Names Searched Right Now:
Page 329 of 660 FirstFirst ... 229 279 319 327 328 329 330 331 339 379 429 ... LastLast
Results 1,641 to 1,645 of 3298

Thread: Ttc 2013

  1. #1641
    Join Date
    Sep 2012
    Location
    Los Angeles
    Posts
    4,598
    Quote Originally Posted by skylark View Post
    I know what you mean, Rowan. I have placenta previa right now and will only be allowed to attempt a vaginal delivery if the placenta moves 2.5cm from the cervical opening. If I was in Australia it would only have to move 1.7cm from the cervical opening to attempt vaginal delivery. I assume the reason is that a C Section is expensive and my American hospital makes more money if I have a C section than if I have a vaginal delivery. If the government paid for the procedure (like how it works in almost every other western industrialized nation) it would be in their best financial interest to avoid an unnecessary cesarean. We have really nice health insurance right now, but unless my placenta moves past 2.5cm my money won't be able to buy a vaginal hospital delivery because hospitals are just too greedy. Sometimes my husband and I look at good paying jobs in other countries and think about how much it would suck to be an immigrant, but how nice it would be to have universal healthcare/dental care.

    Fox News has convinced the elderly that Obama is going to have a Death Panel killing all the old people. That is one of the major things holding our country back in terms of healthcare. Hopefully the younger generation won't fall prey to fear and lies so that someday everyone will be able to see a doctor when they're sick - not just rich people.
    Your assumption is thankfully false. The reason you have a mandatory c-section with a previa is that laboring with a previa nearly always causes a massive hemorrhage and death of the baby. The mother can usually be saved. When your cervix dilates to a full 10cm, a placenta that is <2cm from the cervical os before labor is suddenly blocking it [the placenta is implanted in the wall of the uterus; it doesn't move.] Labor can only result in repeated trauma to the placenta and tearing, hence the hemorrhage, which in days of yore resulted in fetal death 100% of the time and maternal death in a good chunk of others. 2cm is the standard, accepted number in the medical literature; not sure why your particular OB or hospital has 2.5cm unless they had a series of bad experiences. Australia's number seems dangerous to me for two reasons: 1) it assumes **perfectly symmetric cervical dilation** [10cm dilation= diameter of a circle; divide by 2*pi and you have the radius. 10/2*3.14 = 1.6cm, so 1.7cm would be a RAZOR-THIN margin], and 2) the baby's head would most certainly bang up against the placenta during each contraction before actually exiting if the placental edge was only 1mm away from the os.

    I should know, not just from theoretical knowledge, but I'm also a pregnant woman staring down the same unfortunate barrel (my placenta is 0.7cm away currently, and it's been bleeding daily for weeks). I really, really don't want a c-section, but at least I'm not harboring paranoid suspicions that greedy hospital execs have made up this protocol to rake in the cash. C-sections don't just charge more, they COST more. You stay in the hospital longer, there are many more personnel involved, you have a mandatory OR charge (OR time in the US costs variably between $2000 and $3000/hr-- just to be in the room, not to do anything!), etc. Running and maintaining the machines, using all of the equipment, using more medications, etc all COSTS the hospital more, and they charge you accordingly. There are definitely cash cows for hospitals, don't get me wrong (elective joint replacement, anyone? gamma knife surgery?) but maternity/obstetrics care, including c-sections, is usually at best a break-even operation.

    And I agree with you 100% on universal health care. On the spectrum of commodity -> human right, I am firmly in the "human right" camp, and would love to see this country catch up in its thinking (even if it will most likely damage the free market incentives currently driving a lot of the research & development that makes this country unique).
    Blade, MD

    XY: Antoine Raphael
    XX: Cassia Viviane Noor

    Aurea * Emmanuelle * Endellion * Fleur * Jacinda * Lysandra * Melisande * Myrrine * Rosamond * Seraphine * Sylvana * Thea * Verity / Blaise * Cyprian * Evander * Jules * Laurence * Lionel * Malcolm * Marius * Quentin * Rainier

    كنوز الصحراء الشرقية Hayat _ Qamar _ Sahar _ Maysan _ Farah / Altair _ Fahd _ Faraj _ Khalil _ Tariq

  2. #1643
    Join Date
    Sep 2012
    Location
    Los Angeles
    Posts
    4,598
    Quote Originally Posted by skylark View Post
    I just looked up the infant mortality for live births on wikipedia and it says the Netherlands had less infant deaths than the US, UK, Australia, etc. But it also said that this figure doesn't include still births and miscarriages. I wonder where you could get figures on that.
    I posted international perinatal mortality rate data in cvdutch's thread. Infant mortality is, by far, the wrong statistic to look at if you're interested in making cross-national comparisons of maternity/obstetric care. Infant mortality includes all deaths in the first year of life, whereas perinatal mortality includes only stillbirths from 24+ week's gestation up to live infant births in the first 7 days of life. Unfortunately, for reasons I find very difficult to appreciate, only the US and Canada count extremely premature infants who are born with signs of life as "live births." Other countries exclude all infants born at <500g, even if they breathe and have a heartbeat.

    They probably don't want to encourage the epidural because it increases the risk of cesarean (despite what they teach the doctors in the US currently).
    Thank goodness we have you to enlighten us! What thoroughly researched, peer-reviewed, randomized controlled trial / angry mommy blog did you get that information from, because I would love to read it! Fortunately the actual impartial science backs up the hard-n-fast claim that epidurals do NOT increase the rate of cesarean birth. I posted the relevant papers in the same thread mentioned above, and I believe they are not too technical such that someone without any particular training in science, medicine or statistics can read them and glean useful information from them.

    Believe me, you don't want a C section unless you absolutely need one. A cesarean section involves serious short term and long term risks to mother, child, and any future children that mother may have. I'm talking to women on a placenta previa forum who have to have hysterectomies and partial bladder removal due to placenta accreta/percreta caused by unnecessary cesareans. I would gladly forgo a bunch of needless blood tests, ultrasounds, and pain medication if it meant I could also avoid a c section.
    Definitely agree. Repeat c-sections dramatically increase the risk of future placental problems, which is certainly an issue if you're planning a large family. But it's extremely difficult to say whether or not a particular c-section was necessary or unnecessary. The only way to know for sure is to deliver the same baby to the same woman at the same time both vaginally and surgically, and compare outcomes. Which, of course, is impossible. You have no idea how much research and thought is being devoted to this very question-- identifying ways of differentiating genuine fetal distress from temporary fetal distress, and how much perinatal oxygen deprivation (how much time) actually results in permanent disability. No dice yet, but here's hoping.

    Doctors here are so afraid of getting sued that they often won't let women try for a natural birth if there is even the slightest risk that something could go wrong - like in my case. I asked my midwife what would happen if my baby was breech and she said it would be a C section because no one knows how to deliver a breech baby anymore. There are tons of youtube videos that show how to do it and it really doesn't look that complicated to me, but since there are a few more risks to the baby if the doctor yanks on the baby doctors are afraid of getting sued.
    Med-mal in the US is a major problem, as is CYA (cover your ass) medicine. Tort reform states have done a great deal in reducing frivolous lawsuits and therefore defensive medicine, but the rate of major intervention such as c-section versus vaginal birth has NOT changed as those decisions are not made on the basis of anything other than the individual clinical situation.

    Delivering a breech baby vaginally is actually quite difficult, and it's not done because it carries a 3% mortality rate (and every single one of those deaths-- which don't include permanent neurological disability-- is preventable by c-section). Do you understand the risk of a breech presentation regarding compression of the umbilical cord? Do you understand why it's not a "variation of normal" but a potentially life-threatening situation? No matter if baby is head-up or head-down, the head itself is still (nearly always) the biggest part, and the most difficult to deliver. It take just as long to deliver the head if the body is already out as if the body were still in, but the difference is that the head is squeezing the umbilical cord up against the cervix and completely pinching off blood & oxygen to the baby. If you can't deliver the head in 5min, neurological disability results. If you can't deliver the head in 15-20, death. You want to read horror stories? Read breech delivery stories before the advent of surgical birth (or in settings where it's unavailable). Attendants/midwives hack open the cervix to pull the baby out, provoking serious hemorrhage and lifelong cervical dysfunction. Or they just let the baby die to save the mother.

    And I'm sure you know how ludicrous it is to watch a video on Youtube and feel you've mastered the technique. Watch a video on cardiopulmonary bypass or piloting a fighter plane... it doesn't quite compare to having to do it.

    They also like to cut corners to save money on C sections here like using staples, which have an increased risk of wound separation but take only seconds to close the incision. They have this super glue stuff called Dermabond that has a tendency to pop open during recovery if it's not applied properly, but it takes only seconds to close the incision compared to half an hour with double layer stitches so it's the preferred method in many hospitals. If one of those dermbond or staples women decides to try for a VBAC a lot of times the doctor will say they're not comfortable with it because they didn't get double layer stitches and there is an increased risk of uterine rupture.
    I am not trying to be rude but you really, really don't know what you're talking about here and you sound quite silly. Everything you wrote is factually incorrect, and I highly doubt you gleaned this information from a surgeon or an obstetrician, but rather yet another op-ed blog written by a layperson.

    The uterus is sutured closed each and every time. It is not glued, glue is used for the epidermis only. It's sutured in a double-stregth "baseball stitch" technique with permanent 2-0 suture. The uterine scar itself is the only thing of relevance when it comes to discussing future uterine rupture risk in TOLACs, etc.

    Next to be closed is the fascia-- the abdominal wall. This is sutured with 2-0 Maxon in a 'figure-of-eight' pattern. It is the major strength layer of any operative repair. Once the fascia is closed, the rest is gravy/cosmetic, including the skin incision.

    Third to be closed is the dermis and connective tissue. This is typically sutured with a dissolving stitch, usually 3-0 Polysorb, in a buried fashion.

    Finally, the skin is closed. Once the dermis has been closed the skin is more or less approximated and even if nothing further is done, it will heal in a linear scar. The "plastic surgery closure" favored by surgeons is a running subcuticular stitch with a 4-0 or 5-0 monofilment suture, clear in color. Other types of surgeons use Dermabond. The epidermis itself is NOT a strength layer of the repair and very little stress is placed on the most superficial layer of the incision (not to mention the fact that epithelialization usually occurs within 48h), so glue works just fine if you prefer it.

    General surgeons and OBs often use staples instead of the latter two (the dermal and epidermal sutures). Stapling takes approximately 20-30s whereas suturing takes 10-15min. Since OR time is $2000/hr ($3000/hr in New York), cost-conscious doctors will staple you to avoid charging you/your insurance the extra $500. If you would like a plastic surgical closure you should feel free to request it.

    I've talked to a lot of women who had cesareans at the hospital I go to who say a student did the epidural or surgery or incision closure and they screwed it up because they are just learning how to do it and an OB didn't watch the procedure.
    Here again, I'm afraid, you're in too-deep waters. I have no doubt these women *told* you that's what happened, but they're wrong.

    Medical students do not place epidurals, and medical students do not perform operations. *Resident physicians* (doctors already graduated from medical school, with an MD, with a medical license, etc, but in specialty training) DO. They never do anything without adequate supervision [else the attending physician is held liable, could be fired, and could be subject to professional disciplinary action including losing their license]. If you are certain you would not like to encounter any trainees in the course of your stay, simply seek care at a small community hospital without any residency programs. However, multiple studies have validated the fact that the best care is delivered at academic teaching hospitals and that the presence of trainees makes all aspects of medical care more safe. This is true in every industrialized country, not just the US (after all, every doctor in every country in the world has to be educated and trained).
    Blade, MD

    XY: Antoine Raphael
    XX: Cassia Viviane Noor

    Aurea * Emmanuelle * Endellion * Fleur * Jacinda * Lysandra * Melisande * Myrrine * Rosamond * Seraphine * Sylvana * Thea * Verity / Blaise * Cyprian * Evander * Jules * Laurence * Lionel * Malcolm * Marius * Quentin * Rainier

    كنوز الصحراء الشرقية Hayat _ Qamar _ Sahar _ Maysan _ Farah / Altair _ Fahd _ Faraj _ Khalil _ Tariq

  3. #1645
    Join Date
    Sep 2012
    Location
    Los Angeles
    Posts
    4,598
    Quote Originally Posted by skylark View Post
    Blade ... seems strangely anti pain medication-free vaginal birth at times
    I am only anti-scaremongering and anti-ignorance. If you or any other woman wishes to be truly "educated" on matters of obstetric science and/or policy (as educated as one can be without actually becoming, you know, formally educated), you should have all of the real data with which to make decisions.

    I really want women to know that if they're avoiding pain relief because a) they believe the drugs pass on to the baby and affect the baby or b) they believe epidural analgesia in particular "stalls out" labor and increases the risk of c-section, both of those claims are completely false and have been repeatedly studied and repeatedly disproven.

    If they have other, personal reasons, such a spiritual or religious beliefs, fine. Unlike many other decisions in childbirth, pain relief affects the mother alone, not the baby. I fully believe in individual autonomy and completely support and if a mother simply wants to feel the pain of childbirth by all means, feel the pain of childbirth.
    Blade, MD

    XY: Antoine Raphael
    XX: Cassia Viviane Noor

    Aurea * Emmanuelle * Endellion * Fleur * Jacinda * Lysandra * Melisande * Myrrine * Rosamond * Seraphine * Sylvana * Thea * Verity / Blaise * Cyprian * Evander * Jules * Laurence * Lionel * Malcolm * Marius * Quentin * Rainier

    كنوز الصحراء الشرقية Hayat _ Qamar _ Sahar _ Maysan _ Farah / Altair _ Fahd _ Faraj _ Khalil _ Tariq

  4. #1647
    Join Date
    Jan 2013
    Location
    Australia
    Posts
    2,846
    @Frances - Congratulations! Lovely news. Great to hear that the fireworks were your lucky charm!

    @Blade - Yes, I thought Skylark's comments seemed rather broad and unfounded. Particularly the comment regarding delivering breech babies via c-section because "nobody knows how to deliver a breech baby anymore". Really? Not because it's extremely dangerous? Well, in her defence, she researched using Wikipedia and You Tube, so you can't blame her for a few errors in her comments
    Last edited by sarahmezz; July 7th, 2013 at 04:54 AM.
    First baby due on September 7, 2015!

    Audrey - Beatrice - Clara - Daphne - Jane - Margaret - Susannah - Violet

    August - Barnaby - Edward - Frederick - Henry - Rupert - Theodore - Walter

  5. #1649
    Join Date
    Apr 2013
    Location
    Currently on the west side of the U.S.
    Posts
    421
    Thank you Blade. As always, you cut-thru a lot of crap and unsubstantiated info with real facts - and help restore at least part of my sanity. I hope your move was as painless as possible and that you're feeling well!
    Christine

    Pregnancy #1: lost to mc, 10/11

    Amelia Joelle arrived on 11/28/13 at 7 pounds, 4 ounces of pure beauty. Couldn't be happier to finally be mommy!

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •