We understand the problem: the VBAC (vaginal birth after cesarean) rate is too low. It's time for a bold solution. We need a "VBAC Court."VBAC is a safe option for most women, and almost 3/4 of women who opt a VBAC will deliver vaginally and avoid another C-section. But we also know that approximately 0.8% of women attempting VBAC will end up with a ruptured uterus, a catastrophic complication ...
Amy Tuteur, MD
What is defensive medicine in obstetrics?
Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.Reducing adverse outcomes? Check. Deterring medical malpractice claims? Check. Pre-empting liability? Check.Consider the precipitous decline in the rate of VBAC. That's avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.There's an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven ...
Explaining why belief in pseudoscience is often evidence resistant
What links belief in tarot cards, UFOs and vaccine rejectionism? Yes, they are all forms of superstitious or magical thinking, but are there characteristics that predict who will believe in such nonsense? That's one of the questions that psychologists Marjaana Lindeman and Kia Aarnio seek to answer in their paper, Superstitious, magical, and paranormal beliefs: An integrative model.Lindeman and Aarnio postulate that believers in superstition, paranormal phenomena and ...
The biggest problem faced by pilots and obstetricians alike is nature
It's a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.That's because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless ...
Natural lifespan and whether a woman is designed to give birth
Advocates of alternative health attribute all sorts of fantastical properties to the human body. The body supposedly "knows" how to live a long healthy life; the body is supposedly "designed" to work perfectly. The tenets of natural childbirth philosophy also invoke these fantastical properties. The body "knows" how to give birth; a woman's body is "designed" to give birth.On their face these claims are obviously false. The body doesn't "know" ...
Induction of labor should be restricted to medical indications
It seems rather obvious that medical procedures should be reserved for medical indications. Why? Because almost every medical procedure, even some of the simplest, have small but real risks of complications. And risking complications can only be justified if the medical benefit outweighs the risk.That rule applies to labor inductions, although many obstetricians have forgotten it. Induction of labor for non-medical reasons, primarily convenience, is attractive, but labor induction is ...
For autism, vaccination is the simple answer that is tragically wrong
It is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccination is presently unknown.Vaccine rejectionists never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. Vaccine rejectionists always insist that vaccines ...
Being a good mother is not about specific mothering choices
Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it's worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering.Simply put, I believe that good mothering is about choosing mothering and not about mothering choices.What does choosing mothering mean? It means actively embracing ...
Cancer in a transplant kidney, is it the doctor’s fault?
May you never be an interesting case.That's a cautionary proverb familiar to medical professionals. While it's bad to get sick, it's much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting ...
Measles from rejecting vaccines, and the price society pays
Vaccine rejectionism is based on a profound lack of knowledge about immunology, statistics and science. Virtually every single empirical claim of vaccine rejectionism is factually false, but parents who lack even the most basic understanding of immunology are often incapable of evaluating those empirical claims.Indeed, those parents most likely to proclaim themselves "educated" on the topic are generally the most ignorant.A new paper on a recent measles outbreak, Measles ...
Waterbirth dangers to newly born babies
Waterbirth has become a central component of "natural" childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don't need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, ...
C-section rates and its association with lawsuits
The National Center for Health Statistics recently released a new report, Recent Trends in Cesarean Delivery in the United States. The report is most notable for a startling statistic; the C-section rate has reached the astronomical level of 32%, an increase of more than 50% since 1996. This is disturbing news.Why is the C-section rate sky high?The pervasive nature of the increase may hold some clues. The increase has ...
Preventive medicine may not always help patients
If there's one thing everyone agrees on, it's that preventive care is always a good thing. Well, I'm a doctor and I'm afraid of preventive medicine.The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse ...
VBAC should not be a woman’s right
VBAC activists are clinging to their resentment and aggressively ignoring reality.Amy Romano at Science & Sensibility asks the bizarre question: Do women need to know the uterine rupture rate to make informed choices about VBAC? It's bizarre because she implies that this is a medical question and that the answer is unknown. However, this is a legal question and the answer has been clearly established by the courts. Not ...
Homebirth does not protect against serious maternal infections
Homebirth advocates like to tout the many "advantages" of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your "own germs" are in your home, you are protected.Yes, you are protected from hospital acquired infections, but the most dangerous infectious agents are actually those that live inside the mother, not the ones in the hospital. Consider that for newborns both Group ...
Doctors are responsible for a minority of medical mistakes in radiation therapy
The New York Times recently featured a disturbing expose of serious medical errors associated with the newest forms of high tech radiation treatment, entitled, Radiation Offers New Cures, and Ways to Do Harm. The piece is an example of excellent medical journalism, compelling stories of two individuals who sustained truly horrifying injuries as the result of treatment errors framed a detailed investigation of similar errors that have occurred in New ...
Should body mass index (BMI) be used as a college graduation requirement?
It's official. America hates fat people.Human beings are constantly searching for socially sanctioned reasons to feel superior to others and in 2009, those who are thin feel mighty superior to those who are not. How else could a college dare to make body mass index (BMI) a graduation requirement?According to James DeBoy, the chair of Lincoln's Department of Health, Physical Education, and Recreation, the point of the new policy is ...
Can less aggressive cancer screening recommendations be better for patients?
Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold.It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don't doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated ...
Why pregnant women should get the H1N1 flu vaccine
Doctors are often compelled to make quick decisions in life threatening cases with only limited information. Unfortunately, pregnant women are now going to be put in the same situation.The H1N1 flu has taken an extraordinary toll among pregnant women. A new vaccine is now available. Because of the nature of the emergency, there has not been time to do any long term studies of the vaccine. Yet pregnant women will ...
The alternative, complementary, and integrative health obsession with toxins
Everything old is new again and that is certainly true in the world of "alternative" health. One of the axiomatic premises of contemporary "alternative" health puts its believers behind the times ... by approximately 500 years.A fundamental premise held by believers in "alternative" health is that we are swimming in a world of "toxins" and those "toxins" are causing disease. Like most premises in "alternative" health it has no basis ...
