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Re: ob profession (was postpartum intercourse) From: Robert J. Woolley (wooll005@gold.tc.umn.edu) Sat Jun 28 23:21:45 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Harrison Sheld: "Re: ob profession (was postpartum intercourse)" Previous message: Robert J. Woolley: "Re: birth plans" Maybe in reply to: David Hunter: "ob profession (was postpartum intercourse)" Next in thread: Harrison Sheld: "Re: ob profession (was postpartum intercourse)" In message <33B5DAE8.3F89@ctrvax.vanderbilt.edu> writes: > Robert J. Woolley wrote: > > > >" Operative deliveries are not a valid indication for episiotomy." > > > >I knew that...just tried to give some slack to those who would argue that > midwives low epis rate is attributable to this difference... thanks for you > great info on this! > > Deborah Actually, we already know that the difference in epis rate is not due to differences in the patient population: Chambliss et al prospectively randomized patients to management by either the obstetric residentsÕ service or the midwivesÕ service within the same California hospital [22]. The participants continued their usual care without restriction. The primary intent of the study was to determine whether the previously observed discrepancy in cesarean section use between the two services was due to differences in case mix or differences in management styles; perineal damage was a secondary outcome variable. Presented with an essentially identical patient population, the midwives had a significantly lower rate of episiotomy (10.8%) than the residents (35.4%). When an episiotomy (mediolateral versus midline not reported) was performed, the midwives also had a lower likelihood of rectal extension (8% versus 22%), indicating a difference between the practitioners in the nature of the incision, other related management variables (such as the observed variance in operative vaginal deliveries), or both. Unfortunately, the authors did not clearly say whether any severe spontaneous lacerations occurred, so the overall rate of sphincter damage cannot be compared. They did, however, conclude that Òour study suggests that episiotomy may be associated with more perineal trauma.Ó BTW, the midwives accomplished this better outcome (more intact perinea) with shorter first stages and shorter second stages, too. --------------------------------------------------------------------------- --------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota "Words never fail. We hear them, we read them; they enter into our mind and become part of us as long as we shall live. Who speaks reason to his fellow men bestows it upon them. Who mouths inanity disorders thought for all who listen. There must be some minimum allowable dose of inanity beyond which the mind cannot remain reasonable. Irrationality, like buried chemical waste, sooner or later must seep into the tissues of thought." -- Richard Mitchell in *Less Than Words Can Say* Next message: Harrison Sheld: "Re: ob profession (was postpartum intercourse)" Previous message: Robert J. Woolley: "Re: birth plans" Maybe in reply to: David Hunter: "ob profession (was postpartum intercourse)" Next in thread: Harrison Sheld: "Re: ob profession (was postpartum intercourse)"

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