There has been a post circulating the Facebook circuit called "Olivia's Law". This is an article meant to infuriate mothers and initiate a "call to action to end the use of forceps". I unfortunately have had to grieve with families in the loss of a newborn and it is a pain that is unlike any other. I can't imagine having a nursery, an embroidered diaper bag and no baby. Furthermore, I am a mother and like every momma grizzly, I want to protect my children from harm.
However, I am a board certified Ob/Gyn. I am able to separate my emotions from the facts on this particular subject. I have found NO Ob's that have offered an opinion on this proposed "law". I know that this blog is risky business, but I have to speak the truth on this subject. My job is super fantastically happy, except for when it's not. Sometimes babies die. Sometimes we know why, sometimes we don't, but this I know: I have never killed a baby with the use of forceps.
The cliff notes regarding this case are as follows: a mother reportedly 4'11'' (and by the pictures provided appears that the father of the baby is a man about 6'0") is post dates. She reportedly asked her OB for a cesarean section, as she felt the the baby was too big and was denied her request. She went in for an induction and reportedly pushed for many hours, was horrendously off of her labor curve, forceps were applied. The couple claims that they heard a cracking noise, that the mother was literally pulled off of the bed with the force he used, that the baby was not able to be delivered vaginally, she was rushed for an emergent cesarean section and that her baby suffered a fractured skull and subsequently was pulled off of life support. It is also of note, that the doctor they chose has reportedly had his license suspended or revoked (according to some sources) in two states.
This case is not the forceps fault. They did not jump out of the sterile bag, and into this woman's vagina for the sole purpose of killing her baby. This case appears (as I have not heard a formal statement from the doctor on this case so what I'm hearing is one sided, thus far) to be a series of bad decisions.
Problem number one: research your doctor. Know how he or she thinks and how they feel about operative delivery. Ask questions before you are 42 weeks.
Problem number two: listen to your patient. If my patient thinks the baby won't fit, I don't argue with them. They live in that body, not me. Induce them at 39 weeks in the hopes that a smaller baby has a better chance of fitting while minimizing any prematurity risks.
Problem number three: Friedman's labor curve. You are either on it, or you're not. If you are not, there's usually a darn good reason why. One you don't want to find out about in an emergency.
Problem number four: if you apply any method of operative delivery and the fetus does not move, you are done. You don't try to pull the Mom off of the bed with a vacuum or forceps.
Whether this physician chose forceps or a vacuum, the result would have been the same. I have seen skull fractures, as brain bleeds, skin trauma and other issues happen with the vacuum. I have also seen flawless forcep applications with smooth deliveries of healthy pink little babies. I use both. And I use them sparingly and when appropriate. It either fits, or it doesn't. If it doesn't, put the spoons away and grab a knife and have a safe delivery.
I ask those of you who think that the vacuum is such a "safe alternative" to delivery to do this experiment. The next time you get in the shower, put some shampoo in your hair, apply a suction cup and try to lift your head. It will pop off and provide no lift power. Or better yet, take a toilet plunger and suck it onto your leg and try to lift it. See how much force it takes over that one spot to lift it. Now grab a set of large salad tongs, place them around your knee and do it. The force is evenly distributed and requires much less pulling to achieve the same effect.
On an abrupting baby with a ton of blood pouring out and a head full of hair, those forceps are all that kid has. You don't have the 6-10 minutes it takes to go "to the back" for an emergent c/s. You can apply a vacuum with a bunch of pop offs and get an impressive hematoma on his head or you can gently apply the forceps around his head and with one gentle pull, save his life. I've done it. Medicine is an art. It is also science. It is also intuition. You can't legislate these things. At least I sure hope not.
No comments:
Post a Comment