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Friday
May272011

"So, what do you really think of the blog?"

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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.

 


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Reader Comments (23)

And I, in turn, am less jaded.

May 27, 2011 | Registered CommenterJill

I wish more doctors read this blog.

May 27, 2011 | Unregistered CommenterBecka

Me too Becka

May 27, 2011 | Unregistered CommenterNaomi

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)

May 27, 2011 | Unregistered CommenterSelena

Great post- good to hear from the "other side"

May 27, 2011 | Unregistered CommenterLorene

Evidence based practice can change everything. Informed Doctors, informed Midwives & informed Women. It starts somewhere..... Here is good. Thanks <3

May 27, 2011 | Unregistered CommenterDina

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.

May 27, 2011 | Unregistered CommenterMy OB said WHAT?!?

Great post! Wish we had more of a meeting ground like this more often with the obstetrician population.

May 28, 2011 | Unregistered CommenterDiana

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.

May 28, 2011 | Unregistered Commentercrystal_b

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.

May 28, 2011 | Unregistered CommenterLeigh Anne
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