would complain to the hospital. My sister works for a local hospital and her entire job pretty much consists of talking to patients who feel the hospital has screwed up in some way, and at least for this hospital, they take it pretty seriously.
posted by crankylex at 8:40 AM on February 22, 2012 [3 favorites]

The anesthesiologist was out of line. The conversation they initiated with you belongs between you and your OB/GYN or primary care physician or just about any other doctor at any other time. You may want to vent over at First, Do No Harm - it's a blog dedicated to stories of fat prejudice in healthcare. I'm very fat and do encounter doctors that interact with me badly because of it. Usually, I'll write them afterwards and explain that their message could have been delivered better, and how. (I wish I could do this in person, but I want to remain composed. Not sad. Not angry. I feel like it's important to deliver the message in a very logical, measured way.) I acknowledge that I understand their concern, but their message was alarmist/poorly worded/insensitive to my medical history/not fact-based given my medical history/etc it made me feel defensive/hurt/stereotyped/whatever, and they may be able to reach fat patients better if they changed their approach. I don't know if it helps. But it helps me feel better about it.
posted by ferociouskitty at 8:42 AM on February 22, 2012 [4 favorites]

First of all, congratulations!!

I think it's worth calling the hospital's Patient Advocate office to file a complaint about the anesthesiologist's conversation with you post-op. As was mentioned before, he is not qualified to diagnose anything regarding your pregnancy. Not to mention that that was not the time to be talking to you about these things - if your weight really had been an issue, that conversation could have waited until a better time.
posted by DrGirlfriend at 8:44 AM on February 22, 2012 [5 favorites]

That's a hard way to start motherhood and I'm sorry you went through such callous, rude behavior by the anesthesiologist. I think you would be doing a good thing to complain about it in the hopes of protecting others from that kind of bs. I would suggest that you write a narrative of it right away while it's still fresh in your mind.

I had an emergency c-section with my first child and while I didn't end up with a general it was still a traumatic experience. It's not your fault. Please don't beat yourself up over the way your child arrived. It's all too easy to do that and to feel like your body betrayed you. I agree with DarlingBri as well - don't let people's well meaning comments about all that matters is a healthy baby. While that's obviously critically important your experience and emotions matter too!

Congratulations on the birth of your child! Try to focus on healing and enjoying your new baby! I'm sure you're going to be a great mom - you've already made a good start by focusing on your child's needs.
posted by leslies at 8:46 AM on February 22, 2012 [2 favorites]

I am so sorry that happened to you -- an emergency C-section due to fetal distress is no picnic even if you are treated in the best way possible.

Feedback from my brother the ER doctor about hospital complaints: write a letter, give specifics, and also concretely say what you want the outcome to be.

Also, if you are considering seeing a therapist, I know someone who specializes in pregnancy/postpartum issues, and there might be someone with a similar specialty in your area. If you have a local moms mailing list, you could ask for a referral.
posted by chickenmagazine at 8:50 AM on February 22, 2012

I'm sorry they were so awful to you, and as others suggested I would talk to the hospital.

A friend of mine who had a pretty traumatic c-section started a website to help other mothers navigate the territory.
posted by frecklefaerie at 8:52 AM on February 22, 2012 [1 favorite]

It took me four years to communicate my dissatisfaction with my primary OBGYN's verbal content following my c-section. At the time, the nurse of the facility suggested contacting the business manager for the practitioner's office. The minute I spoke up (gave them horrible review online), I felt instantly better. Wish I had. Then I wouldn't have been carrying that aggro around for 4 years. I say speak your mind, be it phone call, letter, or review, so you can move on.
posted by Ys at 9:01 AM on February 22, 2012

Document every detail of the conversation that you can remember, the time, the specifics, and what your husband heard. When you're up for it, send the hospital administration a letter letting them know how disappointed you were by the care of this person.

You don't have to do it right this minute -- you have a baby to concentrate on and healing to do. You can do it later or months from now (I did, about three months later, for similar reasons, although unfortunately it was not just one person)*. But if you can sketch out the notes today, when you want to complain, it will be more meaningful if you have all of the specifics at hand and you'll be better able to relate the experience dispassionately, which is always good for credibility.

*They called me and apologized and some people got in trouble. It still hurts, because some people screwed up my experience at the birth of my daughter, but I did what I could when I was ready to do it, and ultimately I had to let it go because what else can you do? I do hope that my complaining probably made it better for some woman who came after me--I'd like to think that.
posted by A Terrible Llama at 9:02 AM on February 22, 2012 [4 favorites]

Relevant personal notes as to where I am coming from: my wife is a surgeon. I have friend who are anesthesiologists. I have a child.

I don't see what is so bad about what the anesthesiologist had to say.

He/she explained what happened, why it happened and what can be done to not have it happen in the future. He/she needs to explain things clearly for litigation purposes and be completely clear. Your morbid obesity was the gating factor in impacting his/her ability to do their job and it could have very much impacted your baby's health. There isn't any 'fat prejudice' in saying what is scientifically factual.

As to the anesthesiologist saying you were a terrible mother, you can be upset about that, if it did really happen that way. There was a LOT going on with emotions, hormones, in and out of reality, etc. Often times there is a English-Second-Language barrier (not sure about your experience), and it comes off terse. I truly hope he/she didn't say this to you. I can see him/her saying that you can be a more active mother if you have the lap band surgery and active mothers can enjoy their child more... but that IMHO isn't a judgment as much as it is more evidence that he/she thinks you would do well with the lap band surgery.
posted by LeanGreen at 9:03 AM on February 22, 2012 [13 favorites]

Personally sounds like to me they are trying to head off any complaints about how badly they handled the spinal block by trying to make you think it is your fault. If you are in the US they have done spinal blocks on people of all sized before, you will not have been his first, he bodged it up and is trying to cover his ass. Write a clear letter to the hospital explaining your experience and what bothered you about it and why lecturing a new mother on any subject before she's even seen her child is not on. Yes your weight may or may not have been an issue, and it may or may not have had to be addressed, that was not the time or place. By the way obese people make great mothers too, you did not almost kill your child by being overweight and what happened to you could have happened to anyone of any size your weight is not to blame.

Back in my thinner days (overweight but not obese at the time) I had to have a spinal tap, it was supposed to be a 15 minute procedure it ended up taking 5 hours and a whole team of doctors, the head of Neurology in a major Australian teaching hospital had to come in and do it in the end as no one else was able to get the needle in and that was with the help of an xray machine. I was not understress, or scared for my unborn child or under any sort of time constraint and still they couldn't do it. It is not your fault.

TL;DR Your Anesthesiologist is a dick who is trying to cover his ass.
posted by wwax at 9:05 AM on February 22, 2012 [6 favorites]

I am so very sorry. No one should ever have to go through what you went through, and I have been through a traumatic birth experience, too, so I really do get it.

First of all, the anesthesiologist was an ass. Please let your OB know, the chief of anesthesiology know, and the office of patient relations know that the communications you had with this doctor were not of an appropriately professional manner, and that he was, quite frankly, cruel to you both during the procedure and after.

Secondly, don't let anyone tell you how you should or shouldn't feel about what happened. People will try to tell you that, oh, hey, there's a healthy baby! But you matter too. The real outcomes of birth should be a healthy baby and a healthy mother, but too often in the rhetoric surrounding birth, it all comes down to the baby. This was how I felt after my traumatic birth --- I couldn't wrap my mind about how what I had gone through was okay because there was a baby at the end of it when someone else going through a similar egregious hospital error (this was why my birth was traumatic) for another procedure that didn't involve a baby wouldn't be told it was okay.

It's not okay that you went through that. It is okay that your baby is healthy. And for what it's worth, I absolutely think you made the right call on the c-section with the information you had at the time. That still doesn't make what the anesthesiologist did okay. And it's truly okay if you're upset with your experience -- doesn't mean you don't love the baby, just means you went through something, too.

Please, feel free to MeMail me ANY TIME YOU LIKE. However you feel is fine. Don't force yourself to move beyond it if you're not ready. You can both love your baby and what had to happen for your baby to come into this world.
posted by zizzle at 9:06 AM on February 22, 2012 [4 favorites]

Also, anonymous, you may find Solace for Mothers a helpful resource.

They have warm lines, too. If you call and leave a message, they will call you back.
posted by zizzle at 9:10 AM on February 22, 2012

Hey, good work being an informed, prepared, Bradleyesque mama and rolling with the punches as shit hit the fan.

The anesthesiologist sounds like a dick. You are completely justified in complaining if that's what you want to do. You don't deserve to have someone else's body issues thrust on you like that, especially at such an emotionally vulnerable time.
posted by thirteenkiller at 9:10 AM on February 22, 2012 [2 favorites]

I'm so sorry that that happened. I also had a c-section and some of the interactions between "natural" birthing (I ended up with an epidural) and the eventual c-section were frustrating. I also found the docs for post-op care on the C were much more perfunctory and less warm and fuzzy than the midwives and OB. I also found it strange that they had to go through this whole song and dance about what a C-section entails and what would be happening as I had already researched it but, in retrospect, that is part of their informed consent procedure.

The anesthesiologist is not the go-to person for hand-holding, I don't think. And, it sort of sounds like they were trying to cover their ass in a very ham-handed way -- "you wouldn't have had this problem if you weren't so fat." I think what your objection is to the anesthesiologist not acknowledging your fears ahead of time and then later following up with some unasked for medical advice and opinion. What you'd like is for this person to learn that this is not appropriate care and they shouldn't subject any future c-section patients to this treatment. So, focus on that.

Ask a friend to find out how you can submit a patient complaint or give feedback. They can call the hospital and figure out a procedure and then help you submit the information. I say ask a friend because you and your husband need to focus on your recovery and health and your new baby! Just because you are fat does not mean that you don't get to focus on your new life -- your recovery is just as important as caring for your infant. Give yourself a reasonable time scale in which you will focus on the immediate and after that you can start expanding your focus on other things.

It took me about 8 weeks of recovery from c-section before I started feeling stable again. It took me probably 6 months until I started to feel some semblance of "strong" again. It took 9 months before I was able to look in the mirror and say, "Hey, things are coming back into place." It took nearly a year out to start focusing on how I wanted to actively get back into shape (as opposed to just doing what I consider minimal: taking the baby for walks, a little swimming, gentle mama/baby yoga classes). At a year out, I'm now finally looking at pushing myself into activity and setting goals.

So, give yourself a break. Talk to your husband about how you two can make the most loving, supportive, healthy environment for all of you right now. And, yes, complain to the hospital -- provide feedback on your experience and then let it go. Even hippie birthers who have the natural, pan-flute experience that they were planning on are likely to look back and go, "Whoa! That's not what I was expecting!" Birth is really sort of like jumping off a cliff into a vast pool of water -- once you go over, anything can happen and you have little to no time to process it. At the end of the day: it's one amazing, overwhelming, crazy trip.
posted by amanda at 9:18 AM on February 22, 2012 [1 favorite]

Aw sweetie. Congratulations on your baby, Mummy! And what the anaesthetist said was inappropriate, unprofessional, cruel, utterly disgusting AND A LIE.

I'm a hugely fat chick, HUGE, and it's complete bullshit. Memail me for some cyber hugs, support and more details.
posted by taff at 9:23 AM on February 22, 2012 [3 favorites]

Just as a data point, at the time of the birth of my first child I was about a hundred pounds overweight. I also had violent, full-body shakes when I called for the epidural. My anesthesiologist was able to place my epidural extremely successfully within three minutes. If your anesthesiologist was unable to do the job competently because of external factors, he should have called for someone more experienced. I understand that it was an emergency, but if he's not qualified to work on fat people, he should say so up front.

Congratulations on your baby! Welcome to motherhood!
posted by KathrynT at 9:26 AM on February 22, 2012 [3 favorites]

That anesthesiologist sounds like an asshole. I think there are non-trivial number of physicians who are basically unable to communicate with other humans. Sometimes other people will be kind of like "Well, doctors have letters from God saying that they are perfect, so don't complain!" but I think that's bullshit.

Doctors are providing a service. It's important work, for certain, but it's still a service. It's okay to speak up and tell them that they are acting like a dick.

I'm sorry this was part of your entry into motherhood. I think there is so much body-shaming that is done to women, and also... boy, I don't really even know how to say this, medical people can get really into a kind of worldview wherein your female body is a delivery vehicle for a baby, as though you yourself do not actually inhabit it.

I think that's anti-feminist and not okay and generally totally uncool. So if you need my thumbs-up about maybe sending a sternly-worded complaint letter to the hospital, you've got it. FWIW, every time I have had upset feelings about anything like this, speaking up has always made me feel better (even if it didn't really lead to anything).

Congratulations on your baby!
posted by thehmsbeagle at 9:28 AM on February 22, 2012 [1 favorite]

It sounds like you may want to look into whether you have had a traumatic birth experience. Birth trauma is starting to gain more notoriety, but it's still not widely discussed. Birth can be a traumatic experience on its own. Having an emergency surgery can be traumatic. Having birth + surgery + jerky doctors can be very traumatic. I encourage you to talk to your doctor about whether any counsellors in your area deal with postpartum issues. This can help you deal with complex feelings and perhaps ward off postpartum depression and other complications from an experience like that. I don't mean to assume you suffered trauma, but I think it's worth looking into.

In my case, I experienced birth trauma, but I didn't realize it till later. I pushed the experience aside and it only came out later when something else happened.

I'm sorry your doctors were awful to you. What kind of doctor attacks a woman's body image and motherhood capabilities right after birth? Not that it's cool to do that at any time, but what insensitive jerks. There are ways to have conversations without attacking or shaming people...and timing is everything. Do they really expect that you're going to go on a crash diet when you just got out of delivery? Jerks.

I got the hospital's psychiatrist to write up the way my delivery was handled. So I fully support you if you want to write a letter of complaint.
posted by Chaussette and the Pussy Cats at 9:48 AM on February 22, 2012 [1 favorite]

Hi. I was the anonymous poster of this question recently about a bad dr experience I had while pregnant. (Not at all as bad as yours, but I was pretty upset.)

I ultimately decided that the doctor just had a crappy bedside manner, and that I didn't want to spend my energy complaining to him about that. (The askme seemed to fully serve my needs for venting and affirmation, imagine that!) I figured that instead of making the doctor defensive, what I really wanted was to get information from him about my condition and his professional opinion, and that complaining about non-medical stuff would just get in the way. When I went in for my follow-up, I felt calm and had a helpful, informative conversation about what was going on.

So I guess what I'm saying is that you might want to think about separating out your need for affirmation about what happened from your need for good medical information. In your shoes, I would REALLY want to know exactly what happened with the failed spinal block, why I had to have general anesthesia, and exactly what happened later on to complicate the birth. You're not going to get all the information you need if you approach the doctor in an adversarial way -- he'll get defensive instead of informative.

After you have gotten the info you need, if you still feel like it, you can write a formal complaint about the post-op lecture.
posted by yarly at 9:50 AM on February 22, 2012 [1 favorite]

It sounds like the guy was a dick. Doctors are often dicks, though: it's a job which requires you to be super organised, to thrive under high stress, love to solve problems and to want to take on tremendous responsibitues. You need a certain mindset for that and it tends to attract type A, jockish peeps. It can be hard for people like that to understand people who aren't like them, and in my limited experience they can often be impatient and judgemental. (There are many lovely doctors in the world, of course.) The guy was clearly insensitive and acted like a bit of a prick, and I think you should write the administration a letter if you want to. But, sometimes people just are like that.
posted by Diablevert at 9:58 AM on February 22, 2012 [1 favorite]

My whole family is thin and hard to get blood from, but when a phlebotomist fails with one of us, they don't lecture us about our sneaky veins. They apologize and try again.

That's not a perfect analogy, but my point is that the anaesthesiologist's job is to give good care to all the people in the hospital -- not to blame those people when things go awry.

"Dear hospital,
I wanted to give you some feedback about my care during my c-section of February 21.

I feel that some of the communication surrounding my surgery was quite poor, especially with regards to Anaesthesiologist X. I have a serious medical needle phobia --one which has made me faint in the past -- and brought this up with X before the surgery. However, X was dismissive when I brought this up.

When I got the spinal block, I did begin to faint, and wound up needing general anaesthesia. Then, right after I awoke, X came to tell me that I was to blame for the surgical complications because I am obese, and that my weight makes me a bad mother. X then proceeded to advise me to get lap band surgery.

In both instances I felt that X's bedside manner augmented the trauma of an already stressful situation. I feel that patients entering surgery should be listened to, especially regarding information which might impact said surgery. I also feel it is inappropriate immediately following surgery to come assign blame to the patient for poor surgical outcomes.

I don't want this to happen to other patients. Please share this letter with X; I hope he/she will be more careful in the future.
Sincerely, anon"
posted by feets at 10:07 AM on February 22, 2012 [18 favorites]

Well Rounded Mama is a blog specifically about how the medical profession can mis-serve mothers with high body weights. You may find stories that mirror your experiences there, and examples of what others in your situation have done in response.

Congratulations on your new baby! I'm so sorry you had such troubling experiences around the birth.
posted by Sidhedevil at 10:42 AM on February 22, 2012 [1 favorite]

Hmm. It seems like it is well-known that obese patients need less anesthetic in epidurals & spinals than non-obese patients. So it may have been a medical error they were trying to blame on your obesity -- or you may have just heard their explanation as blaming, given your emotional state.
posted by yarly at 11:26 AM on February 22, 2012

I didn't have the same situation, but my kid was in NICU.

I remember being in my hospital bed, having only seen baby for a SECOND before he was off to NICU (with his Dad). And the neonatal doctor came in and was a total asshole to me.

But looking back a few things to consider:
- It was 4am.
- Many doctors are not great at communicating. They are great at being doctors. This is especially true for specialists.
- The HORMONES ARE SERIOUS. I was weeping and acting totally nuts. (And this will continue for you for a few weeks too.)

So yes, it sucked, but I would move forward and focus on baby. Revisit this in a few months when you've had time to let the hormones chill a bit.

And most importantly, CONGRATS!!!
posted by k8t at 11:31 AM on February 22, 2012 [1 favorite]

Whether the anesthesiologist screwed up or not, he/she had no business lecturing you on your weight and recommending ANOTHER dangerous surgery to you as you recover from a traumatic c-section.

I had an emergency c-section a few months ago, and I was emotionally overwrought, and also extremely dizzy and exhausted, for over a month. While I think you're justified in complaining, I would spend this time resting and adjusting to the baby, which I hope is home with you now. The complaint will keep. Just put it aside for now until you can be really clear-minded and methodical about how to address the problem.
posted by daisystomper at 11:33 AM on February 22, 2012 [2 favorites]

Mod note: From the OP:
Thank you to everybody for your responses, whether sympathetic or tough love. They were all helpful as far as I'm concerned, and... well, the hormones are kicking in again and I'm getting weepy. But in a good way. However, some thoughts from before I started getting emotional again follow in case anybody is still reading.

- The "telling me I was a bad mom" thing is definitely more inference than quote; I don't remember the exact words as the situation is fading into a general low-key anxious wash again, but believe me I would have been atypically aggressive about pursuing something like that while I was still in the hospital. (I accept a lot of things, but not something as obviously beyond the pale as that.) Rather, aside from the valid medical issues brought up, the anesthesiologist's talk felt more like the way Karl Lagerfield talks about the overweight and obese - kind of offensive in a "I used to be, but I got over it so I can say anything I want" sort of way. My particular issue was with the lap band discussion, which both my husband and I remember clearly and seemed to have no real place in the conversation. Not even as an ass-covering maneuver. (Did I just confuse the issue more? I think I might have. Sorry!)

- I also have no desire to make any aggressive accusations or sue the hospital. As I said, literally every other person I interacted with was wonderful, and I was not expecting the anesthesiologist to have a stellar bedside manner. I don't really see the need for a lawsuit, anyway; I am happy with the overall outcome, and thus far there has been no lasting harm to anybody involved... other than my own worries, of course.

I think that I was too emotionally involved when I wrote the question so I went too far into the details, which obfuscated the only reason I'd want to say anything at all in the first place... that being a desire to spare other people who might end up in a similar position a lecture from someone who might not have understood how they came off. Anything else belongs in therapy in this case, IMO.

Regardless of what I decide to do - whether I let it go completely or eventually write a gentle note regarding my concern - I will definitely give it a few months. Again, thank you all!
posted by jessamyn (staff) at 1:37 PM on February 22, 2012

So without being a doctor, it sounds like your medical care was appropriate, if distressing, but the bedside manner wasn't. The anesthesiologist was out of line.

Get together with your husband and write down an account of what happened while it's still fresh in your memory. Then get in touch with the hospital's ombudsman to file a complaint.

Even if you don't get anything out of it--although an apology would be nice--the letter will go in the doctor's file.
posted by elizeh at 4:09 PM on February 22, 2012

Just Jessamyn's post with your update.

Don't let it go. Writing a letter doesn't obligate you to do anything, and it won't ruin the guy's career. It will get circulated to his boss, who will tell him to do better next time, and go into his file.

You will probably be doing another patient a huge favor.
posted by elizeh at 4:12 PM on February 22, 2012 [1 favorite]

I'm a hospital nurse, though I don't work in labor/delivery.

Hospital management cares A LOT about this kind of behavior. I encourage you to write up the details of the incident while they're still fresh in both your and your husband's minds. Also, you will probably get a follow-up phone call or written survey asking about your hospital stay experience. Answer them honestly. Starting this year, part of US hospitals' budgets will be determined by the scores on these surveys, so they're highly motivated to score well.

And I promise you that if I ever hear a doctor lecturing a patient like this, I will cheerfully invent a phone call and get his/her ass out of the patient's room, stat.
posted by shiny blue object at 4:24 PM on February 22, 2012 [10 favorites]

I'd recommend that you take that conversation with the anaesthesiologist and file it under "Who gives a shit."

The important point is that you got appropriate care, and baby OP is doing fine - congratulations for that! By focusing on the dingbat doctor you are taking a precious resource - your time and energy - and giving it to something that won't change. You will never turn the dingbat doctor with crap bedside manner into a caring person with great social skills - never never neverever.

Put your time into your new baby, your health and your life. Don't waste it focusing on the past and on something you can't change (the situation) and a person who won't change (the anaesthesiologist).
posted by lulu68 at 4:33 PM on February 22, 2012 [1 favorite]

Wow, there's a lot for me to comment on here.

Let me start by adding my voice to those congratulating you on having a healthy baby, and to the extent that it matters, as an anesthesiologist I apologize for my colleague not making your experience better. (I also appreciate that like all relationship questions hearing the other side of the story may be informative)

It has been a while since I did OB anesthesia, but I am tangentially involved with it enough to know that in some ways it hasn't changed since I was a resident in the 1990s. It is one of the few times when patients are truly happy to see us walk in the room, but there are times when it can be as stressful as having a trauma patient roll straight into the OR (more on this later).

To address your specific concerns I will have to speculate a lot, but the questions you raise are worth addressing, especially in a public forum where people might be able to learn something about a medical specialty that is often invisible to the public.

You mention being morbidly obese; that covers a lot of territory and without having seen you in person it is hard to know what that means. We once had a 700 pound patient on our labor and delivery floor; in addition to other difficulties taking care of her, the toilets in the hospital could not support her. Even if you are not that big (and I assume that you aren't), obesity has a number of implications that your anesthesiologist would have been thinking about. To begin with IV access can be difficult, which in an emergency situation involving not one but two patients makes things even more stressful. Obese patients have a number of physiologic changes that make anesthesia more risky, including excess soft tissue in the airway, leading to difficult intubation and/or ventilation and changes in respiratory mechanics leading to a decreased FRC . The FRC is in some ways the body's reserve supply of oxygen, and will be used up more quickly in the obese patient, as their oxygen consumption is also increased, so that if there is any difficulty securing an airway, the time before things get really scary is decreased significantly.

Now let's make that person pregnant. The physiologic changes of pregnancy are well documented, although the Wikipedia article is actually pretty incomplete. Suffice it to say that all of the potential problems related to obesity are made worse by pregnancy, with the added wrinkles that swelling of the vascular tissues of the upper airway makes airway management more difficult and prolonged retention of food in the stomach makes aspiration of gastric contents more likely. Although not something that is widely discussed outside of medicine, these concerns were the focus os a major motion picture.

On the other hand, women with all sorts of serious medical problems have uneventful deliveries, and obesity is hardly an unusual condition. With a little forethought, even women with medical conditions far worse than obesity (such as only having half a heart) can do well. So don't beat ourself up over this.

While in all but the most emergent surgeries anesthesiologists have a good deal of say as to when and under what conditions a procedure will be done, labor and delivery is generally not one of those times. The general consensus is that if the obstetrician says a baby needs to be delivered now, we will make it happen. One of my most poignant memories of my medical career is the time a pregnant woman came to the labor and delivery floor with some spotting; a routine ultrasound ended quickly with the cry " we have a complete abruption!". I met the woman rolling down the hall to the OR while sticking the largest IV I could in her (even after 20 years I remember it was 18 gauge) and asking what medications she was on and if she was allergic to anything before we put her on the OR table. Both she and the baby did fine, and didn't even need a transfusion and she probably doesn't even know my name. The reason I relate this is that if your obstetrician indicated you needed to go to the OR right away, your anesthesiologist may have needed to take the Winston Wolf approach:
The Wolf: Get it straight buster - I'm not here to say please, I'm here to tell you what to do and if self-preservation is an instinct you possess you'd better fucking do it and do it quick. I'm here to help - if my help's not appreciated then lotsa luck, gentlemen.
Jules: No, Mr. Wolf, it ain't like that, your help is definitely appreciated.
Vincent: I don't mean any disrespect, I just don't like people barking orders at me.
The Wolf: If I'm curt with you it's because time is a factor. I think fast, I talk fast and I need you guys to act fast if you wanna get out of this. So, pretty please... with sugar on top. Clean the fucking car.

Bedside manner goes by the wayside when things need to happen in a hurry and your description in the question is not enough to know how urgent your delivery was, but terms like meconium and decreased heart rate variability make it sound like your physicians may have had a good deal of concern for your baby's well-being. Merely communicating the ideas I have written above can take too much time in an emergency, and having the anesthesiologist discuss them in detail (and you sound like the sort of person who appreciates detailed explanations, which is a good thing in most cases) would slow things down to the point where you or your baby might suffer.

On the other hand, you certainly deserve a reasonable explanation of things after the excitement and stress of an emergency delivery are over. I have a few thoughts about your experience but will probably miss some things, so feel free to me mail me or contact me via whatever means you are comfortable with if you want more info. To begin with, your concern that you weren't able to communicate your concerns to the anesthesiologist were probably true, just as they may not have had time to communicate their concerns to you. In your situation there are a number of concerns that go into the decision of spinal versus epidural versus general anesthesia (for example, a spinal anesthetic only lasts for a finite time, so you have to be sure your surgeon can be done before the anesthetic wears off). In general spinals or epidurals are considered desirable in OB anesthesia both for avoiding the airway concerns mentioned above (general anesthesia often involves invasive airway management, if only temporarily) as well as letting mom and whoever else she wants) see the baby right at delivery. However, as you found out in person, any time you prepare to anesthetize patient, you have to be ready to go to a general anesthetic if needed; there is no such thing as the patient can have the surgery but only under a certain anesthetic technique.

Now to my thoughts on what happened to you. You mentioned that your anesthesiologist called you "fat". If that was their actual description of you, it is something I would have phrased differently. Here in GA I often see 12 year olds who outweigh me (I am 5' 10" and weigh around 230-240 pounds and have had a BMI between 30 and 40 for a while, so am not skinny by any definition) and when discussing any weight-related concerns with their family I try to use terms like "big" and "large" rather than the more emotionally loaded "fat". For what it's worth I have seen heath care professionals from other countries who aren't so attuned to the emotional connotations of terms like "fat" and so might have said it out of ignorance. That doesn't necessarily excuse their other behaviors, though.

Without seeing your medical records I can only speculate on what happened in the delivery suite, but nothing you describe is outside of my experience. Difficulty placing a spinal (or perhaps epidural[i don't agree with everything in that link but it isn't too bad as a description of epidurals for a non-medical audience]?)l in a large pregnant woman who is anxious and presumably can't sit still is not unusual. On the other hand, the drugs used function at the level of sodium channels on your spinal nerves and nerve roots and so your level of anxiety wouldn't affect a spinal anesthetic. But your description of events after the spinal makes a lot of sense. The tingling in your arms was definitely abnormal, and could be due to a number of things, including a high spinal (a complication of spinal anesthesia for the lower body where the anesthetic spreads too far up the spinal canal, causing weakness of the arms and/or respiratory muscles; sometimes seen with difficult epidurals where the much larger epidural dose of anesthetic is injected into the subdural or [very rarely] subarachnoid space), intravascular injection of the anesthetic, or your anxiety leading to some hyperventilation. In any event, if the health of the baby is a concern it is standard practice to quickly convert to a general anesthetic (even with its risks; otherwise you run the risk of having the mother going into a near cardiac arrest scenario of her own, which means you are potentially running two emergency drills: one for the baby and one for mom). I remember one case as a resident where I had to rapidly convert a failed epidural (it gave good pain relief for labor but it wasn't good enough for the urgent c-section the obstetrician wanted; complicating factor: the patient was one of the surgeons who had been on faculty since I was a mere med student)to general that stressed everyone out but turned out fine (and given your concern about weight, her BMI was comparable to mine, so rest assured that there are plenty of us fat folks in medicine, and sometimes we get to look out for each other).

I am disappointed that you anesthesiologist didn't take the opportunity after your delivery to explain things to you better. From what you have said it sounds like the system worked as it should and you have a healthy baby to show for it. If your anesthesiologist did not communicate to you that it was a stressful situation but everything worked out well (and apologized for anything offensive they said in the heat of the moment) and explain what happened (as I mentioned, your description fits several scenarios for not being able to do a c-section under spinal, and there are others I haven't mentioned) Definitely let the hospital know your feelings. This recent thread sheds some light on how important patient satisfaction is to hospital administrators. The surveys you will get are far less important than a letter or phone call to the appropriate person. There may be an ombudsman, patient care representative, or hospital administrator in charge of fielding patient complaints, but given what you described, a phone call or letter to the chief medical officer or the chairman of the anesthesiology department may be in order (I don't know how the hospital you are in is organized, but once again, if you want to email/memail me with details I can help sort through the bureaucracy. Just to make it clear, you should not feel guilty for having had a baby and the medical folks who took/are taking care of you should be giving you plenty of reassurance (unless there are more complicating factors that we don't know about).

A few other things I feel are worth addressing:

Keep in mind they will probably see "law suit" above your head...
Not necessarily; a good hospital administrator/administration will put liability risk in a larger perspective and if you and your child are healthy will be more concerned with getting you and your peers to use that hospital for future health care.

anesthesiologists do not have a reputation for being people-persons
A common stereotype, but in fact most anesthesiologists are aware that although they interact with their patients only briefly, it is during a high-stress time where good interpersonal skills are a real plus. Pathologists, on the other hand...

The anesthesiologist was out of line. The conversation they initiated with you belongs between you and your OB/GYN or primary care physician or just about any other doctor at any other time.
I disagree with this; as I alluded to above, given the poster's description of the situation there are some concerns unique to anesthesia that should have been addressed with her at some point. And given that anesthesiologist are fully-trained physicians in their own right, they do not need to have these discussions under the auspices of an obstetrician, family practitioner, or any other primary care physician.

The anesthesiologist is not the go-to person for hand-holding, I don't think.
In a lighter vein, this comment reminded me of the time as a resident I took care of a little old lady for a relatively minor procedure. Given the situation a little mild sedation was all that was needed, but she was so nervous that even after a little something in her IV she wanted me to hold her hand while she had the procedure done. So I held her hand for the 30 minutes or so it took and a couple of weeks later found out she sat behind my parents at church and had gone on about that nice young man with the ponytail (a novelty among physicians in GA, especially 25 years ago) the entire time before the service. So yes, hand-holding is indeed a service anesthesiologists provide.

I understand that it was an emergency, but if he's not qualified to work on fat people, he should say so up front.
Again, this is something I alluded to above, but if you can't deal with people who are overweight in a competent and caring manner, then you probably shouldn't be in medicine (at least in the US, although obesity is hardly unique to this country).

I think there are non-trivial number of physicians who are basically unable to communicate with other humans.
This is true; I try to not fit in that category but I am sure I fail sometimes.

And finally, I can't find the quote (it is past my bedtime and I didn't look too hard) but there were one or more comments suggesting that the anesthesiologists behavior was ingrained and would never change. That is not true; there is a burgeoning literature on various forms of disruptive physicians (once again, getting too late to look for some info for you, but googling the phrase should help) and interventions that can help them interact with others.

It seems as though this question pushed my buttons on a few levels; not only am I an anesthesiologist but a parent as well and have been on both sides of the drapes in the delivery room, and I feel strongly that there is no reason for the anesthesiologist not to make the experience as positive as possible, even though there are many reasons it can be stressful for both patient and physician.
posted by TedW at 9:45 PM on February 22, 2012 [25 favorites]

I love when TedW provides his perspective on anesthesia. He offers a lot of compassion while sharing the perspective of the single most important person on a surgical team. The surgeons' job is not to kill you; the anesthesiologist's job is to keep you alive.

My issue is entirely with the anesthesiologist's bedside manner, not with the work they did, and I mostly want to spare other people in a similar position that same kind of conversation.

If you decide to follow up, I would focus my complaint on this. (In other words, I don't think you've confused the issue more; I think you've clarified it very well.) I would point out that 20 minutes after having your abdomen closed following emergency surgery is not an appropriate time to make unsolicited recommendations for further lap band surgery, and that both his timing and his bedside manner were inappropriate and callous. I think TedW's point that obesity is a common condition is well worth making, and suggest that the doctor and his future patients would benefit from additional training in dealing with obese patients in a "competent and caring manner," which is an excellent and precise phrase.

In writing this letter, I would be as terse, factual and non-emotional as possible. I would not talk about how it made you feel; I would instead focus on standards of care. I would also rely on the hospital to pull and review your records rather than recapping the entire delivery. I say all of this because it is a sad fact that women, and particularly post-partum women, are often dismissed as unreliable narrators, over-emotional or indeed, hysterical, and so I would pre-emptively seek to defend against that interpretation. In a vaguely related OB mishap (where like you I actually had every right to be over-emotional and hysterical), this approach served me well and my complaint was treated seriously; it resulted in a full faculty case review and better training procedures, which was the best and only outcome I could have gotten. I hope it can serve you.
posted by DarlingBri at 10:24 PM on February 22, 2012 [2 favorites]

I was also overweight, Bradley-trained, and hoping for an intervention-free birth. I also had an experience that was 180 from my hopes (although I did not have a C-section) and I also had an anesthesiologist complain about my weight, telling me that he could not do his job because (and I quote) "This sure is a lot easier on a little skinny woman." And yes, I dealt with post-partum anxiety afterwards. But I wrote letters and I got an apology from my OB for the actions of all the doctors who were on call in her place.

Another thing I found _extremely_ helpful was to order my hospital chart and read it a few weeks after I had calmed down a bit about the experience. I was convinced that the OB on call wrote terrible things about me in my chart and the anesthesiologist had branded me a fat cow, but instead I found all of my care documented in a very straightforward, clinical manner that helped me realize that although I took a lot of what happened personally - and rightfully so, in most ways - the doctors did not.
posted by Addlepated at 3:39 PM on February 23, 2012 [1 favorite]

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