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It is vast isn't it.
Obstetrics Case
- Thread starter Lonestar
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It is vast isn't it.
1
177983
I agree with Hukd's thoughts, but I also would like to posit a more innocuous idea as well. In the U.S., using a nurse midwife is much less common. So, for those that do, it's a very conscientious and they're generally very well informed. They may also go au natural and forgo pain meds of any kind. I had a friend in NC who did this, had a home birth, the whole 9 yards. By making choices like these, you're much more aware of the general amounts of pain a birth involves, I think.
Here's one final, very cynical point that the docs can reject if it's not true. I think the people who use midwives are also much richer than non-midwife births as a whole because in the U.S. insurance often won't pay a penny of the midwife costs. I believe this is true, though it may not be. I wonder if richer people tend to sue less because they aren't necessarily looking for a jackpot payout or maybe have more realistic expectations of the potential outcome... Any thoughts on that? It's a bit harsh, so call me out if you want.
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Ok, way too much bs anti-c-section sentiment in this thread. Why is it that physicians who rigorously demand evidence basis for their own specialty accept with minimal question that the c-section rate is inherently bad and the numbers should be reduced?
What is an appropriate c-section rate?
"Natural childbirth" advocates like to condemn the US and other developed countries for exceeding the WHO recommended c-section rate of 10-15%. This number was derived by a consensus conference in 1985. Data to support this range is at best sparse.
The truth is that we do not know what the best c-section rate is because it is difficult to study and therefore has not been well elucidated. However, Betran et al inadvertently provided some good data in their March 2007 Paediatric and Perinatal Epidemiology article. They demonstrated that the average c-section rate for countries with low maternal/neonatal mortality is 22% and rates as high as 36% are consistent with low maternal/ neonatal mortality. In fact, they showed only two countries with low maternal/ neonatal mortality which had c-section rates below 15%.
If we look at Brazil where c-section rates are as high as 90% in the private clinics, we do not see a huge increase in maternal/ neonatal mortality for the moms/ babies who are in these clinics.
In America, the highest rates of c-section are in the most wealthy, educated, and litigious areas. Manhattan comes to mind. Once again, we do not see highly increased levels of maternal/ perinatal morbidity.
In this litigious environment, if c-sections were routinely being performed solely for OB convenience/ income you would not see many OBs still in practice doing this. In my experience, the rush in 5PM c-sections is not doing c-sections in moms who would not otherwise get them, it is the ob realizing that these moms are most likely headed for c-section and want to get them done in a timeframe that is SAFEST and most convenient for EVERYONE involved.
To TopDocChick, show me outcomes data to support that it is safer/ better for a woman who has labored for 10 hours without making progress to continue to labor. In fact this is one of the areas where data exists and clearly shows that the longer that labor is stalled out, the less likely you are to have a positive outcome. Good luck in OB you have my admiration and sympathy. I would recommend reading Dr. Amy Tuteur's blog. She has some of the most interesting cogent arguments on this subject, and on the subject of being a physician and OB in general. Her reasons for leaving clinical practice closely mirror my reasons for leaving OB for Anesthesia.
http://open.salon.com/user_blog.php?uid=1808
- pod
What is an appropriate c-section rate?
"Natural childbirth" advocates like to condemn the US and other developed countries for exceeding the WHO recommended c-section rate of 10-15%. This number was derived by a consensus conference in 1985. Data to support this range is at best sparse.
The truth is that we do not know what the best c-section rate is because it is difficult to study and therefore has not been well elucidated. However, Betran et al inadvertently provided some good data in their March 2007 Paediatric and Perinatal Epidemiology article. They demonstrated that the average c-section rate for countries with low maternal/neonatal mortality is 22% and rates as high as 36% are consistent with low maternal/ neonatal mortality. In fact, they showed only two countries with low maternal/ neonatal mortality which had c-section rates below 15%.
If we look at Brazil where c-section rates are as high as 90% in the private clinics, we do not see a huge increase in maternal/ neonatal mortality for the moms/ babies who are in these clinics.
In America, the highest rates of c-section are in the most wealthy, educated, and litigious areas. Manhattan comes to mind. Once again, we do not see highly increased levels of maternal/ perinatal morbidity.
In this litigious environment, if c-sections were routinely being performed solely for OB convenience/ income you would not see many OBs still in practice doing this. In my experience, the rush in 5PM c-sections is not doing c-sections in moms who would not otherwise get them, it is the ob realizing that these moms are most likely headed for c-section and want to get them done in a timeframe that is SAFEST and most convenient for EVERYONE involved.
To TopDocChick, show me outcomes data to support that it is safer/ better for a woman who has labored for 10 hours without making progress to continue to labor. In fact this is one of the areas where data exists and clearly shows that the longer that labor is stalled out, the less likely you are to have a positive outcome. Good luck in OB you have my admiration and sympathy. I would recommend reading Dr. Amy Tuteur's blog. She has some of the most interesting cogent arguments on this subject, and on the subject of being a physician and OB in general. Her reasons for leaving clinical practice closely mirror my reasons for leaving OB for Anesthesia.
http://open.salon.com/user_blog.php?uid=1808
- pod
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I haven't yet read beyond the above post, so if someone's already beat me to the punch with a similar reply I apologize for the repetition.
Well, TopDocChick, one primary reason is because we live in the United Litiginous States of Lawsuit-Happy America where every baby should be perfect. Assume you're the attending, and through absolutely no malpractice-related fault of your own, the vaginally-delivered baby isn't 100% perfect. Chances are you'll soon receive an invitation to a deposition, potentially followed by visiting the insides of a courtroom, where your failure to call a c/section will be examined in microscopic detail by the plaintiff's attorney for the laymembers of the jury.
Regardless of whether the decision to allow a vaginal delivery contributed to the baby's problem, there exists a very high potential for you to be found at fault because a c/section could have possibly prevented the problem.
Hand over a blank check.
Sad, but true.
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Don't know if it is true or not, but if it's true it would be very funny -- at least to me. I was born at my mom's house (i.e. was delivered by a midwife) in India because my parents didn't have enough money to send my mom to a hospital. Many people of my generation in India were born in villages with the aid of midwives. Although I realize the times are different and the country is different, to think a hospital delivery would be cheaper still makes me laugh.
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It's a common reason for a c-section, particularly nowadays. Babies are bigger than the mom's pelvis can accomodate.
<sigh>
1) 10 hours is NOT a "pretty short time frame"! I don't know where you're getting your ideas, but 10 hours is a fairly long time. The OP doesn't say what stage of labor she was in....but if, for instance, you're hanging out at 4 cm for TEN HOURS, that is a REALLY long time. If you've already ruptured your membranes, the chances that you'll introduce infection into the uterus increases quite a bit.
Even a prime at 4 cm for ten hours is NEVER going to deliver vaginally.
2) The woman in the OP had an epidural placed. She's not going to be "walking around."
(Or standing up, for that matter.) She chose to have an epidural placed, and that's her perogative. 3) You're underestimating how much of this could have been patient preference. YOU, maybe, were willing to wait out 40 hours or more to deliver vaginally - but many women are NOT. After 10 hours of labor, many women will actually request to be cut.
But not enough research to understand how labor is managed.
Again, you don't know what stage of labor the OP's patient was in. Again, if she's just not dilating, then it's really not going to happen.
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I take it this is just a wild guess on your part.
Insurance does pay for midwife births.
Richer people sue less? More realistic? Don't kid yourself.
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I had a longer post ready for you but I realize it isn't worth my time but to say you are very confused and misinformed.
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I do not claim to be the biggest expert on this subject so please clarify for me the following which I have learned on my own:
Doesn't the pelvis lose some of it's space when a mother is laying on her back as opposed to when she is in an upright position? Also, doesn't a babies bones in his head mold to fit through the pelvis - which is why many vaginal babies come out with a cone shaped head that eventually rounds out?
You are correct in saying the OP doesn't say a stage of labor but what does failure to progress mean really... is the baby stuck in the pelvis, is the cervix not opening, it can be many reasons which failure to progress does not seem to answer. Failure to progress is more of a symptom than a diagnosis... what is the actual diagnosis?
Why ignore the underlying cause of why she is hanging out at 4 CM?
Infection is only introduced after an internal vaginal exam is done. As long as fetal heart rate is normal and mom is fine, why is it normal practice to check dilation in the first place- especially with ruptured membranes? It is done so routinely and never questioned... and this in itself is the cause of "necessary" c-sections.
Don't say never - because I have done it twice. I will not go through my entire birth stories here but my 1st and my 3rd were 26 hour labors with no pain meds and I was stuck at 4-5 on the first for at least 10 hours. the third I asked not to be checked so I can't tell you where I was. Guess what, both were vaginal deliveries (as was my 2nd).
I love how you say this. I have seen how women "chose" to have epidurals. They are not told of any of the risk factors, including an increased possibility of c-section. Hospital birth classes and the infamous "what to expect when your expecting" encourage it as a safe option.
I can't argue with this, but it begs the question of whether we are educating women enough about their capabilities and educatiing doctors enough about techniques to help move labor along that aren't surgical. Strapped to a bed with monitors and machines that go beep is not exaclty encouraging a woman to labor the way her body was made to.
Go ahead, educate me. I am seriously wondering what the story behind it all is. Why do doctors turn a blind eye to the amazing successes that midwive assisted births turn out - homebirths, birth centers, and hospitals. I know that midwives are taking low risk patients - so why not refer all your low risk patients to midwives? Then I wouldn't be appalled at the high c-section rate of OBGYNS. If midwives took on the low risk births, docs would be expected to have a close to 100% c-section rate - but hey, why not, they are high risk. It just seems rediculous that a healthy woman who decides to see a doctor instead of a midwife has a ~25x chance of ending her pregnancy with abdominal surgery.
Again, I strongly disagree with that statement from personal experience and wonder why you so strongly believe that if you have never even given her a chance?
Doesn't the pelvis lose some of it's space when a mother is laying on her back as opposed to when she is in an upright position? Also, doesn't a babies bones in his head mold to fit through the pelvis - which is why many vaginal babies come out with a cone shaped head that eventually rounds out?
You are correct in saying the OP doesn't say a stage of labor but what does failure to progress mean really... is the baby stuck in the pelvis, is the cervix not opening, it can be many reasons which failure to progress does not seem to answer. Failure to progress is more of a symptom than a diagnosis... what is the actual diagnosis?
Why ignore the underlying cause of why she is hanging out at 4 CM?
Infection is only introduced after an internal vaginal exam is done. As long as fetal heart rate is normal and mom is fine, why is it normal practice to check dilation in the first place- especially with ruptured membranes? It is done so routinely and never questioned... and this in itself is the cause of "necessary" c-sections.
Don't say never - because I have done it twice. I will not go through my entire birth stories here but my 1st and my 3rd were 26 hour labors with no pain meds and I was stuck at 4-5 on the first for at least 10 hours. the third I asked not to be checked so I can't tell you where I was. Guess what, both were vaginal deliveries (as was my 2nd).
2) The woman in the OP had an epidural placed. She's not going to be "walking around."
I love how you say this. I have seen how women "chose" to have epidurals. They are not told of any of the risk factors, including an increased possibility of c-section. Hospital birth classes and the infamous "what to expect when your expecting" encourage it as a safe option.
I can't argue with this, but it begs the question of whether we are educating women enough about their capabilities and educatiing doctors enough about techniques to help move labor along that aren't surgical. Strapped to a bed with monitors and machines that go beep is not exaclty encouraging a woman to labor the way her body was made to.
Go ahead, educate me. I am seriously wondering what the story behind it all is. Why do doctors turn a blind eye to the amazing successes that midwive assisted births turn out - homebirths, birth centers, and hospitals. I know that midwives are taking low risk patients - so why not refer all your low risk patients to midwives? Then I wouldn't be appalled at the high c-section rate of OBGYNS. If midwives took on the low risk births, docs would be expected to have a close to 100% c-section rate - but hey, why not, they are high risk. It just seems rediculous that a healthy woman who decides to see a doctor instead of a midwife has a ~25x chance of ending her pregnancy with abdominal surgery.
Again, I strongly disagree with that statement from personal experience and wonder why you so strongly believe that if you have never even given her a chance?
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That is simply wrong. There is solid data on this. Epidurals DO NOT increase rate of C-sections....
Women with epidurals (the way we do them today) tend to have slightly longer 2nd stages of labor....that's it.
You are committing very common errors in medicine....ones typically committed by medical students and poorly trained doctors.....Allowing ANECDOTAL experience to guide your beliefs and intended practices.
Sure..you may have birthed 3 kids one way, but that doesn't mean it is the right thing to do STATISTICALLY....
Medicine is ALL about STATISTICS.
"natural childbirth"....the way they did it in the 1800's....had a certain mortality rate for both mother and child....go back and look...you may be surprised at how high it is.
Modern day medical management of labor...with it's "high" rate of Sections have a different set of mortality data....
I choose the modern way....along with most women.
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TopDoc, why have you chosen to engage an Anesthesia forum in a discussion about C-sections?
I'm sure you would find a captive audience in, say, the OB/Gyn forums. Granted, their traffic is a small fraction of ours.
I'm sure you would find a captive audience in, say, the OB/Gyn forums. Granted, their traffic is a small fraction of ours.
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I think MMD just about covers that point, but I'll add a couple of things. If you actually look at the studies, especially the "recent" one (2006?) in the NEJM it shows NO increase in C section rates, a small increase in second stage time, and an increase in forcep delivery rates. Might want to check the studies before spouting off. If youve actually followed women in labor, Im sure you would see many of them convert from a dysfunctional to a normal labor pattern following epidural placement. Look up the contribution of pain management and catecholamines to labor patterns.
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If you can hack an OB residency(pun intended), you will cut out almost as many babies as you catch. You will also realize as I have early in residency that most of what you do in the hospital will depend on the drugs of a smart ass anesthesiologist(and yes we do know this too😀)
Beware, reality is fast approaching.
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Well you got one thing right. Really your post is such a fertile field of propaganda and half-truths with such little basis in reality that I am going to have to try to limit myself for fear of pissing off my anesthesia colleagues by discussing an OB topic at such length on our board.
As anesthesiologists, most of us don't really give a damn anymore what exactly failure to progress means other than time to go to the OR. It is a catchall phrase for baby not coming out vaginally despite active medical management and adequate labor. It is typically due to arrest of dilitation or descent and it means the OB HAS considered the reasons that this patient might be hanging out at X cm (typically > than 5) and made a determination that there are no further REMEDIABLE causes.
WRONG! This is an utter fallacy spouted by the "natural childbirth" crowd to indict physicians. There is no evidence to support the contention. Infected mom's who haven't had a vaginal exam and who, on further questioning, realize they ruptured spontaneously prior to presentation do show up in triage. Any time you open a passageway between a previously "sterile" environment and an area of the body that is flush with bacteria, like the vagina, it is only a matter of time before the bacteria work their way into the previously "sterile" area. The only question is can you get the baby out before the bacteria cause sequelae.
Because the evidence that does exist states that moms who do not follow a normal labor curve are at a statistically higher risk for poorer maternal/ fetal outcomes. Why wait for the baby to show signs of distress before you realize that a vaginal delivery is unlikely? Those who say things like, "this is never questioned" either do not have an understanding of what it means to be a physician or have an agenda to push that is served by viewing obstetricians as unthinking, money-grubbing, women-hating drones.
I could have guessed that from your first post. Guess what? Just because you did that does not make you more or less of a woman than those who choose to have epidurals or choose to have c-sections or those who are required to have c-sections. Nor does it make your contentions more statistically relevant.
What you are failing to realize is that the real "agenda" types are not those of us offering epidurals and c-sections to those who need them. Personally I would just assume that every woman labors and delivers vaginally without me having to wake up and manage her pain. Those with an agenda to push are the "natural childbirth" people who make women feel guilty for being less "in tune" with their body because they requested an epidural or needed a c-section.
Apparently, anesthesiologists in your neck of the woods practice significantly different than the anesthesiologists here. I have yet to meet an anesthesiologist who does not at least mention the risks/ benefits during their informed consent discussion prior to the procedure.
Even though lumbar epidural are extremely safe, if I were to lie to my patients and tell them that there was a 4-5% chance of their baby dying after I placed the epidural, most moms would still want the epidural. Once again the people setting up unrealistic expectations for women are NOT the hospital birth classes or the "What to Expect" book you mentioned. It is the "natural childbirth" folks who think you are less of a woman if you need pain management.
Every woman is built differently and while there are some women who can go out an run the Ironman, is it fair to denigrate the women who can not?
You still haven't told me why this "high" c-section rate appalls you so much. Where is the data suggesting this is a worse outcome for women? If there is no real outcome difference then why are you propagating false fears and expectations for women?
Care to share a reference here?
-pod
Apologies to the anesthesiologists here, I really just couldn't help myself.
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Does anyone else here consider this as way to much vagina talk for an anesthesia website?
Well said anyway, periopdoc.
I have come across many of these women that denigrate women that choose an epidural b/c they delivered without one. Personally, I think they are more dangerous than the midwives.
Well said anyway, periopdoc.
I have come across many of these women that denigrate women that choose an epidural b/c they delivered without one. Personally, I think they are more dangerous than the midwives.
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Some of the best, most frank advice I have seen on SDN in a while. I just had to reiterate it. We should probably sticky it.
Sorry for the Va-jay-jay talk, it is just something that totally torques me off. Is it any wonder I had to leave OB?
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I'll fight anecdote with anecdote.
At the turn of the century my great-grandmother was a midwife in a rural farming community. She gave birth to nine children herself, and two of them died. At that time c-sections were unheard of--as was a woman having all living children. It was also fairly common for women to die in childbirth, so you ended up with lots of split families: men had children from a first and second wife. This was the case with my great-great-grandfather. His first wife died giving birth to their third child. He remarried and had four more children with his second wife. Well, maybe I should say six children, as two were stillborn.
If you want to use history to prove that women can birth vaginally, you need to know what really happened back then. The late 1800s/early 1900s were not romantic. Life was beautiful and simple, but it was also harsh. My grandmother, now almost 93 years old and still very cogent, marvels at the fact that hardly anyone has a stillborn child anymore, and she doesn't know any young women who have died during childbirth.
At the turn of the century my great-grandmother was a midwife in a rural farming community. She gave birth to nine children herself, and two of them died. At that time c-sections were unheard of--as was a woman having all living children. It was also fairly common for women to die in childbirth, so you ended up with lots of split families: men had children from a first and second wife. This was the case with my great-great-grandfather. His first wife died giving birth to their third child. He remarried and had four more children with his second wife. Well, maybe I should say six children, as two were stillborn.
If you want to use history to prove that women can birth vaginally, you need to know what really happened back then. The late 1800s/early 1900s were not romantic. Life was beautiful and simple, but it was also harsh. My grandmother, now almost 93 years old and still very cogent, marvels at the fact that hardly anyone has a stillborn child anymore, and she doesn't know any young women who have died during childbirth.
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I know someone who did this too - labored for 3 days at home with the nurse, etc. Baby was delivered - rushed to nearby hospital doa. They were told if they had delivered at the hospital, the baby probably would have been fine. All this "natural" stuff isn't necessarily good - death after all is natural too.
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I have quite a few stories just like this. We have a large midwife population with many home births. Every year we get a few rushing into the ER with one disaster or another. The babies are flown to Childrens in Denver while we take mom to the OR.
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and I will reply to your anecdote with some facts...
Myth: Birth became safer when it was moved from a home setting managed by midwives to a hospital setting managed by doctors.
Fact: Death rates rose when women started having babies in hospitals. In the 1920s middle class women began having their babies in hospitals with physician attendants. By the mid 1920s, half of urban births took place there, and by 1939, half of all women and three quarters of urban women gave birth in hospitals. In 1915, prior to the major changeover, 60 mothers died per 10,000 births. Despite the shift, the 1932 US maternal mortality rate reached 63 deaths per 10,000 births, and in cities where hospitalization for birth was more common, it stood at 74 deaths per 10,000 births, substantially worse than the overall rate. Meanwhile, between 1915 and 1929, as the shift in birth site and attendant occurred, infant deaths from birth injuries increased by 40 to 50 percent.
Maternal mortality did not begin to fall until the late 1930s when antibiotics to treat infection were introduced and more stringent controls were placed on obstetric training and practices. Many factors contributed to reduced death rates including better living conditions, good nutrition, child spacing, and the development of blood transfusions, but moving birth into the hospital and under doctor control was not one of them.
Goer, Henci, The Thinking Womans Guide to a Better Birth(New York: Perigee Books, 1999),202.
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and I know someone who had her first baby in the hospital and after complications during labor, the child ended up with SEVERE cerebral palsy. Should we play the match bad outcomes game? Studies have shown that for healthy women screened for risk factors home birth with a trained midwife (or doctor) is just as safe (if not safer*) than hospital births. There is no point in arguing that point - it has been very well established.
Birth is inherently risky, and anyone who says otherwise is kidding themselves.
*mortality rates are the same, morbidity rates are lower in a home birth
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I have to notice that no data is actually mentioned past the 1930s. Error by omission is still an error. A good proportion of the CNM patients that come to the hospital do just fine, but I bet the ones that needed physician intervention were sure glad they were there. Dental work used to be done with no anesthesia either. I'll bet you get novocaine when you go to the dentist.
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OK Topdocchick, can you tell us what makes the hospital deliveries so dangerous?
And when you say "death rates rose when women started having babies in hospitals", are you talking about the baby or the mother? I know you talk about maternal mortality below but I want to be clear here.
And when you say "death rates rose when women started having babies in hospitals", are you talking about the baby or the mother? I know you talk about maternal mortality below but I want to be clear here.
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There is such a difference.
First of all, I do not believe that all women should never have an epidural. I know that people experience pain differently and have vastly different tolerance levels. Here is the thing I have a problem with - a woman who comes into the hospital and does not want pain medication but is offered it every time she has a contraction by her "helpful" nurses. I am not talking about first timers who are maybe idealistic or ignorant about how bad the pain can get, I am talking about veteran birthers who have done this 3, 4, 5 times. IF you are comparing the pain of contractions to the pain of dental work you are essentially saying that the childbirth pains have absolutely no beneficial role in labor.
First of all, as the pain intensifies, it signals that labor is moving along. This can actually be encouraging to women since they can use it as a signpost.
secondly, psychologically, the pain is very good for some (not all) women to experience -especially if their labor does end in c-section. The feelings of failure are less pronounced when a women feels that she really tried all she could. And, please don't deny that many women feel like failures when they have c-sections. Many women who turn to natural births do it in response to the unwanted surgery.
I am sure there is more to say but lets just, for now, agree to disagree.
I hope that as a physician - learning everything you know, and still believing in the natural process of birth, I can help bridge the gap between midwife and doctor care. I don't know why there needs to be such animosity on both sides when both sides really do have major positives. The high risk women of today can really thank the medical interventions that have allowed them to have children. I just wish that physicians would appreciate that low risk women should be encouraged to birth as naturally as possible.
Is there any debate that breastmilk is better than formula? One case where natural overcame the medical establishment. I have no doubt that this trend will be repeated in the future with births, that the natural will be encouraged over the medical. When this happens, maybe more women will birth in hospitals because they will feel that their wishes to birth naturally are not just being rediculed and laughed at, but encouraged and heped along. This can make everyone happier - no?
As one poster said previously, midwives are sued less because their patients are usually more educated and more a part of the decision process at every stage of labor. It may be a long road before the general public can be educated to that degree and possibly sue doctors less as well, I hope I am around when that is the norm. Good luck to all of us. 😍
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For starters, EFM over intermittent doppler which has not shown any benefit to infant mortality but has shown a large increase in cesearan rates. I believe 9 studies have shown this correlation.
Maternal rates.
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Mortality rates are lower in countries where midwives and home births are the standard of care for low risk women. For example, the Netherlands versus the United states. This is according to the World Health Organization's published results in 2000.
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midwives are less sued because they have less money. the role of pain in labor is your opinion and has no factual basis. women do not, in fact, feel like they failed if they felt no pain and then move to c/s. and people who chose them are not MORE educated. every physician, lawyer, businessman, engineer, etc that i know had a physician help them deliver.
topdocchick, your numerous incorrect statements and, at best, a beginner's knowledge of obstetrics and a non-existent understanding of anesthesiology and pain management, your arguing against attending physicians with years of experience in the field is alarming. you're at best a 4th year student and you have got all the answers?
calling physicians druggers and cutters is inflammatory, at least.
i'll tell you what. you can chose to do what you believe (apparently based on 1920s literature). and no drugger (i call them anesthesiologist) or cutter (surgeon) will interfere with your natural birth.
in fact, do us all a favor and get all your healthcare naturally, preferably from nurses. natural selection, free of that evil modern medicine, should take care of the rest.
topdocchick, your numerous incorrect statements and, at best, a beginner's knowledge of obstetrics and a non-existent understanding of anesthesiology and pain management, your arguing against attending physicians with years of experience in the field is alarming. you're at best a 4th year student and you have got all the answers?
calling physicians druggers and cutters is inflammatory, at least.
i'll tell you what. you can chose to do what you believe (apparently based on 1920s literature). and no drugger (i call them anesthesiologist) or cutter (surgeon) will interfere with your natural birth.
in fact, do us all a favor and get all your healthcare naturally, preferably from nurses. natural selection, free of that evil modern medicine, should take care of the rest.
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TDC, I compared homebirths at the turn of the century with births now. You are comparing the former with hospital births in the 1930s. It's utterly ridiculous to base current decisions on 70+ year old data. That's like basing the decision on whether or not to have a knee replacement based on options available in 1935.
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Just for the record, most homebirths are attended not by CNMs but by lay midwives who are not nurses nor do they have any formal certification. Most CNMs practice in the hospital alongside physicians.
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Please, please, don't confuse the self-proclaimed expert student (or is it student expert) with mere facts.
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I have yet to speak to a woman who regretted her decision to have an epidural. I work at a hospital where we are not allowed to speak to the patients until they request the epidural. Some come in with a birth plan stating they will not get an epidural, and do not want anyone to suggest it. That's great.
What I have a problem with is the families who supersede the mom's decision. I've had two in the last month that were in significant pain, and requested an epidural. Before I could speak to them, the family convinced them it was the wrong thing to do. Where do you stand- is it the mom's choice or the family?
My concern with the breast feeding debate is that women that choose otherwise are ostracized for their choice. Regardless of their motivations for doing so, these women are meant to feel as though they have failed as mothers, that they are unable to provide even the most basic requirement of life to their newborn. Is that healthy?
To characterize the medical establishment as some evil empire interested only in perpetuating needlessly scientific proceedings is just false. We do what we believe is best for our patients, based on objectivity, not emotions. It's based on scientific study, not what our grandmothers did, or what influential authors suggest. You have apparently entered medical school with very strong principles against the medical practice model. You hope that in the end you can reconcile these with scientific support, but I'll tell you it will be difficult. The more you read and understand medical literature and principles, the more you will doubt the theories and basis of these propaganda books you quote.
I wish you luck, but you will have some heavy soul-searching ahead. Your current mindset is incompatible with modern OB/Gyn practices, so you will have some serious reconciling to tackle if you expect to graduate from an accredited residency program.
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Again, I think I have said this before - I am not anti-physician assisted births -heck, it is what I want to do. I am just anti the anti-natural birth movement. Why is that so crazy? I'll try to analogize my point. Dr. Atkins wanted us to eat just protein and fat but then he died of a heart condition. Protein is healthy, in moderation, as are carbs, fats, sugars etc. Modern medicine should not be versus natural medicine. There is a lot of evidence supporting the claims of both groups who seem to hate eachother. If this was a natural medicine forum, I would be arguing the other side. I just don't understand why we can't see the positives on the other side of the case. I am sure that you are a wonderful attending with many years experience, but how many homebirths have you attended? How many fully naturally unmonitered births? I would say that the midwives might have a little expertise in their own niche area that is constantly criticized by physicians. I hope you can get over yourself and see that maybe, just maybe, they have some valid points. I hope they can do the same by you. I am talking only about CNMs by the way. I do not know any DEMs so I can not speak on their behalf at all.
Maybe it can help you to try to understand why women choose midwives or homebirths over physicians and hospitals instead of deciding that they are crazy. In the end, it can only be helpful to understand people and their motivations.
Jeff - the cutters/druggers thing, it was a joke, but if you are offended I apologize.
And to everyone, I am not trying to upset any of you. I am seriously learning a lot here from the mouths (hands) of experienced physicians.
Maybe it can help you to try to understand why women choose midwives or homebirths over physicians and hospitals instead of deciding that they are crazy. In the end, it can only be helpful to understand people and their motivations.
Jeff - the cutters/druggers thing, it was a joke, but if you are offended I apologize.
And to everyone, I am not trying to upset any of you. I am seriously learning a lot here from the mouths (hands) of experienced physicians.
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I recommend that you review what the results are based on. Some countries don't count a baby as a birth until they are a certain gestation, like 36 wks. The US has the most stringent criteria therefore, more recorded deaths. You are not comparing apples and apples just like the WHO. YOu are one of those uninformed or closed minded people that believe only what you want to believe.
And the 1930's, come on now. You plan to call yourself a doctor someday right?
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As far as the family versus woman's choice - I would say it is 100% the woman's choice BUT - she may have asked her family to talk her out of it if she asks for one for whatever personal reason she may have. I know plenty of women who ask their family to play that role when they are in labor. You can't possibly know the family dynamic - you are only seeing the woman in question during an intense snapshot of her life. That being said, as a healthcare provider I would try to assess what the women truly wants short-term and long-term.
Yes, i agree with you on the breastfeeding vs. bottle debate. The natural community has gone overboard on the faults of formula to the point of causing terrible guilt in mothers who are unable to breastfeed whether for emotional, physical or any other reason. Still, breastfeeding truly is better for the baby. Formula is a lifesaver, and thank God it is here to help. (Can I make the same analogy about natural births and medical births again?)
And again, I fear the same as you about my eventual residency program. I hope that I can be convinced from my beliefs enough to practice the way I need to in order to get through a residency. I have said it again and again, I am interested in all your answers because it is part of the learning process. As of yet, I am not convinced in your way of thinking and can't imagine I will ever be, but I am open to evidence. You feel that I don't have evidence on my side of the debate - and I feel very strongly that I do - but maybe when I see "real" evidence I will change my mind. We shall see, time will tell, and as long as we can continue to think critically we will all keep learning.👍
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TopDocChick:
I'm not sure where in your med school training you are but you sould awfully idealistic.... have you been exposed to much clinical experience (and no having a baby doesn't count as clinical experience).
I have two family members that are obstetricians. AS much as I malign OBs in general, I also know my family members professionally.. and they are both damned good doctors... and they both go faulted for not acting in a speedy manner... So when it's your decision, when you are in charge, when it's your butt on the line, let me ask if you are willing to wait it out, or step up to the mike and make the hard decision. OB isn't an easy route, there are a lot of hard decisions and its frought with imperfect science but what is true is that the lawyers are harsh and the juries are unforgiving... So, sometimes in life its important to act on the data at hand...
drccw
ps when did this become an OB forum
I'm not sure where in your med school training you are but you sould awfully idealistic.... have you been exposed to much clinical experience (and no having a baby doesn't count as clinical experience).
I have two family members that are obstetricians. AS much as I malign OBs in general, I also know my family members professionally.. and they are both damned good doctors... and they both go faulted for not acting in a speedy manner... So when it's your decision, when you are in charge, when it's your butt on the line, let me ask if you are willing to wait it out, or step up to the mike and make the hard decision. OB isn't an easy route, there are a lot of hard decisions and its frought with imperfect science but what is true is that the lawyers are harsh and the juries are unforgiving... So, sometimes in life its important to act on the data at hand...
drccw
ps when did this become an OB forum
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The 1930s was only in answer to someone's story about their grandma - please people, stop. You are taking it seriously out of context.
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I know the harsh reality - it doesn't mean my idealism is wrong. It just may not be possible to practice this way in the current state of things.
i am hiding from the OB forums so that when I apply for my residency, no one thinks to search for me in an anesthesia forum. 🙂
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Fair enough thought I am not sure the OB residencies are going to be checking Studentdoctor.net in 2012-13 when you apply to residency... I hate to tell you this but you're in for a rough road... when I started med school, I wanted to save the world... after a year, I wanted to save myself...
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Hey dummy,
I have tried hard to hold my tongue while the stream of misinformation has gushed forth from your word-hole.
This is just one glaringly obvious indication of your ignorance. Dr. Atkins fell and cracked his skull while ice skating. Here is his death certificate:
http://lowcarbdiets.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=lowcarbdiets&cdn=health&tm=25&gps=513_1070_1012_591&f=00&su=p674.5.336.ip_&tt=2&bt=0&bts=0&zu=http%3A//www.thesmokinggun.com/archive/bloombergatkins1.html
I sincerely hope for the sake of your patients you exercise a little (any) caution before "treating" them with what you consider evidence based medicine.
Oh yeah.....by the way....a "woman's advocate" future OB/GYN med-student is so cliche as to be laughable. See ya' in 5 years.....
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He's been unusually quiet for the past few days as well. I guess we got to him. I sort of miss him.
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He's been unusually quiet for the past few days as well. I guess we got to him. I sort of miss him.
I haven't seen a beat down that bad since Tenesma sent womensurg into retirement. I guess it's worse since dfk was beat down over a series of threads. Now I see why he and isoman usually wait until post #357 of a thread (when the answer has already been stated) to chime in with their thoughts.
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If you could prove that assertion I would appreciate it southpaw.
Arch Guillotti
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RELAX, Frances.
He is only being mildly facetious🙄.
Don't come over here trying to stir up trouble or you will be dealt with accordingly.
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Should be?
I think that women "should be" encouraged to birth however they feel like. If they want an elective c-section, that's up to them. If they want an elective IOL at a specific time, also up to them. If they want their husband to throw exotic spices up in the air while muttering an ancient Aztec chant as soon as she reaches 6 cm dilation, that's up to them too.
<shrug> There is a certain amount of patient autonomy that DOES need to be honored. And this holds true for OB, anesthesia, surgery, peds, family med, etc.
I'd hope that by your MS4 year, you'd know better than to call a forum full of anesthesiologists "druggers." No one is saying that women who choose midwives, homebirths, or doulas are "crazy."
But it is NOT good medicine to claim that ALL low-risk women "should" be encouraged to choose natural birthing/homebirths. That is as narrow-minded as you accuse others of being. And it makes it seem like you're more interested in pushing an agenda than, you know, actually FOLLOWING one of the major tenets of the practice of good medicine - honoring patient autonomy.
<sigh> I do worry, though, that you will be very disappointed if you pursue OB/gyn.
You will do things that you do not want to do, and do not believe in, because of the medico-legal climate. EFM is applied to all women who walk in through the door - and you're going to have to accept that, even though it has many flaws.
You may have to do circumcisions, even if you don't believe in them. You may have to do c-sections on women even if you don't believe it is warranted.
It's a tough road for someone of your beliefs. 🙁
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Upon further review I could not find you posting unoriginal thoughts at post #357.
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TDC...I'm not sure what stage you're at in the game, but as an MSIV I find your idealism admirable.
That being said, there is a huge difference between the perfectly healthy vaginal delivery overseen by a midwife and the sick as hell emergent C-Section by the OB. And between those two extremes lie just a massive spectrum of gray area. Whereas I'm sure you'd like to tell yourself that with each and every tough decision you'll err on the side of natural vaginal delivery, it takes just one bad outcome wherein your judgment was questionable for you to find yourself in a huge lawsuit. I imagine that the medicolegal environment in which OB lives would not suit someone like yourself well. But we'll see. Best of luck.
That being said, there is a huge difference between the perfectly healthy vaginal delivery overseen by a midwife and the sick as hell emergent C-Section by the OB. And between those two extremes lie just a massive spectrum of gray area. Whereas I'm sure you'd like to tell yourself that with each and every tough decision you'll err on the side of natural vaginal delivery, it takes just one bad outcome wherein your judgment was questionable for you to find yourself in a huge lawsuit. I imagine that the medicolegal environment in which OB lives would not suit someone like yourself well. But we'll see. Best of luck.
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Just going off the cuff here but I don't remember the last time you chimed in on anything early with any clinical wisdom.
But thats fine. If you followed the DFK (short for Don't F*ckin Know) beatdown I stated that you guys are welcome here. Just don't post any nonsense on a doctors forum as a nurse to which others may construe as information coming from a doctor.
Check out JWK's posts, that dude has his **** down.
