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Re: pelvimetryFrom: CheriCNM@aol.comSat Oct 19 19:34:35 1996
In a message dated 96-10-19 19:01:00 EDT, mcrice@gil.com.au (Michael Rice) writes: << But what do you do if your patient is of the "I want to be told everything" frame of mind? Can it be intellectually honest to give patients only the good news; or is this part of the "art"? Are we practising some sort of quackery when we choose only the good bits to tell patients, or is it justifiably good science? Then gain, if you don't accept clinical pelvimetry as being of use in predicting poor outcome, is it any more valid to accept it as being a predictor of good outcome? >> This is a very good question. I guess I would never feel comfortable telling a woman her pelvis felt smaller than average because my clinical experience has not led me to believe that this has any measurable effect on outcome. As Malcolm says, the only accurate caliper for the functional pelvis is a fetal head in labor. As others on the list have pointed out from their own experiences, I've seen women deliver quite large babies through pelvises which didn't feel overly generous to me. On the other hand, I have yet to experience the converse to be true. When my clinical perception of the pelvis has been that it is of generous size I have never seen an average or above average sized baby fail to fit. Only the occasional truly giant kid has not made it through. So I don't feel that I'm being intellectually dishonest in this case, only selective about what information I feel like volunteering. When asked directly for this information by a woman whose pelvis did not feel especially large by clinical pelvimetry, I tell them that there is no true predictive value in assessing the pelvis ahead of time and that women were made to have babies. I emphasize the importance of upright postures in labor and using various positions to help the baby move through the pelvis. I believe that the language we use to describe things is critically important to the way we are heard and to the message which is actually received by the listener. I see no harm in giving factual information in the most positive possible framework, and indeed I see a great deal of good in doing it this way. I believe this truly is the "art" of what we do, and definitely do not consider it to be "quackery." Cheri Van Hoover, CNM Kaiser Hospital Redwood City, CA
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