"they only do caesareans when they're necessary" - UPDATE - Page 2

[pampered_mom]

Originally Posted by maxmama

To be fair to the 45 other nurses on our unit, there is not one I would ever expect any less from. Our unit policy is to support NCB and exclusive BF. It's not me; it's the culture of our floor.

I wasn't referring to your floor or your hospital. I was referring to hospitals in general and in that case, yes, you are an exception to the rule.

[wannabe]

I don't know, Maxmama, I had you and one other nurse during my birth, and in terms of caring support, you trumped her. It may be unit policy, but she didn't really have the right touch.

LOL, does that even make sense?

[sapphire_chan]

Originally Posted by wifeandmom

This would be in the teaching hospitals he's worked in, as the residents who have been working that shift only get 'credit' for a birth that actually occurs on their shift. So if mom doesn't deliver til 10 minutes into the next guy's shift, that guy gets credit, so instead of allowing that to happen, it was common to see the first resident in question insist on sectioning mom. Does that make sense? (Not as in, it's ok to do it, just it seems so wordy, so does what I'm saying make sense?)

WHAT?!??!?
:

If I wasn't at work right now I'd be screaming.

*THIS* is how doctors are trained about birth?!?!? How the *bleep* do they expect ... oh wait, that's how the instructors were taught and their instructors ad infinitem.

Ugh...

Not to mention it's totally unfair for the residents. Well, unless of course they have the choice to stay on shift? But then you run into that whole "being awake for 48 hours straight thing". Although, then maybe they'd be willing to just sit in a corner and sleep until something happens. Bother...

I do *not* care how good a given hospital is, I will *never* voluntarily support something so fundamentally flawed.

Please, tell me there are teaching hospitals that do something different--and better. I want to have some faith in humanity.

[wifeandmom]

Originally Posted by sapphire_chan

WHAT?!??!?
:

If I wasn't at work right now I'd be screaming.

*THIS* is how doctors are trained about birth?!?!? How the *bleep* do they expect ... oh wait, that's how the instructors were taught and their instructors ad infinitem.

Ugh...

Not to mention it's totally unfair for the residents. Well, unless of course they have the choice to stay on shift? But then you run into that whole "being awake for 48 hours straight thing". Although, then maybe they'd be willing to just sit in a corner and sleep until something happens. Bother...

I do *not* care how good a given hospital is, I will *never* voluntarily support something so fundamentally flawed.

Please, tell me there are teaching hospitals that do something different--and better. I want to have some faith in humanity.

I certainly cannot say this is how it works EVERYWHERE, but it makes sense in a sick way.

OB residents have to do a certain number of cases (any resident in any specialty has this requirement, for example my own DH had to do so many general anesthetic cases, so many regional blocks, etc before sitting for boards). The only way you get 'credit' for a birth is well, to actually attend the birth.

So if Dr. X has been attending Mom all shift long, and Mom shows ANY indications whatsoever that things aren't going exactly.according.to.textbook....well, Dr. X can allow the next doc coming in to deliver Mom and get NO credit for that birth, or Dr. X can do a section and get another operative delivery to count.

Aside from unnecessary surgery, I find it appalling that women are being LIED TO, *then* to add insult to injury, unless said woman is *very* lucky, when she has baby #2 (or 3 or whatever the number may be), she better hope she's in the 'right' place to attempt a VBAC since those are getting harder and harder to find providers for.

Oh, and then there's the policy (not sure if it's still in place, cause military moms CAN now choose to go outside of the military hospital to give birth, making them have to 'cater' to mom a bit more than before) that you can see a midwife for your pg, but the 'residents need the practice', so midwives weren't allowed to attend births at all. Yeah. Awful isn't it?

[TexasGirl96]

I am completely aware that there are a lot of compassionate, competent, hard working nurses out there on L & D units - unfortunately my experience confirmed that there are also nurses who enjoy their jobs a lot more when moms are immobilized and strapped to monitors. Maxmama, I wish I had gotten a nurse like you. My nurse's idea of comfort and assisting me in labor was to pop her head in every once in a while, type a few notes on the computer, and check to see if I wanted a popsicle or an epidural (she had also told me that she could monitor us just fine from her screen at the front desk). I had mistakenly taken the hospital's birthing classes where they told us about all of the laboring techniques that our nurses would love to help us with, so it was only DH and I at the hospital. I will never make that mistake again. I just hope that next time if I do get a nurse like the first one I will have the courage to demand that we get the care that we deserve, and if I happen to get a wonderful nurse that I will also recognize that and be able to trust him/her.

[Storm Bride]

wifeandmom: The policy you describe doesn't even actually make sense. If the residents let the mom birth when she was going to birth, I bet it would more-or-less even out at the end. Okay - 1st resident's shift is ending, and the mom on the ward hasn't had her baby, so the 2nd resident gets the "credit" on his shift, and the 1st resident "loses out". But...the odds are pretty good that the 1st resident probably already got the "credit" for a mom that a 3rd resident had been with through her whole labour, and "lost out" on when his/her shift ended.

Do they just not see that sometimes only getting "credit" for the birth part of it is going to work in their favour when the shift changes, or do they just want to be guaranteed a certain number of points??

[Knittin' in the Shade]

Originally Posted by maxmama

To be fair to the 45 other nurses on our unit, there is not one I would ever expect any less from. Our unit policy is to support NCB and exclusive BF. It's not me; it's the culture of our floor.

Can I come deliver on your unit? That sounds like an awesome L&D floor! NOTHING like the nurses where I've delivered my kidlets. Seriously, I swear, each and every nurse that walked in during all of my labors was SHOCKED that I didn't ask for an epi the second I walked in the door.

[wifeandmom]

Originally Posted by Storm Bride

or do they just want to be guaranteed a certain number of points??

You got it.

The way in which medical decisions were made in the teaching hospitals that I birthed in was appalling to be honest.

One conversation I overheard during a NST with my twin pg went something like this:

Resident A: 'Well, 10 is in trouble.' (10 being the mom in room number 10)

Resident B: 'Hmm, should we use forceps or just section her?'

Resident A: 'I need another forceps, so we can try that first.'

I kid you not....it came down NOT to a matter of explaining the risks vs. benefits to MOM and allowing HER to have some input, it came down to which type of delivery the resident in question 'needed' that week.

I wanted to puke personally, as I firmly believe when there is a CHOICE to be made (and obviously there WAS a choice to be made since nobody was frantically running around at that point)...well, the CHOICE should have at least a little bit to do with what MOM wants.

DH had instructors that would flat out ask him 'What kind of case do you need this to be?' if a question arose as to what type of anesthetic would be best for a particular case. It was NOT a matter of him not getting MORE THAN ENOUGH of every type of case necessary to sit for boards either. He had enough of each type of case for boards with MONTHS left to go before his program officially ended and boards were even an issue.

It's the same way with OB residency programs from what I've seen/heard.

[Storm Bride]

That's really disgusting. I wish I could say I was surprised, but I'm not - not at all. I really do not understand why a training program is set up in such a fashion as to ensure that residents have to worry about their "points", instead of about providing care. :

[sapphire_chan]

Originally Posted by Storm Bride

That's really disgusting. I wish I could say I was surprised, but I'm not - not at all. I really do not understand why a training program is set up in such a fashion as to ensure that residents have to worry about their "points", instead of about providing care. :

Because anything else would be too close to midwifery which "everyone" knows is a dangerous and unsafe model.

[hypatia]

Originally Posted by MsElle07

A lot of OBs have stopped doing external versions -- they are seen as too risky now. I know two women who had primary C-sections for breech presentation, and their OBs were unwilling to try versions. I haven't read up on the stats, but that seems to be the current climate.

External version may be dying but it's not dead -- my neighbor was actually complaining because her OB tried to pressure her into an external version. She refused and ended up having a c-section for breach presentation.

[hypatia]

Originally Posted by wifeandmom

He DOES comment often on how irresponsible it is for docs to do sections 'just because', usually right around shift change he always seems to notice a sudden increase in the number of 'problems' that seem to miraculously crop up. m,

If I had infinite time and access to medical reports, I would do a study comparing time of c-sections and hospital shift changes. I bet it would be pretty interesting.

[alison_in_oh]

Originally Posted by wifeandmom

This would be in the teaching hospitals he's worked in, as the residents who have been working that shift only get 'credit' for a birth that actually occurs on their shift. So if mom doesn't deliver til 10 minutes into the next guy's shift, that guy gets credit, so instead of allowing that to happen, it was common to see the first resident in question insist on sectioning mom.

Hm. I can't see that happening with my husband's program. He's not in OB but his RRC does require a procedure log. Nobody's concerned about meeting their quota of procedures -- any hospital worth having a training program at will have enough procedures to go around. And nobody signs out active cases just because their shift is over. He might have had almost no rest between his last two shifts, he might want to come home to his pregnant wife, but my husband will still stay hours over if necessary to see his patients' care through. And that's for shiftwork, which is "supposed" to have a start and end time. When he's on call, all bets are off; his window of when he might come home is hours wide -- I am quite sure that nobody is watching a clock there either!

I guess with the tendency to cover OB with a night float team instead of overnight call, and the tendency of surgeons to be overzealous with their eagerness to do procedures, the shift-change shenanigans you describe might be more likely on an OB service. But it still sounds weird to me.

[wifeandmom]

Originally Posted by alison_in_oh

But it still sounds weird to me.

Weird isn't the word I frequently use to describe the crap he comes home telling me about.

More like...disgusting, infuriating, malpractice...

What makes me the maddest is the complete disregard for what MOM wants. The docs he worked with at the last teaching hospital wouldn't hesitate to say a section was 'necessary' for some of the most absurd reasons. It never occurred to them to even ASK mom what her future plans were for childbearing. We had one neighbor who wanted a really big family, 5 or 6 kids was the minimum they were considering. Too bad they sectioned her for no medical reason whatsoever (she was most assuredly a shift change section with an over-eager resident known for doing this type of thing) with their FIRST baby.

The next duty station her DH was stationed at didn't allow VBACs. It sucked all the way around.

Some women want a couple of kids, don't really care how they get here, a section is fine by them, etc. And for those women, a shift change section isn't nearly as big of a deal, but I'd guess that situation is NOT the norm, and it's a shame that the residents in question didn't think about the long term consequences of what they were doing.

[Celery]

he he he

So, the book (obstetric myths) arrived at her house on the Monday, a friend of hers had a baby on Wednesday I spoke to her on Thursday, and her comments included:

"she had an epidural, and you know they slow things down"

"well, inductions just muck everything up"

etc, etc. Hooray!

She even talked her friend out of being angry at her doctor for not inducing her on request!

[sapphire_chan]

Originally Posted by alison_in_oh

Hm. I can't see that happening with my husband's program. He's not in OB but his RRC does require a procedure log. Nobody's concerned about meeting their quota of procedures -- any hospital worth having a training program at will have enough procedures to go around. And nobody signs out active cases just because their shift is over. He might have had almost no rest between his last two shifts, he might want to come home to his pregnant wife, but my husband will still stay hours over if necessary to see his patients' care through. And that's for shiftwork, which is "supposed" to have a start and end time. When he's on call, all bets are off; his window of when he might come home is hours wide -- I am quite sure that nobody is watching a clock there either!

Just saw this. Give your husband a huge hug of appreciation please!

[sapphire_chan]

Yay!! Good job passing on the knowledge Celery!!