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Re: Ina May Gaskin/Quilt (long) From: Dr Eberhard Lisse (el@lisse.NA) Sat Feb 11 13:22:41 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Anhydramnion" Previous message: Ina May Gaskin: "Re: scope of practice" In reply to: Ina May Gaskin: "Re: Ina May Gaskin/Quilt (long)" Next in thread: Henry Gregor: "Initials" Reply: Henry Gregor: "Initials" img, (Hankybaby, before you ask, these are her initials, not her nickname :-)-O) on 2/11/06 8:06 PM Ina May Gaskin said the following: > I guess that the excellent idea is that we count every maternal death so > we can learn from past mistakes, right? The one sentence is true and the other is true, but unfortunately we don't use the connection. Reminds me a bit of one death is murder, 5 are serial killing, 10000 are statistics. >> I personally think that the quilt is a lousy implementation of an >> excellent idea. But then I must confess I haven't got a better idea. > > Lousy implemention? Could be. I'm learning quilting as I go, and now > I've got an expert doing the fancy stitching together of the panels and > the quilting. But even with my less than perfect work, the quilt bears a > message and gathers information that would be hard to convey otherwise. It's difficult for me to express this in writing, but it feels too Politically Correct to me, for example naming the patients. Doesn't contribute to anything, just the opposite. It's like naming the baby before it is born, calling patients clients and this stuff. And, who really cares about the quilt? 7 or 70 or 700 people? But not the 270 million insured US citizens. > Frinstance: someone sent me news of a US nurse-midwife who died by > amnio. Now I've learned about 4 other cases (not all in the US). Seems > like this fact should be part of the informed consent on amnios. Lots of > women I've talked to feel pressured into having one only because they're > over 30. And what does the quilt achieve in this context? I am fortunate that I don't have to practice in the US. Even if the malpractice premiums here are very high, I do not have to pressure any 30 year old into an Amniocentesis, just because if the baby has Downs' she will sue me whether she is 30 or 47. > At any rate, it's a quilt of sentinel events. Seven of these were AFE > deaths from Cytotec (2 were spontaneous labors & two were induced with > oxytocin), which seems significant (not in the statistical sense) to me, > since only one such AFE associated with Cytotec death has been reported > in the medical literature to date (unless we count one other case > mentioned by Cochrane Library in 2000, I think, that was reported at a > S. African conference). Isn't the issue more, why are so many women induced in the US? We have correspondents boasting to this list that they induce (almost) every patient (other than the ones they cut electively). > Why were none of these (or the 19 AFE Cytotec > deaths reported to the FDA between Nov 1 1997 and Sept 30 2004) > presented as case studies in the US obstetrical literature, as used to > be done? (The type of article exemplified by Hudgens & Conradi, "Sudden > death associated with terbutaline sulfate administration", Am J Obstet > Gynecol 1993;169:120-1?) It's easier to think that Cytotec is safe if > one uses the "right dose" if nothing appears in the medical literature > documenting these deaths (from small doses). I know too many relatives > of women who took Cytotec and died, who wish they had known earlier that > the drug can kill, however rare these deaths may be. One could argue that even Paracetamol can kill, but then I induce almost never (the last post mature was not engaged so I bypassed), and use Cytotec only for IUD/ToP in the second trimester. Oxytocin only with favorable Bishop's Score >> I also disagree with you that the way the CDC counts, matters. > > The CDC thinks it matters. Well, and George in the Bush thinks it matters how the CIA counts WMD. So what? > According to Berg et al, "Underreporting of > pregnancy-related mortality in US & Europe", Obstet Gynecol 106(4), > 684-92, "Collecting all available medical information from various > sources, at best through specific forms, is essential for accurate case > classification. From this perspective, confidential inquiry on maternal > deaths, first developed in the United Kingdom, may be considered as a > model." I feel that *EVERY* maternal death should be handled as "Unable to Certify Natural Causes", and I remember 2 patients during my time with the State where I did just that, ie triggered a proper inquest. Incidentally these resulted in "no Living Person Responsible" verdicts, with the side effect that one can not be sued. > Maternal mortality declined in the US between 1918 and 1981. The US and > Canada rates were about the same between 1920-1975 or so. Canada then > had a sharper reduction of deaths over the next 30 years than the US, > with the US showing no improvement since 1982. (They're around > 5-6/100,000 and we're now around 13/100,000--was 7.5/100,000 in 82 ,not > because of better reporting). If we're going to understand why, we had > better start counting accurately-especially with all the medical > innovation going on. What could be contributing to the rise in mm in US? > C-section on demand? Unrestricted use of fertility drugs resulting in so > many more high multiple gestations? Older women? Fatter women? Cytotec? > There's no way to know for sure if we don't count accurately. I am quite sure it's the insurance. Once you approach 110% coverage like in the US you got to get problems. In places with 99 to 100% such as Canada it's obvious that you have less problems. Reminds me of Fahrenheit 911... > So, all in all we agree 100% percent :-)-O Do you carry a stethoscope? Because that smiley is *MINE* :-)-O. > What could be better than that? Lesser mortality. Infant and Maternal. Peace on Earth. Lower Temperature in Windhoek during the summer (now) :-)-O. I live in the country with the biggest difference between rich and poor. On earth. And nobody has even really figured out what that means for health care. We haven't even got a proper body count, UN applies a *MODEL* every second year or so. But I am quite sure that private practice results are comparable to Middle Europe, which means that the national figures are at least 10 times higher, but I think it's at least twice that, and there are places that by far surpass AA. So, of course you are right, we agree 101% :-)-O el Next message: art fougner, md: "Re: Anhydramnion" Previous message: Ina May Gaskin: "Re: scope of practice" In reply to: Ina May Gaskin: "Re: Ina May Gaskin/Quilt (long)" Next in thread: Henry Gregor: "Initials" Reply: Henry Gregor: "Initials"

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