Re: Brachial Plexus/Erb's Palsy
From: SONNENSTUHL PAT (webmidwife1@home.com)
Mon Oct 18 18:46:29 1999
Way to go!
I wish more practitioners would really work with their obese clients and
help them eat in more healthy ways. It's not enough to just give them a
diet. I know it is time consuming, but essential. This discussion
certainty supports engaging the client in their own care. Is Obesity an
easily bill able service in Canada, like: nutritional counseling etc,
etc?
Pat Sonnenstuhl, ARNP, CNM
"Kathi Wilson, BHSc, RM" wrote:
>
> At Mon, 18 Oct 1999, DoctorJoe@aol.com wrote:
> >
>
> >The poor mom who posted that webpage about shoulder dystocia admits to being
> >morbidly obese and therefore at risk for numerous things. It's interesting
> >(and I'm saying this in general, not about her specifically) that many
> >problems we doctors (and midwives) get blasted for are ultimately the
> >PATIENT'S own doing. We end up playing catch up, being behind the 8-ball,
> >fighting against a handicap, etc, etc.
> >
> >On the other hand, if someone comes in and gives you the 3rd degree about
> >shoulder dystocia and risk factors and Erb's palsy, simply schedule their
> >elective c/s at 39-40 weeks and go about your business.
>
> Which is sad, in't it? Not evidence-based, puts the woman at increased
> risk, but covers the practitioner's butt (for which I do not place
> blame, BTW). And it negates the opportunity for some health education
> which might alter the situation.
>
> These pages all focus on the practitioner, but don't address the issue
> of what the *woman* should do to aid in prevention. (Nor do they
> discuss in any detail the literature that demonstrates that some
> brachial plexus injuries are unrelated to birth or shoulder dystocia.) I
> must say that we counsel *all* our women to eat in much the same manner
> that gestational diabetics are counselled to eat, but right from the
> get-go (i.e. several small meals a day, complex CHO over simple sugars,
> etc). AND, I go into a *big* rant about staying away from fruit juices,
> and excess fruit in general. You'd be surprised how many woman get real
> quiet when I talk about this, and admit that they're drinking a litre or
> more of fruit juice a day (in the belief that it's good for them).
> Water, I tell 'em. Stick to water (and some low-fat milk, if they can
> tolerate it).
>
> Had a woman couple of years ago, who, when I booked her into care, told
> me her last birth "they'd" tried to break the baby's clavicles to get
> the 10 pound kid out. "Oh?" said I (the sweat running between my
> shoulder blades). "Tell me about your diet". "Oh, I eat *very*
> healthily" said the woman proudly "I have 6 different kinds of fruit for
> breakfast" (not to mention what she ate the rest of the day). Well, in
> short, I got her to clean up her act *big time*. This baby was 1/2
> pound smaller, but more importantly, was long and proportional, actually
> had a neck and slender shoulders. Slid out like a bar of soap. The
> woman, interestingly enough, said she felt much better during this
> pregnancy, too.
>
> --
> Kathi Wilson BHSc RM
> Thames Valley Midwives
> London, Ontario, Canada
> http://tvm.on.ca
> mailto:wilsonk@gtn.net
|
|
