The big babies of the Hunter Valley and birth trauma.

It's been a couple of years since my last blog post so hopefully I have overcome my Game of Thrones-like writers block.

The reason for this new post was talking to a general surgeon over the weekend who pulled me up about "What the heck is going on with you lot in this city?"

So you understand a general surgeon deals with abdominal and bowel injuries, they try to avoid birth like the plague.

He had been asked to help with a woman at the John Hunter when a home birth had gone badly wrong. This led me to think about the people who offer these unsupported home birth services and the pregnant women who seek them out.

First a bit of history.

The very first time I turned up at the John Hunter Hospital after the professor had picked me up from a dark and wet Newcastle train station one evening in August 1998 he said to me "Newcastle is the shoulder dystocia capital of Australia!".

Shoulder Dystocia is a terrifying complication where the baby's shoulders get stuck and won’t come out after the head has delivered. Every midwife and doctor fears a true case of it, and my instinct was to get back on that train. This was my first clue that this city and the valley as a whole has some of the biggest babies in the world being born here.

This means obstetrics can be extra challenging especially for the mothers who birth those babies. It also means challenges for their caregivers and our hospitals have had their difficulties down the years.

And I am going to tell you that much of the blame lies with us doctors. The recent senate inquiry into birth trauma has shown that often communication during birth can be poor. There are several reasons for this and I'll explain part of it.

As a starry eyed junior doctor coming to this city in 1998 I looked at some of the specialists (not all it has to be said), especially those in private practice, as titans of the speciality. Due to doing births constantly they were incredibly skilled and there was no complication they could not deal with. It's obvious when you think about it that the surgeon doing the most operations will have the most experience and skill, isn’t it?

Surgery is an apprenticeship. So I looked at these doctors and decided I would be like them one day. It has taken many years but I have finally joined their ranks.

But my point is nowadays, perhaps due to work/life balance, I don't think the juniors look at me and think "My ambition is to have had his lifestyle and gain his skillset one day".  Family and time off is important to them and I have to agree up to a point.  In Australia these days medical students are chosen mainly academically and I feel our universities often do not pick the right people to train for our caring profession.

This means some of our doctors, the junior ones especially, do not communicate properly to women especially in stressful situations.

Do you remember how we discussed the big babies of Newcastle? The biggest reason for a difficult birth is a baby that is positioned posterior in the birth canal. This means the baby is spine to spine or "sunny side up". Anyone who has seen a birth knows the baby appears face down, so face up is a much bigger diameter to fit out and is bad news,
Sometimes it occurs randomly out of the blue but often it can be predicted. With my own patients we look at how the baby is lining up in the week before the due date and if it is lying posteriorly we try exercises and use a chair to help them turn.

A big baby in a posterior position is a challenge for the most skilled obstetrician. For a junior doctor who is more at home in a library it's a nightmare. Because these doctors are scared themselves they may use coercive language and some women are not happy and seek care elsewhere for their next birth. Some seek care privately with me and it's a great joy of mine to allow these women to have a better and empowering experience the next time.

When I hear stories of coercive language being used in birth I have to say I am rather bemused. The senate committee heard that a common threat by some doctors is that if you don't do what I say the baby will die.

I think this is a dreadful thing to say and I am proud to say I have never once in my career said it to a pregnant woman or their partner. But that is because I know I can deal with whatever complication ensures from the woman's choice.

So I have instead said many times... "I'll go along with any plan as long as it's not too crazy".

Only recently when talking to a woman who wished to attempt a vaginal birth after two caesarean sections I explained “I am happy to support you for the labour because I know I can get us out of any deep hole we get into if there are serious complications".

It took twelve years of training and many others of being one of the busiest obstetricians in town to be able to say those words without hesitation.

And my point is, the junior doctor cannot yet confidently say those words so they communicate badly in the heat of the moment.

Others who have been let down in their first experience or those who maybe have not been made aware of the big babies of the area explore home birth, where we started this chat.

Some home births are obviously being conducted by people who are far too the other way and over-confident to the point of being cavalier, and I will cover that in the next blog.

To be continued.