It's been a long time since I really had a dropped jaw moment but this
thread is creating them left and right.  In particular, the realization that
Sarah, as an anesthesiology resident, is required to assess and classify the
'airway' of every woman on the labor ward, which she does during the
anesthesiology rounds there, if I have understood correctly.  Sarah, your
last post left me wondering whether you are also required to inform the
women that "Moms at our institution, by virtue of simply being there (and
depending on which OB is on call), are setting themselves up for at least a
30% chance of cesarean delivery."  If not, why not?  Because it's too late
to matter by the time they are admitted in labor?  What would happen if the
person responsible for childbirth preparation at this hospital started
informing expectant parents of this statistic?  Would they be praised for
honesty or fired for scaring women away?  The largest maternity unit in
Norway published their figures showing the chances of a primiparous woman,
with no obstetric risk factors, having a normal birth plummeted to about a
third of what it was at the outset, if she got an epidural.  The most common
indication was failure to progress.  Big surprise (not!).

I am nearly one hundred per cent certain there is not a hospital in Norway
where anesthesiologists make rounds on the labor ward.  I've never heard of
such a thing and I doubt my colleagues here will believe me if I tell them
there is a hospital in the US where this is routine.  Maybe it is routine in
many hospitals and no one has ever mentioned it because it is just a given.
It's news to me, and very startling news at that.  I'd like to hear from
people privately about what the routine is in their hospitals.  I can't even
imagine what it would be like to have that many anesthesiologists around,
and I work at a regional hospital with a tertiary care neonatal unit that
serves a population of well over one hundred thousand people.  

Brace yourselves now: in most labor wards in Norway, the on call
obstetrician doesn't make rounds to all the women in labor either.  What
does happen is that the charge midwife on the labor ward sits down with the
on call obstetrician around nine in the morning, and they briefly review the
labor record and obstetric history of every woman currently on the ward.  If
there is a woman who needs to be examined by a doctor, the doctor goes with
the midwife and examines her.  A healthy woman laboring normally will never
see a doctor during her labor or her postpartum stay, unless she develops
complications then.  Barring that, the midwife on duty provides all her
care.  She might not even catch a glimpse of a doctor in passing, they spend
that little time on the ward.  

It is so rare that a mother is intubated, I can barely remember the last
time.  We use spinal anesthesia for virtually all CS, planned and unplanned.
Since the anesthesia department began with this practice several years ago,
intubations are a thing of the past.  We do still tell women not to eat or
drink anything after midnight if they are scheduled for a CS the next day.
All other women in labor eat and drink ad lib.  If a woman with an epidural
for a vaginal birth ends up with a CS, I believe they just increase the dose
of anesthetic in her epidural, though I could be wrong on that.  Our
epidural rate is under ten per cent but we do use scary amounts of fentanyl
IV (don't get me started!).   I've worked in this hospital for a couple of
decades now and I am not aware that we have ever had a mother aspirate her
gastric contents, not once.  We have plenty of women who are way overweight
and not very healthy.  We have a lot of migrants from Asia, South America,
and Africa, as well as all of Europe, east and west.  In my hospital we have
more than the average number of adolescent mothers.  Anyone in the area who
is having a baby has to come to us because it's the only show in town, and
in about four towns in all directions from here too.  We don't get to pick
and choose and only take the healthiest upper crust of the populace.

Here I was, thinking I work in an unbearably technified setting where normal
birth is an endangered species, and now I realize there is hope for us yet!


Rachel Myr
Norway, one of several countries where it is safer than in the US to give
birth or be born in 2007

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome