OK, so in place of antibiotics what would you suggest, Alimat? Spitting on infection sites? Rubbing some mud in? 200 babies died in the UK from GBS; would their parents have preferred routine ABs or your cautious approach? ABs do far more good than harm. They are not bad things to be shunned.
And one 'chance' you mentioned was not a 1 in 1000 'chance', it was 1 in 15,000. I personally would take that chance.
My objection to most of the alleged 'risks' being waved about here is that those crying wolf are not stating what the real risk is. 1 in 1,000 is a long, long way from 1 in 15,000.
As for the claim that US maternity care has a different ethos from the UK -- not so. Same slop, different bucket. Practices in US hospitals do not vary all that much from the UK, though they vary greatly from hospital to hospital and even from doctor to doctor, or MW to MW. If anything, there's an even greater pressure to 'perform' in the US, women there have low bfing rates and have to return to work much earlier. And afterwards there's no HV to come round.
'Math - ages ago you asked how often we give out tinzaparin as you didnt believe it was a big problem for postnatal women dying of DVT.
In my unit I would think that 1:4 women go home on 7 days of tinz and around 1:15 go home with 6 weeks supply.'
I don't know how you managed to misread me so thoroughly. I didn't believe the cost should be touted as a big problem. I didn't believe increased monitoring after an epidural was causing DVT/ VTE problems or deaths.
Again, read what I posted about the causes of DVT. They are not labour/ epidural/ monitoring related, which was the context of my remarks. DVT is a byproduct of pregnancy, beginning at 16 weeks, with risk increasing to term. You tried to suggest it was the increased need for monitoring with epidurals, and women lying in bed during labour instead of moving about, that caused it. You were misinformed.
Here's a RCOG information publication (pdf) about DVT. Heparin is used to prevent clots during pregnancy and is continued after birth for those who have used it up to birth maybe these patients account for some of your 1 in 15? You can bfeed with heparin and it does not cross the placenta. Apparently the only problem with heparin is that an epidural cannot be given until 12 hours after the last injection of heparin, if a woman has been using it during pregnancy. And get this "You will have the option of alternative pain relief" -- Not in some hospitals you won't. Here the RCOG apparently sees no problem with heparin, states that it is used to control conditions related to pregnancy itself, not to lying in bed during labour, and also seems to say that pain relief raises no eyebrows.
You also told us how much a 6 week course of tinzaparin costs for that 1 in 15 woman £995 as if that should be a consideration when deciding if a woman should get an epidural. If cost is going to be factored in then women should just squat where they are when pushing time comes and avoid hospitals and prenatal care altogether. I marvel at your priorities.
Apparently:
Monitoring = bad
Effective pain relief = risk of death for mum and baby
Antibiotics = the work of the devil, and not the way forward
Costs associated with childbirth in hospital = unconscionable
Real statistics to back up scaremongering = to be avoided
Tell all that to my mum's cousin, the now retired district midwife, and she would laugh in your face.
From RCOG statement on NICE Clinical Guideline 55, Intrapartum Care: Note that the requesting of epidurals and the prevention of unnecessary pain are seen as an advantage of having women labour in freestanding birth units as opposed to delivering at home (the context of the paragraph). 'Co-located unit ... also provides women with the option to request an epidural for pain relief. It avoids long waiting times and a possible ?rough? ride in an ambulance when mothers are already in pain or in the second stage of labour.'
Cleo -- wrt VEs. Yes, VEs are intrusive and yes they are done despite that, because they are one very useful way of assessing progress in labour. You can check whether the cervix is ripe or open and how far labour is advanced when a woman first turns up at the hospital. You can check progress of cervical opening, and effacement, and how far the baby has descended, plus whether baby's head or some other part is engaging, and whether the head is facing front or back. They are not the only way, but one way. To say an epidural cannot be administered until a VE is done and then refuse to perform one and end up with a patient who does not therefore receive effective pain relief is just cruel. If VEs are to be avoided, then other signs can surely be used in order to provide clues about timing for the purposes of an epidural?
And furthermore, it is a huge contradiction to express concern for the how women feel about VEs, concern about their intrusiveness and the feeling that someone has poked their fingers up to your tonsils, yet argue against epidurals. I suspect that most women given a choice between having a VE or going without an epidural would choose that VE, intrusiveness be damned.
OBs in private practice in the UK see 'normal' patients. Same in Ireland, where there's a dual state/ private system and proportionately more private patients. They train far longer than midwives do and have a basic general medical and pharmacological education that is far superior to midvives' education before specialising. Outline of training here from RCOG. They specialise in pregnancy, labour and delivery and their training encompasses both normal and unusual situations.
Arsebiskits, you really don't like The Man, do you? 'It is the midwife's responsibility to provide the evidence, where it is available, as to the risks and benefits of any intervention. But if that same client group is going to call midwives' integrity into question, or simply refuse to believe what they're saying, then there's no point in us even practicing. Being 'with woman' goes deeper than just saying, "yes, you must have that intervention because you want it, and of course you must have it right now because you stamped your foot, no of course it won't cause you any harm." Being 'with woman' involves telling the truth about interventions then supporting their informed choice.' That statement is one of the most arrogant and contempt-filled I have seen about any group of patients and about any medical professional's mission. Everyone involved in L&D is out of step except you apparently. The integrity of midwives is called into question when they fudge facts and present risk as likelihood, and omit pertinent information like actual figures -- 1 in 15,000 for instance.
WRT CS rates -- the foremost factor contributing to CS rates is maternal obesity.
Poppyella -- 'facts as they happen in real life' are not statistics. They are anecdotes. If you feed your patients anecdotes you are not telling them facts, you are not telling them what the real risks are. You are recounting your own experience and they are not the same things at all.
And as to assuming I went back 5 times so it couldn't have been that bad for me my own experiences (one epidural, four non-epidural, three inductions, two spontaneous labours need a venn diagram here -- one lazy, horrible, mendacious nurse and all the rest fab) have nothing at all to do with my thoughts on the way other women are treated. My arguments here are based on facts and not my own personal experience masquerading as the ultimate truth (in contrast to what many of the MWs here seem to be doing); the idea that if I got on ok why should I be bothered by the experiences of others is a cold one indeed.