I’ve been catching up with blogs of late, and wandered back to a post on Fogelson MD’s blog about a DEM in OR who thinks (as I do) that breech at home without someone with lots of experience (more than a handful) is a bad idea. I liked the tone of his post, I like that he has a DEM in his family and gets to chat with a homebirth provider about these issues.

If you have the stomach for it though, read through the comments and see how he takes a first year midwifery school apart, before being an ass to her preceptor, and then again to the student. It made me think about a couple of things which have dismayed me of late. I recently heard that a local training hospital is all-of-a-sudden doing ultrasounds at the labor bedside to confirm presentation, often after a VE where the fetal skull was palpable. Why? A few curious doula’s asked. My suspicion is that there is a new crop of residents about, and their hand skills aren’t terrific. Perhaps it’s a box they must check on their charts. I don’t know. Made me think of the med students I worked with overseas who had never seen a fetoscope, let alone understood how handy they are for you know, assessing fetal position.

The other incident involved a trip to the hospital with a friend who suffered some outta-the-blue abdominal pain. After an xray and an ultrasound while waiting for a CT, I asked for permission and gently pounded on her CVA. Predictably, she yelped on pain. Turned out she had a kidney stone (it was confirmed by the CT). She hadn’t had a physical examination though. The ER physicians literally hadn’t laid a hand on her. Ok, I know, those tests probably didn’t do any harm, aside from the hours of waiting, and the expense, the discomfort of the ultrasound and what ended up being a waste of resources, but I don’t understand is why a simple examination was omitted. Bottom line it wouldn’t have HURT to put your doctor hands on my friend’s body and actually assess what may have been causing her pain.

So anyway, Mr Fogelson railed against the evidence supporting moxibustion as a decent effort to try to turn a breech baby, I got a really unpleasant taste in my mouth. It’s not that I think that moxa is a particularly good or a bad thing to try if you have a babe who’s breech, or acupuncture, or any of the other things folks try to vert babies which *are* really, totally unsupported by randomized controlled studies. I DO think that if the end point is a cesarean section, why the hell NOT throw everything AND the kitchen sink at it. The fact remains that those things give scared moms and dad’s something to DO with their upside-down baby while they contemplate a surgical birth the idea of which they’re probably not wild about. I don’t see the NIH rushing off to begin a RCT of Pelvic tilts or inversions or flashlights and dad’s voices in the crotch! Why not try it?! It certainly ain’t gonna hurt!

Why does a doctor feel like encouraging a dad to lovingly talk his baby into moving head down is “woo-ism”. Why would it matter if it was the dad, or if it was the baby simply deciding it was time to turn head down? There is simply NOTHING BAD about that. Again, while no-one is doing RCT’s of this method, I’m sure there are midwives and parents who have enjoyed the giant roll of a baby late in pregnancy and the solid thunk of a cranium engaging in a pelvis shortly after a session of dad-chat.

Why is it that physicians come so far from actually touching patients/clients? Why can’t we wrap our head around the thought that families and babies sometimes actually interact meaningfully in-utero and the ramifications of those moments ripple onward into extra-uterine ways in ways which we actually can’t scientifically quantify. Why is the un-quantifiable automatically discarded by the medical as irrelevant? Why does it seem like some of these docs default all too often to the tests, and the technology and the almighty “science” at the expense of human interaction and compassion, and occasionally yes, leaving the door cracked just a little for the inexplicable. Worse, that seems increasingly to be the way they are taught!

This becomes evident even in our interactions with each other (docs and midwives) on the vast, impersonal informational dumping ground that is the internet. Mr Fogelson speaks a pretty game of “how nice it is to have a conversation with a ‘sensible’ homebirth midwife”, but the disrespect and tone of his later comments to the student midwife and her preceptor who had been quite clear in their transfer and referral process for breech were uncalled for. She, like me and many other midwives, doesn’t plan breeches at home because she’s not adequately trained to attend them. They showed up in essence to support his initial post, and the midwife whose letter he posted, and instead he was a jerk, while trying to school a green midwifery student. I’m still not sure why.

This in the face of that recent study talking about how a great chunk of ACOG recommendations are based simply on opinion, it’d strike me as more respectful if he’d perhaps actually acknowledge that. Midwives expert opinions are often grounded in a different philosophy and expert opinion, often no great studies, but some awfully good observation from many hundreds of years of practice.

How is that any different?

In the meantime I’ll just pour some more love in my hands. No evidence for that, but guess what. That improves outcomes.

Rant over. That is all.

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