* * Anonymous Doc

Tuesday, August 2, 2011

"So I just checked on the test, and, sure enough... you're pregnant."


"Great. I'm going to refer you to the OB service, and you can set up an appointment--"

"Oh, I'm not going to do that."

"Why not?"

"I don't want any doctors involved in this."

"In your pregnancy?"

"Yeah. I've heard stories."

"About doctors?"

"About people being injected with poison, people being cut open, babies being pulled out. I want to do everything like nature intended. I am not interested in a doctor being part of this. No offense to you."

"No offense taken, don't worry. But I think it's important to see an OB, even if you don't want to have an OB deliver the baby. They can take blood, monitor you to make sure everything is going okay--"

"No one's taking any blood from me, or from my baby. You people push this agenda to turn pregnancy into something medical."

"It's a medical event. I would just be concerned about making sure you're not taking on any additional risks for you or your baby, that's all. Unfortunately, not every pregnancy ends up as easy as we wish they all were. I'm not an expert, but we have some OBs who are very well-trained."

"People gave birth for thousands of years without doctors or ultrasounds."

"That's true. But, unfortunately, a lot of women and babies died in childbirth, and luckily we have the ability to identify risks now, and intervene where appropriate to save lives and provide for healthy babies."

"My baby is perfectly healthy."

"Odds are that's true. But a checkup and someone being able to monitor you along the way can help provide peace of mind and catch problems before they become dangerous."

"Doctors cause more problems than they solve."

"I know it may seem that way, but I don't believe that's true. I wouldn't have chosen this profession if I thought it was true."

"You don't deliver babies."

"That's right, I don't. But the people who do are very well-trained to do so."

"I don't want anyone touching me or my baby."

"I'm going to give you a referral to the OB clinic, and I hope you'll decide to make an appointment. No one's going to do anything, to you or your baby, without your permission."

"I want to have a water birth so my baby will grow up knowing how to swim."

"Please make an appointment with the clinic."


  1. 1. Birth is NOT a medical event--unless YOU make it one. She is right, once you get involved with CERTAIN OBs, you end up strapped to a bed with continuous monitoring, invasive internal monitors, IV pitocin, talked into an epidural, so you end up with a foley catheter... only to end in a c/s. The average number of wires a pregnant women "in labor" or being induced is hooked up to is SIXTEEN. P.S. This is coming from a labor and delivery RN. If I'm healthy, I will NEVER EVER have my baby in the hospital with an OB.

    2. Did you think even once to refer this woman to a midwife? There are a lot of hospitals that have midwifery services and offer things like water birth or at least hydrotherapy for pain relief. Seeing as how this woman also needs some education, a midwife would likely give her longer appointment times, more autonomy in making childbirth decisions, and personalized care. Just because you're now jaded and judgmental doesn't mean ALL health care providers are.

  2. Sure-- OB clinic has midwives as well-- the post isn't meant to be anti-midwife, just pro-anyone-- happy to foster OB vs. midwife discussion in the comments... not meant to seem against midwife, though inclined to think OB should be involved in background if needed.

  3. My understanding is that midwives check for complications and refer patients along if it looks like an OB would be the most appropriate care giver. Midwife would be a good resource for someone who "doesn't want any doctors" involved in making sure she has a healthy pregnancy.

    What puzzles me is why this person would see a doctor in the first place if she felt that strongly about it. Pregnancy tests are available at the dollar store - much easier and less expensive than going to a clinic.

  4. Well it sounds like she's off anyway and probably not a good candidate for home birth, but I do take issue with your statement that they won't do anything you don't want them to.

    OB does what OB wants, particularly when moms are most vulnerable.

    In the future, a more persuasive argument might be how she'll be treated when she shows up at the ER with a complication. They won't be prepared for her and she'll get lots of judgment at best, a CPS call at worst.


  5. @POP: Really? So, all OBs are out to take advantage of their patients? With a chip like that on your shoulder, no wonder you think you have a knack for finding crappy doctors.

    And seriously...you think that the best you'll get in the ED is judgment and at worst a CPS call? How about a dead baby? Or maybe even winding up dead yourself?

  6. "Midwife would be a good resource for someone who "doesn't want any doctors" involved in making sure she has a healthy pregnancy."

    Really? How is a midwife, in any way, prepared to make sure that she has a healthy pregnancy? Does she have special powers that allow her to view the developing fetus without a sonogram? Or super hearing to check the fetal heartbeat?

    I've never understood why so many people get duped into believing the homebirthing / midwife ruse.

    Apologies Anon - for some reason, the whole anti-science attitude of people like this really get me spun up.

  7. @medschoolodyssey: There are LOADS of really competent, skilled, experienced midwives out there. My wife and I used one for our daughter, birthed at home. Before you judge, my wife is the alternative medicine nut and I am the science/western medicine nut. We thought it through quite logically, made plans and contacts with the closest (and largest/best) hospital in the case of complications, and generally managed to find a way to bring our disparate beliefs into reasonably close harmony.

    Given that only AD was in the room with the patient, the rest of us are merely guessing at the real reason this patient would choose such an unwise course of action. A midwife at the OB clinic may be viewed with the same mistrust as an MD, and so she may still choose to ignore AD's recommendation. That is, after all, her choice. You can lead a patient to care, but you can't make them consent... or something like that.

  8. They are called nurse midwives (not to be confused with a lay midwife.) They are advanced practice nurses who administer all the normal tests an OB would give - ultrasound, urine, blood, etc. And of course they can refer you to an OB (often in the same practice). At the same time, part of their training is to help foster a natural childbirth. I have nothing against OBs - but I chose a nurse midwife in a practice with OBs. State law here requires and OB within 500 feet. That gives me peace of mind should there be an emergency - at the same time, I like the philosophy of care provided by a nurse midwife. (And their are OB midwives, just to confuse things, who have studied that same philosophy of care.)

  9. Uh MedSchoolOyssey...I had no issues with my OB but if you've read birth stories, you would see that's unusual. I certainly had pressure re: their agenda, but in the end they actually worked with me. Our doula was shocked. She'd never seen anything like it.

    Also, I have family in L&D. Surprisingly, they don't think I'm the ass you seem to believe I am and share similar views on the subject.

    Further, I've actually spoken to women who've had to transfer in the middle of a home birth. I don't base my comments on my imagination.

    Midwives involved in home births vary depending on the laws and structure provided by the state. They can offer routine prenatal care (with ultrasound) while supporting home birth. Which is ideal for moms who want that. Other states have illegal lay midwives which is not good.

    In some places in Western Europe, home birth is the default unless there is a complication.

    I am sure to OB, everything they do is reasonable, but patients do not experience it that way. Also, there are legitimate alternatives to current practices that our paradigm is unwilling to even consider.


  10. medschoolodyssey -

    Check yourself. You sound like a complete and utter fool. Midwives, particularly certified nurse midwives (as I will be one in a matter of months), are FULLY equipped with ultrasounds, doppler, the ability to do bloodwork, and of course, referral to OBs if necessary. And over 90% of certified nurse midwives practice within hospitals. People are not confined to having a home birth simply because they chose a midwife. HOWEVER, I do believe that every woman should have the choice as to where she gives birth, provided that she is healthy with an uncomplicated pregnancy.

    As a labor and delivery nurse and almost a CNM, I am passionate about birth and ensuring that women have the birthing experience that they desire. I have too often seen women belittled by their OBs, forced into interventions that they do not want or need, or subjected to a c/s because the doctor wants to make it home because it's 7:30pm and they want to eat dinner with their families. Physiologic birth needs to be honored.

    I pray to god that you are not on your way to becoming a medical professional. Actually, it just makes me want to be a better midwife. Midwifery is not a "ruse" as you said. Maybe check out the new systematic review showing stellar outcomes from midwives--in fact, better outcomes than OBs. http://www.midwife.org/080211

  11. @POP - There's not a single part of Western Europe where "home birth is the default unless there is a complication". There's only one country where you could say home birth is even common - the Netherlands at about 30% and falling - but their outcomes compared to hospital births there are nothing to brag about.

    I'm not sure what it means to say birth is not a medical event. It isn't... until that split second when it does become one. If that happens, I know I want to be in a hospital with the best equipmemt available. I want someone who knows pregnancy inside and out checking along the way to be sure all is well throughout. I see both OBs and CNMs during pregnancy, and don't find they have an agenda to push other than healthy moms and babies. I just can't relate to the anti-medicine and anti-science hysteria that makes some women thing OBs are at best making birth more dangerous with tests, or at worst out to get them just because they can.

  12. I wandered over from the Skeptical OB...

    A recurring theme linking the entirety of anti-medicine hysteria (anti-OB, anti-vaccine, CAM enthusiasts, etc), seems to be the power disparity of the doctor/patient relationship. A fair number of patients seem to be personally offended when it comes to receiving routine medical advice. Which is fascinating.

    In my anecdotal experience, the only agenda mainstream medical doctors, including my own beloved OB, are pushing is health based on scientifically-informed best practice protocols.

    Actively rejecting medical advice can artificially inflate the patient's social status by inappropriately ascribing greater medical expertise to oneself. (Just my personal off-the cuff theory....)

  13. Humans are the only mammals that require assistance to birth their young because for humans, birth very much is a medical event. We walk upright and have enormous brains - which means we have to give birth to babies with very big heads through tiny pelvises. The birth process for human beings is much more complicated than it is for any other animal. So it's only smart to use our big brains to get the best medical care available.

    For some this might include a certified nurse midwife or an OB. I would stay far, far away from anyone who is a CPM / lay midwife or tells you that birth is a natural process that requires little to no intervention. That person is living in a deluded fantasy world and could seriously endanger you and your child.

  14. Why wouldn't a CNM or an OB say that birth is a natural process??? IT IS. It DOES require little to no intervention if you are healthy. Why do OBs insist on having someone push in the lithotomy position? It not only narrows the "small pelvis" that you speak of, but it also causes the uterus to put pressure on the vena cava, decreasing blood flow to both mom and baby, causing undue stress to both.

    Women should TRUST in their bodies. Those "small" pelvises you speak of have been birthing babies for centuries. While humans do have large brains, the skull is also equipped with sutures that are not fused at birth so that the baby can fit adequately through the pelvis. Our bodies are MADE to birth. It's ignorant assholes such as yourself who teach women to fear birth, distrust their bodies, and fuel an overall feeling of inadequacy. You disgust me.

    I would never endanger a mother or a child. I believe that home birth is beautiful and SAFE when done with an experienced CM or CNM and there are safeguards in place, such as a close hospital and OBs that we can collaborate with. I also think hospital birth can be beautiful, if we allow physiologic birth to take place.

    Please, do yourself a favor and read "Gentle Birth Choices" or "Our Bodies, Ourselves." Maybe even (if you're open-minded, although I take it you're not...) take a gander at "Orgasmic birth." Or, since you obviously don't read much, or have adequate facts, maybe just watch the movie "The Business of Being Born."

  15. "Women should TRUST in their bodies. Those "small" pelvises you speak of have been birthing babies for centuries."

    Yes, and women and babies have been dying, for centuries.

    "Our bodies are MADE to birth."

    They are also made to grow cancer cells.

    Your sunshine and lollipops view of child birth and belief in the beauty/perfection of nature is exactly the kind of attitude that puts women and babies at risk.

  16. "Yes, and women and babies have been dying, for centuries"

    Exactly, Silly Rabbit!

    And I can't believe anyone with an original thought in their body would suggest watching "The Business of Being Born" for "adequate facts." That is one the most one-sided, hysterical, woo-filled documentaries out there, and mostly lacking in fact.

  17. www.hurtbyhomebirth.com

    I have met many OBs, and I've never had a one push "their agenda" on me. They've all acknowledged that they are just there in case that one split second happens were things can turn disastrous. People who are so anti-OB, or even anti-midwife, have apparently never talked to any significant amount of either group. If you did you would realize that most of either group will acknowledge that most of the time births go along fine, but occasionally help is necessary and it is very possible for childbirth or pregnancy to turn deadly.

  18. @ Pissed off Patient

    Sorry, I LIVE in western Europe (Germany), I've been to Austria, Britain, France, the Netherlands, Switzerland and Itlay and the standard here for giving birth is a HOSPITAL birth.

    Personally, I feel that a midwife attended birth is safe IF the midwife has at least the educational standard of a CNM and if the transfer time to an actual OR in case of emergency is less than 10 minutes.

    Also, in Europe we don't have DEMs (direct entry or lay midwifes), since their education in ob/gyn matters, especially ob/gyn emergencies (which can even occur in "normal" pregnancies and in births that start out "normal") would not be acceptable by the regulations we have here.

  19. Our bodies are MADE to birth. It's ignorant assholes such as yourself who teach women to fear birth, distrust their bodies, and fuel an overall feeling of inadequacy. You disgust me.

    Why so combative? I don't get it, do you truly believe in your heart that because womens' bodies are so perfect that there can never be anything that can go wrong that you would not be able to deal with in a home setting? Really? Because some of us think that being even 10 minutes from a hospital during childbirth is a scary proposition. Why does that make us "ignorant assholes?" It's a statistical fact ... More babies die at home under the care of lay midwives than die in hospitals. Choosing to acknowledge this fact and base our choices on it does not mean we are are ignorant assholes, illiterate or closed minded. But you certainly make yourself look like an asshole when you say so.

  20. Oh the crazy homebirthers have flocked here, yay; have to comment! In science women aren't "made" or "designed" and there is no "nature intended." if that's what you think, you are out of a scientific discussion and in a religious/philosophical one (which nature intends for 20% waste in miscarriage and some 6% in childbirth?). Western Europe, home birth is not the default, and also not comparable as they have trained HB midwives with screening and transport, the US HB is crap (as are CPMs). In the US HB has a higher mortality rate for the states that keep stats. Other countries (Netherlands, western Australia) have also shown HB to be riskier than hospital (in 1 even low risk HB had higher death rate than high risk hospital). If MANA released their data, msybe we'd know more. You can have a happy unmedicated birth in a hospital or related birthing center. Water birth, that's just extra stupid, if having a healthy baby isn't beautiful enough for you that you have to add water and risk drowning, you should reconsider being a mom. The US has excellent perinatal stats (comparably), I'm happy to take advantage of them.

  21. FYI, I'm not Dr. Amy, so please don't accuse me. She'll clearly put her full name if she comments.

  22. "The Business of being born" was produced by Rikki Lake, an actress and talk-show host who is responsible for shows where the episodes are titled stuff like "My daughter dates married men" and "Drag Queens come clean".

    She has NO qualification as a journalist, as far as I'm aware, she has NO degree in anything, let alone medicine or biology....and you take her word over that of the American Academy of Pediatrics (AAP) and the American Congress of Obstericians and Gynecologists (ACOG) who BOTH state that homebirth is a LESS safe for mother and child than birth at a hospital?

    I mean, have you watched her show? You have to shut off your brain to watch those inane reality-TV shindings....and even if it's all rainbows and unicorns, the same goes for "The business of being born", which is just as mind-numbing and inane, but prettier to look at.

  23. Babies are such a precious cargo and require such a sacrifice over the nine months of pregnancy and I want to KNOW that bub is OK and not just rely on wishful thinking. I don't understand why people would risk that of which is most important - mom's and bub's life.

  24. @andrea: If my mother had listened to people who wanted her to eschew doctors altogether, I would've been stillborn instead of a VLBW preemie. My sister might've become a 15-lb monster and probably gotten herself stuck - Mom had a hard time birthing her when she was a 7-lb 4-week preemie (yes, she was seven pounds at four weeks premature... Uncontrolled gestational diabetes isn't cool).

    Fact is, two hundred years ago, sure births were natural and all that, but infant and mother mortality were huge. Moms died of infections and blood loss. Babies died of pregnancy difficulties now managable, birth defects now treatable, infections now avoidable, and sometimes just plain ol' suffocation from difficult births. Before you try to jump down my throat and point out that all those can happen nowadays, yes, I'll concede that, BUT it must be said that it happens far, far less often than it used to.

    Why do you think so many of the old books had characters whose mom's died in childbirth? It was common back then. If you want to see how often the manure used to hit the fan back then, look at maternal death-in-childbirth statistics from developing countries and compare them to our own: In Sierra Leone, Afghanistan, Malawi, Angola and Tangir, over 1,500 women die in childbirth for every 100,000 births. In developed countries, the number drops to 20. In Sub-Saharan Africa, the lifetime risk for death in childbirth is 1 in 16. In developed countries, 1 in 2800. If you're a woman in a developed country, you're more likely to die in childbirth than in an accidental drowning over the course of your life.

    So don't try to imply that childbirth is safe and all roses and daisies because it's natural. Not all natural things are safe: I doubt you'd want to eat all the berries on a belladonna plant, for example. Nor would you want to inhale the dust of perfectly naturally-occurring asbestos, or experience the very natural fall that would come of walking off the edge of a cliff. Some natural things are dangerous. That's the world we live in. If science and medicine have a chance at making them far less dangerous than they would be otherwise, sign me up.

  25. People who think they're "close enough" to the hospital to homebirth have NO CLUE what it's like to transfer during an emergency situation (I do). 10 minutes to the hospital when the world is sunshine and roses is not the same thing as 10 minutes to the hospital when your baby is dying and you're in hard labor.

  26. @ andrea

    Add on to Sarah's post:

    And BEFORE you go around spouting some nonsense about women in developing countries being not comparable to mothers in first world countries because they are allegedly all malnourished and sick: I've been to developing countries (Africa and Asia) and worked at hospitals there (which also had L&D wards):
    The mothers I met there were quite healthy and quite well-nourished, thank you very much. They had houses, livestock, gardens.

    And guess what: complications DURING birth or shortly before / after were a MAJOR issue, and led to complications and death, because good, modern medical care wasn't as available as it is here. Often, all there was, was a (well-trained and experienced!) midwife with a stethoscope (and not much else equipment).

  27. I like the comments, on this one.

    I once had a new dad, looking all pale and being a tad quiet, say 'This is just barbaric...', after his wife had just delivered their healthy little baby in an otherwise uncomplicated delivery (in a hospital, without painmeds, maybe a little bit of contraction stimulating stuff in an IV). And I looked at him, stumped, and I said: "But sir, life pretty much is a barbaric event, anyway, if you ask me." Why, oh why, would childbirth not be? We just stared at one another, and I don't think he quite got what I said. The nurse who assisted the delivery alongside me, later said that I'd nailed it. Life is barbaric. Childbirth is barbaric. Death is barbaric. And you can invent any luxurious thing you want, you won't get rid of all the barbaric events in life. Better get used to it.

  28. I just don't get why when the midwife does the labor, it's not 'medicalisation'...
    Here in Brazil when giving birth in a terciary hospital, the woman usualy has a simple IV line and a pulse oximeter, give birth in a controlled environment, with the right temperature, a neonatologist waiting the baby, and within less than 10 minutes of the labor is painless, sure that her baby is OK, and surrounded with anything she and the baby would need, in case of an emergency..

    I have just one doubt:
    Usually here after normal labor, mom and child are discharged within 48h... What are the standards in america/europe?

  29. Not even going to bother pressing my side of this argument anymore--I'll just have to stop reading the thread after this. No one here is open-minded enough to get some real facts and I'll just have to accept that. I go to graduate school and learn about maternal and fetal health. I work in the hospital on a labor and delivery unit that sees a LOT of high risk patients, because we have a level 3 NICU at our hospital.

    I'm not saying that OBs are bad! They aren't. There are some really nice, ridiculously smart, and have saved many moms and babies. I'm not suggesting that everyone who is pregnant must have a midwife, but for someone who fears doctors, such as the woman in the original post, or someone who is looking for more personalized care or desires natural childbirth should see a certified nurse midwife.

    For the person who said they would have been stillborn without an OB: GOOD THING YOUR MOM SAW ONE! That's what OBs are for. They are trained to see the pathologic processes of pregnancy, and they are excellent surgeons. Your sister was obviously a high risk pregnancy, too, and needed to see a high risk physician.

    As for the mortality rates: are you shocked that the US is better than developing countries in that regard? The US is the richest country in the free world! Try comparing the US to all of the developed countries (who use midwives for most uncomplicated pregnancies within the hospital system) and the US ranks about 42nd. I've also been to many developing countries, "anda". They are developing for a reason. They don't have all the resources that developed countries have, regardless of whether they have a nice house or a nice farm. I've also been to Ghana, Togo, Liberia, Zambia, Guatemala, Panama, and Honduras to provide medical care. Yes, the entire country is not living in poverty, but the majority are. As for the L&D wards: barbaric. You just can't compare the majority of the hospitals/clinics in developing countries to what we have access to in the US. In Liberia, (on the labor and delivery ward), I was given one pair of gloves per day and was told to wash my hands with the gloves on. That would never happen in the US.

    Also, for the well-trained midwives in those countries having only a stethoscope--again, it's not like that in the US. Midwives, whether they work in the hospital, birth center, or at home, have dopplers! Fetoscopes! Terbutaline! Pitocin! Methergine and Hemabate! Oxygen and resuscitative equipment for mom and baby! They are very well equipped.

    And if the midwife is in the hospital, they have all the same access to medications that physicians do, they just don't do surgery. But thankfully, midwives also have a collaborating physician in case surgery is necessary.

    I'm signing off from this silly argument, because I'm getting nowhere and just being brought down by everyone's closed-mindedness. I've read a lot of research articles regarding not only midwifery care but also home birth, and there is no increased infant or maternal mortality with PLANNED home birth with a skilled birth attendant (aka CNM). And if anyone cites that JR Wax study on home birth, I'm going to laugh in your face. It's a ridiculous piece of "journalism" that somehow made its way to ACOG and is laden with statistical errors and inconsistancies.

    I'm done responding to the rest of the threads, because it's taking too much of my energy, and it's likely all in vain, as I don't think anyone REALLY cares or wants to learn another side of the child birth process. I'll just go meditate and do some loving kindness mantras to get myself back on track ;)

  30. I found out I was pregnant last September, and planned to give birth at a birth center. The only other option in the town I lived in (and the town is in AK and only accessible by land or air, so going to the next town over was not an option) was a small community hospital with a > 40% c-section rate, to be delivered by a family doctor (no obs in town either). At the 20 week ultrasound, we found out she had a congenital diaphragmatic hernia, which is fatal is about 50% of cases (depending on severity). We moved across the country to deliver at the Children's Hospital of Philadelphia, and she's now 3 months old and thriving. Both myself and my husband are young, healthy, active, with no medical issues and no family history of medical issues. No one knows why CDH happens, although it's pretty common (1 in 2500 births). Whether I'd delivered at the birth center or community hospital, she would have died the day she was born if we hadn't had that ultrasound done and been able to deliver at a level 3 NICU. Anyone who refuses basic pregnancy screening is risking their baby's life. It doesn't matter if you have risk factors or not, or how close to a hospital you are. Another CDH baby who was delivered undiagnosed at a hospital near CHOP (mother had no ultrasounds) was in the bed next to my daughter. He hadn't yet passed away when she was discharged, but he was regularly satting (blood oxygen saturation) in the 20s and 30s (percent). Again, I had NO RISK FACTORS. I am young. I am active and healthy. My baby still would have died.

  31. I have a fear of medicine too. It's because I don't understand it. I also hide when the moon is full. (How does it go from reound to skinny) Anyway, this has made me hire a undereducated midwife to deliver my child. I fugure the dumber she is the less afraid I'll be because she won't be scaring me with stuff like "abruptions" "death". Silly people, go with a midwife and labor like it's 1050 with me

  32. @Silly Rabbit: Humans are the only mammals that require assistance to birth their young
    Just shows how little you know. Any baby can be turned awkwardly, regardless of species. Turned wrong, the baby won't fit through the birth canal - doesn't matter if it's a human or a colt or a calf... When problems occur, either assistance is needed or the mother/baby die. It happens in cows and horses (and probably every animal), just as it does in people. Ask any vet, animals can get preeclampsia. Any mammal can run into trouble during birth and require assistance (or die).

    @medschoolodyssey: How is a midwife, in any way, prepared to make sure that she has a healthy pregnancy? Training. Lots of it. Not OB training, to be sure, but then midwives want to help moms deliver healthy babies, not become gyn surgeons.

    Does she have special powers that allow her to view the developing fetus without a sonogram? Or super hearing to check the fetal heartbeat?
    You obviously don't have any idea what midwives do. The ultrasound is a great tool. So is the stethoscope. Midwives use them. Midwives do the exact same things for prenatal checks that OBs do. The goal isn't a return to the dark ages. The goal is a healthy mother and healthy baby using only the interventions that are needed to keep things safe.

    OBs vary in different parts of the country, but they're well known around here for scheduling inductions & c-sections for the convenience of the doctor's schedule, with little regard to what the scientific literature say about what's healthiest for the mom & baby.

    Midwives spend more time with patients than doctors do. If there is a complication that requires the patient to transfer care to an MD, the midwife would take the time to explain why that would be what's best for mom and baby.

    Medschoolodyssey, if you are eventually admitted to medical school, you might benefit from shadowing a certified nurse midwife for a week or two so that you can speak more intelligently about this subject when it comes up with your future patients.

    @Anonymous Doc: sorry for the long rant

  33. warm socks, you may to read up on the difference between a CPM and CNM. You use midwife without specifying which kind you mean. CPMs & DEMs usually do hpmebirths in the US, and they are not nearly as educated or trained as a CNM. Also, do you have a citation for your reference that midwives (and which kind do you mean?) spend more time with patients than OBs? And, are their outcomes better because of it?

  34. "OBs vary in different parts of the country, but they're well known around here for scheduling inductions & c-sections for the convenience of the doctor's schedule, with little regard to what the scientific literature say about what's healthiest for the mom & baby."

    I'd really like to see you back that statement up with actual statistical evidence, rather than anecdotes and hearsay.

  35. @warmsocks: "Just shows how little you know. Any baby can be turned awkwardly, regardless of species. Turned wrong, the baby won't fit through the birth canal - doesn't matter if it's a human or a colt or a calf... When problems occur, either assistance is needed or the mother/baby die. It happens in cows and horses (and probably every animal), just as it does in people. Ask any vet, animals can get preeclampsia. Any mammal can run into trouble during birth and require assistance (or die)."

    Well duh. What I meant was, non-captive animals tend to give birth alone, without the assistance of other animals, regardless of the outcome, whereas humans have almost universally given birth with assistance in almost all cultures and time periods, mainly as a function of our anatomy which makes even routine birth somewhat more complex. I was thinking specifically of our primate cousins when I wrote that. Chimpanzees for example have very straightforward birth canals that don't require baby chimpanzees to turn their heads the way human babies need to in order to navigate its mother's narrower pelvis. They also emerge facing away from their human mother, making it harder for her to clear out fluids, etc. That's not to say humans can't give birth alone, but those that seek assistance from other humans have a much greater chance of survival.

  36. Hey doc, just stumbled upon this blog - brilliant. I am currently a pre med student and I've spent some time shadowing and doing rounds as a volunteer in hospitals and all that. I think my biggest problem is going to be my patients. One of my shortcomings is that I am very impatient, especially with ignorant stupidity. How am I supposed to handle a situation like this? when I see patients like this I want to laugh and shake them until they realize how ridiculous they are being and actually doing themselves harm while I am just trying desperately to help them. you seem cool and collect dealing with it- were you always able to keep your cool and keep reiterating that you think its best if she sees an OB or have you had to work on it? Also from your other post- how are you supposed to help and advise someone who is hellbent on still taking cocaine if he had just suffered from a heart attack? I'm afraid that everything I think of doing/saying to these "wonderful" people will one day get me fired lol..

  37. I would recommend watching One Born Every Minute from the United Kingdom if you would like to learn more about the role of midwives. They are the main medical professional involved in pregnancy; an obstetrician is usually only involved if something goes wrong.

    Although it isn't the same as real experience, I have watched One Born Every Minute USA and have seen that it is very "medicalised" Everyone is in a hospital gown, laying in a bed with a drip in their arm. Why are they not walking around? Why are they not trying alternative pain relief?

    I would like to be an Obstetrician myself; pregnancy and birth fascinates me and I think I could make a big difference to complex pregnancy and labour problems. Is it not a huge strain on resources to expect an Obatetrician to be at every birth, even if there are no complications?

  38. I think a woman owes it to her child to be SURE that she is healthy before deciding to refuse OB care. After that point, choose whatever method of birthing and delivery you will, but don't gamble with your child's life by not getting checked out.

  39. When my mom went into labor with me (two weeks past her due date), she made the choice to go to the hospital to see her OB, which is a very, very fortunate thing. It turns out that between her most recent checkup and her labor, I had turned myself upside down and no one knew about it, even Mom. The doctors said she pretty much had to have a C-section if I was going to live; Mom didn't hesitate a second. If she had selected home delivery, I might not be alive today (the hospital was an hour's drive away on windy country roads and we were in the middle of the snowstorm of the decade). I know there are exceptions for every rule, but I for one am grateful for OBs and for my mom not taking any chances with me.