Thursday, July 31, 2008



So my post on evidence-based medicine is a little long in coming (it's in draft form) but in the meantime I wanted to share. Looking up medical PDA applications for my mom (there are a lot) I came across something I think says a lot about the way you might deliver with a doctor.

As a doula and someone who talks with women about pregnancy and birth, I hear so many women say "I trust my doctor," or "I like my doctor," when contemplating birth choices. They believe that this will be enough to give them the healthy, normal birth experience they want. I know that there are many fabulous doctors out there - I haven't been able to work with many of them, but I know that there are doctors who practice more like our conception of midwives, than some certified nurse-midwives do! (And I have worked with some of those CNMs - never assume that because someone is a "midwife" that they have a certain standard of practice.)

But when women tell me things like "I like my doctor," I get an uncomfortable feeling. That you like your doctor is great, but that should only be the first item on your list. Like this person? Okay, check. Now let's ask: What are their intervention rates? What will they allow you to do and not do in labor? Under what circumstances? What's their c-section rate? What percentage of women in their practice deliver without medication? Would they be willing to deliver a breech baby vaginally?...etcetera.

When women say "I trust my doctor," do they trust them because they've gone through all the above questions with their doctor, or because they assume that all doctors practice identically and their doctor's training will be all they need?

And in the end, if you like them and trust them, is your doctor even in the room for more than a few minutes at the end to catch the baby? Because they could always be tracking you down in the cafeteria, or from the comfort of their own bed, with this:

For serious, people. Your doctor can monitor your contractions and fetal heart tones from their iPhone! Real time! Talk about hands-on medicine!

More information here, if you want it.

All I have to say is, if I'm ever in the position of needing an OB, my first question might well be "Will you be turning me into an iPhone application, or treating me like an actual person?"


Chris said...

Thanks for discussing AirStrip Technologies. This posting raises some issues that deserve response.

Your point of view is clear – the concern that OBs will treat patients less like women and more like abstracts. But in reality, nothing could be further from the truth.

The experience from docs that use AirStrip OB is that it enhances their ability to make the best decisions on behalf of their patients. OBs have made fast decisions to change course in the L&D process as a result of danger signs they have seen on the strip using AirStrip OB – things that might have otherwise gone unnoticed by others, or misreported to the doctor.

There have even been reports that doctors keep AirStrip on while performing other procedures, to alert them about patients who have shown trouble signs.

Doctors have to multitask – frequently bouncing from a hospital, to a private practice, and so on, juggling a number of patients at all times. As you know, being a doctor is a hectic, stressful 24-7 job – not a 9-to-5 Monday thru Friday office gig.

Doctors deserve credit for caring enough about their patients to use a product like AirStrip OB – which allows them to be closer to monitoring the status of their patients full-time than ever before.

AirStrip OB is intended to enhance patient safety and reduce bad outcomes to moms and babies – and every indication from every doctor that uses AirStrip OB is that the software does exactly that.

I encourage you and your readers to visit to learn more about what AirStrip OB does, and how doctors are using it to effectively provide better care for their patients.

publichealthdoula said...

I respect your opinion that AirStrip OB is useful for doctors who are bouncing from patient to patient and rely on remote monitoring to track their patients. My question is whether mothers would find it as beneficial. Perhaps this would be appropriate for high-risk situations where labor needs to be monitored very closely. My question is whether that is the kind of care that a woman looking for a normal, healthy birth experience expects. These women do not benefit from continuous fetal monitoring - in fact, CFM has been shown to increase c-section rates without improving fetal outcomes. A woman seeking a normal, healthy birth should be looking for a provider who will make decisions with her, in person, with the recognition that there is so much about labor that cannot be judged from lines on a screen. A woman seeking a normal, healthy birth should be looking for a provider who can be hands-on - literally - to help her through her labor and birth experience. Again, a program like this might be helpful for high-risk patients but I cannot imagine a reason that, as someone seeking a normal birth, I would want my care provider tracking me continuously on a program like this.