I’d like to comment on three articles.
The first is the straightforward article on eclampsia (O&G Magazine Vol. 19 No. 2 Winter 2017 p18–21). It’s comprehensive, but I’m a bit disappointed they didn’t use the expression ‘hypertensive encephalopathy’, which is succinct, yet accurately descriptive.
The second is re Ian Pettigrew’s article on shoulder dystocia (O&G Magazine Vol. 19 No. 2 Winter 2017 p36–7). I’ve known Ian personally for many years. He mentions doing an episiotomy in passing, but makes no justification for it. Shoulder dystocia is a bony physical obstruction, not a soft tissue one. The perineum has already passed the head, proving its elasticity, so apart from possibly providing easier manual access for the usual stepwise manoeuvres (and that’s debatable), what does an episiotomy do to assist delivery of the shoulders? I congratulate him for even achieving that in a woman that size on all fours, on the floor.
The third item is the extremely disturbing report of the bureaucrat reporting a Fellow to AHPRA (O&G Magazine Vol. 19 No. 2 Winter 2017 p73–5) when the colleague concerned had already taken every reasonable step to comply with the law. This is outrageous and I hope the Fellow sued for compensation for losses and stresses incurred. This is where we need test cases to better strike a balance between ‘professional responsibility’ and exposure to this sort of politically motivated attack, often made by people whose thinking has no basis in rational science.
I had a similar experience in Western NSW some years ago when, as a locum, I casually checked the PPH box in the delivery suite and discovered there was no misoprostol. I was informed it had been removed by the bureaucracy. There was no F2a to replace it. I was directed to the area office some 500km east of where I was, to be told the directive came from Sydney. I spoke to the chief pharmacist of NSW, after speaking to Sydney colleagues, who assured me no such directive had been made.
I was lied to by the area health office and it interfered with my safe practice. I complained, when presented with a 17-year-old G1P0 for suction curettage, that the lack of misoprostol had increased the risk of the procedure greatly. This was before Mr Abbott was overturned by the Parliament on the misoprostol access debate. At one point in my attempts at cervical dilatation, I was faced with the choice of waking her and sending her to Adelaide, or carrying on. After a brief wait, I was able to dilate the cervix enough to complete the procedure. When I went to a pharmacy in town and obtained supplies, I was threatened with sacking by the CEO if I brought that medication into his hospital. This case also highlights how political interference in medical practice, without scientific basis, is an ongoing hazard. The state law in Qld and NSW remains in the 19th century, due again to politicians with mindsets having no basis in rational science. I note that the President of RCOG has just written to the PM in London expressing concern about the Democratic Unionist Party’s attitude to abortion services. I hope she receives a measured response.
Thanks for the opportunity to vent.