Otterday! And Open Thread.

Today’s ottery goodness consists of newborn Asian Small-clawed Otters at Sea World Orlando. Peep! Peep! Peep!

Please feel free to use this thread to natter about anything your heart desires. Is there anything great happening in your life? Anything you want to get off your chest? Reading a great book? Anything in the news that you’d like to discuss? What have you created lately? Commiserations, felicitations, temptations, contemplations, speculations?

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Categories: Life

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12 replies

  1. I have missed HaT, but been too busy to read it lately. Hi Hoydens! How are you?

  2. Hi Anna! Good to see you and Happy New Year!

    Quiet holiday time, mostly, for me. Hoping to get out and enjoy some Sydney attractions next week when the bulk of the Xmas/NYE tourists have buggered off back home.

  3. so cute! and the peeping just adds to the cuteness.
    i have a question for lauredhel or any other medical/birthing-knowledgeable hoydens (apologies to those triggered or just not interested in descriptions of medical procedures; please feel free to skip.)
    i was having a discussion with a fellow medical student regarding giving birth in the prone “lithotomy” position vs. an upright seated or squatting position. the other student stated that one of the reasons that a prone position would be preferable to and upright position was that, if a laceration was to occur, in the lithotomy position the laceration would be more likely to tear down towards the anus, whereas in an upright position the laceration would be more more likely to tear up into the urethra. a perianal tear would be preferable because it is easier to repair than damage to the urethra.
    thus far i haven’t found anything online or in the literature to support this. anyone have any insight?

    • I’m not sure about the tearing thing, but I am sure that the lithotomy position is supine, not prone. Pregnant women generally do not do prone!
      I’d be interested in comparative tearing rates anyway for active births versus lying-down births.

  4. whoops! thanks, tigtog, that’s what i meant. 🙂 sorry!

    • No worries, you just niggled one of my pet peeves is all.
      Like folks talking about their pronating feet when eny edjumacated fule kno just by looking that their feet may well be doing all sorts of unstable things, but pronating isn’t one of them (my hindfeet adduct on heel-strike and my forefeet supinate on push-off, thank you). All these people outside med circles blithely using very specific terminology in a general fashion gives me the grimacing.

  5. Ladoc: sounds like handwaving to me. There’s a stack of evidence that not forcing lithotomy on people while birthing is a good thing for both adult and baby/ies; I haven’t specifically looked up tearing stats, except just to say that while tearing is important there are other issues also. Getting up or side-lying means a shorter labour, bigger pelvic outlet, better comfort, better blood supply to the baby. Also, when you’re up, someone’s less likely to get near you with the scissors and/or forceps, which are much more damaging to the perineum than a birth tear.
    Plus, you know what, the presmise is faulty in the first place. A third or fourth degree tear or cut is _not_ that easy to repair, if it (3rd degree) is picked up in the first place. And not infrequently results in long-term problems, problems that the accoucheur is unlikely to see.
    Poking around for cites, here’s one:

    Outcomes of the [Albers] study showed that warm compresses and massage with lubricant provide no apparent advantage or disadvantage in reducing obstetric genital tract trauma, compared with hands-off management of second-stage labor. Strong predictors of genital tract trauma were found to be nulliparity and high infant birth weight. Two factors associated with lower risk of trauma were birthing in an upright position and delivering the fetal head between uterine contractions.

    More from the same review:

    In contrast to the traditional lithotomy position (supine with legs in stirrups), upright and lateral birthing positions have been found to have many benefits to the delivering mother. These include shorter second stages, reduction in assisted deliveries, fewer episiotomies, and reduced anterior and perineal tearing (Albers & Borders, 2007; Roberts, 2002; Roberts & Hanson, 2007).

    More here, in which it is clear that this prospective doctor, if truly interested in preventing perineal trauma, should not just keep her nose out of positioning business, but should keep out of accoucheuring normal birth altogether in favour of midwives. Or perhaps, as a second best option, should choose to learn about the craft at the hands of experienced midwives (not obstetric nurses) rather than from the medical profession.
    P’raps you could re-educate your colleague with trufax?

  6. yes, there’s definitely a lot of misuse of medical terminology out there. and i don’t even have the excuse of being a layperson!
    this also reminded me of another excellent malapropism i made recently while presenting a case to my senior resident:
    ladoctorita: . . . and her neurologist wants her started on keflex.
    resident: what? why?
    ladoctorita: for her epilepsy.
    resident: what are you talking about?
    ladoctorita: she’s been taking depakote, but the neurologist would like her switched to keflex.
    resident: um . . . i think you mean keppra.
    ladoctorita: yeah, what’d i say?
    (for the non-medical, keppra=seizure med, keflex=antibiotic. oops.)
    not one of my prouder moments, that. 🙂

  7. thank you so much for the additional info, lauredhel. i really appreciate it.
    most of what i found was similar, i.e. that upright birthing results in decreased trauma in general as compared to a supine position, but i wasn’t sure if there was data on the specific issue of the direction of tearing. furthermore, the idea that this alleged chance of preserving the urethra would be worth risking all the other negative outcomes associated with the supine position seemed fishy, but as i’m still early in my training i wanted to be sure this wasn’t some widely-accepted idea that i’ve been blithely unaware of.
    colleague shall be re-educated forthwith. thanks again!

  8. ladoc: I expect it’s closely related to other aspects of magical wishful thinking in birth attendants – the idea that it’s better to cut than to tear, the idea that women with birth plans inevitably end up needing C sections and it’s their own damn fault, the idea that babies will drown if born underwater, the idea that holding your breath is the best way to push, the idea that continuous electronic fetal monitoring must be best because you can “see what’s going on”, the idea that people shouldn’t eat or drink because they’ll vomit, the idea that all membranes must be artificially ruptured to ‘speed labour’, the idea that cervixes must dilate at a fixed rate or the baby will die, the idea that a cord must be cut straight away to prevent jaundice and so you can whisk the baby away to resuscitate it… pretty much every non-evidence-based bit of standardised care has hand-wavey “benefit to the mother/baby” justifications that aren’t borne out by the data, but just happen to be all convenient for those who want to provide hands-0n interventional “care”.

  9. Just a reminder to Australian Hoydenizens that Torchwood: Children of Earth begins airing on ABC2 tonight (Friday Jan 8th), at 8pm, and should subsequently available on ABC’s iView for two weeks.
    I won’t be watching it myself, as I wasn’t a fan of this mini-series when I saw it last year, but I figured that there are probably a few people here who are interested in seeing it.

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