HW # 39 - Insights from Book - Part 2

1. “Much of the risk of cesarean emerges in the next pregnancy, 91% of which today will be delivered by repeat surgery” (Block 116).
“The uterine scar can of course rupture in a future pregnancy” (Block 116).
Description of cesarean scar being the cause of the placenta ripping open the uterus and even the bladder right after birth causing severe hemorrhaging and
major surgeries.

“Michel Odent …put a database online, where one can search studies that have connected narcotics at birth with addiction in adulthood; induction of labor with autism; and cesarean section with immune disorders. The research is far from conclusive, but it points to the large, unknown territory of the impact of medicalized childbirth” (Block 134).

“A British midwife told a researcher that the sounds women make when they’re on artificial oxytocin are hauntingly different: “It’s a panic, it’s a scream and it’s different from the noise they make when they’re working with their bodies…It sounds like someone’s being murdered.” (Block 135).

2. Cesarean births are performed much too often and can be dangerous to the mother and the baby at the time of the birth and in later years. In general, when a woman enters a hospital, even if she is healthy and nothing is wrong, she is hooked up to all these monitors and given Pitosin too quickly to speed up contractions, which causes pain and makes her need drugs, and then if the baby still doesn’t come soon enough, she will get a cesarean section. Nature is not given enough time to act, and women aren’t given ways to handle the pain without drugs.


3. “If we put women in hospitals with restrictive policies – they’re hooked up to everything, they’re expected to be in bed – of course they’re going to go for the epidural, because they’re unable to work through their pain,” (Block 174).

Use of epidural anesthesia in childbirth at large hospitals increased from 22% in 1981 to 66% in 1997 and is estimated to be 80% today” (Block 170)

“’Americans trust doctors and they trust hospitals, and they equate the two with health. What they don’t understand is that obstetricians are surgeions, and they know pathology, but they really suck at wellness.’ They are trained to sew up a tear, but not to prevent one” (Block 176)

“As doulas ‘reframe’ the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. Hedley did her job so well that even though she felt her client was ‘abused,’ her client will go right back to the sambe obstetrician and hospital for her next pregnancy” (Block 160)

“Caillagh (superstar midwife) was known widely for successfully treating even serious prenatal conditions with diet and herbs, for stopping postpartum hemorrhages, and for resolving complications that would otherwise be dealt with surgically. She could turn babies who were entering the pelvis askew; ‘prolonged labbbor’ was language she never employed” (Block 223)

3. “Necrotizing fasciitis, the flesh-eating bacteria, afflicts 1.8 per 1000 surgical patients and is profoundly disfiguring or fatal” (Block 117)

OBJECTIVE: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong.
DATA SOURCES AND STUDY SELECTION: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'.

DATA EXTRACTION: All articles involving necrotising fasciitis in Hong Kong were included in the review.
DATA SYNTHESIS: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis.

CONCLUSION: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.