Saturday, July 22, 2006

Call Me Blade

I'm starting to wonder if I am going to attend a natural delivery ever again. This month I have staffed 15 deliveries, 7 were c-sections. Granted, 3 were emergent, 1 was repeat, and 1 was breech presentation, leaving only 2 for failure to dilate/descend, but come on! In the last 2 weeks that I have been covering myself and OtherDoc I've had 2 completely spontaneous vaginal deliveries, one vacuum-assisted delivery, and, count 'em, 6 cesarean deliveries. I have another one of OtherDoc's patients, a potential cesarean for breech, lurking about on labor and delivery, trying to become pre-ecclamptic on me. Don't get me wrong, I love to operate, but there is something so satisfying about a completely spontaneous and natural birth.

Unnecessary induction of labor can be blamed for this rise in cesarean births, and it is definitely true that in a small community hospital that one is much more likely to deliver a baby by cesarean for an ugly fetal heart tracing. I did a research study in residency that did reveal a correlation with purely elective induction of labor and subsequent cesarean birth. Some physicians will induce patients for their convenience. I try not to induce without medical reason, pre-ecclampsia, post-dates, LGA, SGA, etc. In this day and age, it is the patients that are the ones demanding the scheduled deliveries; even if they may end up with a c-section, even if their bodies aren't ready.

This is frustrating to me. Labor is so much faster and easier if it happens on its own time schedule. We humans are such control freaks. I cannot tell you how many times I am asked to predict the time of arrival of a precious newborn. It is probably my number one most asked question. My reply is always the same, "If I could predict *that*, then I wouldn't need to work because I'd be a self-made millionaire." Inside, I'm saying, "whenever it damn-well happens!" Color me bitter. Grumble, grumble.


Anonymous said...

Just discovered your blog, and am enjoying hearing about your patients. It's good to hear that life after residency is better.

dr. whoo? said...

Thanks alice! Looks like I'm going to have to start a blogroll :)

Northwoods Baby said...

I'm astonished not only by the induction/section rate, but that so many women go their entire pregnancy (and sometimes beforehand) without smoking, drinking, using caffeine, etc., then demand any and all meds available the second they are admitted. Even moreso, I'm flabbergasted by the docs who accommodate them. Well, no, that's unfair, the patient *should* be able to request pain control if she wants it, but I wish more docs were more supportive of unmedicated births, suggesting positions, vocalizations, etc.

But then again I'm a cruncher so I may be biased.

I so appreciate your stance on induction and I hope you are able to stand firm on it.