More equipment to attach to birthing women!
Ultrasound "clips" to measure dilation? Come on. How much further do we have to go before we've excised caregivers' hands (and eyes, and brains) from the picture altogether? The manufacturer claims that it "enables obstetricians to make decisions based on accurate and timely information, resulting in significantly improved medical care, reduced costs, and a lower risk of malpractice." Right. Because the information you get from observing and examining a patient--or at the very least, communicating with the NURSE WHO DOES--just can't be counted on to be "timely and accurate." Not when something as important as "reduced costs" and "lower risk of malpractice" are at stake!
I'm curious how, exactly, introducing a new (expensive) piece of equipment is going to reduce costs. I can't think of a single way. My guess is that the only change this would introduce into practice would be to raise the C-section rate, much like the standardization of continuous electronic fetal monitoring. And that is certainly not going to "improve medical care" or "reduce costs." In terms of malpractice, it's just another tool which will end up essentially demanding intervention instead of determining the actual need for it. This is especially interesting, in the section "for Mothers-to-be," regarding manual (hand) cervical checks: "The information available to the caregiver is inaccurate due to the objective nature of the measurement and intermittent. In the event of non-progressive labor, the diagnosis may be delayed, thereby preventing the mother from obtaining the best medical care."
First of all: I think they mean "due to the SUBJECTIVE nature of the measurement," not OBJECTIVE nature. An OBJECTIVE measurement is purportedly what they're trying to obtain with this machine. And we're going to use a vaginal probe manufactured by these people?!
Second: even correcting for the above error, stating that information is unequivocally inaccurate merely because it is subjective is a complete blind leap off the cliff of logic. It would be acceptable to say that it may be inaccurate (due to its SUBJECTIVE nature), or is more likely to be inaccurate, but to say point-blank that subjective information is inaccurate is...well...inaccurate, as well as just. plain. stupid.
Third: "In the event of non-progressive labor"--did they make that diagnosis up themselves? A new diagnosis to go with the new technology? Because other diagnoses, such as failure to progress, are already adequately assessed and defined with the current means--"the diagnosis may be delayed, thereby preventing the mother from obtaining the best medical care." Meaning...what? There's a chance that labor will stall and we'll miss it for awhile and she might end up delivering vaginally? I'm assuming that by "the best medical care," they're referring to an instantaneous C-section as soon as the probe reflects that "progress" has hit a pause?
If we recognize that multiple vaginal exams are a problem, how about we just plan to keep them to a minimum? A very wise older doctor who used to practice at Iowa always said "Curiousity is not a good enough reason to check a cervix." In other words, if it's not guiding your practice and the answer won't have an impact on what you do, just don't do it. It's invasive, it's uncomfortable, and it's unnecessary. (Many midwives and nurses hold that a good caregiver can determine a woman's dilation without ever touching her. The physical and emotional "signposts" that accompany the various stages of labor are, when not interfered with, pretty unmistakable. Of course, that all goes out the window when all of your patients have an epidural.)
And if there's anything MORE invasive than having a doctor or nurse's hands in your vagina, it's having them attach a machine (a quick and comfortable process, I'm sure!) that will stay there throughout all of labor!
Minimally disrupt comfort, my ass.
The thing that really bothers me about all of this is that it's just another opportunity to obliterate the actual SKILLS required to be a doctor or a nurse. We've already given up skills like palpation and fundal measurement and Leopold's maneuvers to ultrasound, and most of the nurses I work with have a single skill in their labor-support pain relief arsenal: get them an epidural. Now, assessing dilation and effacement and station--one of the more fine-tuned of the physical assessment skills in labor--could go by the wayside as well.
Finally, the part that especially creeps me out on the product's site is where it says "Your partner will be able to be an active participant in the labor process as he/she follows the progress of the partogram on the screen next to your bed." As opposed to what he could do (counterpressure, massage, walking with you, warm compresses, ice packs, getting you the birth ball, supporting you in a squat, helping you into a tub or shower, providing verbal encouragement, assisting you to a change in scenery, slow dancing with you, getting you a snack or a drink) if you weren't stuck in bed, strapped to a monitor.
Ultrasound "clips" to measure dilation? Come on. How much further do we have to go before we've excised caregivers' hands (and eyes, and brains) from the picture altogether? The manufacturer claims that it "enables obstetricians to make decisions based on accurate and timely information, resulting in significantly improved medical care, reduced costs, and a lower risk of malpractice." Right. Because the information you get from observing and examining a patient--or at the very least, communicating with the NURSE WHO DOES--just can't be counted on to be "timely and accurate." Not when something as important as "reduced costs" and "lower risk of malpractice" are at stake!
I'm curious how, exactly, introducing a new (expensive) piece of equipment is going to reduce costs. I can't think of a single way. My guess is that the only change this would introduce into practice would be to raise the C-section rate, much like the standardization of continuous electronic fetal monitoring. And that is certainly not going to "improve medical care" or "reduce costs." In terms of malpractice, it's just another tool which will end up essentially demanding intervention instead of determining the actual need for it. This is especially interesting, in the section "for Mothers-to-be," regarding manual (hand) cervical checks: "The information available to the caregiver is inaccurate due to the objective nature of the measurement and intermittent. In the event of non-progressive labor, the diagnosis may be delayed, thereby preventing the mother from obtaining the best medical care."
First of all: I think they mean "due to the SUBJECTIVE nature of the measurement," not OBJECTIVE nature. An OBJECTIVE measurement is purportedly what they're trying to obtain with this machine. And we're going to use a vaginal probe manufactured by these people?!
Second: even correcting for the above error, stating that information is unequivocally inaccurate merely because it is subjective is a complete blind leap off the cliff of logic. It would be acceptable to say that it may be inaccurate (due to its SUBJECTIVE nature), or is more likely to be inaccurate, but to say point-blank that subjective information is inaccurate is...well...inaccurate, as well as just. plain. stupid.
Third: "In the event of non-progressive labor"--did they make that diagnosis up themselves? A new diagnosis to go with the new technology? Because other diagnoses, such as failure to progress, are already adequately assessed and defined with the current means--"the diagnosis may be delayed, thereby preventing the mother from obtaining the best medical care." Meaning...what? There's a chance that labor will stall and we'll miss it for awhile and she might end up delivering vaginally? I'm assuming that by "the best medical care," they're referring to an instantaneous C-section as soon as the probe reflects that "progress" has hit a pause?
If we recognize that multiple vaginal exams are a problem, how about we just plan to keep them to a minimum? A very wise older doctor who used to practice at Iowa always said "Curiousity is not a good enough reason to check a cervix." In other words, if it's not guiding your practice and the answer won't have an impact on what you do, just don't do it. It's invasive, it's uncomfortable, and it's unnecessary. (Many midwives and nurses hold that a good caregiver can determine a woman's dilation without ever touching her. The physical and emotional "signposts" that accompany the various stages of labor are, when not interfered with, pretty unmistakable. Of course, that all goes out the window when all of your patients have an epidural.)
And if there's anything MORE invasive than having a doctor or nurse's hands in your vagina, it's having them attach a machine (a quick and comfortable process, I'm sure!) that will stay there throughout all of labor!
Minimally disrupt comfort, my ass.
The thing that really bothers me about all of this is that it's just another opportunity to obliterate the actual SKILLS required to be a doctor or a nurse. We've already given up skills like palpation and fundal measurement and Leopold's maneuvers to ultrasound, and most of the nurses I work with have a single skill in their labor-support pain relief arsenal: get them an epidural. Now, assessing dilation and effacement and station--one of the more fine-tuned of the physical assessment skills in labor--could go by the wayside as well.
Finally, the part that especially creeps me out on the product's site is where it says "Your partner will be able to be an active participant in the labor process as he/she follows the progress of the partogram on the screen next to your bed." As opposed to what he could do (counterpressure, massage, walking with you, warm compresses, ice packs, getting you the birth ball, supporting you in a squat, helping you into a tub or shower, providing verbal encouragement, assisting you to a change in scenery, slow dancing with you, getting you a snack or a drink) if you weren't stuck in bed, strapped to a monitor.
3 comments:
I especially like "slow dancing with you" and I look forward to doing that and all those things. All well said. Love you so much!
Not a fan of the serif font.
Thanks for the link! This is really a ridiculous piece of machinery, and I agree that the solution is to reduce vaginal exams by simplyg NOT doing them so often. Wow, what a novel idea!!!
BTW, I also went to the U of I and am finishing my PhD from there, end of this fall semester hopefully!
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