how common is it for the anesthesiologist to refuse to give an epidural?
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Anonymous
midwives/natural birthers don't want women to die. but they seem to be motivated by an ideology rather than science (despite all the claptrap about "evidence-based birth.") |
Anonymous
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Link for Article 1 above isn't complete, but there is plenty of data in the references for the other articles. Prior PP's analysis is called a summary, or a summation.
Article 2 references Zhang, J., Troendle, J., Grantz, K.L., Reddy, U.M. Statistical aspects of modeling the labor curve. Am J Obstet Gynecol. 2015;212:750–752. Cohen, W.R., Friedman, E.A. Perils of the new labor management guidelines. Am J Obstet Gynecol. 2015;212:420–427. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Obstetric care consensus no. 1. Obstet Gynecol. 2014;123:693–711. Friedman, E.A. Labor. Clinical evaluation and management. Appleton-Century-Crofts, New York, NY; 1967. Friedman, E.A. Labor. Clinical evaluation and management. 2nd ed. Appleton-Century-Crofts, New York, NY; 1978. Cohen, W.R., Friedman, E.A. Labor and delivery care: a practical guide. John Wiley and Sons Ltd, Oxford (United Kingdom); 2011. Ledger, W.J., Witting, W.C. The use of a cervical dilatation graph in the management of primigravidae in labor. J Obstet Gynecol Br Commonw. 1972;79:710–714. Bottoms, S.F., Hirsch, V.J., Sokol, R.J. Medical management of arrest disorders of labor: a current overview. Am J Obstet Gynecol. 1987;156:935–939. Poma, P.A. Use of labor graphs in a community hospital. Int Surg. 1979;64:7–12. Zhang, J., Troendle, J.F., Yancey, M.K. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187:824–828. Deaver, J.E., Cohen, W.R. An approach to the prediction of neonatal Erb palsy. J Perinat Med. 2009;37:150–155. Gross, T., Sokol, R.J., Williams, T., Thompson, K. Shoulder dystocia: a fetal-physician risk. Am J Obstet Gynecol. 1987;156:1408–1418. Garrett, K., Butler, A., Cohen, W.R. Cesarean delivery during second stage labor: characteristics and diagnostic accuracy. J Matern Fetal Neonat Med. 2005;17:49–53. Cohen, W.R., Newman, L., Friedman, E.A. Frequency of labor disorders with advancing maternal age. Obstet Gynecol. 1980;55:414–416. Chazotte, C., Madden, R., Cohen, W.R. Labor patterns in women with previous cesareans. Obstet Gynecol. 1990;75:350–355. Weizsaecker, K., Deaver, J.E., Cohen, W.R. Labour characteristics and neonatal Erb’s palsy. BJOG. 2007;114:1003–1009. Verdiales, M., Pacheco, C., Cohen, W.R. Effect of maternal obesity on the course of labor. J Perinat Med. 2009;37:651–655. Friedman, E.A. Patterns of labor as indicators of risk. Clin Obstet Gynecol. 1973;16:172–183. Friedman, E.A., Neff, R.K. Labor and delivery: impact on offspring. PSG Publishing Company Inc, Littleton, MA; 1987. Schifrin, B.S., Deymier, P., Cohen, W.R. Fetal neurological injury related to mechanical forces of labor and delivery. in: L. Zhang, L. Longo (Eds.) Stress and developmental programming in health and disease: beyond phenomenology. Nova Biomedical, New York, NY; 2014:651–688. Ashton-Miller, J.A., Delancey, J.O. On the biomechanics of vaginal birth and common sequelae. Ann Rev Biomed Eng. 2009;11:163–176. Handa, V.L., Harris, T.A., Ostergard, D.R. 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Joseph, K.S., Young, D.C., Dodds, L. et al, Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol. 2003;102:791–800. Durst, J.K., Tuuli, M.G., Stout, M.J., Macones, G.A., Cahill, A.G. Degree of obesity at delivery and risk of preeclampsia with severe features. Am J Obstet Gynecol. 2016 May;214:651.e1–651.e5 DOI: https://doi.org/10.1016/j.ajog.2015.11.024 Tabet, M., Flick, L.H., Tuuli, M.G., Macones, G.A., Chang, J.J. Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy. Am J Obstet Gynecol. 2015;213:548.e1–548.e7. Anonymous. AHRQ comparative effectiveness review no. 80. Rockville (MD): Department for Health and Human Services; 2012.. Australian Institute of Health and Welfare. Maternal deaths low in Australia, Sydney, 2008. Available at: http://www.aihw.gov.au/media-release-detail/?id=6442464747. Accessed May 17, 2016.. Bailit, J., Grobman, W., Rice, M. et al, Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals. Am J Obstet Gynecol. 2013;209:446.e1–446.e30. Landon, M., Hauth, J., Leveno, K. et al, Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–2589. Bickford, C., Janssen, P. Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study. CMAJ Open. 2015;3:E158–E165. Gardner, K., Henry, A., Thou, S., Davis, G., Miller, T. Improving VBAC rates: the combined impact of two management strategies. Aust N Z J Obstet Gynaecol. 2014;54:327–332. Chalmers, J., Chalmers, I. The obstetric vacuum extractor is the instrument of first choice for operative vaginal delivery. Br J Obstet Gynaecol. 1989;96:505–509. Anonymous. Krankenhausstatistik–Grunddaten der Krankenhäuser und Vorsorge–oder Rehabilitationseinrichtungen, Statistisches Bundesamt, Bonn, Germany, 2014. Available at: https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/KrankenhausentbindungenKaiserschnittBundeslaender.html. Accessed May 4, 2016.. Martin, J.A., Hamilton, B.E., Osterman, M.J., Curtin, S.C., Matthews, T.J. Births: final data for 2013. Natl Vital Stat Rep. 2015;64:1–65. Anonymous. NHS maternity statistics–England, 2012-13. Available at: http://www.hscic.gov.uk/catalogue/PUB12744. Accessed Jan. 1, 2015.. Tempest, N., Hart, A., Walkinshaw, S., Hapangama, D.K. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labor. Br J Obstet Gynaecol. 2013;120:1277–1284. Nash, Z., Nathan, B., Mascarenhas, L. Kielland’s forceps. From controversy to consensus?. Acta Obstet Gynecol Scand. 2015;94:8–12. Committee on Practice Bulletins–Obstetrics. Operative vaginal delivery. Practice bulletin no. 154. Obstet Gynecol. 2015;126:e56–e65. Dupuis, O., Silveira, R., Dupont, C. et al, Comparison of “instrument-associated” and “spontaneous” obstetric depressed skull fractures in a cohort of 68 neonates. Am J Obstet Gynecol. 2005;192:165–170. O’Mahony, F., Hofmeyr, G., Menon, V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 2010;11:CD005455. Dietz, H. Forceps: towards obsolescence or revival?. Acta Obstet Gynecol Scand. 2015;94:347–351. Dietz, H., Gillespie, A., Phadke, P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol. 2007;47:341–344. Dietz, H.P., Shek, K.L. Validity and reproducibility of the digital detection of levator trauma. Int Urogynecol J. 2008;19:1097–1101. Kearney, R., Miller, J.M., Delancey, J.O. Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn. 2006;25:50–54. Dietz, H.P., Bernardo, M.J., Kirby, A., Shek, K.L. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22:699–705. Dietz, H., Simpson, J. Levator trauma is associated with pelvic organ prolapse. Br J Obstet Gynaecol. 2008;115:979–984. DeLancey, J., Morgan, D., Fenner, D. et al, Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109:295–302. Dietz, H.P., Chantarasorn, V., Shek, K.L. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol. 2010;36:76–80. De Lee, J. The Principles and Practice of Obstetrics. 7th ed. WB Saunders Company, Philadelphia, PA; 1938. Atan, I., Hall, J., Langer, S., Shek, K., Dietz, H. A Tale of Two Hospitals. J Ultrasound Med. 2016;35:S53. Dietz, H., Caudwell-Hall, J., Shek, K., Langer, S. The effect of replacing primary Vacuum delivery with Forceps. Ultrasound Obstet Gynecol. 2014;44:95. Sultan, A.H., Thakar, R. Lower genital tract and anal sphincter trauma. ([Review] [118 refs])Best Practice & Research in Clinical Obstetrics & Gynaecology. 2002;16:99–115. Skinner, L., Dietz, H.P. Psychological and somatic sequelae of traumatic vaginal delivery: A literature review. Aust NZ J Obstet Gynaecol. 2015;55:309–314. Lowenstein, E., Ottesen, B., Gimbel, H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J. 2015;26:49–55. Lowenstein, E., Ottesen, B., Gimbel, H. Response to the letter to the editor by HP Dietz. Int Urogynecol J. 2015;26:1091. Thomas, V., Shek, K.L., Guzman Rojas, R., Dietz, H.P. The latency between pelvic floor trauma and presentation for prolapse repair: a retrospective observational study. Int Urogynecol J. 2015;26:1185–1189. Gyhagen, M., Bullarbo, M., Nielsen, T.F., Milsom, I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. Br J Obstet Gynaecol. 2013 Jan;120:152–160 DOI: https://doi.org/10.1111/1471-0528.12020 Glazener, C., Elders, A., MacArthur, C. et al, Childbirth and prolapse: long-term associations with the symptoms and objective measurements of pelvic organ prolapse. Br J Obstet Gynaecol. 2013;120:161–168. Caesarean Section: NICE Clinical Guideline 132. 2011 [cited 22.1.2012]; Available at: http://www.nice.org.uk/guidance/CG132/documents/caesarean-section-update-full-guideline2. Accessed May 17, 2016.. Hull, P. Author's reply re: Caesarean section should be available on request. Br J Obstet Gynaecol. 2015;122:1571. Kirkup B. The Report of the Morecambe Bay Investigation. 2015 [cited 3.6.15]; Available at: https://www.gov.uk/government/publications. Accessed May 17, 2016.. Leveno, K.D., Nelson, D.B., McIntire, D. Second Stage Labor: How long is too long?. Am J Obstet Gynecol. 2016;214:484–489. American College of Obstetricians and Gynecologists. Limitations of perineal lacerations as an obstetric quality measure. Obstet Gynecol. 2015;126:e108–e111. Dietz, H., Pardey, J., Murray, H. Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services. Int Urogynecol J. 2015;26:29–32. Cumberlege J, et al. Better births: Improving outcomes of maternity services in England. Available at: http://www.england.nhs.uk/ourwork/futurenhs/mat-review. Accessed March 15, 2016.. Dietz, H., Stokes, B. A plea for professional independence. Med J Aust. 2012;196:104–105. Srinivas, S., Fager, C., Lorch, S. Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality. Obstet Gynecol. 2010;115:1007–1013. Rogers v Whitaker. Canberra: Commonwealth of Australia; 1992. Available at: http://www.healthlawcentral.com/rogers-v-whitaker/. Accessed May 17, 2016.. Montgomery v Lanarkshire Health Board, Supreme Court of the United Kingdom, 2015: London. Available at: https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0136_Judgment.pdf. Accessed May 17, 2016.. Bolton, H. The Montgomery Ruling extends patient autonomy. Br J Obstet Gynaecol. 2015;122:1273. |
Anonymous
Oh, I see. You didn't look at the links, I suspect. The latter two links are to published journal articles critical of the ACOG guidelines. That is kind of the opposite of how you characterized the, These would probably be an interesting and informative read. |
Anonymous
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I don't want to read 10 pages, but this happened to me after I'd already been induced at Columbia-Presbytarian.
It was some young resident or something who stated that he would not due it due to my multiple sclerosis. I had my laptop there -- and I'm a professor (and I taught . . . torts) -- so I can research quickly and get the full text. And I objected vehemently. The process was already in motion and I was high-risk all along and no one had said anything. There is no contraindication for MS patients. I was really, really angry because they had already started induction. They ended up giving me two epidurals. I cannot imagine not having anything. I might have had a cardiac incident. |
Anonymous
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Pretty sure ACOG totally changed 50 years of labor guidelines based on one study done by Zhang. So yeah, women deserve to know that and decide if they want their labor to be managed more conservatively. That’s feminist—giving people all the info and letting them make their own decisions to the extent possible.
“We assert that the dilatation curve promulgated by Zhang et al cannot be reconciled with direct clinical observation. Even if they were correct, however, it still does not follow that the ACOG/SMFM guidelines should recommend replacing the coherent system of identifying and managing labor aberrations described by Friedman. That system is grounded in well-established clinical principles based on decades of use and the objectively documented association of some labor abnormalities with poor fetal and maternal outcomes. Recommendations for new clinical management protocols should require the demonstration of superior outcomes through extensive, preferably prospective, assessment. Using untested guidelines for the management of labor may adversely affect women and children.” |
Anonymous
Or HER call |
Anonymous
I'm the PP who kicked off the discussion of the link between epidurals and possible reductions in infant and maternal mortality. I don't know the extent to which this has been studied. I absolutely know that both of my children got stuck in my birth canal, leading to hours of pushing. In my son's case, he also had a cord wrap and experienced HR decelerations (that were ultimately controlled). Without an epidural, there is no way I could have vaginally delivered him with a nurse and a midwife literally tugging on my vagina for an hour to help him get out from under my pubic bone. I would have fainted in pain. Instead, the OB would have had to push him all the way back up in and deliver him by C-section. A code they started to call twice during my delivery, until I was able to calm down and actively start making long enough pushes to help him progress down the birth canals. The epidural, in my case, was empowering and allowed me to actively participate in making my son's birth safer for both of us. You have an outdated understanding of the information mothers have as they approach the delivery of their children. We are not being put in twilight sleep, and we understand the relative risks of many options. I live in California, which I think has an overall more progressive approach to maternal care...but I started my first pregnancy in DC (with a male OB no less), and I did not feel talked down to there either. Of course improvements are needed, but your position is at least as extreme as that of the people you are railing against. |
Anonymous
I don't agree that all women understand relative risks of different choices or that fully informed consent is always happening. This is actually a popular topic right now. It sounds like you were well informed by your providers during delivery but many, many women don't have your experience. https://www.google.com/amp/s/www.self.com/story/informed-consent-in-childbirth/amp https://www.google.com/amp/s/www.yahoo.com/amphtml/lifestyle/metoo-helping-women-understand-rights-around-giving-birth-193447261.html |
Anonymous
I think midwives are motivated by their clinical observations of women experiencing less harm and trauma and they and their babies having the same or better outcomes when they receive adequate labor support, customized care, and a least-invasive labor management approach. |
Anonymous
Clinical observations =/= sound scientific evidence. |
Anonymous
Clinical observations =/= sound scientific evidence. |
Anonymous
If the argument is it's untested, then they should stop doing inductions since induction protocols are also untested... and there are multiple studies showing induction is associated with higher rates of severe perineal tearing. |
Anonymous
How would they know if they are only present at midwife-assisted births? I can't imagine having better outcomes either for myself or for my child if I was denied epidurals during my births - which midwives would have certainly advocated for under their philosophy of the least-invasive labor management approach. |
Anonymous
Well clinical observations are the crux of the PP's entire argument against changing the Friedman curve. They had sound scientific evidence that labors have gotten longer by a well-designed, credible study, and then a bunch of clinicians said 'but that's not what we've observed in real life! that's just a theory!' and demanded it be tested on patients in a prospective study. Clinical observation is always a relevant factor. Anyway the scientific literature is rife with evidence of the benefits of midwifery, particularly when it comes to lower rates of perineal lacerations, with women and babies having outcomes equivalent to or better than standard care. https://www.medscape.com/viewarticle/810005 http://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-early https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324579/ https://www.sciencedirect.com/science/article/pii/S1049386711001605 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061621/ |
Anonymous
| And actually, Atul Gawande's writing about obstetric care is remarkably balanced. I recommend The Score to all pregnant ladies. It's an excellent piece. |