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Re: Gyn: rapid orgasmFrom: Ana (aocana58@yahoo.com)Tue Jun 28 16:03:43 2005
Ask to your patient not to estimulate this area in first place only ten to 15 minutes after. Try to focus the sexual estimulation on other parts of the body first of all. Ana Ocana, MD Sexual educator Mexico --- "D. Ashley Hill" <dahmd@cfl.rr.com> wrote:
> Listmembers: I have a 40ish multigravida patient who
Rekindle the Rivalries. Sign up for Fantasy Football
>From Stmidwife@aol.com Tue Jun 28 22:31:14 2005 I was given permission by Dr. Helen Sandland to post her response, which was originally posted on a blog sight to the recent circulated newspaper article. The original article is below her response, I know it was posted on this list. Thought you might be interested. Sue Just for clarification--my babies were most likely to be born at 39 weeks--none were born "post-mature", there was no increase in macrosomia or diabetes. I have had NO permanent brachial plexus injuries--a couple of transient ones that healed completely--over 17 years. I get one or 2 more clavicle fractures a year but they are not deemed significant unless there is a brachial plexus injury and there wasn't in these. I was well within published norms for clavicle fracture but the reason I feel I had one or tow more a year than thte other OB's is that I as doing 3 times the average percentage vaginal births. That is the only issue--there is no increase in REAL problems--actually less since I didn't have to deal with post -op complications!! I have had no brain damaged babies and hope to keep it that way! It is the position of WHO and MArch of Dimes that low birth weigth and prematurity are the biggest problem faced by newborns--they have allocated over 7 million dollars this year to study the problem. I was very proud of my low prematurity rate --never thinking for a nano sceond that I would be cited because my babies were more likely to be TERM (not post term) and heavier(NOT MACROSOMIC) Oh well--life is forever a mystery---but I will continue to do my thing in Mississippi. It was very important that I send my children a clear message on this---how could I cut women open just so they could keep kayaking on the Cape Fear River??? My soul is very much at peace with my decision to leave--I would have lost all my self-respect and sleep had I caved. Posted by: _Helen Sandland_ (mailto:drsandland@yahoo.com) Original article Dr. Sandland – known for the past decade as the doctor local women went to if they desired natural, vaginal deliveries – moved to Mississippi last week after being told by New Hanover Regional Medical Center administrators to do more c-sections. She refused. “I leave NHRMC with my morals and backbone absolutely uncorrupted,†Dr. Sandland wrote in her resignation letter dated May 15. “I am going to practice with a long-time friend, whose scruples I admire, and in a place where unnecessary surgery is not encouraged.†During a time when national health officials have sounded the alarm that the cesarean section rate is at an all-time high and needs to be sliced, Dr. Sandland’s case raises questions about what factors are pushing the numbers higher. The rate doubled in five years and continued to increase until 1990, when it peaked at 22.7 percent. It held steady and slightly declined through the 1990s before picking up again in 1998. The rate now sits at 26.1 percent of 4,021,726 births nationally. North Carolina’s rate is 26.4 percent. “I don’t see any end in sight right now,†said Dr. Bruce Flamm, regional chairman of The American College of Obstetricians and Gynecologists, saying there’s little concrete data on how many c-sections are unnecessary. “All of the current pressures seem to be going in the direction of more c-sections, not less.†He and other national medical experts are concerned with the trend; a trend they believe is pushed by medical liability issues, convenience for both doctors and patients, and perhaps hospitals’ financial and staffing pressures. “There are some doctors who say the only cesarean section I have ever been sued for is the one I didn’t do,†Dr. Flamm said. “It’s a sad but true situation.†Not only is there a decreased chance of getting sued if a c-section is performed, but it’s less time consuming to perform c-sections instead of waiting out long and sometimes difficult labor. But, as many obstetricians will point out, pressure by doctors or hospitals is only part of the equation. Some women, they say, really are looking for a c-section because they fear the pains of labor or want to schedule it when grandparents are in town or around holidays. Regardless of the reason, health officials across the country are concerned with the rates. Leading medical groups such as the Centers for Disease Control and Prevention, National Institutes of Health and the World Health Organization have all spoken out against the increase, demanding the medical community investigate ways to lower the rate to 15 percent or below. Dr. Sandland thought she was doing just that. In the decade she has delivered babies and cared for their mothers in New Hanover County, she has always had a rate below 10 percent. “I’ve always maintained I’m a midwife with a MD behind my name,†she said from her two-story Pine Valley home last week while preparing to move. “It’s better for Mother Nature to decide when it’s time, not the doctor. My philosophy is you don’t interfere unless you really have to.†Her philosophy, admittedly different from the mainstream, attracted many patients who wanted the best chance of having a vaginal delivery. Dr. Sandland became known as one of the few doctors in the area who would try to deliver breech babies naturally or pursue a vaginal birth with a woman who already had one child with a c-section. Her solo practice boomed. If her lack of medical malpractice lawsuits and gratitude of patients are of any account, she was not only popular, but also successful. Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was considered too set in her ways or a renegade by some doctors, he admired her talents to deliver naturally in situations when other doctors would have automatically pushed for a c-section. “She was a valuable asset for patients,†he said. Dr. Sandland said she became the target of the hospital’s professional review and credentials committees. Because it is confidential by law, she could not legally discuss the peer review process. But the Star-News viewed two letters addressed to her from committee members. Written on New Hanover Regional letterhead dated July 6 and July 7, 2004, the letters discuss the conversation committee members had with her. The first letter, written by Dr. Cobern Peterson, chairman of the Professional Review Committee, stated “concerns†regarding her practice. They include higher than average infant birth weights, much lower than average c-section rates and later than average gestational age of neonates at delivery. The letter states “the main concern reiterated several times was an overall practice attitude rather than any individual case.†The next letter, written by Dr. Janelle Rhyne, acting chairman of the Credentials Committee, states Dr. Sandland’s privileges at the hospital would be reappointed for a period of six months but monitoring would continue. It reads, “Your c-section rate is to be within an acceptable range as determined by the NHRMC OB/GYN Department with a plus or minus deviation of two.†No reason was given in the letters, other than adding the committee would be watching other outcomes like collarbone fracture – something experts say is a minor, common complication of vaginal deliveries. New Hanover Regional spokeswoman Kendra Gerlach said two standard deviations equates to five or six percentage points above or below the average. The c-section rate at New Hanover Regional is 27.9 percent. At the time, Dr. Sandland said, it was about 26 percent. That meant the committee was requiring her to reach at least a 20 percent c-section rate. To do so, she’d have to more than double her current rate. “It’s just not something I could see happening,†she said. “You just don’t change your practices overnight. I certainly wasn’t going to change them to meet some arbitrary quota.†Jack Barto, chief executive officer of New Hanover Regional, said he was not familiar with the letters but that it sounded to him more like a “guideline†than a “quota.†But Dr. Sandland said that in a March conversation with Mr. Barto, part of the reason became clear. “Barto said in a separate meeting that a c-section rate of 25 percent would reduce the likelihood of getting sued,†she recalled. Mr. Barto confirms he had a meeting with Dr. Sandland but would not discuss the conversation. “I had a private conversation with one of my physicians,†he said, asserting he did not recall discussing liability issues. “I talked with her about a variety of topics.†The hospital’s chairman of the OB/GYN department, Dr. Bora Duruman, declined to comment on Dr. Sandland but said doctors are not pressured to do c-sections nor do they pressure patients toward c-sections unless the procedure is medically necessary.
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