Dr. Dangerpartum Von Deathtrap (ha ha ha ha, Jill!) is at it again at The Unnecesarean.
The replies are flying quickly, and the manure is flying even more quickly. Dr. Amy is in poor form, misquoting abstracts and using the death due to shoulder dystocia baby card for babies within normal weight range. Huh?
Anyway, I can’t reproduce all my replies, because they are flying too fast and furious to keep up with.
When I told of a personal experience of being at a frustrating delivery that involved a protracted labor due to an induction in a first time mom, I pointed out that her normally sized baby (8 lb 11 oz) had no shoulder dystocia problems. And, evidence on the subject, including UpToDate, agrees that fetal weight below 4500g (that baby was below 4000g) is not associated with shoulder dystocia.
Dr. Amy’s response:
“He ended up being 8 lb 11 oz, and there was no problems delivering the shoulders.”
So what? Do you think that’s a defense suitable for court: “the last woman with a big baby didn’t have a shoulder dystocia”?
What would you do if you were RESPONSIBLE in the event that a baby died because you didn’t do everything you could to prevent it? Would you shrug it off? Would you tell the mother, “Too bad things didn’t work out, but it’s more important that fewer women have C-sections than that you have a live baby?” How well do you think that would go over?
Oh, OK, because when I say he didn’t have any shoulder delivery problems at all, what I meant was, the baby died and I shrugged it off, and all I care about is practice patterns, not live and healthy babies.
Here is my reply
Wow, I guess that’s what happens when I comment without reading the other comments.
Dr. Amy – She had NO risk factors or indications for a macrosomic baby and the baby did not have macrosomia. Are you proposing if, in 3 years when I am a practicing obstetrician, I do not section all similar patients, I am risking killing their babies?
Here is a quote from Up to Date:
Fetal macrosomia — Studies have consistently shown that macrosomia is a major risk factor for shoulder dystocia [2,3]. Fetal macrosomia is best defined as an estimated fetal weight (EFW) of greater than or equal to 4500 grams, as morbidity and mortality increase above this level [4,5]. The overall prevalence of birth weight over 4000 grams in the general obstetric population of the United States is 10 percent , but falls to 1.5 percent for birth weight over 4500 grams .
Her baby was more than 500 g below this threshold, and did not have an EFW above that threshold.
What do you think of the idea of doing an induction at 39 weeks with a Bishop’s score of 2 on this low risk patient? Based on ACOG Practice Bulletins and other online materials on quality care, my interpretation of the risks and treatment decision tree is pretty spot on. How much more do you think the baby would have grown if her physician waited for her due date at least, and how much would that increase her risk of shoulder dystocia?…
Have you read this article yet? The Obstetrics and Gynecology Risk Research Group still thinks obstetricians are misrepresenting risk to patients, to the detriment of women and their babies. You do it also, repeatedly. You have this citation from the thread from more than a week ago. You proceeded to cite a study from the same group the very next day, so you must think it is a good source.
Then the good doctor wanted to set some baseline “facts” about defensive medicine:
Let’s go back to the facts that I set out.
1. Most parents of a baby who dies will contemplate suing the doctor.
2. Many parents will consult a lawyer.
3. The ONLY way to prevent a lawyer from filing a lawsuit is to convince him that he can’t win.
4. The ONLY way to convince a lawyer that he can’t win is to demonstrate that everything possible has been done.
Do you agree?
I responded (in a tag team with hostess Jill):
Right, because obstetric litigation is actually due to substandard care (note the use of citations, Dr. Amy).
One documented way to decrease obstetrics litigation is to DECREASE unnecessary interventions by following evidence based protocols. Funny, one of those protocols was on induction, which is what I was complaining about upthread. Not only did these evidence based algorithms decrease interventions, including cesarean sections, and improve outcomes (preventing those preventable deaths), but they also reduced litigation. Imagine that. With a citation.
Watch Dr. Amy completely invent imaginary conclusions contrary to the actual studies I posted, and then dig her heels in when I present her with the actual conclusions of the studies, and she can’t provide any quotes.