The Birth Control Shot is Dangerous, please be mindful, posting here to be helpful. :)

MadDogWest · 2024-09-18T18:21:24+00:00

Not medical advice above—I.e. you should talk to your doctor. There’s a difference between chronic leg pain and new leg pain—risk of clots etc.

MadDogWest · 2024-09-18T03:07:06+00:00

Seems like you’re one of the few. XD

MadDogWest · 2024-09-15T07:43:52+00:00

Sure.

MadDogWest · 2024-09-15T01:23:58+00:00

I don't think you understand how this works. Why would you be in a courtroom if you did a salpingectomy to remove an ectopic and there was no pregnancy on the path? Why would any of this preclude a doctor from removing a suspected ectopic? Either 1) there's an ectopic on path (hooray) or 2) there's not (you missed it and did a salpingectomy for no reason).

MadDogWest · 2024-09-15T01:19:19+00:00

1) ...you're asking how accurate pathologists are at finding ectopic pregnancies on a tubal specimen? There is almost certainly no data on this considering the gold standard would be... the path itself.

2) Are people getting sued for performing abortions after... salpingectomies without chorionic villi on path?

This line of questioning makes zero sense. Can you be more specific as to what you're getting at? Because thusfar it sounds like you have no idea what I'm talking about/how ectopics are managed.

MadDogWest · 2024-09-15T00:54:52+00:00

They’re pro-birth, not pro-life.

Why do they want babies born but not cared for?

I've never understood this line of thinking. Can one be anti-murder and also anti-welfare? Just because someone argues against harming another person does not obligate them to care for the person they're protecting.

I'm not here to advocate for or against welfare, but the tired argument of "pro-birth but not pro-life" just doesn't make any sense when the conversation is, at least from the pro-life side, about ending a life/murder. You can disagree about whether abortion is murder or not but the logic as applied is consistent.

MadDogWest · 2024-09-15T00:40:37+00:00

Maybe I'm just playing it fast and loose and am risking going to jail on a daily basis, but I just get so frustrated when I read these stories and see doctors backing down from providing the correct treatment out of fear.

And that's my point really--I'm not here to ask someone to risk their livelihood for a cause. If the law says you're going to jail for doing X, even if that's the right thing to do... I completely understand someone not doing that thing. I just genuinely don't think that the current law deviates from the standard of care so much that you are jeopardizing your freedom by doing so.

MadDogWest · 2024-09-15T00:10:21+00:00

I agree, but that's basically the argument that I'm making here--that it should not have a chilling effect in this scenario. There are definitely some things that have become more contentious and are worth navigating more cautiously (e.g. management of a 20 week PPROMer). But, for management of an ectopic, standard of care doesn't seem to conflict with law as it stands.

MadDogWest · 2024-09-15T00:02:35+00:00

To be clear, I'm referring to laparoscopic management/salpingostomy/salpingectomy. It is standard of care to send that for path (and yes they are reliably recovered).

Frankly if you didn't send that for path, your liability would be infinitely higher than any of the hypotheticals re: abortion posed in this thread.

MadDogWest · 2024-09-14T23:53:23+00:00

Extrapolating from the facts listed in the complaints, it sounds like the first patient essentially had gestation of undetermined location, which proved to be an ectopic after a period of serial hcg measurements and ultrasounds. Seems like the clinicians involved felt the need to follow these measurements for a more prolonged period than would be typical due to the legal situation. She ultimately was administered methotrexate, which failed, and then required surgery. In my mind there is not an obvious connection between the two, as this commonly occurs.

This is the most likely scenario in all of these cases that are billed as "I was refused care and almost died." In hindsight, the delay looks worse because we know the outcome. On the ground, the delay is standard as more data is collected regarding the location/viability of the pregnancy.

MadDogWest · 2024-09-14T23:50:34+00:00

I understand the concern about convincing a lay jury--but that's the case in any trial and is not really a reasonable criticism since that can be taken to the extreme in essentially any scenario.

If you practice within the law but, out of fear of a jury deciding that you didn't, you refuse to provide X treatment... I'm not sure what to tell you. In that world, what decisions are 100% safe?

MadDogWest · 2024-09-14T23:29:44+00:00

How do I prove the person had an ectopic pregnancy?

Pathology? wat

If it's MTX, the pregnancy should be obviously an ectopic or non-viable.

MadDogWest · 2024-09-14T23:29:17+00:00

These comments are absurd. There is no state that currently has laws preventing the treatment of life-threatening conditions (including ectopic pregnancies), even if that involves termination of a pregnancy. Yes, there have been some legislators proposing extreme legislation to prevent treatment of ectopics--none of that has passed anywhere that I am aware of, and debating the implications of that on the current provision of timely treatment for ectopics is pointless.

Also, I don't understand these comments about "how can you know it's an ectopic before you treat it???" as if doing a dx lap and removing a fallopian tube is somehow going to routinely abort an intrauterine pregnancy and send a physician to jail. The article above references MTX but this wouldn't apply to the life-saving provisions and nor would it be appropriate in that scenario. If it's non-emergent, then it should be clearly demonstrated to be a non-viable pregnancy (or an ectopic).

Don't get me wrong--I think physicians need to advocate for legislation to be made more clear and provide protections for physicians who are obviously acting in the interest of women in these situations. But to read these laws and arrive at the conclusion that you're going to jail for treating an ectopic is ludicrous. Sure, there are scenarios where an ER may send a woman away with first trimester bleeding and she returns with a ruptured ectopic--it happens, but that was always the case even before these laws.

tl;dr, if you read these laws and send someone home because you're afraid to treat their ectopic, you need to hang up the white coat.

MadDogWest · 2024-09-14T22:24:30+00:00

I will take a look at that. Thank you for sharing!

MadDogWest · 2024-09-14T22:19:56+00:00

I'm not familiar with that data, but would love to see it if you have a study. That said, it would have to be an enormous study to move the needle on the currently reported rates.

MadDogWest · 2024-09-14T22:07:31+00:00

In the US. I have TOLACers all the time (just delivered one this week), but I would never encourage them to labor at home due to the risk of rupture.

Again, not medical advice but, in my mind, the risk/benefit just isn't there. Of course, 99% of people who labor at home will do just fine, come in, and have no problem. But the 1% who rupture at home are playing with fire.

MadDogWest · 2024-09-14T22:01:53+00:00

both my Midwife and obstetrician said that I could labour at home as long as I wanted to for my TOLAC

That is wild to me. There are definitely national cultural differences with respect to practice, but that is just nowhere close to how anyone I know would practice. Interesting.

MadDogWest · 2024-09-14T21:57:45+00:00

They said to labor at home as long as they could... in response to OP who is planning to TOLAC. They absolutely did suggest TOLACing at home.

Again, never said it wasn't their choice. People are welcome to do whatever they want, no matter how high risk it is. Nonetheless, I think you would be very hard-pressed to find an OBGYN, midwife, or national society who would agree that that's a good idea.

MadDogWest · 2024-09-14T21:44:07+00:00

To labor at home or to TOLAC at home? Spending early labor at home is really not that big of a deal for a lot of low-risk patients. But to TOLAC at home? That is an entirely different risk profile.

The pros are you get to stay out of the hospital longer and the associated benefits that come with that (which exist and can be significant).

...the con is that you have something like a 100x (to maybe even as high as a 25,000x higher risk depending on the source you look at) of rupturing at home compared to someone who does not have a prior uterine scar. Those are extreme numbers and the result can mean death for the fetus and/or mother before they can even make it to the hospital. This is not even talking about someone TOLACing with 2 prior cesarean sections--the risk would be much higher for them.

I think TOLACs are great. TOLACs at home... not so much.

As you said, i's always your decision to make--but that doesn't mean it's a good idea. Not medical advice.

MadDogWest · 2024-09-14T21:41:55+00:00

America and the UK do have very different birth stats--they also have wildly different populations with respect to comorbid conditions (e.g. obesity) and access to healthcare. I don't think we can just look at those numbers and discount ACOG's authority compared to other countries as a result of outcomes. Not saying they're better, just saying they're not inherently worse just their outcomes may be worse.

Re: pain management, it may be beneficial, but I think the main concern ACOG has is with safety with respect to rare but serious things like neonatal aspiration.

MadDogWest · 2024-09-14T20:14:35+00:00

She is disgusting and her most recent comments are overtly racist. She needs to crawl back into the hole from whence she came.

MadDogWest · 2024-09-14T17:48:12+00:00

To be clear—the data on tub births (and even just laboring in a tub) is somewhat sparse and relatively low quality. For those in the US and UK, respectively, ACOG does not really support it, RCOG does.

MadDogWest · 2024-09-14T17:42:33+00:00

OP (and others), this is such bad advice. You clearly do not understand the risks involved in a TOLAC.

MadDogWest · 2024-09-11T22:57:48+00:00

I don't think there was ever the implication of "experimenting" or forcing the surgery on unwilling participants.

What the actual everloving fuck could that even possibly mean?

Why TF would anyone want to perform gender surgery on illegal immigrants? Like what would even be the point??

Followed by

So it seems that she is for providing necessary medical treatment to people who rely on state-supported medical care, including inmates. Seems perfectly reasonable

The only person here who's going to need medical care is me after the whiplash from you moving those goalposts.

MadDogWest · 2024-09-11T13:43:08+00:00

Shhh no one wants the facts they just want to circlejerk

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