Today we had a very interesting discussion on natural childbirths. It made me think deeply about some of the conversations I keep having with expectant mothers on how to overcome the fear of labour.I think as doctors we focus very little on the psychological preparation of the expectant mother.May be we need to have support from counsellors and childbirth educators for giving more time and understanding the mother----to hear her story! We need to tell our mothers that labour is a kind of physiologically monitored physical and psychological strenuous event in their lives which they have to deal with like any other challenging phase in their lives. They should practice regular meditation and focussed concentration breathing to divert their minds away from unfounded fear. There is nothing to fear when you are surrounded by relatives and health professionals you trust .Like they say what you believe in actually happens ,so believe in your body,mind and the ability to birth your own baby because nature has made us that way.
Rinku Senguptadhar.com
Friday, July 24, 2015
Sunday, January 4, 2015
What should I expect from my ultrasonologist?
Ultrasonologists and obstetricians are having a unique relationship in private
obstetric practice .It is time that they educate each other about many
obstetric issues for the overall well being of the mother and baby. As an
obstetrician in private practice I feel
that obstetricians and ultrasonologists are giving advice to patients independent
of each other leaving the patient highly confused .Recently I saw an ultrasound report from a renowned
ultrasonologist mentioning occipitoposterior position of the baby at 38 weeks on routine scan
and even telling the patient that it is an unfavourable position for normal
delivery. First of all position of the baby before start of labour does not
change the obstetrical management in any way. It is only the presentation
cephalic or breech ( head at lower pole or not) which matters. Secondly why
confuse the patient with a statement which does not alter management in any way?
90% of occipitoposterior positions will turn to the more favourable
occipitoanterior position. The ultrasonologist in question felt that he was
helping the patient and the obstetrician by remarking on an additional foetal parameter .But in reality
he or she implanted seeds of anxiety and fear of failure in the patient”s mind
before she began her labour journey. Most of the time we as obstetricians don’t
give feedback to the ultrasonologists thinking they will not understand .
By the way this patient
had an uneventful vaginal deliveryMonday, December 29, 2014
WHAT DO YOU EXPECT YOUR DOCTOR TO TELL YOU IN THE FIRST ANTENATAL CONSULTATION?
Think hard. You are
an educated professional enthusiastic expectant mother at 30 or above. But
unfortunately discussions regarding pregnancy and childbirth have been taboo at
home. Whatever knowledge you have gained till now is clearly from” hearsay” Now
suddenly everybody has some valuable knowledge to offer you regarding a
forbidden topic .Most of them will tell you about negative experiences that
they have heard of and a list of thing that you should not do to avoid poor
outcome. A time may come that you are filled with negative stories and you
constantly think how you could prevent anything bad from happening. You expect
your doctor to tell you all the things in a systematic manner that you should
or should not do to prevent all the nerve racking medical horror stories you
have heard.
So you go for the first antenatal consultation feeling
powerless vulnerable and totally dependent on the medical community. Typically
in a typical urban hospital set up the primary care provider is an obstetrician
who has trained for 6 years intensively to detect associated disease in
pregnancy and minimise complications arising from them. When you go and tell her
how powerless you feel and how worried you are that something bad is about to
happen and you expect her to give you a long list of things you should do or
not do
Well she is quite uneasy. There is no such divine list she
can offer you. Pregnancy is not a disease and complications happen in only 10
to 15% women and it is absolutely imperative to also add that no doctor however
competent can prevent most complications from happening. If miscarriages have
to happen they will happen ,if pregnancy induced hypertension has to happen it
will happen and if preterm labour has to
happen nobody on earth can prevent it. Then Why are
doctors required?
Many doctors also seek the answer to this question .There
are some doctors who feel so powerless and vulnerable that they wonder whether
their being or not being there could ever make a difference There are others
who take full advantage of the complexity of the situation and project
themselves as being always in control as
if to say that every good outcome is their credit and the fact that the mother did not have a
miscarriage or a growth restricted baby is because of the excellent care that
they have provided.
As expectant mothers it is very important that your
expectations match the reality .Our job as doctors is to make you feel confident
and project on the positive aspects of pregnancy care. There are some inherent
limitations of medicine because of which some serious complications cannot be
foreseen or prevented. But nevertheless you should empower yourself by knowledge, innate positivity and leading a
healthy lifestyle. You must have the confidence in yourself that things are
fine because things are usually fine most of the time. After all you don”s
sit on the driving seat of your car everyday thinking that
you will have an accident today!
Sunday, December 7, 2014
To DEmedicalise normal Births
I am reconnecting with you all after a long time. Meanwhile our whole team is working towards a lot of issues I discussed in my previous post. We are very focussed and commited to DEmedicalising normal births .We believe that the maternity care system has to have radical changes to make our dream come true. An optimal outcome for a mother who comes for her delivery in a hospital is much beyond a healthy baby and healthy mother.It is about how you enjoy your pregnancy,it is about creating confidence in the mother on herself ,it is about how well you are prepared physically,mentally and spiritually for this journey.This is team work and a very important member of this team is the pregnant mother herself and her partner .How well they understand that birthing is a physiological process and the trust that is created between them and the caregivers go a long way in determining the experience of care.The emphasis on not only what happens but how it happens!
Monday, August 12, 2013
What you can do to reduce your chances of caesarian section ?
It"s lovely to talk to you again.I also welcome the new members to the site.Although I don't know you personally I feel a special bond towards you as I can share my thoughts with you.
You will all agree that a lot of us lead a very sedentary life without realising it's fall out and implications. I may be busy the whole day but most of my time is spent sitting or standing and talking. These nonphysiological postures and workpattern put a heavy strain to our body physically and mentally. Have you ever wondered why other mammals and even primates do not need assistance for birth the way most humans do? Also why first births are apparently so much more difficult now compared to when your grandmother or great grandmother delivered?
Let me try to answer the first question first. Humans are the only mammals who are exclusively bipedal. This probably makes our pelvis narrower and less weight bearing. Also our brain size has been increasing over centuries and therefore the ratio of human baby"s head size to maternal pelvic diameter has been steadily increasing. This is a part of natural evolution and individually we cannot do much about it. The human birth is a fascinating phenomenon.The preparatory phase of labour starts days to weeks before the actual labour.To begin with the cervix or the mouth of the uterus starts loosening out .The connective tissue thins out and the cervix becomes softer and stretchable.There are some irregular uterine contractions (cramps)which may make you slightly uncomfortable.It is very important to wait it out and bear this slight discomfort. If you do regular exercise and walk for atleast 30 minutes a day your chances of going in spontaneous labour may increase.Besides there is medical literature to show that exercise can shorten labour and reduce your need for labour pain relief.
You will all agree that a lot of us lead a very sedentary life without realising it's fall out and implications. I may be busy the whole day but most of my time is spent sitting or standing and talking. These nonphysiological postures and workpattern put a heavy strain to our body physically and mentally. Have you ever wondered why other mammals and even primates do not need assistance for birth the way most humans do? Also why first births are apparently so much more difficult now compared to when your grandmother or great grandmother delivered?
Let me try to answer the first question first. Humans are the only mammals who are exclusively bipedal. This probably makes our pelvis narrower and less weight bearing. Also our brain size has been increasing over centuries and therefore the ratio of human baby"s head size to maternal pelvic diameter has been steadily increasing. This is a part of natural evolution and individually we cannot do much about it. The human birth is a fascinating phenomenon.The preparatory phase of labour starts days to weeks before the actual labour.To begin with the cervix or the mouth of the uterus starts loosening out .The connective tissue thins out and the cervix becomes softer and stretchable.There are some irregular uterine contractions (cramps)which may make you slightly uncomfortable.It is very important to wait it out and bear this slight discomfort. If you do regular exercise and walk for atleast 30 minutes a day your chances of going in spontaneous labour may increase.Besides there is medical literature to show that exercise can shorten labour and reduce your need for labour pain relief.
Tuesday, December 4, 2012
Labour support
Today I want to reemphasise the need of a good birthing support partner in labour. The fact that positive birthing support can do wonders for the labouring woman is now evidence based. We all know and it is proven by research that continous support in labour decreases the need of labour analgesia( pain relief) and medical interventions in birth. The big question is now who gives support because it is very important to understand that just like positive support can do wonders ,negative presence (not intentional of course) can do everything to break the morale of the patient.You are the husband of the expectant mother and you cannot see her in discomfort.Ofcourse we appreciate your love and concern for her but it is also your responsibility not to feel weak at this moment and keep reinforcing her positively,keep telling her she can do it,physically support her and positively divert her mind.This is how you can actually express your love for her and not start getting nervous yourself and panicking.We ofcourse appreciate that every human being is not cut out for this and if you feel you cant do it it is better to stay away and let another person who is better suited for this take over, it could be your wife's sister or friend
We are very sensitive to this issue and we are trying to give 1;1 continous medical support to all our mothers but your understanding and passive and active support to your wife and medical caregivers can go a long way in helping the expectant mother to do all she can for a natural noninterventional birth experience.
We are very sensitive to this issue and we are trying to give 1;1 continous medical support to all our mothers but your understanding and passive and active support to your wife and medical caregivers can go a long way in helping the expectant mother to do all she can for a natural noninterventional birth experience.
Monday, July 9, 2012
Public Private Health Divide
THE GREAT PUBLIC PRIVATE
HEALTHCARE DIVIDE-------a doctor speaks
I joined the
medical profession in 1992 technically speaking, as I was a medical student before that. There is a vast
difference in the way I think, the way I behave and the way I treat from then
and now.I used to look for role models then and in my own way I used to always
find them.The calm surgery house surgeon who taught me for hours how to put
intravenous cannulas,the surgery senior resident who taught me how to remain
awake after a 24 hours duty and still have the enthusiasm to teach the steps of
appendicectomy to an intern he would never meet after a week,the medical senior
resident who grilled us for hours during morning rounds just to empower us with
more knowledge. There was always so much to learn and so much to imbibe that not
a moment was spent in procrastination.The medical education in the preclinical
days however was quite ruthless according to me. Hours of cramming fat
dissection books ,15 people working on the same cadaver,tough practical exams
after every two months when the demonstrator would get some animal like
pleasure in announcing your pitiable low scores.The behaviour of the professors
and teachers made one feel that failing in one of these exams was akin to
damaging your career for ever. In the first six months of my starting the
medical journey,there wasn’t a single night when I didn’t cry myself to sleep
thinking that I wouldn’t be able to go to college the next day. The students
who had their siblings as seniors generally fared well.They already knew what
was expected and accordingly crammed up the inticracies of arteries, mucles and
veins in advance.Every thing that we gobbled up whether it was biochemistry,physiology,pharmacology,microbiology
and so on was far removed from the reality that we would be facing in the
subsequent years.But looking back I think that every single day of those long
years of hardships toughened us up for the long corrugated journey of the
medical world.
It was during internship that I got a taste of
professional life that we would be facing in future.The plight of poor patients
moved me and I realised how poor people suffer in disease physically and
socially. Women coming in with a 2 gm%
haemoglobin with inversion uterus,women brought in a charpoy with
rupture uterus ,women with intestine hanging out of uterus dumped in front of
us and relatives untraceable for hours after that. I could see the obstetric
residents working for hours and still not being able to do enough. During my postgraduation years that I came
face to face with human suffering and physical pain. There was no room for
exhaustion. During the 12 hour continous duty we would see sometimes the whole
spectrum of obstetric mishaps starting from intractable postpartum haemorrhage
to secondary abdominal pregnancy.We could save some and we couldnt save some
but each patient taught me to be a better clinician and a more humanitarian
doctor.When I moved to the private sector due to lack of government jobs in the
city the scenario drastically changed. The medical practice in government
hospitals is so different from care giving in private hospitals that as a
doctor I took very long to adjust to it.In the former you had these scores of
patients in the labour room where you
are taking a quick history ,doing quick obstetric examinations and the whole
focus is on making a fast diagnosis and expediate the treatment so that there
is a speedy turn over of patients. Beds were always in demand and the quicker
you were in managing the patient the more competent you were considered by your
seniors. I slowly and steadily improved
my clinical and surgical skills. By the time I became a senior resident I
became quite settled in the art and
science of Obstetrics. We were often so enthralled in the variety and
complication and the challenge of certain neglected cases that we were quite
unaware of the social and humanitarian aspects of these patients. You could say work was worship for
us and for the 36 continous hours that
we were on duty virtually nothing crossed our minds except how efficiently we
could clinically manage our patients. We were also under pressure of proving
ourselves academically to our teachers so that we could be better clinicians.
If we could diagnose a case of silent rupture of uterus or a very rare case of
secondary abdominal pregnancy we got a pat on the back and we felt proud about saving
a precious mother”s life . It really did not matter to our seniors how much we
talked to a sick patient or how much time we spent in counselling the
relatives. The fact is that we really did not have so much time because we had to move on to the next patient who
required our help. At the end of each month we had an audit in which the focus
was how much better and quicker we could have clinically managed a patient
leading to lesser morbidity. The scenario drastically changed when we moved
onto the private sector. It took a long time for me to understand and accept
that 60% of the gynaecology patients belonging to the upper socioeconomic class
who reported to the OPD (outpatient department) did not really need any
significant expert medical help but only routine check ups and a lot of
assurance and counselling. Now how good a doctor you are was solely decided by
the patient and her attendants and their perception on the other hand was quite
often solely depended on your bedside manners and how well you talked to
them. Clinical skill and clinical outcome
was important but secondary. It was a lot about how patient you are in
answering sometimes the same questions over
and over again during a consultation. In this context I must also add that
the success of the practitioner is mostly depended on the referrals she gets
either from other doctors or from her old patients. In the process many bright but novice less
manipulative private practitioners have failed to even make a beginning in this
terribly competitive world of private practice. As a society we are constantly
losing out on the services of some very well trained young enthusiastic doctors
. In a country with an appalling doctor
patient ratio of 1:1700 it should ideally never be the doctor”s responsibility
to procure patients. The
private sector is profit driven. Academic medicine which provides the medical profession the
wellspring to thrive, study, carry out research, evaluate, treat, learn and
improve is often ignored.Academic medicine and Research also contributes to the overall
progress in medicine and brings down health care costs . I know that one day in the far distant future
things will change and more public private partnerships will create a balance between the overworked
exhausted doctor in the public sector and the underutilised dedicated young
doctor in the private sector.I am also optimistic because I know some young
hospital directors who are aware of this paradox and want to change the situation to improve the overall quality
of health care at all levels
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