Waiting for the miracle of life | |
The obstetrics manual. |
The obstetrics manual, by Michael Humphrey, Inaugural
Professor of Obstetrics and Gynaecology at the North Queensland
Clinical School, the University of Queensland, is particularly
germane to the current problems faced by rural obstetric
practitioners, for whom it was especially written. Although not as
comprehensive as the author seems to have intended, it certainly
gives succour to those isolated practitioners dealing with
pregnancies that are not quite normal, and should, it is hoped, also
encourage city general practitioners who want to do more than just
token office shared care.
The chapters on normal pregnancy are particularly well written, with the emphasis on avoiding "medicalisation". An example is the very useful tip of measuring fundal height with a tape measure -- a low-cost alternative to the increasing trend of expensive multiple ultrasound examinations in normal pregnancies. The weighing of pregnant women is fairly debunked -- because of the lack of clinical information obtained from this measurement and because of the guilt engendered in the patient. The universal determination of hepatitis B antigen status for pregnant women is not mentioned, raising the question that perhaps this low-risk group is still being discriminated against. The book mentions, but provides no evidence for, the "dangers" of the pregnant woman causing harm to the fetus by lying on her back. Women who are proven to be iron-deficient in pregnancy would scarcely need the six iron tablets a day recommended in this book. That advice is probably as out of date as the data quoted in normal reference levels (1966), which are of another era in terms of diet, age group and parity. The terror of shoulder dystocia is well described, but there is no mention of the useful manoeuvre of turning the woman through 90 degrees so there is enough room -- with her buttocks over the side of the bed -- to get the head out more easily. Nor are there any flow charts for this emergency (although there are exceptionally well done flow charts in other places in the book). The section on breast-feeding is excellent, emphasising the role of assistance from a caring midwife and the importance of correct attachment to the breast rather than timing feeds by the clock. The argument that most mastitis is caused by ascending infection is, however, sadly revisited. Shining through the book is the author's fervent belief that the obstetric needs of rural communities are best served by experienced general practitioners, and not by fleets of flying ambulances with city-based obstetricians. This outstanding book will provide comfort to those dedicated to serving these distant communities, particularly in the lonely hours spent waiting for the next "miracle of life" to happen. Mark Beale
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