Digest Number 691

[Guest guest]

In response to Todd's question about deliveries by Doulas or midwives. and

whether these patients are adequately informed.

 

The real question is why does a patient seek a Doula or a midwife vs a

Gynecologist.

 

There should be no comparison of a Doula vs either a midwife or a

gynecologist, as unless the Doula is also a Delivery nurse ( practicing or

former Nurse), the Doula is not adequartely trained in diagnosing fetal

distress.

Is the issue a financial one, of a midwife charging less than a gynecologist

? Perhaps.

At our institution, there is an in-house Obstetrician all the time, so the

issue of a midwife constantly in attendance of the patient vs an Obstetrician

having dual responsibility to his office does not arise.

Although most patients, that seek midwifery help, also do not want epidurals,

quite a few change their minds, when confronted with uncontrollable pain, and do

take epidurals.

The "incidence" of C-Section with midwivwes is low, because when faced with

fetal distress, the case is automatically referred to an Obstetrician , who

performs the C-Section.

There is a lot of myth associated with deliveries, doulas, breast feeding,

epidurals, and cesarians, and I am sure the patients that seek help from MDs or

others have their own bias, when given the same information.

 

durgesh mankikar, MD

 

 

 

ayurveda wrote:

 

one thing that shows a significant reduction in the rate of caesarian

is midwifery and doula care are you suggesting these women aren't adequately

informed?

Caldecott

todd

www.toddcaldecott.com

[Guest guest]

Dear Shirish,

 

I brought the issue of intra-uterine seizures / depression of fetus, which may

be masked for

" fetal distress" with a Psychiatrist and an Obstetrician.

Their opinion is as follows:

 

Pre partum and Post-partum depression in mothers is a real issue.

Many mothers are psychologically " attached " to their medications, and feel

threatened by loss of therapeutic help.

The medications are lowered to their minimum tolerable and acceptable levels.

Animal studies with 10 times the therapeutic dosage has not yielded any fetal

problems

Human fetuses are difficult to be studied, but there is no verifiable change

in IQ of children, whose mothers may or may not have taken anti-depressants or

anti-psychotics.

Post partum depression has led to maternal death , suicide, failure to take

care of the child, and many other real problems.

Longer acting drugs are avoided, and so are larger doses avoided, unless the

mother is imminently in danger of severe depression.

Even in the first trimester, where the Central Nervous System is developing,

starting therapeutic lowered dosages has not led to any fetal anomalies in

behavior after birth.

Finally, seizures are possible, and so are arrhythmias, and are manifested as

" fetal distress" , which is an indication for C-Section, but these children do

not manifest any behavioral problems after delivery , after the initial phase is

controlled.

 

While all of this discussion is enlightening, and very academic; when faced with

a patient with mild, moderate or severe depression, there is no Obstetrician or

Psychiatrist in the West, who will not be hounded by the lawyers or their own

specialty societies, or their hospitals' QI committees for not treating the

patients with accepted protocols.

 

Durgesh Mankikar, MD

 

ayurveda wrote:

 

Infants of women who took antidepressants while pregnant, might

experience symptoms of withdrawal, including convulsions, according

to a study published in the Feb. 4 issue of the journal Lancet.