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Archive for the ‘Rants and Raves’ Category

The Myth of the Unnecessary Cesarean

nec·es·sar·y: being essential, indispensable, or requisite

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.

A popular term bandied about is “Unnecesarean”, a catchy little phrase that implies the underlying belief that most cesareans are unnecessary. Frequently, commenters state that they had a cesarean that they didn’t want, and that at some point later in their life someone let them in on the secret that their cesarean wasn’t really necessary, and this is completely accepted as fact. In some cases, people believe that they were robbed of the vaginal birth they were destined to have, or even that they were somehow raped by the their physician.

Frankly, I am tired of it.

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The Changing Face of Journalistic Ethics in Blogging

I have noticed that a number of bloggers have made it a habit of creating posts that are mostly if not entirely lifted from another blogger’s creative work. On a number of occasions it is my creative work that has been lifted. This is improper.

My first experience with this was with the response to my article Delayed Cord Clamping Should be Standard Practice in Obstetrics. After I wrote this article, a lot of other bloggers linked to it in support. This was appreciated. What was not appreciated were the bloggers who completely copied my post and posted it on their own blog, such as the posts at the Birth Balance Blog and Full Circle Midwifery. These posts are not alone, as this article was entirely copied in at least 5 locations. In some cases these posts refer to me and my original post, while some make it look like I wrote the piece entirely for their blog, without reference to the original post at all. While I recognize that the reposting represents some kind of admiration of my work, it is still a violation of copyright, and is not acceptable behavior.

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Categories: Blogroll, Rants and Raves

Micro Tort-Reform: A potential solution to the VBAC Liability Issue

While the NIH Conference on VBAC behind us, the blogosphere continues active discussion of this important issue.  I’ve been involved in this discussion a bit over at Science and Sensibility.

Here’s the message I am getting from a lot of folks strongly in favor of VBAC rights and availability.

The choice to VBAC is an informed refusal of a intervention.  There should be no “right” required to have it.  Hospitals should not be allowed to refuse VBAC attempts, as this is the same as requiring a woman to have an elective surgery.

I hear a general feeling that the risk of uterine rupture is overstated, as is the likelihood of a severe adverse outcome if a rupture occurs.

I hear a general feeling that the short and long term risks of repeat cesarean deliveries are overstated.

I think these are good messages.  I agree with women should be be free to refuse repeat cesarean delivery, even in hospitals that do not have 24 hour anesthesia access and 24 hour OB coverage.  As long as this refusal is informed, it should be a woman’s right.  I also agree that the risks of VBAC are overstated by many, and the risks of repeat cesarean are understated by many.

The problem is liability.

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Delayed Cord Clamping Should Be Standard Practice in Obstetrics

December 3, 2009 302 comments

There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things.   This happened with episiotomy in the last few decades.  Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice.

Episiotomy was supported in Medline indexed publications as early as the 1920s(1), and many publications followed in support of this procedure.  But by as early as the 1940s, publications began to appear that argued that episiotomy was not such a good thing(2).  Over the years the mix of publications changed, now the vast majority of recent publications on episiotomy focus on the problems with the procedure, and lament why older physicians are still doing them (3) (4).  And over all this time, practice began to change.

It took a long time for this change to occur, and a lot of data had to accumulate and be absorbed by young inquisitive minds before we got to where we are today, with the majority of recently trained OBs and midwives now reserving episiotomy only for rare indicated situations.

Though this change in episiotomy seems behind us, there are many changes that are ahead of us.   One of these changes, I believe, is in the way obstetricians handle the timing of cord clamping.

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What is it with anonymous medbloggers?

November 23, 2009 16 comments

Something has got my hackles lately….anonymous medbloggers.

I just don’t get it.  If a physician is going to take the time to create a blog to spread his or her opinions and expertise, why wouldn’t they do it under their own name?  In a way it really bothers me.   There is so much information on the web, and a great deal of it is poorly sourced and unreliable.  I would like to think that physicians will publish medical information that is accurate, at least as well as we know, and that the MD or PhD credential will lend credibility to their writings.   But to me it just destroys that credibility when the doc chooses to blog under a psuedonym.

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