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Re: 1.Lactation 2.Obesity From: J. Bulley (jbulley@cheshire.net) Sun Jul 27 12:09:45 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bruce Speyer: "note to AOL users" Previous message: Margie Dacko: "Re: More On Felonious Penalties for Medical Malpractice" First Bernard Cristalli writes: >In our small private institution (1200 deliv./year) we have no lactation >consultant at all. The midwives deal with it. And for the african >mothers (arabians & blacks) they know what to do without any advice, >their mother tell them. "Our" blacks from the antilles are too civilized >to know and we have to show them. > We didn't yet have a midwifery service (it's coming into being currently) and the lactation program "birthed" itself. Yes - some women just listen to their bodies and do it without needing any instruction. There seem to be lots here in the US who just don't have that capability and this service really helps keep the breast feeding going. Veterinarians and farm folks are often quite fun in their comments and comparisions of how different species do the birth process - I had a vet once say "Gee - if the cats can do it without any instruction, I sure ought to be able to...!" Second I agree - the obese patient's incision (if you must go abdominal) should be decided in the OR after the anesthtic and before the skin prep. I've gone pfannenstiel, true transverse/Maylard(George Morley's Michigan Smile) and vertical staying out from under the pannus. Yes drains by all means. Bookwalter retractor is great. I've seen a few (back in residency -81-85) put large caliber suture through the abdominal wall at the incision, put those in kelly clamps and hand that over the anesthesia screen to the anesthetist to clamp to the OR table! We had one surgeon suture wet sterile towels to the fascia and peritoneum to keep the edges moist as well as hold the fat out of the way. So many options. I like the idea of adding the modifier code and putting explicit descriptions in the op note. Joanne B, Keene, NH Next message: Bruce Speyer: "note to AOL users" Previous message: Margie Dacko: "Re: More On Felonious Penalties for Medical Malpractice"

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