Re: Vaginal Vision
From: Ina May Gaskin (inamaygaskin@gmail.com)
Fri Mar 7 12:24:54 2008
<Unlike some people think, even young obstetricians are trained to
deliver vaginal breeches in emergency situations. Each time a breech
baby was born by Cesarean section, the same maneuvers are done as if
the baby was coming out of the vagina. It is sad to see that some
women are led to feel so phobic about hospitals, Cesarean sections
and obstetricians. >
I'm glad to know this, although I've been told the opposite by many
young obstetricians in this country. I agree that the same maneuvers
are necessary, but I can think of one that is important that isn't
ordinarily used at c-section, and that is Burns-Marshall. Is that one
taught in US medical schools? I've had to use it several times for an
aftercoming head, and I'm still grateful for Phyllis Long, CNM's
letter to me back in the day. She learned it in Africa and
thankfully, taught it to me before I got into trouble for not knowing
it.
The patient's pelvis dimensions were at least as good as her
mother's, which had already been proven for up to a 10 lb. baby.
Manual pelvimetry and fetal weight estimation are arts which can be
well developed through experience.
Ina May
On 6 Mar 2008, at 15:24, allanho@aol.com wrote:
> This appears to be a case of Tunnel Vision of the patient and her
> mother. A case of getting a vaginal delivery at all cost. I can't
> imagine anyone in their right mind would give a blessing to a home
> breech delivery, with an unproven pelvis and a macrosomic baby to
> boot.
>
> If I was the consultant, I would probably have said "Sorry, I will
> not cover you to deliver this patient VAGINALLY in the HOSPITAL.
> If you insist on doing this at HOME, no one can stop you. This is
> a free country. I have enjoyed working with you a lot, but I would
> have nothing to do with this one. Good luck!" Would that be
> considered a blessing for a breech home birth? So many things can
> go wrong! What does this prove? Some women are willing to take
> incredible risks just so that they can feel a baby passing through
> their vaginas? There ought to be a dx in the DSM-IV for this
> condition?
>
> I have a personal interest in vaginal breech because that's how I
> was born. However, my experience has been that very few women will
> accept the risk these days. Who would blame them? I wouldn't put
> my baby in a plane if I was told there would be a 1/100 or 1/1000
> chance of crashing and burning. I would find another way! Most
> mother would accept the risk of a Cesarean section just to avoid
> the thought of a lifeless baby dangling between her legs and the
> head stuck in her pelvis. Most mothers would take the risk on
> themselves rather than on their babies.
>
> Unlike some people think, even young obstetricians are trained to
> deliver vaginal breeches in emergency situations. Each time a
> breech baby was born by Cesarean section, the same maneuvers are
> done as if the baby was coming out of the vagina. It is sad to see
> that some women are led to feel so phobic about hospitals, Cesarean
> sections and obstetricians.
>
> Allan
>
> -----Original Message-----
> From: Ina May Gaskin <inamaygaskin@gmail.com>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> Sent: Thu, 6 Mar 2008 9:47 am
> Subject: Re: Still another GOOD DAY
>
> VNellsch, if you had been on the list longer, you might have known
> that I've been attending breech births for 35 years, so this wasn't
> about me learning to do something a few days ago. If you had read
> my post more carefully, you should have known that two ob-gyns gave
> their blessings to the home birth. I'll add that the person who
> would have done the c-section (if we had needed one) was the person
> who first asked me to consider assisting her pregnant daughter. She
> (my physician friend) was also at the birth, along with 2 nurse-
> midwives and one of my partners.
>
> I think it's irresponsible for obstetricians not to have breech
> skills, since some women with a breech will come in such advanced
> labor that a c-sec isn't an option. I wonder if anyone on this list
> knows of a woman with a breech, who died from a c-section she
> didn't want. (I do.)
>
> I have a question for you, Verner. What if I had put Cytotec
> tablets in women without their knowledge or consent and then sent
> them home to await labor? Would you consider this a responsible
> thing to do?
>
> Ina May
>
> On 5 Mar 2008, at 18:40, verner nellsch wrote:
>
> > you were irresponsible. both you and the mother were selfish in >
> promoting a
> > non surgical birth rather than the safe alternative. you were >
> inconsiderate of
> > whoever would take this patient at the hospital if things had
> gone > wrong. your
> > euphoria was the sensation of having gambled with a baby and
> mother > and
> > your colleagues, and winning the bet. i hear about a case like >
> this one and
> > i wonder what makes a provider do such a thing, knowing that a >
> surgical team
> > could make all the difference. we demand safety and
> accountability. > you may be glad
> > that you learned breech delivery today, but you should not be.
> >
> > vnellsch
>> > ----- Original Message ----- From: "Ina May Gaskin" >
> <inamaygaskin@gmail.com>
> > To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
> > Sent: Wednesday, March 05, 2008 1:14 PM
> > Subject: Still another GOOD DAY
> >
> >>
> >> Mine actually happened on the 3rd, the due date of 25 year old
> >> primip, whose mom was a client of mine for 2 of her kids. They
> >> asked for a late transfer to my care because of a persistent >>
> complete breech lie. External version by ob.gyn was tried but >>
> failed. I also tried and failed. Next, 2 of my ob.gyn consultants
> >> tried and failed. But they gave their blessings to a home birth
> >> for this young woman. So we did it. Her mom, BTW, is also an MD
> >> (FP who does ob and c- secs). Outcome: 8 hour labor, 8.5 lb.
> boy, >> intact perineum, Apgars 7 & 9 (1 and 5 min.). Call us
> lucky, >> irresponsible, etc., but we're all pretty euphoric still,
> and I'd >> do it again for a mom like this if she needed me to. It
> can be >> fun not to stitch. He wasn't even a tight squeeze after
> he got >> about 5 oz. meconium out. Mom said she wasn't impressed
> with >> pain, except for her back and it was! so satisfying when he
> came >> out. I'm so glad I learned to assist at these when it was
> still >> possible. I hope that it will someday be possible again.
> Baby >> latched 35 minutes later.
> >>
> >> Greetings to all,
> >>
> >> Ina May
> >
>
> Supercharge your AIM. Get the AIM toolbar for your browser.
