Women centered labour care

It is great communicating with expectant mothers and understanding their concerns and expectations. Recently one of my collegues was very offended when she had to do a cesarian section for a patient at 2 am and the patients' relatives were very angry as they were under the impression that if the doctor was trying so hard and waiting for so long it had to be a normal delivery.The doctor was highly offended because she felt that she had used all her energy and hard work for a patient and finally due to no fault of hers ,a cesarian happened.The patient instead of feeling grateful is actually blaming her for the cesarian section. As doctors, sometimes we often take a lot of things for granted. Most patients understand a lot of things which we may not necessarily communicate to them. Most patients know that if labour progress is not satisfactory a cesarian will happen.But there is a minority of patients who will not understand that fully.They will assume  that the doctor can assess in early labour whether cesarian will happen and some kind of mismanagment has happened if they were not told beforehand that a cesarian will happen. Our communication channels with the patient should be multi dimensional so that we understand the patients well.Otherwise we may have done a great job but the patient"s perception will be very different 

In continuation of my discussion about overmedicalisation of pregnancy and labour care ,I further want to say that a lot also depends on your approach to pregnancy as" would be" mothers.Please do not consider pregnancy as a medical disease.Remember that no matter what you do and whatever care you take ,how so ever number of ultrasounds you get done or dont get done,whatever number of antenatal check ups you go for ,whatever rest you take or you dont take ,most pregnancies and labour will be uneventful and safe.This is specially true for most mothers like you who are well nourished and are not suffering from any major medical illness.Remember as an expectant mother you should spread positivity which will have a positive influence on your family and care givers.When you are over anxious you may induce your  care giver to worry more about you and that may unnecessarily cause more interventions .Let me give you an example. Say Mrs B has had two miscarriages at 2 months which does not increase the risk of fetal loss at term .But once she is 38 weeks ,she is overanxious and feels there are decreased fetal movements.She comes to the emergency and a CTG and USG are reassuring.After 2 days she again rings up the doctor saying movements are less. Again the doctor does the CTG and finds her movements are fine.When she comes back a third time with the same complaints because of anxiety the medical care giver will in all likelihood induce her (Arificial pains )

Rinku Sengupta@SBISR: Patient centered Approach to labour care

Rinku Sengupta@SBISR: Patient centered Approach to labour care: Today let us talk about postdated pregnancy that is pregnancy that continues beyond your expected date of delivery.In recent times we have seen a large number of mothers being induced for this indication .Let us see why.As the pregnancy continues beyond term,the chances of liqour (water around the baby) getting less and the baby getting less oxygen increases. But nobody knows the exact risk of that happening with you at say term +1 day,term+2 days and so on and so forth.After doing research on thousands of women some international medical organisations have found that the risk of leaving a low risk pregnancy beyond 41 weeks (calculated from first trimester ultrasound) is slightly high compared to leaving them beyond that time awaiting spontaneous labour.The absolute risk to the babby is still very low ,approximately 500 inductions or more may need to be done to save one baby from this risk. Therefore it is important to understand the risk benefit balance in every decision.

Patient centered Approach to labour care

Today let us talk about postdated pregnancy that is pregnancy that continues beyond your expected date of delivery.In recent times we have seen a large number of mothers being induced for this indication .Let us see why.As the pregnancy continues beyond term,the chances of liqour (water around the baby) getting less and the baby getting less oxygen increases. But nobody knows the exact risk of that happening with you at say term +1 day,term+2 days and so on and so forth.After doing research on thousands of women some international medical organisations have found that the risk of leaving a low risk pregnancy beyond 41 weeks (calculated from first ultrasound) is significant.
continued.........

It has been a long time time since I have written on this blog.Being an obstetrician now for almost 20 years ,I feel time has come for us doctors in private practice to empower our patients with more knowledge so that they can participate in managment and do not feel a particular managment plan has been imposed on them .Ofcourse I am only talking from the point of view of pregnancy and labour managment which in recent years is getting more and more medicalised. I am only talking about those mothers and their families who typically visit Private hospitals in metropolitan cities.These mothers are educated,professionally qualified and usually read up a lot about pregnancy and child birth on their own before visiting the doctor.To these mothers I want to give evidence based medical information.I want to make them understand that most medical situations are not black or white ,there are a lot of grey zones.Let me give you an example ,there is this lady who has epilepsy and is pregnant and wants to know whether she can continue to take antiepileptic drugs which are known to be teratogenic (harmful to the fetus).My advice would be that she would have to continue the drugs (under medical supervision) as the risk of not taking it can outweigh the risk of taking it.If she has a epileptic fit then she and her baby could be in grave trouble but the risk of the drugs could be kept low depending on the dose and type of drug. Therefore everything rests on this risk benefit ratio and it is like a weighing balance that all us doctors are mentally using everytime we prescribe you an antibiotic,we decide for induction, we decide to give you antihypertensive drug,decide for cesarian section so on and so forth. I think we need to give you universal evidence based information regarding the risk benefit analysis for situations that are available and then make you participate in your care.