shoulder dystocia-OB breaks clavicle? - Page 2

[JaneSmith1010]

Originally Posted by doctorjen

I'm a family doc (MD by training.) I work in north central IL, in a small town.
The majority of my clients birth squatting, standing, or hands and knees by their choice.

Wow. I didn't know family physicians could deliver babies! That is great. How did you get away from the mainstream med methods of birthing? I would be very interested in going through med school if I could practice in a way that I knew to be best, but that doesn't seem to be easy. I'm currently planning on becoming a CPM. Would you mind terribly giving me some info about the path that lead you to be able to practice this way?

[Girlprof]

Originally Posted by jhow32000

Wow. I didn't know family physicians could deliver babies! That is great. How did you get away from the mainstream med methods of birthing? I would be very interested in going through med school if I could practice in a way that I knew to be best, but that doesn't seem to be easy. I'm currently planning on becoming a CPM. Would you mind terribly giving me some info about the path that lead you to be able to practice this way?

I keep popping back here with my non-expert status because you don't about the clavicle breaking thing very much. I've no idea about MD/OB training, but the mixed practice (OBs and MWs) where I delivered my first has awesome docs. One was a really old guy. I think they kept him around because he'd been trained in vaginal breech delivery and could still do it. One was a middle aged guy who'd worked in partnership with a MW for over a decade. She did all normal birth stuff and he did what OBs are actually supposed to do - surgery and more complicated stuff. THe third was a woman whose mom was a MW. Everyone asked why she had become an OB instead and she said "OBs have a lot of the real power. I want to be able to do birth the MW way, but sometimes you need the letters OB behind your name to make that happen." So somehow they had all kept the view that birth is a normal event despite getting through med school.

[doctorjen]

Nearly a quarter of all family docs in the US attend births, and more do prenatal care. More rural family docs than urban family docs do births, though. I went to traditional med school and residency, but my own oldest 3 were born along the way to being an MD (one in high school, 2 in med school.) I knew all along that I wanted to attend births, and figured out quickly that I didn't want to be a surgeon so I chose family practice instead of OB. Training was somewhat rough, in that I knew that I wanted to practice in a more evidence based way, the way I birthed my own children, but I didn't have control over the situation most of the time. When I looked for jobs after training, I chose one where I would have a lot of autonomy and the ability to practice how I wanted. I attend about 70 births a year, and also practice full service cradle to grave family practice also. I have a great OB back up since I don't do surgical deliveries - he's not someone I would go to for a normal birth, but he is a great surgeon, comes when I call, and doesn't meddle with my clients unless I need him.
To be honest, it was hard swimming upstream at first, but all my nurses and hospital staff are now used to me and don't bat an eye when we have births with no IVs, no cervical exams, no continuous monitoring, or when we all get on the floor together to welcome a baby!

[fionamom]

Just wanted to chime in about my baby's shoulder dystocia- I think his arm was slightly back wihich made it hard for my doc to reach his armpit during McRoberts/pelvic press. She didn't try the Gaskin maneuever- kind of wished she had tried it. After 4 minutes of dytocia with his head turning blue she told me she was going to try to break his arm. I remember thinking "Bones can heal." In pulling his arm, she got him right out and he was limp but had a good heart rate, apgar of 2 I think but a good apgar a few mintues later. In the end, his arm was not broken but had a bump under it for a week or two. He had full use of his arm, maybe only side effect of the whole thing was a bad case of reflux? Not sure it being pulled out with some force can cause reflux. He was only 8 pounds, and my obgyn and my home birth midwife said it was one of the hardest dystocia they had ever seen.

It was a hard birth with a preeclampsia, pitocin induction, and suction forceps, lithotomy position at the very end- hard to know if this all caused the dystocia. I myself was very premature ( under 2 pounds at birth) and can't help but wonder if I have smaller bones and less room. Plus I am overweight, which I guess can make for a little less room for the baby to pass through. The whole thing would have freaked me out much less if he had been a big baby. My doctor said she thinks my baby's shoulders are quite wide- turned out my husband shoulders got stuck at birth too, but not severely. My homebirth midwife said my ob-gyn handled it perfectly and suggests I return to her for the next baby and try to eat a diabetic diet to have a slightly smaller baby. My ob-gyn is open to natural delivery next time and in interested in inducing a week or two early for a smaller baby, but I really would hate to choose that pitocin again! She also says she would support me in a sceduled c-section if I want. Hard decision! Hard to give up my dream of a natural birth but absolutely don't want to put another baby in the position of having bones broken or going through trauma. Never thought I would say this, but maybe a c-section could be the more gentle birth choice?

[mwherbs]

it is something to do I guess if you can't get the baby out- the arm pit is not really something you should be hooking because of the nerve bundle that can be damaged -- a friend of mine had a baby who's mom was in hands and knees- spontaneously broke the clavicle too- it happened so fast during birth and they didn't even see "shoulder dystocia" or know that something happened but this baby did react to pain that is how they found that the baby had a break- baby cried and nursed but when was moved cried more hard to quiet the baby and the O2 stats kept dropping - took them a while to find it in the hospital too- the baby's reaction to pain was what was dropping the O2 stats...

[hopefulfaith]

Originally Posted by doctorjen

To be honest, it was hard swimming upstream at first, but all my nurses and hospital staff are now used to me and don't bat an eye when we have births with no IVs, no cervical exams, no continuous monitoring, or when we all get on the floor together to welcome a baby!

You are so cool.

[Twinklefae]

Not a birth professional, but getting ready to have a baby with my family doc. At my local hospital it lowers your c-section chances by 12% to have your family doctor attending, as opposed to an OB.

[JaneSmith1010]

Originally Posted by Twinklefae

Not a birth professional, but getting ready to have a baby with my family doc. At my local hospital it lowers your c-section chances by 12% to have your family doctor attending, as opposed to an OB.

Huh. I had absolutely no idea a family doc could do this. I just assumed there were regulations against it. So can a family doc also do prenatals/postnatal checkups? Why does using family doc for birth lower c-sxn chances?

[earthmama369]

We had a family practice doc for our children's births, DOs rather than OBs. Don't assume that every hospital SD birth is going to head right toward breaking the clavicle. Bastian was a true one-shoulder SD. Our non-OB hospital doc went right to the McRoberts (I'd already been squatting and changing positions a lot in the water) and corkscrew. In our processing together afterward, our doctor said that a) he'd never had an SD situation before and was scared shitless (not that we could tell at the time) and b) their protocol is usually Gaskin or McRoberts, corkscrew, something else -- I think pelvic pressure, then breaking the clavicle as a last resort.

[doctorjen]

Originally Posted by jhow32000

Huh. I had absolutely no idea a family doc could do this. I just assumed there were regulations against it. So can a family doc also do prenatals/postnatal checkups? Why does using family doc for birth lower c-sxn chances?

Yes, family docs do prenatals/postpartum care.
Not entirely sure why have an FP lowers cesarean rates (although that has been shown in several studies) but I think it's because we have to consult to get one. I have to have a reason that I can convince another doc of (not that it's that hard, you know?) and that extra step may be enough to deter folks. I tell my clients they can be assured they will never have a cesarean with me because I have dinner plans, because I can't do them so have to get another doc to come, who isn't going to want to interrupt his dinner plans to make mine work out!
Also, most family practice training programs really emphasize evidence based care - we have much better position papers on VBAC, breastfeeding, and many other areas then the specialty societies do. Many folks go into family practice because they want to practice in a more holistic way, also, although that is not always the case.

[mwherbs]

so the reasons I think that FP docs have lower rates- they treat the whole person, and the baby they are not surgeons, they have better judgment-

[JaneSmith1010]

Originally Posted by doctorjen

Yes, family docs do prenatals/postpartum care.
Not entirely sure why have an FP lowers cesarean rates (although that has been shown in several studies) but I think it's because we have to consult to get one. I have to have a reason that I can convince another doc of (not that it's that hard, you know?) and that extra step may be enough to deter folks. I tell my clients they can be assured they will never have a cesarean with me because I have dinner plans, because I can't do them so have to get another doc to come, who isn't going to want to interrupt his dinner plans to make mine work out!
Also, most family practice training programs really emphasize evidence based care - we have much better position papers on VBAC, breastfeeding, and many other areas then the specialty societies do. Many folks go into family practice because they want to practice in a more holistic way, also, although that is not always the case.

Hmmm....so maybe med school is for me. I'm sure we'd all like to continue a little digression and dicuss this educational/career path. If you'd like to share, tell the process of ed you went through. I have a b.s. in psych now and was planning midwifery training soon. Can you tell me what I'd have to do to go FP? I have a friend who'd also like to know.

[doctorjen]

FPs do a typical pathway for an allopathic or osteopathic doc, which is a 4 year degree complete with finishing pre-med prerequisites (usually several years of biology, inorganic and organic chemistry, biochemistry, and typical undergrad type classes like humanities, English, etc.) then 4 years of med school (allopathic or osteopathic medical school) and then at a 3 year residency program in family practice.
Folks with a bachelor's degree already may have all their requirements already depending on their degree, or may need to complete some more science courses. There a are colleges/universities that offer what they call post-baccalaureate courses for folks wanting to apply to med school to finish your pre-requisites if you did not get them all during your original degree completion.
To apply to medical school you need all the prerequisites and to take the MCAT (medical college admission test) and then apply. Usually you take the MCAT the spring before applying to schools - for most typical pre-med undergrads that would be spring of junior year, for most folks coming from a post-bac background that would be spring one year before your intended entry to school.
Medical school consists of 2 years of basic science course work (although many schools now integrate clinical teaching into these 2 years) and then 2 years of clinical rotations. Med school is the same for all MDs (or in osteopathic schools DOs) except that you get some elective time in the 3rd and 4th year (4th especially) to do some rotations in things you are particularly interested in. Everyone must do the basic science coursework and clinical rotations in all the major areas of medicine, ie internal medicine, pediatrics, OB, surgery, psychiatry, and often FP, ER, and neurology.
Residency is your specialty training (FP for me, this is when an OB would start to train exclusively in OB for example) It's 3-4 years of long hours, nights on call in the hospital, and hard work, although this is where you start to follow your own patients and learn more in depth about your chosen field.
It's a long freaking haul to tell the truth! Eleven years typically from high school to done, and 7-8 years once you start medical school.

[NZmumof2]

I just wanted to chime in as another family doctor (general practitioner) in rural New Zealand to say it really is a fantastic job! It is such a priviledge to be part of people's lives from before they are born and be able to watch them grow, know their parents and grandparents and be there from that first worried mum call at 2am to the day grandma dies and more.

Rural medicine is just wonderful!

Anna, cruchy rural doc, mum to Bede 7, Emmett 3, another due in January and partner to Leah for 10 years

[JaneSmith1010]

I would love to be an FP but after looking around I don't think my husband and I can afford it and put my kids through college and retire someday.