OB-GYN-L Messages for December, 2005: Re: Second degree tears, was Episiotomy/laceration breakdown

Gail

I think it is strange that women don't really get a choice over there. Here you were making it sound like that was the place to practice. NO WAY!

There is a big difference between midwifery care in different settings, but almost everywhere women have more choices than you are describing. This includes the choice to go to OB's who will section them on demand, induce them on or before their due date, and refuse to do VBAC's and breeches OR, at the other end of the spectrum, what we have in this area call themselves Zion Midwives. They do no vaginal exams or heart tones, just offer comfort and prayer. Women can find whatever they want. That is the point, I think. Unfortunately, as you have been learning, their "choices" don't necessarily mean a hill of beans if there is a bad outcome.

In my practice, which is mostly OB with a little "well woman GYN" (annuals, contraception, std screens, vaginitis, etc), I am the accoucher with 94% (just sent my stats to the MP ins. company so this is as of this year) of the patients that see me for antepartum care. The others I am taking a rare day off, out of town, or have referred to my consulting OB's for VBACs or high risk situations. I have women in my practice for whom I have "delivered" 7 or 8 of their kids! (too many, I know, tell that to their pastor). I do a pap if one is due, and by that I mean after considering their history of # of partners, previous STD's, presence of HPV etc. Many of my patients who are monogamous and have had only one lifetime partner wait every three years (after a few good paps to convince me that their husband is doing the same). Others in high risk professions (yep, I have those too) or with HPV etc, get a pap every year, and sometimes more often. It is individual. That is information you can only get from seeing the same patients year in and year out.

I could not imagine not seeing my bottoms after I had repaired them, or not seeing the moms and babies for ongoing health care. That must be hard, and I sympathise.

Peace on Earth

Fran

From: GA12L@aol.com
Reply-To: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Subject: Re: Second degree tears, was Episiotomy/laceration breakdown
Date: Tue, 20 Dec 2005 18:23:00 -0600

In a message dated 21/12/2005 00:11:47 GMT Standard Time, 530rose@msn.com writes:

am very surprised to hear that you never see the women you care for again. After a 9 month relationship, that seems somewhat harsh!

Yes it is harsh. Midwifery here could be better, a lot better. We only see the women up to 28 days post delivery. The GP sees the woman at 6 weeks and does the smear test if one is due. Do you do one after each birth regardless of the gap bewteen babies? Here women get one every 3 years. Is that enough?

If a woman is lucky she might see the same midwife for antenatal care but it's a lottery about who she gets to care for her on the labour ward. She doesn't have any say in her midwife but she can change her if she doesn't like her but that can be difficult.

Gail

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