[Issue 2:10]:
I am a student midwife and want opinions about some of the methods my
preceptor uses and believes in. First, he thinks of birth as a biological
process and that the midwife's/doctor's job is to let the body birth in
peace. They should only help the mother be more comfortable, etc. He also
has a very low intra-hospital cesarean rate--10%--which is the lowest in
the region. He definitely believes in VBAC as long as there is no danger to
the mother or baby, and often sees cesareans as "unnecesareans."
He induces at 40-41 weeks if there is no sign of labor. He says he checks
cervical ripeness, and if the cervix is not ready lets it go one more week
so it will be a smoother and more successful induction. He reasons that the
mortality rate of babies after 40 weeks rises very much, the placenta is
older and within a very short time it can become insufficient.
He also does an automatic cesarean if the baby is over 10 pounds. He says
shoulder dystocia is due to oversize babies who should have been cesareans,
and that dystocia is more dangerous to the baby 10 lbs and up than cesarean
would be.
He has a 10% cesarean rate, and thinks there is no reason for any clinic or
hospital to have a rate higher than 10% without putting anyone at any risks
at all.
-Aiyana Gregori
[Issue 2:11]:
It's true that the placenta, at some point, stops functioning well and the
baby can become at-risk. However, there is no reason why periodic
monitoring of the placenta post-dates couldn't happen (unless access to
this technology is absent). As long as there is sufficient fluid level, and
the placenta doesn't appear to be too calcified, there is no reason to
induce a woman only because she is past her due date. Remember, the due
date is just an estimate--women grow babies at different rates! As well,
women grow babies of different sizes. Unless we are consuming large amounts
of growth hormones from eating animal products, I firmly believe we grow
babies our body can birth! I honor your willingness to question these
practices.
-Jenny Johnson
====
It's odd that he says birth is a "biological process best left to occur on
its own" then is highly interventive! He may have a low c/sec rate, but at
what cost to the "biological" process? It sounds as though he wants to be
very much in control of when women birth and that it is *his* timing of
things that makes it all happen safely. As for doing a c/sec if the baby
"is over 10 pounds," this is merely an estimate and is probably wrong
fairly often, meaning a scheduled c/sec on smaller babies or even large
babies that would have birthed well despite their size. Is this doc aware
of the Gaskin maneuver: all fours for birthing large babies? Maybe he had a
very traumatic dystocia with a large baby that made him say, "Never again."
I would suggest you find a homebirth midwife in your area if possible to
precept with as well. A well rounded experience is extremely important. It
is equally important that direct entry midwifery students have hospital
experience.
-Kelley Hewitt
Reprinted from Midwifery Today E-News (Vol 2 Issue 11 March 17, 2000)
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