Re: Section on demand
From: Meenan, Anna (annam@uic.edu)
Thu Apr 27 21:40:58 2006
In a little over 400 deliveries, I've had 6 3rd degrees, only one
occurring without a ML epis. Two 4th-degrees, both after ML epis.
Most of them were earlier in my career, when I did more episiotomies.
I did very few episiotomies in the last few years. Anyone who's
interested in an exhaustive discussion of the risks v. benefits of
epis. v, spontaneous lac. should consult Bob Woolley's article in
Ob-Gyn Survey 1995 volume 50, pp806-835 (Do ya suppose Bob is gonna
go see the movie "United 93"?)
Anna Meenan, MD
>Heidi,
>I hate to say it- but 100 deliveries is not a lot of experience. And
>you get to cherry pick your clients. It sounds like you have not
>been the primary care giver in them either.
>
>In our practice we have done a couple of primary C/S on demand after
>the info from ACOG came out. I got most of the information to write
>up an informed consent from the ACOG site and the consents the list
>had shared. An elective C/S is not what we as midwives are taught,
>but the major mantra of most midwives (CPM or CNM) is that women
>deserve the birth that THEY want and not what WE want to do.
>
>As a CNM I handle our patients and whatever else comes thru the
>door. Our population is poor, rural, mostly uneducated and just day
>to day living is about all they have the energy for. I am happy if
>they keep more then 5 prenatal visits. The driving distances can be
>long. We average around 250-300 births a year (1 CNM, 1 full time OB
>and one PRN OB)
>
>As for 4th degree lacs- they happen- spontaneously. I can't count
>the number of them , but I know it is at least a dozen in the last 4
>years. You repair them, teach them and hope they show up for the PP
>visit. 3rd degrees and periurethral tears tend to happen when mom
>blasts a baby out or the progress is slow and there is not a lot of
>room. I don't cut epis unless there is real distress. I have
>probably cut less than a dozen in the last 4 years. I would rather
>repair a small lac than a huge epis she may not have needed. Also,
>we have a population here that passes around a lot of HPV warts. I
>learned that if you cut them- they bleed like nuts, but they will
>naturally tears around the lesions. Harder to repair, but easier on
>Mom.
>
>I am glad for your good experience, But one day you are going to be
>in over your head and really need the help of the people you are
>talking to on this forum.
>Somewhere after 500-600 babies, you will probably be able to have
>said you have dealt with most of the complications that might occur-
>if only once or twice.
>
>Don't throw all OBs into the same bag- especially on their forum.
>All docs are different, just like all midwives have different
>styles.The OBs that I work with wonderful to the patients, but they
>have very different personalities and management styles. I found it
>much easier to encourage each person in their strong points instead
>of only focusing on what they are not so good at doing. I have
>learned a great deal from them and they have learned a lot of my
>'tricks' and high touch stuff.
>
>This forum and the OBs on it are very supportive and very
>knowledgeable. The are also very tole rent of all the seemingly
>elementary or stupid questions that I have asked. These are the good
>guys. Please- give them the respect they have earned. These are the
>good guys! They don't have to let us lurk here and they really don't
>have to let us post questions or opinions in their back yard.
>
>As a CP/student CPM you have a long way to go. We each have our
>place to fill in the care of women. I have been doing OB since 1990
>and I still learn every day. A lot of the up to date information on
>every day care and complications has been from members of this forum.
>
>So please understand that this is their backyard and not ours. They
>are really patient with questions. So please don't cut off one of my
>resources for advice. You may have little patience for what one
>person said- but they could just as easily say they have little
>patience with midwives and their questions- and refuse to even let
>us lurk there or ask questions.
>Vicki
>
>Vicki Smith, CNM, MSN
>West Virginia, USA
>Midwives- changing the world one baby at a time.
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