So, considering the last few days and weeks I have had, I shouldn’t be surprised that I was the recipient of a flurry of referrals from Dr.Amy’s blog to mine. She apparently didn’t have enough sarcastic and dismissive things to say about this post I wrote giving what I thought was non controversial, balanced advice to my cousin Susan, who is pregnant for the first time, about things to ask a potential obstetric provider. So, she wrote a whole post about it, how I am “obsessed” with birth, thinks everyone else should be, and how wrongity wrong I was to supposedly ignore “skill level” of the provider in my list of interview questions.
I am sure I am not doing much for my image posting my reply on here, but I am really starting to wonder what is going on. I do honestly try to avoid conflict in most areas, and usually only object to what I think is truly objectionable. I seem to be very unpopular this week with the online medical establishment. I hope this doesn’t seal my reputation as a trouble maker. I am really making an effort to walk the high road when I reply, but I do refuse to stand by silently when I am linked to or talked about. I don’t have higher standards for myself than I do the other people who are engaged in these discussions. I sometimes feel like they do for me, but, oh well.
Here is my reply on her site:
Dr. Amy, you don’t say how to measure this skill level. I asked you several times. How about avoiding complications of a vaginal delivery, since you mention avoiding complications? OK, what would those be? Well, a common one would be a third or fourth degree tear. What is the greatest risk factor for that? Well, an episiotomy.
I am glad more people are going to my blog and reading the whole post than are commenting on here, based on my referral numbers. I don’t see a lot of consent here, either. Even in the cherry picked statements, I think I don’t look all that bad. But hey, Dr. Amy readers, I link to an entire task force position statement on labor and delivery interventions(pdf), among other things, in the original post.
I also must object, again, to your sarcastic and dismissive tone. I am not “obsessed” with the birth process – I am researching obstetrics at medical school, and plan to be an obstetrician. Is Dr. Fogelson “obsessed” with the birth process when he leads off an article about evidence based delivery interventions with a paragraph on episiotomy, and how it should be unthinkable to recently trained physicians?
Evidence based care is the only way I can think of to judge practitioners, and I gave many specific examples of how to ask your practitioner about evidence based practices. Evidence based care comes from researchers like me being interested, not “obsessed”, with birth. Using evidence based standards would be the best way to prevent complications, don’t you think?
Also, I very clearly mention several times that each woman should determine her own priorities when interviewing a practitioner. I, in no way, suggest they need to share my
“obsession” priorities. I have been to many vaginal deliveries (probably more than you have in the past decade, anyway) and currently research birth full time. I can tell you what the worst sequalae of these deliveries are – complications due to iatrogenic unnecessary interventions. As for skill, I have seen a recently graduated midwife handle shoulder dystocias with calm skill, and have seen a seasoned ob/gyn handle it like a first year medical student.
Here are your questions:
HOW should a newly pregnant mother rate a physician based on his or her skill? HOW does she find this information? What SPECIFIC parameters should she use?
Mortality rates are obviously not good, even if they are available, for reasons your commenters have already pointed out. Patient characteristics, along with physicians characteristics, can contribute to mortality rates. Also, in our developed country, mortality rates are not good indicators, since maternal and infant mortality is very rare, and is usually indicative of an underlying pathology or birth defect, not poor skill of the practitioner.
I gave many examples of specific evidence based standards as examples, and some practical and yes, atmospheric issues (like, can my partner spend the night in the post partum room. May be atmospheric, but a first time mom might not even know to ask and probably cares a lot), and made it clear the priorities of the person interviewing were obviously personalized and flexible.
Also, one more question, which I have asked before. What is SPECIFICALLY wrong with using the interventions I suggest as a guide to the practitioner’s adherence to evidence based care? Is that really such a horrid way to judge a practitioner that you need to scold me on my blog and on yours? Just scoffing and calling me naive is not answering this question.