The first speaker at the conference on Saturday was Manny Vallejo, the director of OB Anesthesia at Magee Women's Hospital in Pittsburgh. I have to say, regardless of whether or not I agreed with everything he said -- I have got to give him serious credit for speaking at the conference. I'm sure many would have seen it as nothing less than walking into the lion's den.
It was extraordinarily informative to see the thought process behind protocols at Magee and to learn that the actual policies the hospital has are not as conservative as many of the orders that doctors impose, as far as nourishment in an uncomplicated, unmedicated labor. A tray of clear food/liquid were fine with him up to 8cm. And who wants a cheeseburger in transition, anyway?
The epidural rate at Magee is 89-91% which elicited a groan from many. He rightly pointed out that the Magee also receives many high-risk women from suburban hospitals who have medical issues that warrant an epidural; but he also pointed out that there are 15 year old laboring girls who are terrified. I wanted to ask, well, how about making sure that mom-to-be has a doula? He did list the variety of analgesia Magee had at its disposal, and at the top of the list were Lamaze, birth ball, doulas, etc., and then gas/air, IV meds, and finally the epidural. He recognizes that other forms of pain relief are appropriate.
He also showed a photograph of a woman in labor, who was on her knees in bed, with her hands against the inclined head of the bed, with two women (nurse?) attending to her. (For those playing along, this is a lot like what my labor with Badger looked like.) I, like many others in the room, saw a woman being guided by her body. He saw a patient in pain, and said something to the effect of, "This is what you don't want to see," and that she probably should've gotten an epidural before this point. There is a difference between pain and suffering, and honestly, perhaps he had more background on who that woman was and how she felt in her labor, but I found it very interesting that he saw suffering where others saw the productive pain of labor.
Oh, and for TOLAC (ahem. not my favorite term.), he thought an epidural should be placed, even if "just in case." Aggravated me on many levels, although I did appreciate that he didn't feel that it needed to be utilized, just the catheter put in place.
All in all, a good speaker and we could've asked him questions all day long. He answered most questions in a fairly transparent way.