OK, I am supposed to be working on my chapter for Our Bodies, Ourselves. But some how I ended up commenting on a comment thread that was being derailed (surprise, surprise) by Dr. Amy. It may OK (or worse, somehow?) because the blog I was posting on was of one of the editors of the book, Amy (no relation to Dr. Amy) Romano’s Science and Sensibility. The original post is by Henci Goer, and is about the woman who coded during labor immediately following her epidural, and she and her baby were “miraculously” saved.
Dr. Amy has, predictably, turned this into a condemnation of homebirth. She also accused another poster of a so called “fallacy” of the “lonely fact”, claiming episiotomy was the only little mistake modern obstetrics has ever made.
I replied. Now, back to work, I swear! *Scurries off*
Dr. Amy, (sigh, can’t believe I am doing this)
“Modern” obstetrics has also had routine high forceps deliveries with an episioproctotomy (what an older academic ob/gyn I know said was the norm when he trained…and he still sees it as an ideal), twilight sleep, DES, thalidomide, enemas, shaving, banning family support from the room…need I go on?
Modern obstetrics is not infallible, and does better when it is examined critically. Dr. Archie Cochrane started what ended up being the Cochrane Database because he thought obstetrics was so poorly based on evidence. It is not infallible. Its history of problems is not a “lonely fact”. Why does examining obstetrics critically scare you so much?
If you are interested in logical fallacies, you should look up “Straw man arguments”. I have mentioned this habit of yours to you previously, a few times.
The original post is about a major complication of epidural (intubation is a big deal) whose absolute risk is higher, yet very similar to that catastrophic (leading to fetal death) uterine rupture during VBAC, which you have repeatedly called too risky.
Who is distorting risks again? Both are absolute risks (of the eligible population) of less than 1 in 1000 (the catastrophic rupture risk is 1 in 2400). Epidurals are a lot more common than VBACs. However, there are other documented medical benefits to trial of labor with VBAC, and other documented risks to repeat cesareans, and other risks to childbirth, period. Is there documented risks to not getting an epidural? Is there documented medical benefit to getting one?
There are a lot more risks to epidural anesthesia than a high blockade. I am not saying they should be banned. I am arguing for it to be treated like an elective medical procedure with risks. It’s not a radical proposal. Why do you have to pretend it is? It should not be a moral crusade on either side.
I have personally sat through several cases of so called “informed consent” for an epidural when the entire explanation of risks was “it won’t hurt you or your baby.” I had an anesthesiologist storm off when I asked how common blood pressure drops are, in his experience. I was honestly trying to reassure the couple, who were there on a homebirth transfer and were terrified of the epidural, and were specifically worried about the blood pressure issue. I expected the anesthesiologist to say he does these all the time, and the women were generally fine. I guess he didn’t want to say that to them. I can’t guess his reasons why.
Look, these are anecdotal stories, but what is your point, Dr. Amy? Obstetrics, doctors, anesthesiologists and midwives are not infallible. Obviously there are different opinions out there on how to improve obstetrics. I know we don’t see eye to eye, but downplaying the very real risks of epidurals is not going to improve obstetrics, especially if it’s only to make it fit in with your point of view to what are acceptable risks (interventions that increase the control balance to the physician) as opposed to unacceptable risks (increasing the autonomy of the patient).