"So, what do you really think of the blog?"
Friday, May 27, 2011 at 2:19PM
An OB-GYN responded to my question, “So, what do you really think of the blog?” with a guest post.
I began reading this blog about two years ago just out of curiosity. I found The Unnecesarean quite by accident as I was randomly searching medical blogs for entertainment value. Initially I wanted to jump in on every post and add some “corrective” comment but, as an obstetrician, I realized quickly that my field was the subject of attack and I might not be welcome. With fascination, I have watched this blog serve as a hub, a clearinghouse so to speak, of information for not just women/mothers but of generalized patient empowerment. This space also serves as venue to vent and have one’s disenchantment with the traditional medical establishment heard. Though I have stayed for the most part on the sidelines, I have heard, I have listened, I have learned and I have evolved into what I hope constitutes a better practitioner. Initially a lot of my replies would have stopped at two words “bite me”. And I might have continued with “Amy is right”. Now they should start with “okay, why?” and end with “Amy, Emjaybee, take a breath.”
I posted my VBAC permit online, then printed and incorporated everything that I could from your suggestions. I did not consider this to be altruistic—I thought it was a cheap way of not missing any high points. Instead I found a resource, though a hostile one at times, but a resource nonetheless, that I have been able to tap and redouble my efforts in offering this, for the most part, viable option. My “payment” received was to have one local hospital pass a no-VBAC-allowed rule and one group I work with drop me from their call rotation. I have remained neutral in my option of VBAC versus repeat cesarean lecture, but I am armed with more information and Monday four patients came to my practice strictly for this reason, all of which desired to continue on this path after my lecture and mandatory (and obviously slanted against) permit.
I am not a researcher. I am the opposite of an academician. I am in a small but busy practice and am not a writer or scholar. I am a board certified and recertified practicing MD who does not take or have the time to theorize about trends. I work in the concrete world. I follow the graphs that our moderator seems to create with a ruthless efficiency. I have used these observations to treat patients more as partners when discussing options. I am more tolerant of questions and more descriptive with my answers. But like discussing childbirth in general, you have to choose your time carefully. Discussing mode of delivery, positions, episiotomy, epidural, etc. is necessary but not necessarily at the first visit. I realized a significant amount of this by reading shunts such as “My OB Said What?!” A respectful, productive relationship between provider and patient takes time to cultivate in both directions. And, as an aside, always remember just as there are two sides to every legal argument, it is possible to take a quote out of context and make it sound horrid.
I am not allowed to work with midwives for deliveries but I see a number of ladies that are planning a home delivery. I know there is a general trend with this group and while I found the White Ladies post amusing, it was one of the few times when I agreed with Amy. I have pushed harder for wanting it all since I started reading here. I crave the midwife laborist in the low acuity center with cesarean capabilities contiguous with the largest tertiary center I can find. I enjoy my delivery assists but I can defer and act as a consultant in a heartbeat if that would provide the better care. Unfortunately, we do not have this system here and for a multitude of reasons home delivery rates are increasing and I simply cannot agree. I am just too allopathic in nature to do so. I became frustrated once at a high risk patient who was attempting a first VBAC at home and suggested that she substitute “breast cancer” for “home birth” and let me know how it came out. I would never do that now. I may still disagree with her but I know better why she is so determined to escape the institution that resulted in her first “suprapubic episiotomy.”
I can pick and choose from the myriad of topics that have crossed these pages but in interest of brevity, I will say that as I have learned over the last two plus decades of practice and now the last two plus years of following this “hub” that there exists a very unfortunate “us against them” attitude in the medical profession. Sometimes I am unsure where I stand and try not to offend with my words both in practice and in the ethereal world of the net. It is hard to achieve a balance. I desire to inform that a provider can refuse care to anyone in a non-acute setting, defend them for doing so and still not enrage the readers that feel this is inappropriate. I work in one of the most obese states with a high teen pregnancy rate, overwhelming diabetes, and hypertension. Here exists one of the highest percentage welfare populations and, by extension, impoverished populations in this country. I have sixteen-year-old patients delivering their third child and declining contraception. What sounds like a great idea in this internet setting of concerned and enlightened readers/writers does not always transition well to my world of babies as “sex trophies” with little to no family support of the new child. I fight a daily battle to strike this balance of counseling and consulting, natural birth or epidural, VBAC or cesarean, home delivery or hospital. That and trying not to explode at the teenager that demands a thirty-six week induction so she can fit in her prom dress.
I read the discussions. I use the information. I occasionally wade in. I usually get my rear handed to me by someone with an IQ. Hopefully I am a better practitioner because of this blog and the leads it has provided. I believe I may have helped occasionally if for no other reason than to say I am Them and I am not against you. If I have blunted even a few sharp jabs by the moderator or the commenters then I have not wasted my efforts. There are times when I will disagree with you the readers and my patients but we should be able to reach a mature, evidenced-based decision that has nothing to do with a prom.
Thank you.
Reader Comments (23)
And I, in turn, am less jaded.
I wish more doctors read this blog.
Me too Becka
Wow, that is one cool doc and you are lucky to call this person a friend.
(We already know you rock and are an amazing resource)
Great post- good to hear from the "other side"
Evidence based practice can change everything. Informed Doctors, informed Midwives & informed Women. It starts somewhere..... Here is good. Thanks <3
You sound like a grounded, down to earth person who meets your patients where they are at, and works to better the environment and options available. The world needs a few more OBs like this! Please consider joining in the discussion when you have time at My OB said WHAT?!? you will find that you would be well received and the commenters would welcome respectful discussion. No one is 100 percent right, and cooperation and collaboration solve many a problem.
Great post! Wish we had more of a meeting ground like this more often with the obstetrician population.
I really enjoyed this post, and I agree and lament the "us vs. them" attitude, but it's hard sometimes not to think that way. I feel very much on the defensive about any future pregnancy and conflicted about my iatrogenic primary cesarean, but I have family members who are physicians who I know would be very upset if I chose to have a homebirth.
I like reading another perspective. It helps thiose of us in the non-ob world understand a little more of the constraints and headaches that you encounter.
I just really appreciate that it's not the "choir" all in the circle talking to ourselves. It's good to have consumers, midwives, OBs, and, yes, even Dr. Amy here. Otherwise there will never be improvement.
I appreciate what is written here. All the factors you mentioned on the home page about a woman being told that she has a small pelvis, a baby that is too big and that the mother may have a hard time delivering the shoulders at birth were all told to my sister.
Her whole pregnancy was healthy with no complications. Why all of a sudden was my thought, were they telling her she has a small pelvis. She was told she had to induce her baby even though she was only 40 weeks and possibly earlier. So she listened to the doctor and got induced and got an epidural and then her baby became distressed and pooped in the womb before birth. So of course she had to have a cesarean. She wanted to have a natural birth but the doctor used scare tactics that are obviously used by everyone.
I am so sad for her that she could not experience a vaginal birth. I think this doctor should be ashamed of himself!!! I had two babies at home and they were both relatively easy births.
I think it is so sad that so many women believe a doctor over themselves. Does everyone want to be delivered like the movie, "Alien?" Or do we want to do something that has been happening for thousands of years. Amazing we have survived this long if Cesarean was the way to go.
http://www.huffingtonpost.com/2011/05/26/malpractice-record_n_867439.html
just sayin,
You don't post an explanation of what you think the article means to this blog post or discussion so I'm just guessing that you posted this link in response to Concerned sister's story. What do you think that the correlation is between her story and the article you posted? That doctor's are justified in abusing their patients because they believe that it is less likely to get them sued? How is coercing as many patients as possible into cesareans going to prevent cases like this when "the jury's decision was made more out of sympathy than hard evidence"? Does this mean that doctors should be making medical decisions out of fear and disdain for their patients as opposed to using evidence and research because that's how a jury is going to do it?
---
I want to say thanks to ALL the doctors who participate on this blog, too. As ANaturalAdvocate pointed out, it takes all kinds to have a discussion. I will add that it is also personally healing to see doctors who think VBAC, and even more so their patients are important.
I feel like this poster's experiences and mine are similar, but in reverse. I came to this blog with the utmost confidence that I was absolutely right. I was being bullied, snarked, threatened and brow-beaten into having another CS. I felt like my options were limited, I couldnt homebirth in my state, couldnt seem to find a VBAC friendly doc, and I was so scared. I found many women here who echoed my thoughts, gave me resources and gave me hope. I found an OB who was willing to work with me, I hired a doula, and I had my hospital VBAC after laboring at home for almost 24 hours. I thought I had won, and I was elated.
Time has passed, and my daughter became my sole focus in life. I followed this blog sporadically, read very few comments, but still felt connected here and so I kept coming back. I dont think it was until the series about defensive medicine that I started to see the "other side". I questioned what I believed, I questioned my reactions to the things that were said during my pregnancy, and I questioned my own confidence in every belief I had about birth. I realized that I had been demonizing so many of the OB's I came into contact with, and I saw how the confidence I had in my own ability to make decisions was compromised by my inability to see the good in "them". Over time my opinions have evolved, sometimes unexpectedly, and I even find Dr Amy more tolerable now. I am still so proud that I was able to get my VBAC, and even more happy that my daughter is healthy, content and whole. I am more glad than ever that I found this blog, now that I realize how rare it can be to find a place where all of us are welcome, where I can just as easily talk to a doula or an OB, and where our opinions can be shared and hopefully taken in by everyone. Thanks Jill
I find this really interesting, because I live in a country where VBAC is the norm. Women who DON'T want to VBAC in most cases have to find a CS friendly doctor.... Midwifery care is the norm, and midwives care for women both in and out of hospital in a continuity of care system. The OB's I work with like that they can focus their skills on complicated cases, rather than on every normal woman who comes though the doors. We still have a rising CS rate, so there is still something "else" going on. But, hearing a doc say he/she is not convinced that VBAC is a safe option and knowing there are hospitals that won't do them, is very unusual from my perspective. I rarely comment here, because my context is so different. I work as a midwife with a successful VBAC rate of about 90%, though of course I have far fewer clients who are VBACing than those that are having normal uncomplicatred first or subsequent births. I have never been involved in a uterine rupture related to previous caesar, only one related to the use of prostin. I don't understand why doc's in the US are so happy to induce (given the rate of complications with that are as high if not higher than the rate of complications in VBAC) but so scared of VBAC. These comments have helped me understand, but I still wonder where the recognition of international research is, and why doc's in the US are so resistant to the proven improved outcomes from continuity of care by a known midwife, working in partnership with OB's.
LilRedMommy,
Well, that was a tear jerker. I remember when you were pregnant, felt honored when you checked back in after giving birth, appreciate your participation in the defensive medicine series and always smile when I see your name in the comments. You are very welcome but I should be thanking you for being here. Thanks.
Jill
Miss Tick wrote: "I rarely comment here, because my context is so different."
I hope you will continue to comment because your context is so different.
I agree with Jill, Miss Tick (and everyone who brings a unique or even mundane perspective).
Man, I am all kumbaya up in here.
Piper--
no, I didn't post the link as a response to Concerned Sister but as a response to the original "So what do you think of the blog?" guest posting. Because there are now 58 million more reasons to lose OBGYN services in Connecticut. I don't know where the original guest poster lives, or works; but I'd be surprised if he or she doesn't gut-check about cases like this. And that just has to drive practice. You can't just say the defendant physician screwed up (not knowing the details of the case, but what little appears in the lay press doesn't strike me as out of line) so he gets what's coming to him... and yes, OBGYNs do make decisions out of fear, including fear of patients and fear of juries. It isn't possible to practice based on evidence and research alone. I wish it were. But it's a hostile world out there.