Opinion from my friend the doctor!

[ohthegoats]

I have a friend who is a high up anaesthetist. We were just out for lunch with her and a group of others, most of whom have kids already.

The doctor's advice on birth is:

If things go early and seem easy, then all is fine - go for the natural option. If you are overdue and they start talking about induction, then do the following: don't turn it down, they are suggesting it for a reason. Go in for the induction sooner rather than later, have an epidural as soon as they will let you. If things work OK for you at this point, then go for the 'natural' option. The minute they start talking about interventions because something has slowed it down, or you're not progressing etc, refuse the drip to speed you up, refuse forceps or ventouse and just ask straight away for a C-section, before things get too far along. Put your foot down on the issue. The epidural is already in, you're not already massively knackered, and often a calm, non emergency C-section is easier to recover from than a failed induction/ natural birth/ forceps tear/ cut. That's what all doctors would do.

So... what do you reckon to that suggestion? Oddly, as she was telling this story I remembered another friend's birth story - she's in obstetrics somewhere, not sure detail of her job, and that was her exact situation.

I agree! Although I have to say, it's true, those of us on team Anaesthetics do have a skewed view on birth because we mostly see the grim side of it.

Before I even conceived, I knew I wanted a CS. Best decision I ever made!

"post dates (40+1) is not at all the same as post term (43)"

In the studies, post-dates has been defined as after 41 or 42 weeks, not 40+1. Induction after 41 weeks reduces stillbirth and reduces emergency sections (before then there are possibly more sections as a result of induction), although clearly and sadly as you and I both know from personal experience stillbirth can happen at any gestation.

"Adding in a third tri and post dates growth scans and umbilical cord dopplers would do a lot to identify placenta function. "

This is a really interesting but there is no evidence to support this (which is needed as it would be costly so they need proof that there is benefit) so a big study is looking at this in Cambridge. although I've not seen any results published from it yet. It involved a few extra scans as you have suggested to see if it made any difference to outcome. I think it will be really helpful when it is published to see if recommendations change as a result.

cambridge-brc.org.uk/content/conduct-pregnancy-outcome-prediction-study

I'd also like to add it takes around 13 years to become an anesthetic consultant. It's not some 3 year fluffy degree.
Anaesthetic doctors have seen and know a lot!

A student midwife also caught my second. I had an epidural with my first, who was face up and had her left hand up cupping her head, so had no idea I was as far into labour as I was with the second.

Saving this for future reference! Sounds eminently sensible

"Anaesthetic doctors have seen and know a lot!"

Of all medical specialisms obstetrics is the only one where the promise that doctors should 'first do no harm' is routinely and consistently violated. I hope in the next century obstetrics will learn to stop throwing the baby out with the bathwater.

Personally I think the view of a doctor who is steeped in a culture of medicalised birth should always be balanced with insight from midwives - who are the only health professionals who are routinely involved in the care of women across the health and risk spectrum.

I had a student midwife at my first birth. She was brilliant and stayed throughout the whole thing, even though her shift had ended.

It was her first birth, too, and although she didn't do much, she was continuity for me, and she made me much more relaxed as things went wrong.

I'd have let a student doctor in. I might have been a bit if the student doctor was doing much, but they have to learn at some point, with someone. And by the end, there were so many people going in and out of my room that I wouldn't have known the difference.

I request a medical student!

My rationale is that:

a) medical students are usually allocated to more experienced midwives, therefore increasing my chance of an experienced midwife

b) medical students are generally terrified that something bad will happen to a patient while the supervising midwife has nipped next door or similar. As they are generally expected to be present for the whole labour, it seemed a good way of ensuring someone was always with me, who would have a low threshold for getting help if I felt something was wrong

c) reciprocity. If complications do happen, pretty much everyone wants to have an experienced obstetrician / anaesthetist / paediatrician sorting them out. How are people meant to learn if they aren't given opportunities?

Hmmmm, have to say the arrangements other people have/have experienced for students are much better than what happened to me. I had a gaggle wander into my room following the consultant on ward rounds. Who then spoke to mw and his colleagues but didn't address me. Made me very wary for the next births.

"medical students are generally terrified that something bad will happen to a patient while the supervising midwife has nipped next door or similar. As they are generally expected to be present for the whole labour, it seemed a good way of ensuring someone was always with me, who would have a low threshold for getting help if I felt something was wrong"

Or having someone with you whose twitchiness, fear and lack of confidence in the process will impact on your ability to labour efficiently.

Sorry, haven't read the whole thread but as a MW one point I want to pick up on is this.what I would say is that in accepting the induction procedure you are accepting the induction procedure. You cant pick and choose which parts of it you want. I.e. I will be induced but not accept the drip, well, that is a big part of induction so if you refuse that option you should speak to your consultant about just having an ELCS because most women need the drip to complete the process and induction is there for the sole aim of delivering the baby.

Nicole, yes, it might.

People are different.

I would rather have someone to send for help than another precipitate labour alone.

I haven't read the whole thread, but my experience runs contrary to OP's advice. I think I chose the right option in my circumstance and am glad I avoided CS.

I had the experience in my birth of getting to the point (after 24 hrs of labour, meconium, epidural, contractions tailing off with exhuastion) of discussing a c-section rather than drip and possible intervention. I was quite clued-up, had heard advice like the OP's friend, and was concerned about forceps and pelvic floor damage.

I was lucky enough to have a consultant who listened to my concerns, gave me time to think and said that he would take me to CS if that's what I wanted, but that in his medical opinion, some syntocinon augmentation would work and I could still achieve a good vaginal delivery. He was right. I did have some help with a ventouse and an episiotomy, but neither were particularly awful and I healed very well and very quickly.

I think that must differ in different trusts angie, I had the pessary, was asked if I wanted to attempt ARM (could have declined), was asked if I wanted the drip (could have declined). The only thing I didn't really have a choice on was the section.

"Or having someone with you whose twitchiness, fear and lack of confidence in the process will impact on your ability to labour efficiently."

Please don't tar all medical students with the same brush!

I enjoyed the labours I attended and was given an increasing amount of (very supervised) responsibility the more I attended. I hope I was a helpful member of the team and supportive of the parents.

I remember one lovely delivery where for the most part the mother slept in between contractions and generally the father and I were at either side of the bed reading quietly.

Just having a bunch of kids in the room, because a lot of them are in the UK where they start training them to be doctors so young, whilst I was trying to accomplish an intimate bodily function was enough to put me off having medical students.

I wouldn't even let them round my daughter when she had cancer.

Too young and immature.

The student midwife who helped deliver DD2 was close to qualifying and had been a nurse for years before, so I felt okay with her.

I wasn't a "kid" as a medical student. I was in my twenties when I started clinical work. Obs & gynae was a 4th year placement which means I was 23 - hardly a child.

It was very hard as a medical student having spent several hours getting to know a labouring woman, trying to support them after having been given permission to work with their midwife to deliver their child - to then have a student midwife raced in once the woman was in second stage "because she needs these deliveries more than you" and be shoved out of the room. It happened more often than not (surprising I managed to deliver my required 30 babies at all!). And I wasn't allowed in after the delivery to congratulate the parents because "she's delivered now, not your concern" - I always wondered what those mothers thought.

If you don't allow doctors to train - where will experienced doctors of the future come from?

I've just never had a good experience, and for some reason my local hospital seems intent on pushing them on me despite sad circumstances.

During antenatal checks, there was a student midwife sat in with my community midwife, and she was tasked with taking my BP. She broke the first machine, went off to find another, couldn't, damaged the manual pump, all the while I was panicking cos of white coat syndrome. She then took an abnormally high reading and they admitted me to hospital. Funnily enough, at hospital it was normal.

When I was in labour with DD1 and my meconium stained waters went, I KNEW something was wrong and was begging them to find the heartbeat. They asked if a trainee midwife could do it. I mean, my world was ending. I was just dumbfounded. And then when she didn't find the heartbeat, she had the nerve to say she would get someone more experienced, like there was still fucking hope.

And with DD2, I have a sticker on my notes saying I've had a previous stillbirth, and I start every scan with a polite request to find the heartbeat ASAP as otherwise I panic. Anyway this one a student sonographer did it, of course didn't bother to say or show me that the heartbeat was ok, and after about 2 minutes I was in complete hysterics - we had to pause the scan. This was my anomaly scan too, and I think it's completely inappropriate to expect women who have had a previous loss to take a trainee when they will automatically be more nervous.

They make it so hard to say no as well, as every single time, I've been asked in front of the student. I am writing no students on my birth plan in case I'm trf to hospital. But never again will I accept one due to the above experiences.

23 is a kid. It's an intimate and personal experience for many women and they are well within their rights to say no to students. Some people are okay with it, others are not.

Oh, I had no problem saying no.

I said yes to all students and even got extra acana for a training day...
How will they learn??

And this was after 3 MCs...

That's great. Exercising a personal choice. How will they learn? Some people say yes, and others don't.

Some have had miscarriages, others have not.

I totally agree. I think that most physiotherapists who deal with birth injuries would probably agree.

"23 is a kid."

That's pretty insulting! Anyway, I was a proper doctor at 22!