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.

After having birth that nearly killed me I totally agree with your friend. Not worth the risk.

Oh and it as the Consultant Anaethetist that saved my life and without him I'd have been dead. So yes I do take what they seriously as they ar the ones that sit there and watch it all go horribly wrong.

Expat I don't disagree with you that lots of 23 year olds are immature, but saying "23 is a kid" as a blanket statement is a bit silly.

Would you say that about a 23 year old woman in labour?

23 isn't a child. Many 23 year olds are immature but then so are many 40 year olds. I've looked after my fair share of extremely immature adults but I wouldn't class them as kids, just adults who have had different life shaping experiences and who may not have had to grow up in the same way others do.

My 3 crappy experiences, all of them were at least 30, definitely older than me.

My current 121 midwife who I'm hoping will deliver my baby is around 25 and younger than me.

It's not an age thing.

When am I going to encounter a woman in labour, fgs?

I didn't want students in the room as all the med students I had experienced by then, and have since, have been immature beyond belief and so it wasn't my choice to share an intimate experience in their presence. So sue me.

No, I think that's completely fine and that's totally your choice!

All I'm disagreeing with is that 23 isn't a kid. You can be immature at 23, 43, 63 etc etc. No-one would deny a 23 year old woman the right to make decisions about her own medical care based purely on her age - because 23 is an adult.

It's completely safe to be born at 37 weeks as that is full term, this is why labour is not halted then.

The comparison is relevant, because it points to the fact that there is no reason to automatically induce before 42 weeks just based on an estimated date. There is as much reason to induce before 42 weeks as there is at 37 weeks in an otherwise normal pregnancy.

Expectant management IMO would do a lot to reduce unnecessary induction, as well as stillbirth. It's my belief (based on anecdotal evidence) that if a baby is suffering from placental insufficiency, that induction (and even natural labour) is too dangerous. I have known completely healthy placentas at 43 weeks, and completely dead placentas at 36 weeks. There is no reason to induce a non iugr baby with a well functioning placenta.

I will state that I'm in no way a medical professional, this information comes from research around DDs stillbirth, and participating in clinical trials for a post loss pregnancy and a vbac.

23 is very young if all you've ever done is attend school and study.

A high percentage of medical students come from educational and home environments which are socially very narrow. I've met some who appear to see ordinary people as being from another planet.

"induction is there for the sole aim of delivering the baby"

I have a problem with this attitude, which was also rife in the hospital where I gave birth - as long as baby is delivered alive and mother is also not dead, they thought all was well

Well, it's not. Post-partum well-being of the mother also needs to be a consideration for choice of birth procedure. That is what OP's friend is talking about - if your induction goes pear-shaped, consider choosing a calm, non-emergency CS from which you'll snap back into your previous self over a failed induction with forceps & ventouse, possibly leading to pelvic floor damage & prolapse, and a huge episiotomy the aggregate damage of which will probably stay with you forever.

I agree Nicole - but I personally started medical school at 26, came from a working class background, hadn't done a first degree, had worked shitty jobs, been living away from home since 18, been poor, depressed, and took a year out of medical school to have dd. My brother is also a heroin addict.

My situation is fairly unique, but don't assume all medical students are the same. I am always astounded at how mature and grown up many of them are, my cohort was 9 years my junior in the end, but many became true friends. Mental health problems are higher prevalence in media students than the rest of the population. Friends if mine dealt with anorexia and deaths and divorces of parents. Not all of them were middle class, some even had regional accents!

Don't assume that just because someone is in medical school they have never known adversity. For many (myself included) it is the reason they choose to study medicine in the first place. Most medical students I have met are far more emotionally intelligent than other people their own age, and I believe the new cohort of doctors coming through the more progressive medical schools will be very different to previous generations.

My mum's memory of students was hearing "we have a vaginal delivery of twins..." and the room filling up with clipboard wielding acolytes of the consultant. She wasn't upset by it in the slightest but she is very, very hard to embarrass just as well.

My biggest worry about having agreed to have medical students in the room (having been one myself, as I've said, I think it is really important for them to get the experience) is that some day I'll go on to the ward and meet my new junior doctors.

"Hello, I'm Dr Snores, the consultant here."

for some poor junior doctor to raise his hand and say,

"Hi, I think we've met before!"

Hello Dr Snores, I watched you poo yourself whilst shouting 'it bloody stings'

Perhaps not the gravitas you want to convey as their boss.

On a related note but in the reverse...

I recently had a legs-akimbo no-knickers MW appointment. At which the trainee MW suddenly recognised me with a cheery "Hello Miss!", having known me about 8 years ago as a fresh faced teacher.

The perils of teaching.

When I had ds, my only svd, the midwives asked if I minded students.

I didn't, I'd got through dd1's delivery, I didn't mind.

I thought they were midwife students, was all cheery.

They came on shift at 8, ds was born at 8.30

Turns out they weren't midwives, but nursing students.
This was their first placement.
They were 17/18.

First thing they saw in their nursing career was ds crowning!

They were SO thankful, and afterwards popped in often to my room, we talked over feeding, nappies, pelvic floor etc. we left 2 days later - the 2 of them had gone out and bought him lovely dungarees and tiny wellies!!

If you are okay with students, let them in. If you change your mind, tell them to go away. If you don't want them in at all, say no.

I just wish they wouldn't ask in front of the student. At my last scan, the student was sat in the sonographers chair ultrasound wand in hand, all ready to go.

Very awkward. I'm going to put a post it on my notes in future.

I can imagine that being awkward.

Not pregnancy related, but my mum was in hospital last November with abdominal pain and needed an ultrasound. Turned out she had an infected bowel. The monographer had an unusual clear shot of the problem area and asked my mum if it would be okay to bring in some students to look at the image. She was fine with that, so in came the students. Then he asked if it would be okay for one of the students to hold the 'scanner' and search for the infection. She declined, as it was really painful for her and she didn't want a student causing her more pain.
I still have no clue how they can tell what they are looking at though. It was a mass of different shades of gray to me!

I had one of my students (a single mum in her 20's) from the FE college I taught at, at my homebirth - we'd struck up a friendship and she wanted to support me, and also was applying to study midwifery so thought it would help her application.

I did remember at one point thinking 'three weeks ago I was marking your essay, now I'm crying and shitting myself in front of you'.

Maybe it was my caterwauling, or the trauma of witnessing a homebirth involving an 11lb baby and a shoulder dystocia, but she changed her study plans after that and went off to do an MA in art history....

I had a student MW deliver my third child, she had never attended a home birth before so I said it was fine. It was educational well, I got a guided tour of the placenta afterwards when they went through all the checks. I'd never really taken much notice before then.
Also had some students in for a colposcopy many moons ago, it helped me as well as them I think. The gynaecologist explained everything in greater detail to all of us and I was more aware of what was going on. She also turned the screen round a bit for me so I could see
One of the students held my hand when I got a bit shaky and tearful afterwards. I think it was her first colposcopy as well..