QUALITY/PHYSICIANS: OBGYNs are scientists, scientists I tell you

Interesting long article in the New Yorker by Atul Gawande about How childbirth went industrial. Briefly it’s about how we stopped using all kinds of techniques for getting kids out that required a lot of skill because we started measuring the results on a universal scale. And the result is a lot, lot more C-Sections. In the UK they don’t use so many C-Sections, so I asked a recently retired British OBGYN I know rather well for his opinion. Here’s what my dad has to say about the article:
It shows yet again that the worst way to deliver a baby is by C/S following a long failed labour. If you could guarantee a normal labour then that would probably be best for mother and baby, at least at the time. This doesn’t allow for the increase in prolapse and Sphincter Weakness Incontinence (Stress incontinence)in later life. It also shows that female doctors are the poorest judge of how they should deliver!

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  1. 1. No matter what drug or intervention there’s always a side effect or consequence.
    2. The longer a women is in an L&D ward the more apt she is to have an intervention, i.e. IV fluids, electronic monitoring and internal exams.
    3. It human nature to want to help and there’s a lot of expensive equipment around to use and pay for. As well, well meaning people just can’t keep their hands off. Its always enticing to want to control a natural process even when the outcome is unpredictable.
    4. It’s a slippery slope that turns necessary intervention into an intervention of convience for the provider and the mother.
    5. Be wary of industrialized medicine as the outcomes do not always justify the intervention.

  2. > OBGYNs are scientists, scientists I tell you
    Engineers. They were not building theories, they were observing outcomes of a mechanical process, evidently using good variability (risk) reduction techniques any Six Sigma Green Belt would use. Then they tweak the process and observe that.
    So, questions for your dad: I don’t see a suggestion that, given the fact of a failed labour, that some other technique might reliably be better than C/S in the absence of a rare-by-definition virtuoso obstetrician.
    Is it permitting a labour to become too long he thinks is bad? Something else? How shall we decide how long is “too long”, or that the labour is likely to fail?