tag:blogger.com,1999:blog-31146535.post115600327160254551..comments2023-09-19T11:02:50.976-04:00Comments on Ob/Gyn Kenobi: Eight babies, four daysdr. whoo?http://www.blogger.com/profile/10315615480530297472noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-31146535.post-36180363609277273382010-09-22T08:18:25.095-04:002010-09-22T08:18:25.095-04:00Brilliant website, I hadn't come across obgynk...Brilliant website, I hadn't come across obgynkenobi.blogspot.com earlier in my searches!<br />Continue the wonderful work!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-66651097186956321582010-08-02T23:58:14.945-04:002010-08-02T23:58:14.945-04:00So THIS is what my life will be like. Haha. I can&...So THIS is what my life will be like. Haha. I can't wait! Great blog Dr. Whooooooo?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-64682364507571641742009-08-30T20:45:51.492-04:002009-08-30T20:45:51.492-04:00hi, i'm a midwife (in ireland where midwives a...hi, i'm a midwife (in ireland where midwives are generally the lead practitioners in child birth)<br />yes you are quite right, midwives do prefer intermittent monitoring;primarily to allow mobility for our patients which as you know, can speed up progress (and believe me i know about progress in labour- all labours in my hospital are actively managed, oxytocin and lots of it!). <br />however your comment about us using intermittent monitoring as a way of ignoring possible fetal distress, nope i dont like that now at all. decels heard equals monitors on- always!! it must be hard to monitor the cardiotocographs from an office though, how do you do that???<br /><br />i am considering a move to the states or canada, found your blog by googling job description.<br />it is remarkable how similar your day in the life sounds to mine (of course i dont do csections or ventouses) i suppose the babies come out the same way no matter where you come from!!!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-85801506470599488002008-01-03T18:57:00.000-05:002008-01-03T18:57:00.000-05:00You know, c-section IS a lot "nicer" then labor an...You know, c-section IS a lot "nicer" then labor and delivery. After a pitocin assisted labor that failed to progress (leaking amnio with B-strep led to induction), the c-section was a snap both to endure and to recover from (no need for narcotics after, no infection, nothing). The 2nd baby VBAC and 2nd degree tearing (he was 10lbs 5 oz, 15 oz more then older brother) was painful and uncomfortable for over a month, and I thought I'd never stop waddling. <BR/><BR/>That being said, I recommend to all the moms I meet that have had a c-section for their first to try a trial of labor for subsequent for all the reasons that you know (health of mom, baby, future fertility) and its just better. As badly as I tore, and I assume I scared the docs with my babies size (and mine), I think its better for a tall (6') fat (300lbs) gal to deliver naturally especially when I knew I could do it merely becuase of the idea of a surgeon having to burrow through the fat and scar tissue....<BR/><BR/>Anyway, c-sections are easier, not better or healthier, just easier, and as I will advocate for VBAC for as long as I can. Thanks for being a supporter of it - in a relatively small hospital as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-56803385078876705422007-05-28T00:30:00.000-04:002007-05-28T00:30:00.000-04:00Love reading your blog...just curious, not a compl...Love reading your blog...just curious, not a complaint or anything of the sort...how do your patients react to you cancelling your appointments for the rest of the day when your needed for a delivery. My biggest complaint with my OBGYN is waiting in his office for five hours to see him (which by the way is almost every time I see him, I take his last appt. for the day 3:30 and I leave his office usually around 8pm) He'll leave for deliveries and then come back for appointments. I think I would prefer the waiting over rescheduling. I often wonder what his wife must think about him always gone...<BR/>From CanadaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1170540933018610662007-02-03T17:15:00.000-05:002007-02-03T17:15:00.000-05:00Ahh, nothing like a polite, identified, helpful co...Ahh, nothing like a polite, identified, helpful comment from someone who actually was with you in the room, yes?<BR/><BR/>I think I found your blog yesterday and have been perusing your archives instead of studying for exams (vet school in my case). I absolutely love your cases and was disappointed there were only 8. I'm only sorry you haven't been blogging for years because I'd love to be able to soak in archives galore. I don't think I need to add I'll be back - especially because I am STILL here.Lionesshttps://www.blogger.com/profile/11066691544599972381noreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1160004304690530062006-10-04T19:25:00.000-04:002006-10-04T19:25:00.000-04:00My God, woman, I beg you never to be my dr.You've ...<I>My God, woman, I beg you never to be my dr.</I><BR/><BR/>You've got it...um, if I only knew your name. I promise not to be your doctor. I appreciate your directive to look into my c-section rates. I'll get on it, thanks.dr. whoo?https://www.blogger.com/profile/10315615480530297472noreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1159981167302425552006-10-04T12:59:00.000-04:002006-10-04T12:59:00.000-04:00geezus! 1/2 of your deliveries you just blogged we...geezus! 1/2 of your deliveries you just blogged were c-sections and 5 were AROM VERY early into labor!<BR/><BR/>My God, woman, I beg you never to be my dr. Those are horrid stats! Have you ever looked into how to lower them? Have you considered that the AROM, epidural, pitocin all may be the CAUSE of some of those c-sections?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1159411183289578822006-09-27T22:39:00.000-04:002006-09-27T22:39:00.000-04:00Hi MollyAqua! "Fluffy" patients definitely make i...Hi MollyAqua! "Fluffy" patients definitely make it more difficult all the way around pre- during and post- delivery. It is so interesting to see how similarly things are counducted on L&D floors around the states...comforting in a way. <BR/><BR/>I would totally say something about being overweight making the epidural placement more difficult. I figure since I am overweight, I can get away with it! :) Thanks for reading!dr. whoo?https://www.blogger.com/profile/10315615480530297472noreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1159292112397041062006-09-26T13:35:00.000-04:002006-09-26T13:35:00.000-04:00It's really fun to be the voyeur in your rooms. A...It's really fun to be the voyeur in your rooms. As a labor and delivery nurse on the Left Coast, it is interesting to see just how similar our lives are. <BR/><BR/>Regarding internal monitors, I'd love to avoid them whenever possible, but our patients are SOOO OBESE that the external monitors just can't "see" what's going on. And pity the poor anesthesiologist who is suppposed to place a catheter in the epidural space of a patient with a five inch fat pad over the spine! Patients get sorta irritated with our "lack of skill" and I just really would like to tell them the truth about why the procedure is so dang difficult!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1156256766998458852006-08-22T10:26:00.000-04:002006-08-22T10:26:00.000-04:00Thanks, Alice! My office is off campus, about 20 ...Thanks, Alice! My office is off campus, about 20 minutes (with traffic) from the hospital, so sometimes internal monitors are needed. Lady #6 and Lady #7 were also pretty overweight, so it was really difficult to monitor contractions unless they had internal monitors. As for office, I'm cringing too! It is not going to be pretty when I come back from vacation. Blech.dr. whoo?https://www.blogger.com/profile/10315615480530297472noreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1156199404020837422006-08-21T18:30:00.000-04:002006-08-21T18:30:00.000-04:00Great set of stories. Thank you for writing them a...Great set of stories. Thank you for writing them all out. I, like Kristina, was wondering why the early and frequent placement of internal monitors, but if you're trying to run clinic at the same time I can see how they would be helpful. I was cringing just thinking of how your clinic must be piling up after cancelling two separate days.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1156118837875337562006-08-20T20:07:00.000-04:002006-08-20T20:07:00.000-04:00Hi Dr. Whoo, I'm glad to have found your blog as t...<I>Hi Dr. Whoo, I'm glad to have found your blog as this is what I want to do. :) Would you tolerate a few questions from a doula/premed? :)</I><BR/><BR/>Anytime!<BR/><BR/><I>-- Why using cervical ripening agent (cervidil?), AND cytotec, and pit? Aren't the first two redundant, and would the combo put her at increased risk for UR?</I> <BR/><BR/>Good question. First of all, I find that not all cervical ripening agents work for all people. Cervidil is something that I used very rarely as a resident, as cytotec was cheaper and the complications due to hyperstimulation were better able to be handled by the 24 hour in-house resident docs and attendings. In the community hospital, we are not always immediately available in-house for overnight inductions, and the nursing staff is more comfortable with cervidil insertions and the ability to remove it should hyperstimulation arise. Personally, I don’t think it works nearly as well as cytotec, and if nothing happens after an overnight dose of cervidil, I will switch to cytotec until I get a bishop score of at least a 5. Sometimes, if the cytotec works, you don’t need pit, and I don’t order it if it isn’t needed. I think of cervical ripening as a time to allow the cervix to be receptive to regular contractions. If regular contractions don’t happen, the pitocin is next. This is why I try to break water before using any agents for induction, to try to get labor revved up without meds. If patients don’t start contracting regularly after AROM, then it’s time for pit. Conversely, if a patient comes in with a Bishop score of 5 or more, I’ll give them a choice or AROM or pit. Most choose AROM first, pit second. I’m not aware of any data on increased risk of uterine rupture with combined cytotec/pit, but it was the cocktail of choice at my residency, and I never saw a rupture in the four years that I was there (we didn’t do cytotec with VBACs, of course!)<BR/><BR/><I>-- YAHOO!! VBAC is alive in some areas of the country, what a relief to read that you attended her, put your worries in your pocket and leapt in with her. What a triumphant moment for that mother!</I><BR/><BR/>I was so happy for her. I’m one of the few docs that give these VBACs a chance in the community hospital. This is a highly litigious area, and it is a shame, really, but if I get sued for one bad baby, it is likely the end of my career.<BR/><BR/><I>-- From your notes here, it sounds like your routine is to break water and put in internals- is that accurate? I know you know this but I have to say it anyway - AROM makes labor more intense, if baby is malpositioned you're taking away the small cushion of fluid that keeps it from going further into the pelvis (thus giving it more time to turn before it descends any further)-- meaning more epidurals, more posterior pushing, more vacuums, etc. Also, why the ifm w/AROM? I know all the details aren't here, but just seeing the pattern in these 8 moms and had to ask. Why not give moms telemetric monitoring that would allow them to be mobile, use water therapy, etc. to cope with pain?</I><BR/><BR/>My answers are not going to jibe with the ideals that you, as a doula, hold dear, I’m afraid, but remember that the patients who seek my care want a hospital birth with a doc and all that goes with it. I love for my patients to go into labor naturally. I want them to walk and do whatever they want to do to cope with labor. Most of my patients want to lie in the bed, not walk, and get meds/epidurals once they stroll in the door. If they want to walk, etc. I totally work with them on this, but I usually don’t induce these ladies unless there is a medical necessity. We don’t have tubs in our rooms, so water therapy, unless you want to stand in the shower, is out. If I am to be out of the hospital (the office) at the time of my inductions, the nursing staff prefers internal monitoring to external, and since I do try to break water on those that I can, I’d rather place them at that time than get called 2 hours later while I’m in the throes of office work to be told that they can’t pick up heart rate or contractions regularly. Having been through labor myself, my water broke on its own when I was barely a fingertip dilated, and it was miles different pain-wise prior to ROM and after. This is why, if my patients have decided on epidurals, I try to get them to get one before I break water. Last week was an anomaly, as I usually try to schedule any inductions I have on a surgery day, so I am in house, and can afford a more leisurely labor pace, if that makes sense?<BR/><BR/><I>-- doulas, nurses, docs- we know too much about birth to 'surrender' to it. So we stay in our heads and we don't get primal, and we have more interventive births. There's a saying I've heard time and again- docs either have homebirths or elective cesareans- they either trust birth or they have 'seen too much' and want to avoid the unknowns of labor, and go for what they know. I don't know true it is - one of my clients is a FP who does OB and she had an incredible unmedicated birth where she labored until 8cm at home, got to the hospital in time to push out her son who was perfect- a very powerful experience for her.</I><BR/><BR/>I was not able to be able to labor on my own, as I developed pre-ecclampsia at term and was induced with cytotec (with a big fat bishop score of 1, for pre-e), myself. I also clamored for my epidural about 20 minutes after my water broke because I was hurting (and I can take pain). From the time my water broke to delivery was just a little over 6 hours, and I would have liked labor much better if my 1st two epidurals would have worked. Let’s face it, they call it labor for a reason! Luckily my 3rd epidural try kicked in just before it was time to push (20 minutes pushing, total), so I didn’t have to feel them sewing me up afterwards, at least. I was totally shocked that I didn’t end up with a C-section. I totally expected one.<BR/><BR/><I>-- Have you considered going into a birth situation as a labor support person? It's something I think all OB docs would benefit from, in a variety of environments, to see what labor can look like at the 'other end' of things. I find my experience as a doula has crafted my values about birth and helps me to stay grounded when I've seen things that have gone bad, and to remember that more intervention does NOT equal less bad outcomes.</I><BR/><BR/>In my spare time, you mean? ;) As a med student, I had some time to be on the midwife side of the labor hall, coaching and what-not. I found myself having to sit on my hands and keep from holding my breath and wanting to DO something. I just can’t watch ugly decels on the monitor and think about the acidosis that is brewing beneath without intervening. Is that motivated from fear of a bad outcome? Most likely. I guess this is why midwives prefer intermittent monitoring?<BR/><BR/><I>-- the suspected macrosomic babies are a HUGE bone of contention among doulas as we attend FAR too many inductions/cesareans for babies that come out 7# and even smaller! It's not fair to women to not give them a chance to try - who knows how large of a baby their pelvis will accomodate? I've attended a shoulder dystocia so I absolutely know that concern, but given how often this is inaccurate, is it worth the risks of a surgical birth for the chance that the baby might be big, for the chance that the baby that might be big, might get stuck? I guess for a lot of docs it is- just throwing it out there as something to think about.</I><BR/><BR/>I’ve learned to take this with a grain of salt, these supposed macrosomic babies (dystocia and all that can go with them), but you wouldn’t believe the pressure from the patients! “I can’t push a baby that big out! How early can we induce/section?” I am not kidding. I have to talk more patients out of inductions than you know. ACOG guidelines state that elective section should be offered to all women whose babies measure 4500 grams or more. I get more than a few takers. Once again, one also needs to factor in the litigious nature of our society, as sad as that is. It is better to section and have a good outcome than to not section and have a bad outcome. This is a mantra that has been hammered into us as long as I can recall being instructed in OB. Times are changing. Again, I suspect the women who strongly desire truly natural birth are seeking OB care from midwives and birthing centers, not from hospital-based, scary, mean old doctors.<BR/><BR/><I>You are doing great work!! Thanks for sharing! :)</I><BR/><BR/>Thank you, thanks for listening, and good luck!dr. whoo?https://www.blogger.com/profile/10315615480530297472noreply@blogger.comtag:blogger.com,1999:blog-31146535.post-1156101080299725462006-08-20T15:11:00.000-04:002006-08-20T15:11:00.000-04:00Hi Dr. Whoo, I'm glad to have found your blog as t...Hi Dr. Whoo, I'm glad to have found your blog as this is what I want to do. :) Would you tolerate a few questions from a doula/premed? :)<BR/><BR/>-- Why using cervical ripening agent (cervidil?), AND cytotec, and pit? Aren't the first two redundant, and would the combo put her at increased risk for UR? <BR/><BR/>-- YAHOO!! VBAC is alive in some areas of the country, what a relief to read that you attended her, put your worries in your pocket and leapt in with her. What a triumphant moment for that mother!<BR/><BR/>-- From your notes here, it sounds like your routine is to break water and put in internals- is that accurate? I know you know this but I have to say it anyway - AROM makes labor more intense, if baby is malpositioned you're taking away the small cushion of fluid that keeps it from going further into the pelvis (thus giving it more time to turn before it descends any further)-- meaning more epidurals, more posterior pushing, more vacuums, etc. Also, why the ifm w/AROM? I know all the details aren't here, but just seeing the pattern in these 8 moms and had to ask. Why not give moms telemetric monitoring that would allow them to be mobile, use water therapy, etc. to cope with pain?<BR/><BR/>-- doulas, nurses, docs- we know too much about birth to 'surrender' to it. So we stay in our heads and we don't get primal, and we have more interventive births. There's a saying I've heard time and again- docs either have homebirths or elective cesareans- they either trust birth or they have 'seen too much' and want to avoid the unknowns of labor, and go for what they know. I don't know true it is - one of my clients is a FP who does OB and she had an incredible unmedicated birth where she labored until 8cm at home, got to the hospital in time to push out her son who was perfect- a very powerful experience for her.<BR/><BR/>-- Have you considered going into a birth situation as a labor support person? It's something I think all OB docs would benefit from, in a variety of environments, to see what labor can look like at the 'other end' of things. I find my experience as a doula has crafted my values about birth and helps me to stay grounded when I've seen things that have gone bad, and to remember that more intervention does NOT equal less bad outcomes. <BR/><BR/>-- the suspected macrosomic babies are a HUGE bone of contention among doulas as we attend FAR too many inductions/cesareans for babies that come out 7# and even smaller! It's not fair to women to not give them a chance to try - who knows how large of a baby their pelvis will accomodate? I've attended a shoulder dystocia so I absolutely know that concern, but given how often this is inaccurate, is it worth the risks of a surgical birth for the chance that the baby might be big, for the chance that the baby that might be big, might get stuck? I guess for a lot of docs it is- just throwing it out there as something to think about.<BR/><BR/>You are doing great work!! Thanks for sharing! :)RedSpiralhttps://www.blogger.com/profile/18307556026724125766noreply@blogger.com