My first birth on my new knee

I am recovering nicely from my total knee replacement. My midwife partner is burning out fast working alone for 11 weeks doing all the births and taking all the call. In order to save her and ease myself back into the practice slowly I have been taking all the call from the answering service and working in the office half days for a couple of weeks . Friday afternoon I went on call at the hospital to do births on my new knee. I was on call all night Friday night and Saturday until 6pm when my midwife partner returned and saved me - boy was I tired. However, I did have a wonderful birth while I was on call. The patient was over due and she really wanted an unmedicated birth. We got her wish. She was awesome and pushed the baby out just beautifully. Dad helped deliver and a great time was had by all. It was a fantastic first birth back and my knee did great.

Then there was the not so fantastic. I also had an induction for placental insufficiency which turned into an unnecessary cesarean delivery. We brought the patient into the hospital for a slow induction so we didn't stress the baby. The family got all hot and bothered because the baby didn't come the first day we worked on it. We discussed plan of care with them, let Mom eat dinner and have a good sleep and then start the induction up again on day 2. Oh NO - the father of the baby was all in a fit and stated that the patient needed a cesarean section because this was taking too long. My consulting physician immediately said yes and told them it would be later in the day, today. So this woman who has successfully delivered vaginally twice before at term with easy fast labors is having a cesarean section on demand because the father of the baby is tired of waiting. When I talked with my consulting about my discomfort with cesarean on demand he said that if we forced her to have a vaginal delivery and anything was wrong or the baby was not perfect she would believe she had grounds to sue us because she had asked for a cesarean and we did not comply, we made her and her baby endure labor. So he feels that if a patient demands a cesarean delivery we are better off capitulating to that demand and doing the surgery. I am frustrated. On the one hand, physicians are painted as talking people into cesarean deliveries and on the other they feel they will be sued if they don't honor the patient request for cesareans on demand. I know from past instances that this woman will probably be sorry that she chose this route, but by then the damage is already done. Now we have to wait for enough women to realize that they made a stupid choice and become verbal about it in order for the pendulum to swing away from cesareans on demand.