Re: Ob: staples at C/S
From: Kim E. Goldman (goldman@calweb.com)
Sat Jul 29 12:18:50 2006
FWIW,
Neurosurgeons almost always staple their craniotomy skin incisions. I
almost always suture mine. Why? Because it feels nicer to the
patient. It is NOT as quick but if you are the one walking around
with it, it feels a whole lot better.
Maybe that is why patients and/or midwives are requesting sutures
rather than staples?
Just a thought.
Kim
On Jul 29, 2006, at 11:55 AM, DoctorJoe@aol.com wrote:
>
> In a message dated 7/29/06 10:11:03 AM, garrys@mindspring.com writes:
>
>> Over the last 3 years since being in a collaborative practice,
>> many of
>> our CNM patients who seem to be a bit more "natural" (maybe many
>> of them
>> have taken Bradley classes) are insistent to a fault about having
>> subcuticular sutures, not staples, for their unplanned C/S closure.
>> Honestly, it is almost as predictable as the sun rising in the east!
>> When I tell them that I prefer staples, and haven't sutured skin in
>> years (and thus am a bit out of practice), well, many seem taken
>> aback.
>>
>> I have found that I don't want to tell the
>> mechanic/gardener/plumber/electrician etc. how to do his job, yet
>> this
>> seems the opposite to me.
>>
>> What's up with that?
>
> Well, in parsing your post, the first thing I'd think is - what are
> the CNMs TELLING their patients about staples versus subcuticular
> stitches? Sounds like educational variation to me. You can always
> "brainwash" a patient given enough time. Is that what's going on?
>
> As for me, I always liked staples better. They give IMHO a
> straighter scar. They come out, hence, do not tend to stay in situ
> and cause (in some cases) more inflammation and sometimes a thicker
> scar. And I always took them out and places steristrips on Day 2 or
> 3, and I did it myself. So that meant I actually TOUCHED the
> patient and rubbed on her belly, so to speak. I think that
> 'bonding' is worth more than the actual technical question itself.
> And oohing and ahhing over how nice the incision looks is a
> positive thing, esp. in a patient with an unplanned C/S (i.e. in a
> patient who has "failed" in her birthing plan).
>
> And no, you wouldn't argue with a "professional" about his job,
> e.g. the plumber or electrician. You WOULD argue with the waiter
> about the way your food was prepared. So does that make you feel
> like more of a "server" than a "professional?" It should.
>
> And therein lies one of the major problems with medicine today.
> Patient and doctor? No. Server and consumer? Yep. We've gone beyond
> the intermediary stage of "client."
>
> Joe P.
>
