OB-GYN-L Messages for March, 1999: Re: Trial of Labor?

Re: Trial of Labor?

From: Larry R. Glazerman, M.D.

glazerman@enter.net

Wed Mar 31 10:43:09 1999

what there is to lose is the trust of your patients when they realize that you aren't being totally honest with them. Sure, having babies is the finished product of thousands of years, etc., but over those thousands of years lots of women and babies died who wouldn't die with today's resources available to them.

I don't minimize the importance of the mind-body connection, but don't you think your population is somewhat self-selected. Are you suggesting that all of us who have section rates of 10-15% are doing that many unnecessary sections, and that you would have delivered those babies vaginally?

What do you tell the woman when the head has been stuck at 0 station for ____ hours (insert whatever number hyou like) in occiput transverse position despite adequate pushing? that she isn't trying hard enough? that her mind-body connection is disconnecter?

At 09:34 AM 3/31/99 -0600, you wrote: >>>>> My inclination is to perform clinical pelvimetry at
>> >term, offer a trial of labor if appropriate; if there is arrest of
>> >dilation or descent with good contractions then go to c/section.
>> >
>> >Any comments?
>> >
>> >--
>> >Yvonne Fried, M.D., FACOG
>
>In 20 years I have NEVER told a woman her pelvis was too small, no
>matter how small it seemed.......and in twenty years my c/s rate has
>remained approx. 2% (out of over 1400 deliveries), and my VBAC
>success rate is 100%.
>
>In no uncertain terms I tell all my patients that they have huge,
>roomy, pelvises and that a baby of any size would fit easily. I tell
>them that women without underlying medical conditions such as
>diabetes, grow babies that are just the right size for their bodies
>to deliver. I reaffirm with them at every appointment that birth is
>a normal function of the human female body and that she is the
>finished product of thousands of years of women having babies
>successfully. I make comments all the time about how well the baby's
>head fits so comfortably in her pelvis. I remind them that the
>reason they are waddling around is because their pelvis is getting
>looser and wider and softer for that baby to come through.
>
>On the wall in my prenatal rooms I have a dilation chart and I point
>out the 10cm circle on occasion to remind them just how open they are
>going to get during labor.
>
>The mind/body connection is very strong, and I find women
>believe and take very seriously what they have been told about their
>bodies.......this is the basis of most eating disorders.
>
>Maybe all this seems silly to many of you, but it seems to work, and
>it costs nothing, damages no one and makes women feel good about
>themselves. What is there to lose?
>
>Margie Dacko, CM
>Nevada
>

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