OB-GYN-L Messages for March, 2004: Re: choices

Re: choices

From: Charlie Chambers

cchamber@gorge.net

Fri Mar 19 10:43:19 2004

You have some valid points, but one correction is necessary. The "well-meaning" obstetricians, midwive, etc didn't put in the patient's ear that with every intervention a perfect baby would result. Our society as a whole has grown to expect this outcome. People don't want to know that sometimes bad things happen to good people. Babys, unfortunately, will die. People will get cancer. Car accidents will kill people. I think one of our failures as a society has been in our inability to grieve and deal with loss. This evolution didn't happen because obstetricians told patients that if you have many ultrasounds, blood test, external monitoring, rupture of membranes, you will have a perfect pregnancy. I frequently tell patients that during their young lives, there riskiest time for health is while they are pregnant.

On Mar 19, 2004, at 9:24 AM, Heidi wrote:

>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Elrod
>
>> My personal opinion is not that choices aren't a good thing, most
>> certainly
>> they are, its the issue of home birth that hits home, pardon the pun.
>> We
>> have a small hospital with 50 deliveries a month, with normal health
>> population. In the last 6 months we have had an infant death in
>> labor, a
>> postpartum hemorrhage requiring an ICU stay for 2 days, 2 postpartum
>> pulmonary emboli within hours to days of delivery and several of
>> the "thank
>> god I was close by" sort of decels. And this is a small facility!
>> Yes,
>> home deliveries are an option, so is driving without a seatbelt.
>> Neither of
>> which I would think are in the best interest of safety.
>
> How many of these complications were in women who had *not* received
> induction/augmentation drugs or narcotic/epidrual analgesia? In
> particular the pulmonary emboli were almost certainly complications
> following surgery, correct? If we look at anecdotes alone (rather than
> matched cohorts or prospective RCTs [which would be unethical, IMO])
> then surely I can even make seatbelts seem dangerous ;) There are
> plenty of 'case-studies' where a person is harmed due to having a
> seatbelt ON at the time of impact, when perhaps if they had been
> thrown free of the vehicle, they might have survived.
>
> We all agree that life is uncertain, and this includes childbirth.
> What we're not quite seeing eye-to-eye on (and we may never, but I'm
> very appreciative of the dialogue we've got going) is whether the
> risks involved actually warrant ALL births occuring in hospital.
>
> I believe the safest outcomes (and this is supported by research)
> result from the appropriate partnership between obstetricians and
> midwives with appropriate training in recognizing and treating
> complications and in knowing when to seek a second opinion. This is
> something that is possible, but not without respect for the role we
> each play in maternal/child health.
>
> Heidi Streufert
>
************************************************************************ ** Charlie Chambers

-- Hood River, OR USA cchamber@alumni. rice. edu

"I'm a goin fishin. Yeah, I'm goin fishin And my baby's goin fishin too!" Taj Mahal

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