Patience and babies.

The breakdown of the mode of delivery for the last 18  months is in again and it all remains very steady.  My practice is very constant now because my patients are happy with it, as am I.

Planned elective ceasars are steady.  Many of my patients have had a bad experience elsewhere and want a better one this time so this makes up for a large proportion of my electives as well as my patients having another one under my care and feeling safe with me and my awesome aneasthetists.  Take a bow Dr Gary Willis, Dr Tod Eggleton and Dr Jacqui McCallum.

Emergency ceasareans are up from 10% to 11% of births which still well less than half the hospitals rate.

Breech babies are born vaginally now and again - yes we still do them at the Private Hospital but we don't make a big deal out of it.   Forceps continue to be very rarely used by me and usually just to turn babies around when stuck.

The big news was new figures made available by the hospital which showed I have a very low rate of the use of late term steroids for mothers and babies together with a much lower rate of admission the special care nursery compared with the hospital average.  

I think the reason for this good outcome is that the people who gravitate to me as their obstetrician work with me to get as far in the pregnancy as is safely possible for sake of baby.

While the use of steroids in premature labour is proven their use later in pregnancy is more of a gray area.  NSW Health condones their use and new studies will hopefully be available soon to help guide us.  I have covered how some eminent peadiatricans are very concerned about their use in late pregnancy  - in the earlier blog post about OB's and nerves of steel.  It is known that when used late in pregnancy they delay reading at school allbeit temporary.  My concern is that surely that confirms they are acting centrally in the brain to do that.  So my answer is to get a few days further - in a safe way - and take away the need for them.

Patience = Less need for late term steroids = Getting past 38 weeks gestation = More spontaneous labours = Less artificial inductions of labour = Less Ceasarean Sections = Higher breastfeeding rates = Less Post-natal depression.

Obviously patience is not required when there is problems or postdates but in low risk pregnancies the growing tendency to deliver earlier and earlier goes against nature.  And you go against nature with care.  I don't say never go against nature because I do that often for the good... but for experimenting on Australian babies (in the UK steroids are not given past 36 weeks) with late term steroids I say "lets proceed with care."