"I have two babies at home and really can't afford a $1,000 fine," on the other hand, seems like grounds for a reduction of the fine."

Why?

How about "I have a dog at home and really can't afford a $1,000 fine," or "I have a teenager at hoem and really can't afford a $1,000 fine," or "I have an expensive hobby and really can't afford a $1,000 fine." ?

What aspect of a fine justifies charging different amounts based on how old one's children are (or whether one has any) at the moment the fine is imposed?

Sk

Anon, the "lecture" is aimed at the spouses/partners of the women as well, hence the Fred Flinstone example. If I remember correctly, Fred was in a panic, while Wilma was perfectly calm. Anecdotally, the lectures in my birthing classes on the need to not recklessly speed to the hospital were aimed at the partners, several cases were mentioned in which the men killed someone on the way to the hospital. But in this particular case, the "reckless driver" (I don't know if this was really reckless, I've seen speed traps in Virginia where 57 in a 35 isn't reckless at all), was also in labor, which can't help matters. I've edited slightly to clarify.

All very true, but you're mistaking as 'law' or 'safety' what is very obviously primarily a cash cow. There's no need for you to join Virginia in blowing smoke.

Bullshit -- I'm getting to the hospital ASAP. My second son was born shortly after we reached the hospital and before our doctor arrived and almost before the house doctor got to our room.

I would take the case to trial before a jury and dare them to convict me of speeding. Anyone want to lay odds on that?

We can trade anecdotes, but my wife and I really wanted to avoid a c-section, and the universal advice was "don't come to the hospital too early, that's the big mistake most people make."

I'm sure what you're saying is generally true, and instructive. However, contrary anecdote: my mother was in labor with me for about 35-40 minutes (total), and my younger sister was born in the car on the way to the hospital after about 19 minutes of labor (total). I wouldn't blame my Dad if he had been speeding (before he pulled to the side of the road and delivered my baby sister).

"Bullshit -- I'm getting to the hospital ASAP"

Thus making the decision that it is worth risking the lives of everyone between you and the hospital? When those other people are, say, my wife and children, I have to draw the line. And so, to be intellectually reasonable, I have to assume that other people feel the same way about their families.

Crisis doesn't give one a free hand. If someone is breaking into your home where your pregnant wife is sleeping, you are not justified in shooting your shotgun randomly out the windows. A car is a dealy weapon, and speed increases it's leathality. I can't believe that people will risk my life, or that of my family, to get to the mall or the ballgame on time. And while the motivation in this case is not as frivolous as those examples, the driver is probably more of a risk than those other speeders.

been in labor, Dave?

I have been reading this page for years. I have never seen a more ridiculous and arrogant post. Never.

I hope you get one of these draconian tickets as poetic justice some time.

I agree with everything you say, David, but that STILL doesn't justify imposing a $1,000 fine on this woman. Give her a nice little lecture or something, but don't actually stick her with any fine, let alone one that huge.

If we're going to swap anecdotes, I can find several examples of overly-officious police officers giving tickets in clear emergency circumstances. I know of one well-reported instance where a police officer tried to detain a woman while she was trying to get her husband, who was having a heart attack, out of the car and into the emergency room. He just HAD to give her that speeding ticket. What was she thinking.

Yeah, "call the paramedics" is the rational choice, but we're not a total nanny state yet. She's got just as much moral right to speed herself to the hospital as the paramedics do.

So what if it turned out to be false labor? If your spouse were to have what seemed to be a heart attack while you were driving down the freeway, and you sped to the hospital, should you be absolved of liability for speeding only if it turns out that your diagnosis was correct? I hope you don't work for my health insurance company:

"Yes, Pat, you had good reason to believe that you needed emergency room treatment, but because it turns out that what you thought was a heart attack was just an anxiety attack, we're not paying for the visit. You should have called your primary care physician first."

Isn't it somewhat important to note that the father (the purported target of the friendly advice) was apparently not there at the time? It's easy to tell a woman to stay home until the last minute when she has someone else there, but what if she doesn't? Then she's in a tough spot. Come in before contractions and you can't get admitted, but once they start you have to stay home and call 911 (even though contractions may be 30 minutes apart or more). Maybe she should go to the hospital early, wait in the parking lot until she is dilated enough, then walk into the ER.

One reason C-section rates are so high in the U.S. is because overeager soon-to-be mothers (and their worried partners) insist on going to the hospital during the early stages of labor, and many hospitals have formal or informal policies of not letting a woman labor there for more than a certain number of hours.

I have been a member of several OB/GYN departments, and Chairman of two. I have NEVER heard of a hospital that had such an informal policy. (On the other hand, at least one highly regarded hospital in Ireland has a policy of ensuring that all patients who meet the formal medical definition of being in labor deliver in 12 hours. It has published extensivley about the outcome of this policy)

Patients with prolonged active labor are apt to undergo cesarean sectoin. This is justified by empiric evidence of fetal outcome.

Your scuttlebutt, "the universal advice was 'don't come to the hospital too early, that's the big mistake most people make,'" is based on a logical fallacy. People who come in early labor who have prolonged labor get sectioned. If labor progresses nicely, and the pregnant woman's cervix is >5 cm dilated when she arrives, this then prolonged labor virtually never occurs. The patient who comes in with early labor, on the other hand, is likely to have strong contractions that are not successfully pushing the baby out. In other words, people with different labor patterns self-select themselves for coming to the hospital early or late. The early comers are more likely to have an abnormal labor pattern, and to have a cesarean section.

BTW I agree that the woman's punishment was Draconian.

been in labor, Dave?

Did you ever write or speak of a situation that you did not personally experience? If so, cut the hypocricy.

I am stunned at the several commenters who subscribe to the ad hominem fallacy. What makes you think that being biologically capable of pregnancy confers expertise on the need to rush to the hospital to give birth?

HOOSIER: I said get to the hospital ASAP -- not get to the hospital by running over every living thing in my path while red-lining the tachometer on my Porsche 911 Turbo through a school zone as class lets out. I don't think going 57 in a 35 is ipso facto reckless. Use a little reason pal.

As a paramedic, I can tell you that the VAST majority of laboring women do not need either an ambulance ride to the hospital or a screaming fast ride in a personal vehicle. What she did was incredibly unsafe for her, her baby, and many bystanders. Would she prefer delivering her baby on the side of the road, or having a strong contraction at the wrong time and driving head-on into a tree or an oncoming 18-wheeler? There was no excuse for her behavior.

She sounds like a future candidate for a Darwin Award. I have driven my wife to the hospital when she was in great pain and anguish suffering from premature labor. However, I did not drive like a fool.

Getting to the hospital 5 minutes earlier is not likely to make a difference.

Whatever happened to the old days of a police escort to the hospital, or did that only happen on TV?

"I don't think going 57 in a 35 is ipso facto reckless. Use a little reason pal."

The second sentence is insulting, while adding nothing to your case. The first sentence is just kinda funny. Posted-35-zones are normally residential or commercial. She was driving above the posted speed for the /freeways/ around where I now sit. Driving 20+ over in a 35 zone may not be "ipso facto" reckless. But I suspect it /is/ rather more often than it /isn't/.

The fact that she was in labor at the time is hardly a mitigating factor. "Have you ever been in labor?" Well, no, not having a uterus and all. But it's not the only kind of severe pain, is it? I have had extreme, intermittent sciatic nerve inflammation for most of the past three years. The pain is horrible, and is, in fact, treated with epidural injections. As is labor pain.

When I was in one of those periods of inflammation, I didn't drive: A sudden onset of pain demands all of one's attention, and doesn't leave room for the sort of attention required to drive safely. Especially at high speeds.

It's useful to ask the question: Would you want your kids playing outside when she drives down your street. My answer is "no." So I can't very well--using reason--say that her's is the kind of decision that I find just swell.

We did the childbirth class. Out of 8 couples in the class, 7 had C-sections, though none were due to arriving at the hospital too early. The doctor and the patient decide on the method of delivery based on the unique circumstances to that pregnancy,fear of trial lawyers like John Edwards, not some hospital policy manual or unwritten rule.

Fixed.

If people believe that there should be a special "but it was really important" clause to driving safety laws, then they are welcome to get the legislatures to pass one. As it happens, most officers de facto WILL forgive in an incident like this, and then escort you to the hospital with sirens (which is the far safer way safe way to exceed speed limits and traffic laws). You can also, of course, always call 911 and at least have an officer meet you on the way. All of these are better than just deciding that you can break traffic laws without any notice to anyone else on the road.

Also, a lot of people also seem to be missing some key facts here.

1) this woman apparently did NOT tell the officer that pulled her over that she was in labor.
2) She wasn't demonstrably in true labor, because she didn't subsequently give birth (as far as I know, she still hadn't given birth by the time of the article) and if she really was on the way to the hospital, she certainly didn't stay there.

She's given various excuses why she didn't tell the officer that she was going to the hospital, but none of that is the officer's fault, and the court clearly didn't find her claims after the fact credible enough to excuse her reckless driving.

As to the high fines, the constitutional matter is over whether the state can limit the fines only to residents. There's no constitutional question over whether they can raise the fines period. And there is every reason to believe that raising fines will reduce reckless driving, whatever your feelings about state revenue. Lots and lots of people seem to be of the belief that it really is safe to drive 60mph in residential neighborhoods and those damn cops just don't understand what awesome drivers they are. I see these morons on the road all the time. I've had people honk at me for not DRIVING THROUGH PEDESTRIANS WHO HAVE THE RIGHT OF WAY when I was turning, or weaving in and out of busy highway traffic. I don't have a lot of sympathy for reckless drivers. Especially since most of the advocates of repealing them have largely mischaracterized them to the public, pretending that they are much more common than they actually are. Most first time offenders in traffic court are allowed to plead down to a lesser charge (the ones without high fines), and you have to really abuse the law to get a reckless driving charge.

It's really sort of funny to see people who claim to be all about law and order, who have stood behind the successful programs to fight, say, gun crime by punishing criminal usage of guns instead of legal ownership, turn around and whine about using the same tactic to reduce something that takes far far far more lives than gun violence every year.

I do still wonder why the law was applied only to state residents though: I haven't heard any explanation of why that was done. What was the point?

Professor Bernstein, with all due respect, do you see yourself as well-qualified to give obstetrical advice? I suggest you leave the advice-giving on this subject to those who truly are qualified, like MDJD2B. (I "caught" 4 babies in one day during the course of my obstetrics clerkship and I know something about birth injuries, to say nothing of the fact that I am the son of an obstetrician, but I wouldn't offer expectant parents advice on this subject.)

What surprises me is that you ignored that which presumably you are well-qualified to opine about, that is the legal questions raised by the provision of Virginia's new law which allows the imposition of much higher fines on VA residents than on non-residents?! (Does anyone know of any other instance in which a state favored non-residents over residents? If not a first, it must be very, very exceptional.) If it were the other way around, with the possibility of much higher fines for non-residents than for residents, is there any doubt that the law would be quickly struck down? Is it any less likely that it will be held unconstitutional because VA is putting to its own much harder than to those driving with other than VA licenses? Already, two VA state court judges have refused to impose the "enhanced" penalties on VA drivers, holding the law to be unconstitutional (state, federal, or both?), and even as we speak legislators are re-thinking this new scheme which just went into effect July 1.

Professor Bernstein, are you driving to Ballston with a Maryland driver's license, is that why you aren't concerned about the legalities of VA's novel approach to "reckless driving"? I'll bet if you had been too heavy-footed on the pedal, hitting 75 mph on the Beltway or GW Parkway, and been tagged with a $1K "augmented" penalty because you had a VA license in your pocket rather than a MD or DC one, you would be focused on the law itself, not the incidental obstetrical angle to this.

I totally agree with the post. The tone struck me a certain way, and I thought I'd share. As far as I can tell, the post is right, as is the speculation blaming sitcoms for the myth that the beginning of labor requires one to rush to the hospital as fast as the car can physically get you there.

MDJD, the difference between "getting to the hospital too early" and "having labor that fails to progress" quickly enough for the satisfaction of the hospital staff, is one without a difference. The hospitals in No. Va. have an average of an almost 40% c-section rate. There are a lot of factors that go into this ridiculously high rate, but "medically justified" is not predominate, unless you thinking that American doctors know something that physicians in every other Western country, where the rates are much lower, don't. I took the effort when my wife was pregnant to read the actual studies on the efficacy of uniquely American meshugas, like routinely using an EFM, and can confidently say that some of our practices either have no medical justification, and of those some are actually counterproductive.

George Weiss:

"but in VA the code [explicitly] denies the right of jury to traffic offenders."

Sorry, please read Code Of VA 19.2-258.1. Appeal of a traffic case to the circuit court from the general district court gives the defendant the right to trial by jury. But in any event that provision is irrelevant. Reckless is a criminal offense in VA, with potential jail time, and one is entitled to a trial by jury on appeal to the Circuit Court of a non-felony case. (Felonies originate in the Circuit Court). Trial by jury in all criminal cases is a right guaranteed by Art. 1, Sec. 8 of the Virginia Constitution. In fact the Commonwealth must agree to the waiver of trial by jury when a criminal defendant pleads not-guilty. In other words the Commonwealth can require a jury trial on a not-guilty verdict.

Porlock--"What I have trouble with is why "the law is the law" is good, while "befhel ist befhel" is bad."

May have something to do with whether the law is generated by a 'Rechtsstaat' or not. Orders are constrained by law under the one, by the limits of the Fu:hrer's imagination in the one.

Ms. Hodges' real crime was attempting to thwart the will of the legislature: she failed to hire VA Delegate David Albo to defend her.

Professor Bernstein, if obstetricians can be dangerous to the health of mother and child, why not avoid them altogether, at least for purposes of the delivery itself? As a reader of the Washington Post, you probably saw their 7/31/07 front-page article on "do-it-yourself" or "freebirths," which some see as "superior to the unnecessary interventions that characterize hospital deliveries and the intrusive presence of midwives." No, nothing I would encourage anyone to do, but I wonder how you view it, given your opinions about the advisability of delaying the trip to the hospital after the onset of labor.

When and how would you want the obstetrician to be involved? Why didn't you and your wife opt for a midwife, since far fewer of the pregnancies they attend eventuate in C-Sections? Any thoughts about the management of something like a breech presentation, placenta previa, cephalopelivic disproportion (CPD), nuchal chord, etc.?

Slightly off topic. Suppose the issue was not a woman in labor, but someone who is driving an accident victim to the hospital? Back in the early 70s, I was a camper at a camp that taught horseback riding. We were about an hour's drive from the nearest major hospital.

One fine Saturday morning, a camper did violated some basic safety rules while riding and had a nasty spill from a horse. His foot slipped through the stirrup and he was dragged...and the horse put a hoof through his skull.

The head of the stables put the kid in his car and raced off to the hospital. The kid lived...with a plate in his skull. I believe that while he was on the way to the hospital, he was pulled over by the Highway Patrol...the officer took one look at the injured child and escorted the stable boss on his drive to the hospital.

I don't put much stock in the fact that it turned out to be false labor (leaving aside the possibility there were no actual labor pains and she's just trying to get out of a ticket). She could certainly have given birth to a baby with the umbilical wrapped around it's neck - a minor problem in a hospital, deadly at home. I would rather give people in emergency situations some lattitude than have the state dictate rules that might end up costing them a family member.

Hoosier:

May have something to do with whether the law is generated by a 'Rechtsstaat' or not. Orders are constrained by law under the one, by the limits of the Fu:hrer's imagination in the one.

Yes, but that's an after-the-fact determination with a generous dollop of victor's justice thrown in. The immediate problem is that you can't distinguish virtuous obedience to a 'lawful' law from wicked obedience to an 'unlawful' one if your only criterion is compliance.

But judging by some of the comments, the myth of labor as an emergency justifying speeding recklessly to the hospital is apparently alive and well.

Does she really need to be completely well-versed in obsetristics to be let off? If most Americans would do the same thing, why is it unreasonable?

As for the false labour - one of the reasons to avoid hospitals is that the stress can stop labour. I imagine that going into labour alone, driving yourself to the hospital, and getting a $1,000 speeding ticket on the way might be stressful enough to stop the contractions.

(The "I have two babies at home and really can't afford a $1,000 fine," on the other hand, seems like grounds for a reduction of the fine.

Prof. Bernstein, the court is prohibited from reducing the fee. The only option is to not convict the person of the midemeanor/felony in question - at which point, any sane judge will only allow the wealthy to have bad driving records.

Bpbatista--
1)I don't think I cited any statistics regarding percentages, since my point is that it doesn't matter.

2) "I can conjure up all sorts of horrible hypotheticals for people who" are driving at excess speeds while distracted. These scenarios occur more frequently than your horrible scenarios--if cause-of-death statistics are a reliable measure.

3) What if I'm driving 57 in a 35 in order to GET TO Denny's for the Early Bird Special? Does that constitutie an emergency? Does the size of the car, or age of the driver, factor into your calculations?

4) How many VCers with children in school /don't/ know anyone in their cohort who has lost a child in a car accident/hit-and-run? Does this put 57 in a 35 in perspective?

MDJD, the difference between "getting to the hospital too early" and "having labor that fails to progress" quickly enough for the satisfaction of the hospital staff, is one without a difference. The hospitals in No. Va. have an average of an almost 40% c-section rate. There are a lot of factors that go into this ridiculously high rate, but "medically justified" is not predominate, unless you thinking that American doctors know something that physicians in every other Western country, where the rates are much lower, don't ... some of our practices either have no medical justification, and of those some are actually counterproductive.

The reasons for our cesarean rate are complex. One is medical malpractice. Another is patient preference. The wealthier and better educated you are, the more likely you are to have a cesarean. This may not be due to an expressed preference for operative delivery, but rather to a desire to take every precaution to have an undamaged baby. If women plan on having <4 children, a strategy of being quick to perform cesarean is not an entirely bad thing, for a number of reasons. You can propose that education and wealth are correlated with making bad obstetric choices, but that argument will be met with skepticism by the sorts of people who generally share the philosophy of this blog. We can probably agree that if the marketplace rewarded physicians for pursuing a practice model that resulted in a low C-section rate, the C-section rate would be low.

European cesarean rates lag behind ours, but are rising. The reasons are the same as in the United States-- malpractice, low number of children combined with a desire for undamaged babies, and desire to preserve their own sexual and excretory functions intact. In some countries (e.g., Brazil) the vast majority of non-indigent women opt for cesarean.

As for counterproductivity, the non-Black infant mortality rate compares with that of any nation. This is despite the fact (at least I understand it to be a fact) that we actively care for, and report, mortality in premature births that occur earlier in pregnancy than the 28 week lower limit of reporting in some European nations.

Obstetric care at institutions such as Fairfax Hospital is excellent. That being said, strategies at such hospitals are skewed toward minimizing birth injury to a greater extent than you and your wife might prefer.

Bpbatista et al. have some strange reactions to this post.

What you are essentially arguing is that one should disobey the law (and be justified in doing so) if one even thinks they are in an emergency situation.

Driving 10m/s through crowed streets because one thinks they are in danger is not only stupid and dangerous, it's reprehensible. Biology does not define adherence to laws, don't pretend it does.

That should be 10m/s faster than the posted speed.

MD/JD, if you read the scientific literature (at least as of 10/05, when my wife gave birth), it says there is no call for routine use of electronic fetal monitors. Using them may be a result of malpractice, overcautious doctors, understaffing of ob wings, or an artifact of their widespread use before the studies were out, but they are clearly not used routinely because they reduce the rate of damaged babies.

In our own case, my wife was in labor for 44 hours, had meconium, a partial posterior birth, and an umbilical cord around the neck. We did have the EFM, but only because of the complications, otherwise we would have refused it.

I wouldn't blame a doctor for wanting a c-section to make things much simpler. But whenever the doctors broached the issue, we asked if the baby was in any danger. They immediately said no. If anyone is reading this and wants to avoid a c-section, that's the most important question to ask.

Of course, obs, trained to respond to emergency situations, are likely to be too quick to operate, as our most surgeons. To a hammer, everything looks like a nail.

You are correct in that EFM has been found not to be superior to auscultation of the fetal heart every 15 minute, and every 5 minutes during second stage. (I was a resident at Parkland Memorial Hospital when they were conducting this classical trial, which did not lead to diminished EFM use there.)

Studies of EFM have been underpowered-- that is, there are not enough patients in the study to show differences of an anticipated magnitude. When the fetal death rate is less than 1% (in the US is is 6/1000), it would take thousands of patients-- possibly tens of thousands-- in each arm of a randomized trial to show a further reduction of, say 1/1000. Such a randomized trial would not be practically possible because of the cost and because of consent issues.

Developments in EFM since early trials that failed to demonstrate a difference show that certain patterns NOT associated with audible decelerations are associated with bad outcome. This is why most obstetricians recommend the use of the procedure.

Your characterizations of doctor's motivation, such as:

"Using [EFM] may be a result of malpractice, overcautious doctors..."

or

"I wouldn't blame a doctor for wanting a c-section to make things much simpler...."

or

"Of course, obs, trained to respond to emergency situations, are likely to be too quick to operate, as our most surgeons. To a hammer, everything looks like a nail"

are disappointing. I am a gynecologic oncologist, and do not practice obstetrics (though I probably spend at least as much time stududying obstetrics as you do, since I supervise obstetricians). My observation of OB's is that they are as well-motivated as other professionals.

I respect your prerogative to choose a mode of delivery that is more conservative than the mainstream, and am happy that your outcome was good. To generalize from this aneccdotal experience and conclude that the general practices of the specialty of obstetric specialty work to patients' disadvantage in ways thay you and other intelligent people can understand is a remarkable jump. It is my experience that people in one field do not understand the methodological problems in another field, and have difficulties interpreting the literature, or appreciating its limitations. I believe this limitation affects your understanding of EFM technology.

In addition to this, as I have said, women tend to want a medical strategy that maximizes the possibility of an undamaged baby (and mprecludes prolonged labor) iven if not cost effective, and even if it increases the possibiolity of maternal complications. It is not evil or sordid for OB's to comply with this demand, which women express both by their willingness to sue their doctors and through their choice of provider. Again, you and your wife are entitled to pursue an alternative strategy, but the majority of medical practice will be geared to providing what the majority of medical consumers desire.

1. I'd agree she shouldn't have driven herself.

2. But if she was going to, the judge should have cut her a lot of slack. If not allowed the necessity defense. My ex's first labor took many hours. But I've heard of women (esp. on subsequent deliveries) delivering in minutes.

3. C-sections -- at least when our first was born, out at Fairfax Hospital, I figured a C-section was inevitable, for personal reasons I won't go into. She was still in labor for I forget how many hours before the doc, reluctantly, brought up the subject and I cut him off and said go with it. I think he was reacting to all the criticism. Hey, when it's needed, do it.

4. How about "I have a dog at home and really can't afford a $1,000 fine," or "I have a teenager at hoem and really can't afford a $1,000 fine," or "I have an expensive hobby and really can't afford a $1,000 fine." ?

What aspect of a fine justifies charging different amounts based on how old one's children are (or whether one has any) at the moment the fine is imposed?

Because having kids are essential to the survival of the human race, having a dog or a hobby is not essential?

The only thing worse than getting a $1000 speeding ticket is being lectured on how to have your kids.

My ex delivered at Fairfax in May 1982. 18 years, almost to the day, before she died there. They used a fetal monitor, and I had only the vaguest idea what one was or what it did, except that it kept falling off. The OB was great, the anesthesiologist rather tardy (it was a belief back then that quick anesthesia made for a slower birth, but I have no proof that was why, except that he did show up promptly after I offered to go get him and act as guide). I had rather to coax the OB into a C-section, feeling a need to assure him that we were not going to gripe afterwards.

Our route was a straight shot out Rt. 50. From Burke it would have been much more complicated. A 35 mph limit would indicate (generally) a residential area rather than a highway. Although sometimes, when quotas were low, the Fairfax officers were known to get desperate for tickets.

I can understand why an OB might be quick on the Caesarian. Look -- if things go bad, would you want to be paying the cost of a brain damaged infant living to 75 or so? It's one thing to work geriatrics, where everyone is going to shuffle off this mortal coil and relatively soon. It's another to have damages based on the total lifespan, and be faced with worries about a close call where the risks are some debatable and perhaps immeasurable harm to the mother, versus being called on the carpet as to why you didn't go ahead with a C-section that would have left a child functional instead of profoundly messed up.

Mind you, when she was dying, there was one (adult) oncologist there whom I keep track of, just do that if he dies before I do, I can relieve my bladder upon his headstone. But that was one %#&#(. Hmmm... reminds me, there is one attorney here whose mortal status I should check up on.

My wife woke me up at 3:45 a.m. on August 4, 2006, to say her water broke. We called the doctor's answering service, and he called back about 25 minutes later. About 10 minutes later, she started having hard contractions. I drove about 100 miles an hour on the freeway. We arrived at the hospital at 4:48 a.m. The nurse told us later that she was born 8 minutes after we went through the door of the hospital. Had I traveled the speed limit, we would have had the baby in the car.

Had I traveled the speed limit, we would have had the baby in the car.

And if you'd left the 25 minutes earlier you wouldn't have had to risk the lives of everyone else on the road.

I don't know if anyone is still reading this, but some of the comments reflect the fact that lots of people don't educate themselves about childbirth during pregnancy. I can't necessarily blame them, because many doctors don't actively encourage it. But if the only information you get during pregnancy is what your doctor tells you in 10 minute office visits, you're not going to know what's going on.

I saw this when we had to go to the ob emergency room once during my wife's pregnancy. There were 2 other women there who thought they were ready to deliver. We heard them describe their "symptoms" to the intake nurse, and we whispered to each other that it's obvious that neither of them were in active labor, which is what they were eventually told. If the whole process is completely mysterious to you, I can see why you'd go to the emergency room at top speed at the first sign of contractions.

As for OB practice, call me a cynic, but a profession that can do tens of millions of episiotomies without bothering to do any empirical studies showing that they lead to better outcomes is not one that is going to have a reputation for practicing evidence-based medicine. And that's putting aside the dark ages (only 30+ years ago), when women were routinely knocked out during birth, and partners weren't even allowed in the delivery room.

Prof. Bernstein,

You lack historical imagination. In the bad old days women frequently died as a consequence of childbirth. When they survived, they frequently developed fistulas-- holes between the vagina and either the bladder, the rectum, or both-- resulting in incontinence whcich frequently was permanent. Brain damage and other birth injury was an expected and frequent consequence of a difficult labor.

In the absence of antibiotics, drugs to stimulate labor, and modern surgical techniques, doctors did the best they could. They used forceps and episiotomies to hasten delivery and prevent lasting damage to the mother. Of course, in those days, they also didn't have the powerful statistical techniques that are a prerequisite to evidence-based medicine. They used their experience, sometimes counted their outcomes, and did the best they could. Retrospectively, they probably were right to perform these interventions.

So forceps and episiotomies became standard parts of obstetrical care until the conditions of medical care changed. Then someone thought of questioning this traditional practice, and routine use of episiotomies was found to be worse than useless. So practice has changed as OB's assimilated this information.

As for knocking women out--

When anesthesia was discovered, it was widely believed that pain was-- for religious reasons-- a necessary part of the birth process. Only when Queen Victoria accepted general anesthesia did the general public accept it as well. Most women find labor to be very painful, and would like to relieve the pain. In the last 30 or so years, epidurals have replaced sedatives, narcotics, and anesthetic drugs for relief of obstetric pain, and most women still want this. Many if not most women find the pain of labor to be excruciating; you and I will never know. Prior to epidural, women tended to want being "knoced out." But there is a large variation in the amount of labor pain women experience and in their reaction to pain, so analgesia is more important to some women than to others. BTW, the effect of epidural analgesia on the C-section rate is still an open question, but the weight of evidence suggests that it has little or no effect.

As I have implied, there is noting mandatory about analgesia for labor; if your wife did not want drugs, that's fine. But relief of not pain is not an evel invention of the medical propfession; it is a response to the legitimate desires of women, who should no more be required not to have pain relief than they should be required to have it.

As for husbands in the delivery room: Traditionally, women would have regarded this as an invasion of their dignity and privacy. This still is true in some traditional communities; I have observed that Hassidic Jewish men do not go into the delivery room. When mores changed, so did obstetrical practices.

MD, I'm not against using epidurals during childbirth. In our case, we didn't want one because given complications, we got the vibe that anything that delayed matters further was going to lead to a c-section, and the studies show that epidural births do take a bit longer (they may not lead to more c-sections in general, though, because you can tolerate labor longer if you're not in pain). I do know a woman that swears by epidurals, even though she had a horrible reaction to one that almost killed her baby after both of their heart rates plunged. She told me this as a part of a pro-epidural pep talk, which I thought was very odd. Like almost any medication or surgery, if you don't need it, you're better off without it, but if you need it, you need it.

Partners in the delivery room: what you're missing is that partners were BANNED from the delivery room, even for the women who wanted them. Similar with knocking out women. From what I've read, that was just what was done, you weren't given a menu of options, at least if you wanted a hospital birth.

Finally, you're right that modern medicine deserves credit for substantially reducing the rate of infant and maternal mortality--I have a cousin who just celebrated his bar mitzvah after being born at 1.75 pounds, on the borderline at the time. I would only go to a hospital with a Level 3 neonatal ward. But, as your previous post implicitly acknowledges, a lot of medical practice is based on habit and tradition, not evidence of what works best, and it's up to the patients to know enough to question. (And btw, my own discussions of childbirth with women have included recent stories of women who discovered they were getting an episiotomy only after it was already done. Awful.)

DB, your response only reinforces my original point.

The existence of bad doctors, and the existence of differences of opinion between doctors, hardly indicates that the opinion of a dilettante - however well-read - should trump that of a qualified, experienced OB/GYN on the medical issues surrounding childbirth. Doctors do not have to be right all the time about all things to know more about medicine than lawyers. By all means, get multiple opinions on a medical condition, and do your own research, but any lawyer who thinks he is a better doctor than an actual doctor truly does have a fool for a patient.

Oh, and the innovative techniques I tried before surgery five years ago, that my doctor had never used before, are now the standard first-line treatments.

One suspects that there is a whole lot more to this story than "Bernstein discovered an amazing new medical technique that is now standard practice." (What is that word again... I used it before... it starts with an "A", and it means "an offensive display of superiority, self-importance, or overbearing pride"...)

I do know a woman that swears by epidurals, even though she had a horrible reaction to one that almost killed her baby after both of their heart rates plunged.

You know, this is right up there with the people who oppose wearing seat belts because "they know someone who died because the seatbelt trapped them in the burning wreckage."

At our birthing class, the nurse told us that 90% of the women at the hospital use epidurals, and in the vast majority of cases this results in a painless, trouble-free birth (another 5% show up too late, and only about 5% want to go "natural"). Choosing an epidural is like passing an IQ test where the bar is pretty low, and apparently 90% of the women pass. =)

Like almost any medication or surgery, if you don't need it, you're better off without it, but if you need it, you need it.

You don't "need" anesthesia at the dentist, either, but are you really better off without it? I'm not a big fan of "natural" dentistry myself, and I certainly didn't encourage my wife to choose "natural" (i.e. agonizingly painful) childbirth when she had a better option.

I suggest a way to empirically determine the motivations of obstetrician. Even the most cynical and lazy of them would want the best possible care for herself and her fetus.

A determination of the obstetric choices and outcomes of young female obstetricians would show whether they take care of themselves the way they take care of their patients.

The study would have to be done by survey, as a large enough sample size will have charts all over creation. One could measure demographics (age, parity, etc.), gestational age at delivery, use of EFM, use of oxytocin, cervical dilatation at admission, time from admission to delivery, gestational age at delivery, birth wieght, mode of delivery (spontaneous/forceps/vacuum/ C-section).

The study would be more interesting, and probably more publishable, with controls. Two appropriate control groups would include women in residencies that do not take care of pregnant women (e.g., surgery, internal medicine, ophthalmology, derm) and recent law school graduates.

To do this would require some refinement ofthe idea, including consultation with a statistician to determine sample size.

The goal of the study is not to determine whether obstetricians of childbearing age are correct in their practices, but to determine whether they believe in the standard American obstetrical approach.

Brut, I didn't "discover" the new techniques, they were published in medical journals, and were developed in Europe, so they took extra time to filter into U.S. practice. I brought copies of the studies to my doc, who took the time to read them, and agreed the techniques were worth trying. I remember him doing a procedure with the study right in front of him, following the directions given by the docs who wrote the study.

Look, with few exceptions, your doctor doesn't have time to spend hours researching your case, but you do. You may have one of a hundred different conditions your doctors sees annually, and it's not hard to imagine an educated lay person knowing more about the latest research on one or more of these conditions than the doctor. You confuse arrogance with common sense.

And since doctors themselves complain all the time that they are forced to change their practices because of malpractice concerns, against their own judgment of what is "best practice" based on the available evidence, why shouldn't one question whether a particular ob practice is driven by the evidence or by malpractice concerns? Or are doctors lying when they say they'd do things differently but for malpractice concerns?

Not any different with law. If he can figure out how to do the research and read the cases, a layperson's hours of research can obviously turn up relevant cases that an attorney doesn't know off the top of his head, even in his area of specialty.

And since doctors themselves complain all the time that they are forced to change their practices because of malpractice concerns, against their own judgment of what is "best practice" based on the available evidence, why shouldn't one question whether a particular ob practice is driven by the evidence or by malpractice concerns? Or are doctors lying when they say they'd do things differently but for malpractice concerns?

The malpractice lawsuit is one of the means by which the public expresses its preferences for what it wants doctors to do. If a person goes to court and asks it to grant a large judgment against a defendant (n any walk of life), a jury agrees, and the trial and appellate courts hold that the award is justified by law-- then this is good reason for the defendant and his ilk to change the way they do things in the future.

There is nothing immoral, unethical or hypocritical about this. Behavior change on the part of defendants and their ilk is one of the things that the legal system is supposed to accomplish.

The malpractice lawsuit is one of the means by which the public expresses its preferences for what it wants doctors to do.

This is only true under a very narrow definition of "preference" which assumes that the public prefers whatever result is produced by the public's actions. It does not allow, for instance, for the possibility that the public might prefer some outcome but imperfectly understands what actions produce what outcomes. It also fails to consider risk avoidance by the doctor.

Plunge,

Safe versus unsafe is purely subjective and dependent on opinion. There is nothing that is without risk in this world.

Most interstates are quite safe well in excess of 100mph, so long as the vehicle is reasonably well maintained.

What makes high speed dangerous is other traffic, mostly, either vehicular or pedestrian. If you're driving through west Texas, the deserts of California, Arizona, New Mexico, Wyoming, etc., I guarantee you that there are places where neither is a problem and visibility is virtually unlimited.

Bernstein, your attitude towards giving medical advice makes me seriously question your legal advice. I find it hard to reconcile any confident legal statements from you when you are so insistent on putting forth extremely questionable medical advice with such confidence. I hope you base your legal recommendations on more than the old wives tales you use for your medical advice.

Professor Bernstein,

While I haven't read all the other comments, I hope someone has pointed out that since Ms. Hodges was driving her pregnant self to the hospital, it is likely she was alone when the contractions hit.

Now, while there may be gossipy wisdom about avoiding hospitals for the first few hours of labor, I certainly don't believe you are advising ladies to deliver their babies at home unattended. And while I agree with you that American hospitals are a bit c-section-happy, such a procedure is nonetheless the decision of the mother in almost all cases. As a woman, I can doubtlessly state that I would much rather be in a hospital than at home alone with in labor and ready to deliver.

I would also like to point out that there is a difference between speeding and just about any other traffic disobediance. Unless Ms. Hodges was running red lights, cutting people off, passing on the curb, I feel that a pregnant woman ready to deliver is a good enough reason to hurry hurry hurry to the hospital if she so chooses. Plenty of people speed for much dumber reasons.

If all she is guilty of is speeding, I think this case is going to get a lot of negative media attention, and rightfully so.

She wasn't ready to deliver, she had her baby 16 days later. If she had been ready, she should have had someone on call to take her to the hospital.

Who said anything about delivering at home unattended? Labor, especially for first babies, can last many hours, 42 in my wife's case. And women often have "false labor." Driving like a maniac to the hospital because contractions just started is not sensible, but, like I said, I can understand why someone would do it, if they didn't bother learning about timing contractions, the stages of labor, etc. With regard to staying at home when in the early stages of labor, this is the one thing that every doctor, midwife, doula, website, and birth class teacher we consulted agreed on. No one said anything along the lines of, "yes, rush to the hospital at top speed at the first sign of labor." Has anyone actually heard such advice from his medical provider? I'd be surprised, with the exception of someone who lives in a rural area many miles from where they need to go.

My wife didn't have [an episiotomy] done with either of the other two kids and she has noticed a real difference in healing time and pain. Why is this practice still the unthinking default for some doctors?

Because some soctors learned how to do it a long time ago during residency and never learned to stop, even after demonstration that routine episiotomy served no purpose. People are reluctant to change what works for them.

She wasn't ready to deliver, she had her baby 16 days later.
Is it reasonable to expect her to appreciate that she was having false labor contractions? If she was in a lot of pain and didn't know what to expect, she might panic.

If she had been ready, she should have had someone on call to take her to the hospital.

We don't know if he had anyone to call upon for this purpose. It is an imposition on other people to have them at your beck and call.

Who said anything about delivering at home unattended? Labor, especially for first babies, can last many hours, 42 in my wife's case. And women often have "false labor."

Typical first labor lasts 12-18 hours. But it can be as short as two hours. I am agnostic as to whether the woman was justified in speeding, but I empathize with her panic. Especially if she had nobody to call on. Someone close to me, who was carrying her fourth baby, had a placental abruption while driving on a 35 mile commute during rush hour in a large metropolitan area. This was before the cell phone area. She drove herself to a hospital while bleeding profusely in her car. And she had people prepared to take her in when she went into labor.

All sorts of things can happen. Most women do not have serious problems. But most women who have not had a baby do not accurately analyze analyze what is happening to them, and seek some sort of assistance.

At my hospital, two women are sent home from the labor floor for each woman admitted, and close to half are admitted for scheduled induction or cesarean. So the vast majority of women who think they are in labor are sent home. That has been my experience everywhere I have been. This fact suggests that stupidity, bad character, and lack of education are not why women who are not in labor come to the hospital thinking that they are in labor.

It is all well and good to cite your experience or even the typical experience. But not all experiences are typical, and people who are having pain that they don't think they can adequately explain to themselves will run quickly to get medical care if they think they may be in danger.

As for whether speeding 20 mph over the limit is safe or not, it rather depends on where you are doing it. There are plenty of two lane highways out west where 100mph isn't unsafe, provided the driver, car, and tires are in good shape, but the speed limit is 55 by federal law. Every now and then, you'll pass some small cluster of buildings that apparently is trying to prove that it's a town - and fund the town government - by putting up signs for a much lower speed limit. But they would never dare to issue a $1,000 speeding ticket for driving 57 in their 35 mph limit.

OTOH, my experience (about 20 years ago) with driving near Fairfax, VA, makes me wonder when and where this woman found the opportunity to drive 57 in a 35 zone. The freeway is bumper to bumper at least 16 hours a day. Maybe it was at 2 am on a residential side street? That would indeed pose an unacceptably high risk of suddenly finding someone or something in the way with no way of avoiding a collision.

Nifonged, our posts crossed. "Assume the hospital is 6 miles away" might be reasonable if you live in a big city. Around Fairfax, I expect it would often be double that. That's still not a good reason for someone who is in pretty bad condition for driving at all to be speeding to the hospital. OTOH, I've been places where it's 100 miles or more to the hospital - if you wait for the ambulance, it will take over two hours to reach the hospital, even if it doesn't get lost. If you're in real need of a hospital, you might try calling for a helicopter, but most likely someone's going to load you in their car and drive like a maniac.

<blockquote>Most officers don't stake out in driveways.</blockquote>

They do in Berryville, VA. Pretty much on a schedule too.

They ought to be more random, shake things up.

It'll get the money to build that new county gov bldg that much quicker.

In Virginia, as the legislature recently admitted, it's all about the money. Public safety's got jack to do with it.

You can also tell that when an officer tells you up front he's running a speed trap--by definition a stretch of road where the limits are set illegitimately low to produce revenue--and also when the usual speed of traffic on the way to work or home is 15mph over the posted limit.

Yours, TDP, ml, msl, &pfpp

Before this thread closes out, would someone who knows what he/she is talking about opine as to the LEGAL QUESTIONS raised by a law which provides for substantially greater penalties for those driving with VA licenses than for those driving with licenses from other states. If the state legislature doesn't reverse course first, will this law stand up to the judicial scrutiny it is go to get?

States can and do charge their residents less tuition at their state schools than non-residents. They may charge their own residents less than they do non-residents to use state parks and the like. And perhaps if they wanted to be truly perverse, they could do the unimaginable, that is hit their own residents with higher user-fees than non-residents. But is a stated permitted to impose higher fines on their own residents for driving offenses than they do non-residents? How about the reverse, that is higher fines for non-residents ticketed for moving violations than for residents ticketed for the same moving violations?

20 or so years ago, the Florida legislature decided to charge physicians not residing in Florida a substantially greater license fee than physicians residing in Florida. (They came up with some cockamamie justification for it.) A federal court told them firmly and unequivocally they couldn't do that.

Would socking it to out-of-state drivers with such disproportionate fines be banned as interfering with interstate commerce?

Eesh, what an idiotic piece of lawyerly drivel, and reposted in the Wall Street Journal, too.

How about "Having A Law Is No Excuse For Acting Like A Heartless Tyrant" as a substitute headline?

Was the woman actually endangering lives by driving faster than the posted speed limit? I don't mean theoretically, in the sense that, gosh, if a child (who wasn't actually there) suddenly darted out into traffic, and the woman didn't see the child who wasn't actually there, then...whatever.

If she wasn't actually endangering anyone (and I doubt she was, or else she'd have been charged with much more serious offenses), and she had a rational reason for what she was doing -- even if, as it turns out, someone much better informed might have realized that her reasoning was faulty, and her health and that of her child in no danger by slowing up -- then arresting her and fining her is the action of a prissy martinet more concerned with followin' da rules than having us all live together in relative harmony.

Blech. This is why the concept of the majesty of the law makes most people laugh (or retch). Folks without a lick of common sense get so enamored of their theories they forget about what normal human beings are like in practise. If we all acted as inflexibly and unempathically as the judge in this case, society would degenerate into continuous warfare.

Not to mention the unpleasant aristocratic contempt for the poor woman's appalling ignorance of modern obstetrics I smell in Bernstein's condescending piece. Ugh. Perhaps he'll change his mind when he gets pulled over flying in a panic to the ER because he's got a funny pain in his chest that won't go away, and the judge says oh you ass, how can you not know the difference between a heart attack and indigestion? There was a seminar at the local hospital just the other day that outlined the differing symptoms...