Christmas 2012: Evolution of Practice

Push, pull, squeeze, clamp: 100 years of changes in the management of the third stage of labour as described by Ten Teachers

BMJ 2012; 345 doi: (Published 19 December 2012)
Cite this as: BMJ 2012;345:e8270

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Afaifel and Weeks do an excellent job of reviewing changes in obstetric practice, by comparing old issues of Ten Teachers with the latest edition.

However, this method of starting from today misses practices such as symphysiotomy which are no longer used in the west, and therefore not mentioned at all in Ten Teachers, yet which are simple and may be the only option in out-of-the way developing world practice.

Secondly: under the threshold for invasive procedures, it should be remembered that the same textbook may not teach appropriately for parts of the world where the threshold for more invasive techniques should remain very high.

Although Ten teachers has changed over 100 years, the possibilities for actual (as opposed to ideal and well-resourced) obstetric practice have not done so in a uniform way.

For this reason, this review should be regarded as descriptive of developed world practice, but NOT as prescriptive of universal practice or all situations.

Application of ideas on what may safely be done in the developed-world to a poor area of the world may lead to the disasters so carefully cautioned against by earlier sets of the "ten teachers".

Thirdly: there is no reference to the peculiar modern habit of standardising delivery with the woman on her back! My father did Obs at the Rotunda in Dublin in the early 1940s and all women laboured and delivered lying on their side! Why has practice changed?

Perhaps clinical updates should be bracketed with comments on which situations they will really be appropriate for.

Competing interests: None declared

James A ERSKINE, part time GP

Lockside Medical Centre, 85 Huddersfield Road, Staylbridge, SK15 2PT

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Dear Editors,

We must never forget that early cord clamping has serious, short and long term, irreversible consequences on children!


Competing interests: None declared

Stavros Saripanidis, Consultant in Obstetrics and Gynaecology

Private Surgery, Thessaloniki, Greece

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The illustration purporting to show the method of bimanual compression of the uterus is not that at all. What it is illustrating is the method to replace an acute inversion of the uterus!

Competing interests: None declared

Stephen H Raymond, Obstetrician & Gynaecologist

Royal Hobart Hospital, Tasmania, Liverpool Street, Hobart, Tasmania 7000, Australia

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