Notes on period obstetrics

[bunnyjadwiga]

The first recorded case of a C-Section operation survived by the mother appears to have been in Germany in 1500, performed by the desperate father-- Jacob Nufer, a pig gelder.

Rectovaginal fistulas (which is one of the complications that episiotomies were developed to combat) were common and long-term complications of birth in the 19th century. Between 1845 and 1850, James Marion Sims came up with a speculum that allowed repairs to be made and perfected a method by operating on a number of African-American slave women who had such fistulas. He later made his fortune performing the surgery on upper-class women who also demanded the now-fashionable anesthesia for the operation.

The 16th century Rosegarden for Pregnant Women and Midwives recommends that overweight women deliver in a hands and knees position that is widely mentioned in the current delivery/midwifery literature as a method for reducing shoulder dystochia (where the child is trapped in the birth canal because the posterior shoulder cannot be delivered). This manuever, however, is not easily executed in a modern standard delivery room due to the presence of monitoring equipment.

Comments

[magicksaff.livejournal.com]

On all fours is one position I didn't try with either child 'o mine. Birthing stools rock and to minimize modern interventions, I found my midwife to rock. LOL... oh and a jacuzzi is a godsend. LOL

When I was prego with Boy, I read a book called Lying In ... it was a history of childbirth in America and made for very interesting historical (and relevant as a mama) reading.

[paquerette.livejournal.com]

H&K is great for posterior too, or sometimes just because. It was my preferred position my first labor.

I don't think it's the monitoring equipment so much as the doctor's comfort (have to get up off their little stool) and the sort of weirding out factor that any position other than lithotomy tends to give the staff.

[bunnyjadwiga.livejournal.com]

I was just going by what the midwifery journals (British) said about the position.

[anastasiav.livejournal.com]

We have a dear friend who is a L&D nurse at a local hospital with a large, very popular birth center (called "the birthplace"). They just built a brand new facility that includes ... wait for it ... full size (ie: "double") beds in every room because so few women were willing to birth in the "on your back and put your feet here" position any longer.

Slowly, slowly the culture is able to drag the process of giving birth back to a more sensible state of affairs. Slowly.

PS: A number of friends have pointed me towards a film called The Business of Being Born in recent weeks. I haven't watched it yet, but if you have a chance I suspect you should.

[madrun.livejournal.com]

"I don't think it's the monitoring equipment so much as the doctor's comfort (have to get up off their little stool)"

Halelujiah.

Trust me on this one...

[bunnyjadwiga.livejournal.com]

If I can't successfully refuse having a wire going into the birth canal, I'm pretty sure I'm going to experience some difficulty getting up on my hands and knees.

*sigh*

[bunnyjadwiga.livejournal.com]

I know perfectly well that I'm being dragged through this medical supervision hell-- and will be badgered to have C-section and/or induction-- for the comfort of the doctors. They are terrified that something will go wrong and someone will sue. In particular, fat mothers and GDM are heavily associated with macrosomia-- big babies-- which is associated with shoulder dystochia which is one of if not the biggest cause of obstetrical malpractice suits. Of course, I will probably have to be completely honest with my doctor and say: "If you force me into a C-section, and something goes wrong, I'm much more likely to find a lawyer than if we do this the normal way and something goes wrong."

[paquerette.livejournal.com]

Shoulder dystocia is somewhat more random than that. About half of all cases are large babies (and not all large babies are macrosomic; there have to be inappropriate proportions that I don't know the specifics of for that). So half of shoulder dystocias are babies about 8 lbs and under. And true dystocia is probably rarer than the stats would indicate. Many cases that get chalked up to it are probably just "sticky shoulders", not stuck long or hard enough to be dystocia.

If you do end up with the scalp electrode, it is possible to move around. Possibly moreso than the belly band. They should tape it to your thigh. A support person can hold and guide the wires while you change positions, walk around even. Some doulas have reported that some patients have had better mobility when switched to internal monitoring.

Of course, intermittent monitoring is the gold standard. But I know that you might end up wanting to pick your battles and that might not be one.

[marinda-4.livejournal.com]

More as a comment on your other comments and not your original post...

Prior to giving birth this past February, I fought tooth and nail to have my child naturally, without drugs. My OB and I - a midwife wasn't experienced enough for the problems I was having - had a great relationship, and she was willing to try anything except let me get in the water tank (long story).

Or in other words, fight for what *you* want, and to h*ll with what the doctor wants. I went through three periods of hearing "you need a C-section" and I fought each one, followed the rules, diet, and insulin (I had GDM), and was ready to do it my way. On my own schedule too, not on what they wanted.

Of course, my child had other ideas and 1 day after my due date my last ultrasound showed that he had turned breech (again) and I had a C-section the following day because *no* hospital in this area will naturally deliver a breech baby for a first-time Mom. (I checked.)

I did a lot of research on GDM, fat Moms (because I am one), etc. Let me know if you're interested and I'll direct you to the sites and books I used.

[bunnyjadwiga.livejournal.com]

Thank you! Yes, I'd like pointers to what you've used. I have done a lot of research but all it's telling me is that the clinical research and the management protocols don't always match. And there's no such thing as attention to Quality of Life in the GD preggo.

[marinda-4.livejournal.com]

Of course, having offered, I don't have the time right now do get it together. I'll leave this reply active to remind myself, and put together a list tomorrow and send it to you. :)

BTW, what did you mean by "Quality of Life in the GD preggo"?

[bunnyjadwiga.livejournal.com]

Oh, "Quality of Life" is one of those medical terms that mean "how much does it suck to be you" and as far as I can tell, in women with gestational diabetes the idea that running 'em around for all this testing might make their lives difficult and maybe even not be worth the stress level hasn't even been considered. Heck, the idea that the misery of induction, NICU, etc. might at all weigh against possibility of shoulder dystochia doesn't show up in the literature. (As far as I can tell, they'd really like to transplant every baby whose mother has GDM into an automatic womb device they could control completely.)