tag:blogger.com,1999:blog-17754833.post5522285565792995637..comments2023-04-24T09:38:11.881-05:00Comments on Why am I still here?: The Way We Give Birth, Part ITiny Shrinkhttp://www.blogger.com/profile/14584375132138526435noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-17754833.post-523246667592611622007-04-22T20:50:00.000-05:002007-04-22T20:50:00.000-05:00Fascinating - both your post and the comments.Fascinating - both your post and the comments.Magpiehttps://www.blogger.com/profile/15460136246441367993noreply@blogger.comtag:blogger.com,1999:blog-17754833.post-50939864818008015132007-04-15T10:42:00.000-05:002007-04-15T10:42:00.000-05:00As a resident, you are also at the mercy of your a...As a resident, you are also at the mercy of your attendings' desires. I had one attending who had the largest volume of patients (he rarely saw them in pre-natal care, he had several NPs doing that) who wanted in by 7 and out no later than 6 so he could go home/party. If all of his inductions (usually at least 3 or more a day) were not ruptured and internalized (IUPC and FSE) before 7 am rounds, you got your ass blasted. By the end of residency, artifical labor, AROM, internals, and pit seemed like the "norm" instead of the exception. We were merely his bots. <BR/><BR/>It took some time to get out of that mindset, but now that I get to manage my own patients, my interventions (and inductions) have gone way down. I still have to race between office and OR and L&D, that's just reality. If I have inductions, I try to do them on my OR days when I am present in the hospital all day long. Funny thing though, labor seems to happen on its very own time schedule sometimes.<BR/><BR/>It saddens me to read your series of posts on this matter. Not all OB docs are trying to punch a clock and set an assembly line, and many advocate for their patients in labor as much as any midwife. The difference is the volume of patients that we need to see to cover skyrocketing malpractice and balancing it with some semblance of a normal life to maintain sanity. Midwives have the luxury of taking on no more than 1-3 patients per month if they wish (and they get to pick and choose who they like!) In solo practice, I need to have about 15-20 deliveries a month just to cover malpractice (more than 9K/month), office staff, supplies, salaries, etc. That makes a big difference in the monthly time crunch. Sigh. <BR/><BR/>Sorry for the long comments, just wanted to advocate for some of the "less evil" OBs out there in the world.dr. whoo?https://www.blogger.com/profile/10315615480530297472noreply@blogger.comtag:blogger.com,1999:blog-17754833.post-75776187572639026612007-04-14T19:36:00.000-05:002007-04-14T19:36:00.000-05:00From personal experience I agree with your judgeme...From personal experience I agree with your judgements about the state of births having experienced an augmented one a year ago at a "cushy" hospital. I was scared into the induction because the doctor said my pelvis was very small and at term she was guessing he'd be 8+ lbs and probably wouldn't fit. Then after telling me that asked what I wanted to do. Then with the induction I didn't feel like I had a choice when they broke my water (I had only dialated <1 cm after about 11 hr cervical ripening and around 5 hrs pit- and might I insert here that Pitocin is Hell on Earth!!!!!!). Then several hours after that my contraction we come on top of one another, Aidan's heartrate was dropping with the contractions, and I had INTENSE backlabor - oh and the epidural lasted all of 45 min! Then again I was asked what I wanted to do as I had not dialated any more.... I felt my options were to go insane from pain (I couldn't even focus to do breathing) or to have the c-section. Needless to say from this little rant I felt pretty helpless but atleast I have my beautiful boy!Simplistic Momhttps://www.blogger.com/profile/15454784235664651948noreply@blogger.comtag:blogger.com,1999:blog-17754833.post-66993649323599764992007-04-13T18:56:00.000-05:002007-04-13T18:56:00.000-05:00i was actually waiting to see what you had to say ...i was actually waiting to see what you had to say about this midwife. tiny surgeon and i have spent much of the past 2 weeks discussing our distaste with 'active managment of labor' and how medical (not natural) the process of birth has become.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-17754833.post-41282849540585645582007-04-13T09:09:00.000-05:002007-04-13T09:09:00.000-05:00That is sadly the state of birth in many places. ...That is sadly the state of birth in many places. I've really become a nag to the residents here. "Is she making progress in labor? Oh, you don't know yet? So, why'd you start the oxytocin, then?", and I try to tell them over and over again that every intervention, every medicine, and every procedure (including internal monitors) has some sort of risk associated with it; so you need to have an indication.<BR/><BR/>I was trained, at least partly, by midwives. I just loved the birth with the crying baby on the mom's chest, the father with the tears in his eyes.<BR/><BR/>We can't even do skin-to-skin here with the baby until after peds gets the baby. Which means that the cord gets clamped immediately (I'm actually a proponent of delayed cord clamping, too. A newborn needs a higher volume than a fetus because it has to perfuse the lungs, so if you can wait a few seconds to let some of the blood from the placenta flow back into the baby, it's probably a good thing). <BR/><BR/>Anyway, I totally agree with you. I'm all about pain control if people need it, and moms with epidurals can't move well and usually can't squat, but even a lot of them are more comfortable pushing on their side, or leaning over the head of the bed.<BR/><BR/>Sorry about that little tirade there. :)Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.comtag:blogger.com,1999:blog-17754833.post-44304369136895250642007-04-12T23:14:00.000-05:002007-04-12T23:14:00.000-05:00:: sigh :: That was as depressing a read for me as...:: sigh :: <BR/><BR/>That was as depressing a read for me as the urology news must've been for you. But I have to say it's not surprising from what I've experienced at the university hospital near me. The students/residents/attendings are always awesome but they are juggling so many things that routine makes it all easier. <BR/><BR/>FWIW I don't think urology is the easy way out especially if its something you are led to not just for the hours or money or whatever. I can't figure out what a man would dig about OB/GYN. I never saw a male OB/GYN who could look me in the eye, that's my turn off. Maybe I'm just too hot ;) LOL But the females have always focused in a different way. Sisterhood of the Vag and all ;)Anonymousnoreply@blogger.com