As you’ve likely noticed from reading many of the posts on this blog, becoming a doctor is a process. But I’ve heard probably a million times in my career that being a doctor is an ongoing process.
Part of that process for me includes maintaining my ABOG (American Board of Obstetrics and Gynecology) credentials, which includes reading articles that the board has selected and answering questions about them.
A few days ago, I had some slow time while on call, so I started to address my credentialing backlog (60 questions done out of 120 needed for the year!).
As always, it’s more fun than I think it will be. For one thing, I enjoy learning and reading. For another, I’m starting to hit more names that I recognize from training or society meetings; that always gives me a thrill. Finally, there are the surprises that make me think about how medical research is done. A great example is one of my current favorite studies, a randomized controlled trial: “Is maternal posturing during labor efficient in preventing persistent occiput posterior position?”
This was a trial of women in labor for whom the fetal head was not cooperating, but rather persistently staying in the occiput posterior (OP) position. This position—where the baby is “sunny-side up”—can make delivery a lot harder, because the diameter of the head that needs to pass through the maternal pelvis is much larger in this position. So physicians would like to get such fetuses to turn around, to make a vaginal delivery possible—and easier.
There’s a lot of lore about OP position and a lot of wisdom from both the midwifery and obstetric literature about using gravity or other techniques to “convince” a baby to turn during labor. It’s a question that’s probably as old as humans: how can I get this fetus through this pelvis most easily? But little of such knowledge has been verified—and that’s what this study tried to do.
In the trial, some women were told to assume one of their “intervention” positions versus just lying down in the bed. (The “dorsal recumbent position” was the control group.) For the intervention group, different maternal positions were attempted to help turn the fetus, based on exactly where in the pelvis the fetal head was, and using computer modeling to optimize the position.
Participants were randomly assigned to either the control or the intervention group, making this study a strong one, scientifically speaking. No differences were found in the outcome between groups.
Look, all studies are flawed, and this one was as well: The women studied almost all chose to have epidurals. One of my midwifery colleagues said that she would like to see the results in a population with a more normal rate of regional anesthesia (although she agrees that it would be hard to do; laboring women without pain relief generally get to be in any position they darn well please!). And I’ll have to assess whether the research is applicable to my patient population here in the Bronx.
But I loved the creative mix of old-school labor questions, 21st-century computer modeling and cold, hard science. As a doctor and researcher, I was excited that people are using the tools of the future to answer an ancient question.
On to the next article!