Lazy Self-Centered Obstetrics

Lazy obstetrics. Self-centered obstetrics.

Yes…lazy and self-centered. I believe that many care providers practice this way. I will explain what I mean, and if you recognize yourself in these descriptions and take offense I am sorry – sorry that you practice this way and are sensitive about it, not for my opinion on the matter.

How do I see some people practice lazy obstetrics? You want examples? How about weighing a woman? Every time a woman comes into my office I have to ask her what she weighs – why? Because she expects me to. I honestly don’t care. I don’t…I simply do not care what she weighs. So why do ‘we’ weigh a pregnant woman? Because it’s easier than asking her about her swelling and feeling her ankles. Because it’s faster and simpler than asking her about how and what she’s been eating (and still gives the appearance that we give a damn). Because somehow it has gotten into the minds of pregnant women that their weight gain tells us something.

Let me break the illusion….it does not!! You can gain what “the books” (that alone makes me cringe) say you should – ie. 25-35 pounds….and you can gain that weight eating CRAP! One meal of Taco Bell and a dinner of KFC and a scoop of ice cream while you watch TV. You can gain less than that because you are a little overweight and have REALLY cleaned up your diet and are, for the first time in your life, actually eating healthy foods and being active! And you know what…you can gain more than that eating healthy food and all that means is that you might have some extra pounds to lose after baby is born.

As for me, I don’t care how you look and a few extra pounds isn’t going to make me love you less. I DO care about what you’re eating and how you’re taking care of yourself. I would prefer that you talk to me…spend time telling me about how you’re eating, asking me questions about diet, etc. The scale….tells me nothing. Yet the vast majority of obstetrical care providers will weigh a woman (it’s assumed!) and never ask her about her diet and activity level.

What about when we practice for ourselves instead of the mom or baby? The self-centered obstetrics? There are examples too numerous to list, but I’ll give you a basic beginning…

1. Medically unnecessary inductions – you are willing to put the mom and baby at greater risk for….what? Convenience? Or maybe to protect yourself legally? Many families don’t realize that we may choose to recommend things that increase medical risk for the sake of providing legal safety for ourselves. Inducing at 41 weeks gestation is an example of this: risks of inductions and cesareans at 41 weeks are much higher than the risks too mom and baby for just being 41 weeks. And yet we induce.
2. Augmentation of labor – just because your labor is going slower than someone else’s might go, why would we increase risk to you or baby by interfering? If mom is doing okay and baby is doing okay….then what’s the problem?
3. Continuous Central monitoring – there has never EVER been a single study to show that continuous fetal monitoring offer any medical benefit, but not only do we often use continuous fetal monitoring, but we watch it from the nurses station (along with your closest 4 friends laboring in adjacent rooms). Do you really feel that this is for you or your baby? It’s much more because we are understaffed and trying to juggle multiple people while performing our duties and charting and everything else.
4. IV’s – I’ve heard the argument “just in case”….but, um, can’t you put one in should “just in case” happen? Trust story: I knew a couple who was doing the tour of birthing rooms; she was 36 weeks pregnant, he was an EMT. The nurse showed the bathroom, the baby warmer, the bed, the monitors, explained when they’d start the needed IV….dad interrupted with, “What if we don’t need an IV?” nurse replied that EVERYONE “NEEDS” an IV…you know, “JUST IN CASE”. She explained to this couple that things can happen at any time during labor and they want to make sure to have immediate access to that vein because they could have trouble starting one if the need arose. Dad, looking truly perplexed, said, “I can start an IV in the field at night on a woman bleeding out from an auto accident in the pouring rain…and you are telling me that you are concerned about starting an IV on my healthy wife in your brightly lit hospital under these controlled circumstances? That really concerns me….why are you not confident in your basic skills?” Me? I thought it was priceless.

It’s frustrating to me when I see colleagues (and yes, I’m sorry, but I do consider nurses and doctors colleagues as well as midwives) practice lazy or self-focused obstetrics. I think that all of us should ask ourselves….is what we’re about to do to this woman for HER or her BABY? Or is it for US…to make US feel better, or because WE are tired, or we don’t feel like taking the time, or we’d rather put her at risk than ourselves.

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