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Re: Informed consentFrom: RModugno@aol.comWed Jun 7 10:52:51 2006
In a message dated 6/7/2006 11:37:47 A.M. Eastern Standard Time, heidi@nybble.net writes: Okay, I promise, I won't post another post for several more months, but I was so pleased to hear this answer Dr. Modugno. Now, may I ask you a question about whether your decrease in performing episiotomies has also been accompanied by other changes in order to decrease the chances of tearing? For example, encouraging delivery in left lateral, rather than in stirrups? Support with warm compresses, rather than aggressively stretching the perineum when the baby is crowning? Very few of the doctors in my area who have low rates of episiotomy seem to complement this with preventative measures to prevent serious tears during the delivery. The ones who do were very often trained in other countries and even with primips they seem to have very low rates of 2nd-3rd-4th degree lacs. You don't have to respond if you don't feel it's a valid question, but I am curious, since even in the midwifery community there is often a wide range of opinion on proper technique to prevent tearing. Respectfully submitted, Heidi S in MD I use the hands off the perineum approach until crowning when I use the Ritgen manuver. I am not aware of any data that says that perineal compresses, etc improve outcome. Unless there are problems with FHT's I try to leave the head stretching the perineum because there is no need to rush. Rarely use stirrups. Have occasionally used left lateral. Unfortunately I have been working in a hospital where the epidural rate is close on 100%. Moving next week to Western North Carolina to join a group of OB/GYNs and "radical" midwives - birth tubs, etc. Looking forward to this new experience as I was taught to "birth" babies by Nurse-midwives in South Africa as a medical student, probably before you were born, Heidi. Robert Modugno MD MBA FACOG Marietta, GA
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