Samitivej Hospital Birth Disappointment...

[samran]

Both our daughters were born at Samtivej. Both naturally. Go figure.

[Soutpeel]

Both our daughters were born at Samtivej. Both naturally. Go figure.

But the OP said they are "forcing" C-sections on people, to generate income. you appear to have shattered his whole position then....

If it was true what he was saying surely you would have been pressured as well ?

[draftvader]

@samran I think you got lucky. It all depends on the load on maternity and the arriving patients progress. Past a certain point in labour there is an increased risk when going for a c-section.

We were scheduled for a natural birth at Samitivej with their leading Ob. His attitude towards us throughout the 3 appointments we had with him was not a positive one with every appointment leading to an unnecessary scan (these checks can be done using a stethoscope and the hands (as was done in Siriraj).

In comparison the Ob at Siriraj was considerate, respectful, honest and continually supportive of my wife's desires for a natural birth (though I will point out, as she did with her honesty, that the father is NOT allowed to be present during the final stages of the birth and the mother WILL be made to lie down.....don't go there!).

The actual birth was so very different from our plan due to our circumstances. The flooding in BKK saw us relocate to Phuket for a month (due to provision of world class medical facilities there). The doctors there also tried to push for a c-section. In the end I ended up delivering our daughter myself in the bathroom of our temporary apartment in Phuket. We had an international midwife in attendance 30 minutes after the birth. We were lucky in that my wife had a "perfect" pregnancy throughout, she is strong, fit and we have great nutrition. The actual birth is another story, long and hard-work, but rewarding (I still get a tear when I think about my daughter landing in my arms and screaming out loud).

4 months after our baby was born our friends (also an expat couple) went to Samitivej for their planned natural birth. Unfortunately their timing wasn't brilliant. She went into labour on the eve of the Songkran holidays and around 4-5pm they said she wasn't progressing quickly enough and c-sectioned her. Unsurprisingly their final bill was 2.5 times the amount they had planned for and she does not look back on the birth with fondness.

So, if you go to hospital with the birth progressed to a certain point they have no option but to allow natural birth.

Think about this.

Natural birth

2 nurses in attendance for up to 24 hours

1 room for 24 hours

1 ob for the final hour

Monitoring of the patient

Any time of day or night (and/or both)

C-Section

A ready prepped theater for 30 minutes

A team of 6 people including 1 ob for 30 minutes

Monitoring of the patient

To the hospital schedule

The cost is marginally lower for a scheduled c-section, yet they can charge more.

Speaking to an NHS doctor friend of mine during our recent trip back to England she confirmed that it is easier to manage the c-section, even if the risk to the patient is higher.

To finish, you can probably tell, 9 months later, that I am still quite disgusted by the attitudes of the private hospitals here. Given another perfect pregnancy I would be happy to deliver my 2nd child (albeit with our midwife friend with us....just for company....mostly!).

@OP. Sorry your birth wasn't the one you wanted.

[Sheryl]

Quite a number of TV members have delivered at Samitivej, often with normal vaginal birth, and I also know many people outside of TV who have done so. It is most definitely not the case that all physicians at that hospital "push" c-section on all patients.

As with any hospital, there is a wide variation among doctors in skills, attitudes etc.

It is true that elective (i.e. non medically necessary) c-sections are extremely common in Thailand (true in some other countries as well) and a very high proportion of private hospital deliveries are c-section, my impression is that this is far more true of the non-international hospitals because for a variety of cultural reasons most Thais able to afford to deliver in a private hospital prefer c-section and indeed the ability to get one on demand is often a factor in the desire to deliver at a private facility. There is a feeling that vaginal delivery is undignified/unclean and not suitable for upper class women (or women aspiring to be so) and also among Thai women a widespread concern that vaginal delivery will have an adverse effect on marital relations in the future and lead the husband to stray.

Not in any way suggesting this was the case with the OP's wife, but it is the case with a lot of Thai women who deliver in a private facility and has contributed to a medical culture wherein c-s is more or less the norm in private hospitals and vaginal delivery the exception.

Advice to delay going to a hospital is extremely unwise and not likely to reduce the likelihood of a c-section. the best way to do that is to carefully select a doctor before hand who understands this desire and is supportive of it. And then to insist ion clear explanation of medical need if it is suggested during labor. Keep in mind though that there is a more than 1 in 10 chance that a c-s will become medically necessary even if no problems had been detected prior to the onset of labor.

Another factor to be aware if is that Thai doctors tend to be very poor communicators and to not expect patients and family to be able to understand medical matters (those who trained in the West will differ). Thus when there is a clear medical indication for c-section, most will not explain this. Again best dealt with by careful pre-selection of the doctor to find one used to a more collegial approach and ready to explain details and reasons for recommendations.

It is often, though not always, possible for a woman to deliver vaginally after having had a c-section, and in the west repeat c-s are no longer automatic. It does require careful monitoring though. The concern is an elevated risk of uterine rupture.

[bkkjames]

We had our first at Rama 9 hospital, after a few hours of labour, wife opted for the C-section after it being suggested to her by the nurse /doctor.

Just had our 2nd son a week and half ago at St.Louis this time. We opted for C-section this time around, as this is what my wife wanted. All went well. No complaints.

[draftvader]

We had our first at Rama 9 hospital, after a few hours of labour, wife opted for the C-section after it being suggested to her by the nurse /doctor.

Just had our 2nd son a week and half ago at St.Louis this time. We opted for C-section this time around, as this is what my wife wanted. All went well. No complaints.

Congratulations on number 2. 1 was enough for me....for now.

[draftvader]

Quite a number of TV members have delivered at Samitivej, often with normal vaginal birth, and I also know many people outside of TV who have done so. It is most definitely not the case that all physicians at that hospital "push" c-section on all patients.

As with any hospital, there is a wide variation among doctors in skills, attitudes etc.

It is true that elective (i.e. non medically necessary) c-sections are extremely common in Thailand (true in some other countries as well) and a very high proportion of private hospital deliveries are c-section, my impression is that this is far more true of the non-international hospitals because for a variety of cultural reasons most Thais able to afford to deliver in a private hospital prefer c-section and indeed the ability to get one on demand is often a factor in the desire to deliver at a private facility. There is a feeling that vaginal delivery is undignified/unclean and not suitable for upper class women (or women aspiring to be so) and also among Thai women a widespread concern that vaginal delivery will have an adverse effect on marital relations in the future and lead the husband to stray.

Not in any way suggesting this was the case with the OP's wife, but it is the case with a lot of Thai women who deliver in a private facility and has contributed to a medical culture wherein c-s is more or less the norm in private hospitals and vaginal delivery the exception.

Advice to delay going to a hospital is extremely unwise and not likely to reduce the likelihood of a c-section. the best way to do that is to carefully select a doctor before hand who understands this desire and is supportive of it. And then to insist ion clear explanation of medical need if it is suggested during labor. Keep in mind though that there is a more than 1 in 10 chance that a c-s will become medically necessary even if no problems had been detected prior to the onset of labor.

Another factor to be aware if is that Thai doctors tend to be very poor communicators and to not expect patients and family to be able to understand medical matters (those who trained in the West will differ). Thus when there is a clear medical indication for c-section, most will not explain this. Again best dealt with by careful pre-selection of the doctor to find one used to a more collegial approach and ready to explain details and reasons for recommendations.

It is often, though not always, possible for a woman to deliver vaginally after having had a c-section, and in the west repeat c-s are no longer automatic. It does require careful monitoring though. The concern is an elevated risk of uterine rupture.

I agree with every point you made. I feel that, due to being emotive, I did not verbalise my thoughts well enough. My point was not to delay, but the coincidence that very often women are happier labouring in their own comfort zone first then moving on later (or just get naturally delayed in the BKK traffic). The decision on when to go to hospital should lie with the mother in all circumstances. If my wife had even uttered the word hospital during our experience she would have been there in 10 minutes (timed and planned....including lifting her to the car).

Please understand that I was merely sharing my experience and the experience of our friends. There was no way of telling whether our friend could have made it through the natural birth process, however the high numbers of people we here of being elevated to c-section against their wishes certainly does not reflect the 1 in 10 emergency c-section ratio (your knowledge on this subject makes me believe you have looked at this) that you describe.

If a doctor in an NHS hospital is sitting on the fence concerning elevating to c-section they will offer all the other alternatives first unless they have fear for life. The feeling we have got here is that this decision is made at the first sign of ANY complication as part of the "healthcare/turnover" balance. Having trained doctors tell me that they wish to perform a vaginal exam at 40 weeks (extra billing) does NOT inspire any confidence to allow these people to attend a natural birth and the low numbers they perform will mean that they are not as confident as they should be.

[Johnniey]

He told my wife straight that as she had had a c-section before, she definitely couldn't have a normal birth.

Not my area of expertise but VBAC isn't suitable for everyone, and one of the factors is the history and reason behind previous C-Sections.

Did your wife have her first baby at Bumrungrad?

He told my wife straight that as she had had a c-section before, she definitely couldn't have a normal birth.

Not my area of expertise but VBAC isn't suitable for everyone, and one of the factors is the history and reason behind previous C-Sections.

Did your wife have her first baby at Bumrungrad?

No she didn't - it was in San Paulo hospital, Hua Hin. This could be a reason - maybe the c-section was not good. There were complications and our baby died at 1 day old.

One reason we went to the so-called best hospital in town the next time. I was disgusted by their behaviour but didn't say much at the time as I was so happy to have a healthy baby. They put the baby in ICU for 3 days as they said it was a precaution, there was slight fluid in the baby's lungs. I noticed that the ICU was empty and they seemed happy to see us and the 15,000 baht a day charge. After speaking with other doctors, this was not necessary - blatant theft, But what can you say in that situation apart from , "yes doctor, whatever". Other little things like charging 300 baht every time my wife used the breast pump, and the amount of arabs.

We had another child in a public hospital and the treatment was far superior, although we are friends with a doctor there. It was a university hospital with some of the best doctors. Instead of a lonely hotel room in Bamrungrad we chose a ward with 12 beds. The event was a very joyous, fun occassion - speaking with all the other mothers and families.

MY mother-in-law also wanted to meet the doctor at Bamrungrad as she said I didn't understand their ways. I found out later that he visited her hotel on the beach three months later, free of charge of course. So, even after bribing the so-called Western educated doctor, we were still cheated.

Go to a good government hospital - you won't get fancy flowers next to the bed but the experience will be wonderful, unless you're a stuck-up snob.

My landlady, BTW, years ago was a billionaire and lived(and owned most the land) next to Samitivej hospital always went to Chula hospital as sis all her family. I asked her why and she said the government hospitals gave better treatment and they had more emergency equipment if something went wrong.

Then again, she was Chinese and used to sell our used newspapers.

I've had 3 friends who are doctors all choose a government hospital when giving birth. The secret to using hospitals in Thailand is to find out who the expert doctor in a certain field is. He may work in a private hospital but will almost always do work in a govt, hospital or have a clinic. Arrange to get treatment outside the private hospital.

One good thing about Bamrungrad, however was they gave a nice little book with my daughter's footprints.

There are, of course, good doctors there but .....

[nocturn]

Actually I wouldn't agree it's all that serious an accusation it's really pretty common ..... it's not considered my medical people as un unecssary operation it's just considered an alternative, thats safer and more profitable at the same time.

OK accept that....but the OP is also accusing the hospital of paying for "propaganda"..... "There are some blogs, which influenced our choice to give birth at this Samitivej, but I now believe they are propaganda , paid for by this hospital to generate business"

I am trying to understand the motivation for the post....is this in the interests of his wifes health or that he had to pay more for the C-section ?

while his allegations are likely true, and it is a given that the Thai medical profession is C section mad, there is little they can do but apply pressure.

I suspect the OP is annoyed he did not stay his course and insist upon natural childbirth.

[Soutpeel]

I suspect the OP is annoyed he did not stay his course and insist upon natural childbirth.

The OP cant insist on anything he is not the one giving birth, the consent rests solely with his wife, interesting to note that in the post he talks about "I" all the time not "We"

[jrtmedic]

It is true that many wealthy Thai ladies prefer to give birth by elective Caesarian Section. Some small women who are judged to have large babies may be advised to agree to a C section but all would be allowed a "trial of labour" if that is what they wished.

I am amazed by the the number of amateur obstetricians posting here ! Beware - a little knowledge is said to be a dangerous thing !!

if you do not like or disagree with advise given by one Doctor it is easy to obtain a second opinion. If you receive the same advise twice( or three times) maybe the first Doctor was correct ! If you recieve conflicting advise you have a decision to make BUT I would urge that people dont fall into the trap of "Dr. Google" he is very often wrong !

Edited July 27, 2012 by jrtmedic

[TommoPhysicist]

There's anecdotal stories of some of the, shall we say, less earnest doctors in LOS wanting to avoid a lady's 'mucky bits' and advising the c-section as medically imperative.

Doctors don't often deliver babies in Government Hospitals.

My wife is very small, the baby was enormous, out in less than an hour, nobody even said the word 'C-section'.

Our kids birth certificate contains the words .......... 'delivered by nurse'

Natural delivery, cost 3k for three nights in a private room at a GH.

Edited July 27, 2012 by TommoPhysicist

[Sheryl]

It is true that many wealthy Thai ladies prefer to give birth by elective Caesarian Section. Some small women who are judged to have large babies may be advised to agree to a C section but all would be allowed a "trial of labour" if that is what they wished.

There are a number of reasons why a C-section might be medically advised and many of them would rule out a trial labor. E.g.:

Diameter of the baby's head larger than the woman's pelvis

Diameter of baby's head so large that even if it was able to pass through the pelvis it would lead to enormous tears and trauma vaginally.

Baby in a transverse (sideways) position (impossible to deliver vaginally, a trial labor achieves nothing)

Baby in breech or other hard to deliver position -- in that instance vaginal delivery can be tried if insisted upon but with significantly increased risk of brain damage etc to the baby

Baby head first but in an abnormal rotation - ditto the above to a greater or lesser extent. In this case it is worth allowing labor to proceed at least until the head is "engaged" (if it is not already so) since the position might sufficiently correct itself. Once the head is "engaged" (lodged within the bones of the pelvis), that's pretty much the position it will deliver in. Head first but abnormally rotated presentations (e.g. face presentation, brow presentation etc) can usually be delivered vaginally but may require forceps or vacuum extraction and/or other manuevers all of which carry risk of harm to the baby and trauma (tears, lacerations etc) for the mother

The scenario of attempted vaginal delivery and then switching to a c-section after a period of labor refers to cases where either the labor is just not progressing or the baby is showing signs of distress. The latter instance is the more "fudgeable" one; if their is no sign of fetal distress there is no harm to continuing to try for vaginal delivery but the woman is generally exhausted and has been in pain for quite some hours so pretty easy to sell her on the idea of a c-section even if this was not her original plan or desire. The former situation -- baby showing signs of distress -- I don't think anyone would or should argue with. At stake is not only the baby's life but brain function, ability to walk etc.

Basically if a c-section is recommended what you need to ask is:

1. Is there a medical indication for this? If so, what is it?

2. If the answer is that the baby is in other than a normal head first position, or that the diameter of the head is too large, you can get a second opinion and even a third if you desire as a short delay will usually not matter, but if they all agree then you'd best consent.

3. If the answer is that the baby is in distress, I do not recommend delaying.

4. If the answer is that the labor is just not progressing, specifically ask if there are any signs of fetal distress so far. If not, then continuing to try at least a while longer for a vaginal delivery is an option if the woman agrees (she of course being the one for whom that decision will mean further exhausting and painful effort)

The problem with the above dialogue is of course that Thai doctors are generally not accustomed to involving patients and their families in medical decisions nor to giving them explanations of a medical nature. This is where it really pays to have shopped around for a doctor and chosen one who is comfortable with a more collegial approach. Although not a hard and fast rule, this will generally be a doctor who trained and worked for a while in a western country. One advantage to delivery care is that you have ample opportunity to interact with the doctor before the critical time arrives. Do not hesitate to change doctors if you are not satisfied with how things go during the pre-natal visits etc.

If delivery is at a government hospital, there are already policies and controls in place (for cost containment reasons) that would prevent a c-section unless clear medical indications were present. On both this account and on general cost, government hospitals are by far better. However, there are down sides including husband not being able to attend the birth and being unable to choose the doctor; may have different doctors/nurses at different pre-natal visits and then yet another one (or a nurse) at the delivery.

[draftvader]

It is true that many wealthy Thai ladies prefer to give birth by elective Caesarian Section. Some small women who are judged to have large babies may be advised to agree to a C section but all would be allowed a "trial of labour" if that is what they wished.

There are a number of reasons why a C-section might be medically advised and many of them would rule out a trial labor. E.g.:

Diameter of the baby's head larger than the woman's pelvis

Diameter of baby's head so large that even if it was able to pass through the pelvis it would lead to enormous tears and trauma vaginally.

Baby in a transverse (sideways) position (impossible to deliver vaginally, a trial labor achieves nothing)

Baby in breech or other hard to deliver position -- in that instance vaginal delivery can be tried if insisted upon but with significantly increased risk of brain damage etc to the baby

Baby head first but in an abnormal rotation - ditto the above to a greater or lesser extent. In this case it is worth allowing labor to proceed at least until the head is "engaged" (if it is not already so) since the position might sufficiently correct itself. Once the head is "engaged" (lodged within the bones of the pelvis), that's pretty much the position it will deliver in. Head first but abnormally rotated presentations (e.g. face presentation, brow presentation etc) can usually be delivered vaginally but may require forceps or vacuum extraction and/or other manuevers all of which carry risk of harm to the baby and trauma (tears, lacerations etc) for the mother

The scenario of attempted vaginal delivery and then switching to a c-section after a period of labor refers to cases where either the labor is just not progressing or the baby is showing signs of distress. The latter instance is the more "fudgeable" one; if their is no sign of fetal distress there is no harm to continuing to try for vaginal delivery but the woman is generally exhausted and has been in pain for quite some hours so pretty easy to sell her on the idea of a c-section even if this was not her original plan or desire. The former situation -- baby showing signs of distress -- I don't think anyone would or should argue with. At stake is not only the baby's life but brain function, ability to walk etc.

Basically if a c-section is recommended what you need to ask is:

1. Is there a medical indication for this? If so, what is it?

2. If the answer is that the baby is in other than a normal head first position, or that the diameter of the head is too large, you can get a second opinion and even a third if you desire as a short delay will usually not matter, but if they all agree then you'd best consent.

3. If the answer is that the baby is in distress, I do not recommend delaying.

4. If the answer is that the labor is just not progressing, specifically ask if there are any signs of fetal distress so far. If not, then continuing to try at least a while longer for a vaginal delivery is an option if the woman agrees (she of course being the one for whom that decision will mean further exhausting and painful effort)

The problem with the above dialogue is of course that Thai doctors are generally not accustomed to involving patients and their families in medical decisions nor to giving them explanations of a medical nature. This is where it really pays to have shopped around for a doctor and chosen one who is comfortable with a more collegial approach. Although not a hard and fast rule, this will generally be a doctor who trained and worked for a while in a western country. One advantage to delivery care is that you have ample opportunity to interact with the doctor before the critical time arrives. Do not hesitate to change doctors if you are not satisfied with how things go during the pre-natal visits etc.

If delivery is at a government hospital, there are already policies and controls in place (for cost containment reasons) that would prevent a c-section unless clear medical indications were present. On both this account and on general cost, government hospitals are by far better. However, there are down sides including husband not being able to attend the birth and being unable to choose the doctor; may have different doctors/nurses at different pre-natal visits and then yet another one (or a nurse) at the delivery.

Possibly the most unbiased answer here. I can't be unbiased due to my own experiences. I am glad somebody is speaking so clearly. Thank you.