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Re: Still another GOOD DAY [longFrom: allanho@aol.comFri Mar 7 19:42:57 2008
Ina May, Thank you for sharing your insight into the Amish psyche. I think you are in a very unique and privileged position to able to practice the way you feel fit. You get to live in the US and practice in a very selective & non-litigious segment of our population that embraces you. And no Amish HMO's to deal with! I don't think you should put down the rest of us though. It's not fair to judge the ob world based on your Safe Motherhood Quilt. Women die and suffer from child birth everyday in other parts of the world where c/s are not their options (or where only midwives are available). I don't know how many of your clients are smokers, drug users, alcohol drinkers, over-eaters, morbidly obese, sedantary, poorly nourished and non-compliant. I don't think you can apply your practice to the rest of the world. Unlike the Amish, as long as women have their freedom to choose, most of them will take the risks for their babies. That's maternal instinct. It's prabably biologically ingrained.  I don't think most women in this country choose to have c/s for selfish reasons, they are motivated to protect their precious ones. I feel the fear mongul strategy to decrease c/s rate is a bit distasteful. 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: Fri, 7 Mar 2008 11:43 am Subject: Re: Still another GOOD DAY [long] Think of the Old Order Amish community that we have served for more than 30 years. Population: around 2,000. Their religion doesn't permit them to accept Medicaid or any means-tested financial aid and doesn't permit the use of birth control. They don't have cars, and there is no public transportation system—no taxi service, no bus. Horse and buggy travel is no more rapid that it was 50 years ago, and some multips tend to have quick labors. We can get to them in our cars, but we're their only choice. Average number of pregnancies per woman is 13-15. The last 4 breeches before the one I mentioned were for Amish women. Dr. J. O. Williams, Jr., had provided maternity care to this community for 16 years before I met him, and it was this experience that convinced him that home birth could be safer than he had been taught in medical school. He tried to take the first breech presentation he encountered to hospital, but the baby's two grandmothers got on either side of him and said, "Our doctor back in Ontario attended breech births at home, and you're as good as he is." After he retired and handed over that part of his practice to us midwives, no other physician stepped in to fill his place. If one had, we would have stood aside. The Amish women don't make the birth control rules. The bishops do, and only men can be chosen to be bishops. (Tubal ligation can be done if we or an MD intervenes to say that another pregnancy could be fatal to the woman. But this argument would not be accepted when a family has had only 4 or 5 babies.) The Amish never sue, and their philosophy is that they actually place a higher value on preserving the life of the mother than on preserving the life of every baby (although they love their babies very much). One possible reason for this: if a mother of 14 children dies, that's a lot of motherless children. The Safe Motherhood Quilt already has several blocks for women who died from diagnosed placenta previa after 3 or 4 prior c-secs. I also had a good friend who died from abdominal adhesions after only 2 c-secs and no other abdominal surgeries. Another block on the quilt is for a California nurse, who had 2 surgeries after a bowel nick during a c-sec for her first pregnancy. She died 9 months after the c-sec from bowel obstruction—not soon enough for her death to be counted as a maternal death by the National Center for Health Statistics. If c-secs didn't also carry these and other possible consequences for women and their babies (I've remember a phone call from a dad who were furious at the long scalpel laceration on the torso of his c-sec delivered baby), I could perhaps agree that vaginal birth was a titillating luxury that only a selfish woman would choose. About 10% of our breeches have been c-secs, brought in early enough that the surgeon didn't have a messy situation with which to contend. The official US maternal mortality ratio for 2005 was 15.1/100,000 live births, up 2 deaths per 100,000 from the previous year, and nearly twice what it was in 1982. Given these facts, it's prudent to be cautious about mother's lives as well as babies. HHS says we should be at no more than 3.3 deaths per 100,000, so we're way too high, leaving out the underreporting factor, which is significant. Neonatal mortality is rising as well. We don't have enough home births (less than 1%) to explain these upward trends.  A good weekend to all. Ina May On 6 Mar 2008, at 18:51, allanho@aol.com wrote: Again, we have to consider the women whose religious beliefs include having large families. What are they supposed to do if their first or second baby is a breech? ...  Anna Meenan, MD Sounds like those women who wants to have large family are willing to sacrifice the safety of the breech in order to have more babies more safely in the future. I guess that's a parent's perogative, albeit sad. Allan Supercharge your AIM. Get the AIM toolbar for your browser. =
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