On 4/14/2014 10:40 AM, Elizabeth Brooks wrote:
> Well, now, one of the *most* BF-friendly and evidence-base-conscious
> docs I know, Lactnet's own Alla Gordina, is making me put on my lawyer
> hat today and take up for all those plaintiffs' tort lawyers out
> there, with her statement "the c/sections (at least in part) should be
> blamed not on OB's, but on lawyers."
Oh, WOW, what a rebuttal!
Ouch! I had to know better.. ;D
First and foremost - the cited comment was dealing with a very small
faction of 'breastfeeding unfriendly doctors' discussion, sealing with
doctors opting to do c/sections rather then "practicing good medicine".
Without claiming being an expert in a legal field (my qualifications do
not go beyond being a mother of a lawyer and a friend of many lawyers,
including some on this list) or the OBGYN (besides being a MIL for the
OBGYN resident), the question (at least partially) is about the whole
medico-legal situation, rather then the mere unwillingness of OBGYN's to
deliver babies 'according to the evidence-based data' (as the question
on what does constitute "evidence-based data" is a subject of another
discussion).
I would like to start with the "call the midwife" (as we all do love
this show) episode, when (among other things) the midwives are called to
assist a woman delivering on board of a merchant ship. Sister Evangelina
is injured and can provide only verbal advise while Trixie is stuck with
management of tricky case of a prolapsed cord. You remember the exchange
that follows? (/*legal :-) */ disclaimer: I am citing by memory, so
please, don't flame over any inconsistencies). Didn't they teach you how
to manage the prolapsed cord? - No, they told us to call the doctor (as
this is a case for a c-section). And that is not 2014, we are talking
late 1950's here, not United States, but Great Britain!
Anyhow, I do agree, that a lot of docs are giving crazy advises
privately and very-very publicly. But what about all those ad's "if your
baby was injured during birth..." and the public's right to simply
submit a complaint through official (legal and professional) and mass
media (face book, health grades and so on) routes?
Generations after generations of doctors, and especially OBGYN's, are
trained in fear of repercussions, and even if they are not sued, the
FEAR of such or the mere proceedings that would lead to the case (not
even a legal case, but a "simple" hospital or State Board complaint)
dismissal, would make any normal human being (and American OB's are
human after all) to think twice before attempting the vaginal delivery
of twins or manipulating a breach into proper position, or any other
heroic action that was so routine before the (also "evidence-based!")
advances of anesthesiology and surgery. And we are talking about OB's
who are COMFORTABLE performing such procedures in the hospitals that are
ALLOWING such approaches. How many of such (doctors and/or hospitals)
are left? Very-very few. Most of older American OB's did lose the skill
simply because they are not allowed, and/or scared, and/or do not feel
comfortable doing it anymore. Residents are not being exposed to those
procedures, so how the new generation of OBs, no matter how aggressive
and well-read they are, will know how to deliver twins without a c-section?
And all that is in addition to the well known general (not just doc's,
but hospitals, nurses, public) beliefs that planned scheduled c-section
is "beneficial" (let's say - convenient) for both mother and doctor and
that "who would wait for the unfavorable fetal tracing?".
We all are taught to practice defensive medicine to begin with (the
motto when I was training in Russian medical school was "you are writing
your notes for the prosecutor, not for yourself") and especially in the
present US atmosphere of malpractice constantly looming over your head -
who would want to risk? Here is NJ we did see the professional exodus of
biblical proportions when by the outrageous malpractice insurance prices
so many OB's were forced to leave the practice either to concentrate on
GYN only or early retiring or changing profession all together, getting
completely out of medicine. And unfortunately, unlike the biblical
exodus, there is no promised land in sight...
So, while I am frantically fighting with the "breastfeeding unfriendly"
attitudes of doctors, hospital officials, nurses and others, and while I
am intrinsically (and some times - unrealistically) optimistic in my
fights, I have to admit that in the present situation the question of
c/sections reduction is... extremely questionable.
Therefore IMHO rather then complaining about "those breastfeeding
unfriendly DOCTORS" let's see what we can do with changing the
"breastfeeding unfriendly ATTITUDES" of everybody involved.
In the particular case of c/sections (that we, in the present
medico-legal climate, most probably would not be able to change too
much) - promoting to OB's and anesthesiologists S2S concept (not
kissing, but prolonged S2S with proper time to latch), changing the
"routine" admissions of stable babies to the observation nursery for
"hypoglycemia monitoring", as well as educating pediatricians about the
"weight loss" in "water-ballooned" babies and thus - the need (or
actually - the absence of the said need) in supplementation. And that,
BTW - despite of the so called "evidence-based research" like one
published in Pediatrics last year (but that is - again - absolutely
different discussion).
Peace!
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
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