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Preventing tears From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL) Thu Jun 8 04:01:01 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Gail Graham: "Re: Informed consent FRI" Previous message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "UA results" Richard, What different maneuvers do you do to manage the posterior shoulder? I'd agree that most of these tears ARE a result of the posterior shoulder and not the head. Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Wednesday, June 07, 2006 4:20 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Informed consent Joe C is correct. I've cut maybe 2 or 3 episiotomies in the last 3 years. If you know the pelvic dynamics and vectors most tears are no greater than a second degree. Understanding that the big tears come from the posterior shoulder and not the head I spend as much care, if not more, delivering the shoulders. Of course, I have had a 'fourth degree' tear in a patient with an intact perineum...a joy to repair Richard Chudacoff, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jamie Sent: Wednesday, June 07, 2006 10:04 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Informed consent I'm curious about your point with the first sentence-are you implying that multips sustain more damage with or without episiotomy? I don't think it goes without saying that episiotomies are done only when necessary. How could it, when episiotomy rates vary so much from one caregiver to another? I have worked with doctors (and nurses, just so you know I'm not picking on doctors) who believe episiotomy is always necessary, and others who do them only for distress. Who's right? The average woman doesn't know enough to question her doctor's episiotomy rate, beyond "of course, doctor, if you think I need one", which leaves her at the mercy of how informed the doctor is. Not every person out there delivering babies is as well informed and up-to-date as those on this list. Episiotomy is a surgical procedure, and like any other surgical procedure, the patient has the right to decide when she is willing to assume those risks and when she is not. Why is patient autonomy such a threat? At Wed, 7 Jun 2006, Joe Cutchin wrote: > >Its a shame women aren't having 4 to 8 vaginal deliveries so you >youngster could see what the perineum looks like afterwards. It goes >without saying that episiotomy is used only when necessary. I would be >surprised if all here don't have that discussion with their patients >during the gestation. Enough. Joe C > >Jamie wrote: >> Advisor, not decision maker. Fortunately, my doctor trusts me. When we >> discussed episiotomy I told him I wanted one only if the baby was in >> trouble and crowning. Many women would rather take their chances with a >> tear, especially given the controversy over whether episiotomy actually >> prevents tearing. There are an awful lot of 3rd and 4th degree tears >> occurring after episiotomy. >> >> For any surgical procedure, the patient has the right of consent or >> refusal. Since the true need for episiotomy really isn't predictable, >> the patient should be informed by the physician of the potential for >> that need, of the risk of not doing one, and of the potential >> complications, and should decide prior to labor under what circumstances >> she wishes her caregiver to perform one. >> >> At Tue, 6 Jun 2006, RModugno@aol.com wrote: >> >>>In a message dated 6/6/2006 8:15:35 P.M. Eastern Standard Time, >>>ajfields@pine-net.com writes: >>> >>>IMO the owner of the perineum, but then I have one so I'm a little >>>sensitive about it. I think it should be carefully discussed during >>>prenatal care and the woman should define the circumstances under which >>>she will consent to an episiotomy. There has to be some trust there, >>>though, b/c it's up to whoever is catching to stick with that request. >>> >>>What unmitigated balderdash! I'm sorry, I don't have a crystal ball - and >>>I've been doing this for 30 years and I still can't tell whether the patient >>>will start to tear during delivery when I see her during the prenatal period.. >>>Sorry, I'm just some idiot, non-caring,.lying, male chauvanist obstetrician, >>>whose episiotomy rate has dropped dramatically over the past years- I talk to >>>my patients, I tell them under which circumstances an episiotomy might be >>>indicated,they PAY me for MY EXPERTISE and I take it that you are saying that >>>the owner of the perineum is the one who should have the say whether an >>>episiotomy is done or not. Does the perineum owner have the expertise to make that >>>judgement call? Surely the physician should act as an advisor in such a >>>situation. Funny, my patients seem to trust me. >>> >>>Robert Modugno MD MBA FACOG >>>Marietta, GA >> >> -- >> JFields, RN, BSN >> -- JFields, RN, BSN Next message: Gail Graham: "Re: Informed consent FRI" Previous message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "UA results"

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