Friday, November 10, 2006

Miami Advice

Last night, members of the Junior League of Miami turned out for my reading at Books and Books in posh Coral Gables. Before the event began, the group sipped chardonnay and sparkling water in the lovely store's open-air courtyard. It was there that I met a local dermatologist, who promptly recommended preventive Botox for women my age, to take care of wrinkles "before the horse is out of the barn." So it was not surprising to me that, an hour later, during the question-and-answer session after my reading, that the same woman was the very first on my tour who publicly admitted to me that, if pregnant, she would schedule an elective cesarean "for cosmetic purposes." Who needs to risk pelvic floor morbidity when you can get a tummy tuck (a la Britney Spears?) while delivering. It's an interesting point. Of course, there are studies that show the mere weight of the pregnant uterus can cause incontinence (usually temporary) among some women. But more and more, we seem to be focused on the concept of the "honeymoon vagina." And how to keep it in tact. Instead of lecturing about how recent studies looking at nearly 6 MILLION births found elective cesareans to be much more deadly for mothers and babies than vaginal births, I turned to another woman in the front row, who had already disclosed that she had had three vaginal births. "How is your pelvic floor?" I asked with a chuckle. "Fine!" she gushed. Enough said.

Earlier in the day I gave a talk at the main branch of the Broward County Library. One woman in the audience told me that many OBs in Florida are not carrying malpractice insurance because it is so expensive. Potential patients must sign a legal waiver acknowledging that they know their doctor has no coverage when they sign up for care. I asked about this during the evening event and almost all of the women in the crowd nodded in agreement, including two attorneys whose OBs had no coverage.

There were two other tidbits I learned yesterday. First, a mother told me that South Miami Hospital has a 63 percent c-section rate (a fact that I have not checked). And another said that a major hospital in the area had banned doulas. Perhaps if there were more doulas present there would be fewer c-sections. Next stop: New York City

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