If you only have a hammer, everything looks like a nail; if you’re only a midwife, every woman looks like she needs a normal birth


There’s an old saying that if you only have a hammer, everything looks like a nail. It means that if you only know how to do one thing, you will insist that is what needs to be done.

Consider, for a moment, the possibility that there was a handyman, Bob, who only knew how to use a hammer. Whenever he was called to a job, he brought his trusty hammer and banged in the nails. Imagine that a new handyman, Steve, comes to town and he knows how to use a hammer AND a screwdriver. He can do twice as much as the original handyman and as time goes by, more and more people call Steve, since many of their projects involve nails and screws.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.[/pullquote]

Bob, the original handyman, now faces a difficult choice. What should he do about jobs that involve screws? There are several tacks that he could take:

He could always learn to use a screwdriver, but that might be difficult for Bob. What else might he do?

He could insist that screws can be pounded in.
He could insist that screws are an unnecessary use of technology; anything that can be made with screws could also be made with hammers.
He could insist that Steve invented screws just to take business away from him.
He could insist that Steve recommends screws for a project when nails would have been just fine.

Or he could take the aforementioned claims to their logical conclusion:

He could insist that only things assembled with nails are normal.

All of these strategies share one thing in common. They imply that being able to use a screwdriver is unnecessary regardless of the situation.

This is not a real world situation, of course; it is an analogy. Midwives are the people with hammers. Normal (or natural) birth is nails and screws are anything that obstetricians can do that midwives can’t.

There has a been a lot of debate in midwifery circles about what exactly constitutes normal birth.

As anthropologist Margaret MacDonald explains in the Lancet, The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth… The recent transition of midwifery in several Canadian provinces from a social movement—for which “reclaiming” natural birth was a critical goal — to a regulated profession within the formal health-care system is a unique opportunity to track changes in how natural birth is understood and experienced. Midwifery in Canada has much in common ideologically with independent or direct-entry midwifery in the USA and with radical and independent midwifery in the UK and so insights about changes in Canada have implications for maternity caregivers in a range of health systems.

Normal birth actually involves lots of technology. There is nothing natural about checking blood pressure, listening the fetal heart with a Doppler or recommending chiropractic. Other technological interventions have also become a part of normal birth:

… For example, a woman asks to have her membranes artificially ruptured after several hours of labour to “get things going” and gives birth vaginally at home… The presence of medical interventions within the realm of natural birth is a relatively common kind of border crossing.

Midwives will also recommend herbs or over the counter medications like castor oil to stimulate labor and prevent a term pregnancy from extending into a higher risk postdates pregnancy. In fact:

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it within the midwifery scope of practice, it is generally regarded as a good thing by midwives  … (my emphasis)

That is the key point. Anything is acceptable as long as it can keep the birth within the scope of midwifery practice. Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.

Just like Bob the handyman, a midwife faces a difficult situation when confronted with a patient who needs advanced technology like a C-section. She also has several choices, remarkably like the choices from which Bob can choose.

She could insist that the patient can give birth safely without a C-section.
She could insist that C-sections are an unnecessary use of technology.
She could insist that obstetricians recommend C-sections just to take business away from midwives.
She could insist that obstetricians routinely recommend C-sections when vaginal birth would have been just fine.

Or she could go “all in”:

She could insist that only vaginal birth is normal.

Proponents of radical midwifery theory use all these strategies. Midwives define normal birth by what is good for THEM, not what is good for women or safe for babies, and certainly not by what is actually normal.

A baby is breech and the midwife can’t do either a version or a C-section for breech. She insists that breech is a variation of normal.

A baby is postdates and the midwife can’t do a postdates induction with pitocin. She insists that babies aren’t library books and they don’t have to be born on a specific date and for good measure, she insists that pitocin causes ADHD, autism, or whatever condition you might fear.

A woman experiences severe pain during labor and a midwife cannot administer an epidural. She insists that the pain is beneficial, that the epidural has too many “risks” and that pain relief hurts the mother’s ability to bond with her baby. (Interestingly, in the UK where midwives can administer nitrous (an anesthetic) by mask, nitrous is considered compatible with normal birth.)

I could go on and on, but you get the idea. Anyone working with a midwife enamored of radical midwifery theory needs to ask herself: Are my midwife’s recommendations motivated by what it good for me and safe for my baby? Or are my midwife’s recommendations motivated by what will allow her to maintain control of me as a patient?

Does “normal birth” actually mean anything, or is it just a way for midwives to make what they can do seem most desirable?

Personally, I think the answer is clear. Normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby.

We’d rightly be suspicious of a handyman who asserted that assembling everything with a hammer is best. We should be equally suspicious of a midwife who insists that every woman wants, needs and benefits from normal birth.

69 Responses to “If you only have a hammer, everything looks like a nail; if you’re only a midwife, every woman looks like she needs a normal birth”

  1. Amy Tuteur, MD
    September 2, 2017 at 10:15 am #

    This piece in the Times of London is brilliant. Sadly it may be behind a paywall for some:


    • The Bofa on the Sofa
      September 2, 2017 at 10:51 am #

      It’s these feelings of failure that the Royal College of Midwives wants to end,

      Why did the RCM create them in the first place? You’ve spent years telling women their bodies are lemons, and now you are concerned that they are concluding that they are failures?

      When my waters broke at home on the Wednesday night and the contractions started coming every one to two minutes (the time at which I was told by my NCT teacher to come in), we drove to hospital. When I had asked my teacher what to do if your waters broke before full labour had started, she replied, “That only happens in the movies,”

      FFS! God that “teacher” is fucking evil.

      There was no option for me to change my mind. I was in a system out of my control. I also didn’t know how to ask for anything else – I didn’t even really know what to ask for.

      I think she somehow missed the memo that natural birth is “empowering.”

      How is it that childbirth – the one thing our bodies do that male bodies can’t – can feel so anti-feminist?

      Because the people pushing it equate “feminism” with “doing the one thing our bodies do that male bodies can’t”

      That’s not feminism, it’s biological essentialism. It’s not about treating women as humans with equal worth, it’s trying to make them valued for their biology.

  2. Sue
    August 30, 2017 at 12:47 am #

    There is an analogy here with psychologists vs psychiatrists. If you can only treat depression with talking therapies, you might overrate their benefits, or talk-up the risks of medication. If you can provide either, you can tailor your treatment to patient needs.

    • Empress of the Iguana People
      August 31, 2017 at 11:58 am #

      my husband’s first counselor (a social worker with a masters) kind of downplayed medicine too. I convinced Dem to see the psychiatrist in the office, too.
      Nice enough man, that master’s level counselor, but I for one wasn’t that sad when he retired last year and Demodocus switched to a psychologist. He’s doing a lot better between the MD and PhD docs.

  3. Who?
    August 29, 2017 at 6:23 am #

    Off topic, but not really…

    Homebirth, freebirth and Hannah Dahlen


  4. Gæst
    August 28, 2017 at 9:24 pm #

    “Normal” birth is pretty ableist, too, and sets up value judgements about births that are entirely unnecessary. See also: “natural”conception. I am teaching my anonymous donor IVF conceived twins that all variations of families are “normal” (so we don’t even use that word – there just ARE all kinds of families), including ours. And including the high risk advanced maternal age pregnancy with pre-e, prematurity, etc., etc., etc. We are normal. We are different from other families, but no less perfect.

  5. no longer drinking the koolaid
    August 28, 2017 at 1:35 pm #

    And, along with control goes the money. A midwife makes the most money if she does the birth. If she has to transfer the mom before and especially during labor she makes less with that birth than she had planned.
    When I use to talk with sister midwives about the long list of conditions that should have seen that family giving birth in the hospital, almost w/o thinking, what popped out of the midwife’s mouth was, “If I did that I’d never make any money.” Then they would catch themselves and give other reasons.

    • Madtowngirl
      August 28, 2017 at 1:52 pm #

      Ding ding ding! Anytime someone is adamant about a specific outcome or product, follow the money…..

    • Anj Fabian
      August 28, 2017 at 1:57 pm #

      One reasonable suggestion is to “fully integrate midwives” into the system.

      It makes sense. Midwives who worked well with the system wouldn’t have any problem finding OBs and hospitals to help them care for their patients with complicated pregnancies. What’s not to love about that?

      The problem is that midwives often don’t want that help. Sending a patient for an OB consult could mean losing that patient and income. This leads midwives to hold onto their paychecks as long as possible, insisting that everything is normal, giving women herbs when they are close to going postdates and so on.

      • swbarnes2
        August 28, 2017 at 2:13 pm #

        It’s not clear to me that the midwives at Morecambe Bay had anything to lose monetarily by referring their patients to OBs. They just didn’t want to lose control.

        The midwife-led system would work fine with midwives who were quick to summon doctors if anything looked off. That just doesn’t seem to be the case everywhere.

        • Roadstergal
          August 28, 2017 at 2:19 pm #

          Ego and health care go together very poorly. And yes, ego can be a problem for doctors – but a: they’re generally more trained/skilled than midwives, and b: they’re accountable to a very strict degree for any bad outcomes. Midwives lack that accountability to a staggering extent, even in the UK’s model.

        • mabelcruet
          August 28, 2017 at 4:46 pm #

          They were employed by the NHS, so they get a set salary that isn’t dependent on the number of births they supervise. They could have transferred every patient that week to the consultant led service and still would have got paid. I agree with you that it was a control issue.

        • Azuran
          August 28, 2017 at 7:24 pm #

          I think it was mainly a problem of bad oversight and inaction from the higher ups.
          Any bad outcome from the midwife led system should have received the same overview as any bad outcome following care by a physician. And people responsible for the overview and training should include OBs.
          It’s very doubtful that every single midwife in that hospital just graduated as a die hard natural birth advocate. It probably started with one or two bad apples, who formed new midwives and eventually spread the mindset so much that any new midwife either conformed or was pushed out.
          The OBs and the administration should have noticed and intervened much sooner.

          • fiftyfifty1
            August 29, 2017 at 8:34 am #

            “The OBs and the administration should have noticed and intervened much sooner.”

            Yes. And this is why the UK’s midwives are not professionals, as much as they may claim to be. To be a professional, the buck needs to stop with YOU. Your mistakes, as well as the mistakes of those under you, get blamed on YOU. YOU have to police your own, and have to police those under you too. If somebody says that Morecambe Bay’s OBs should have noticed and intervened, what they are really saying is that OBs are professionals and UK midwives are not.

          • mabelcruet
            August 29, 2017 at 9:08 am #

            With regard to whether obstetricians should have intervened, it depends on the way in which the midwives and OB set ups were integrated.

            I’ve been involved in a neonatal death case where the midwife led unit was geographically next to the obstetric led unit. The medical staff were not allowed into the midwife led unit to see women unless they were asked to do so, so there was no putting their head round the door and asking if there were any problems. Midwives in that unit seemed to have the opinion that obstetricians coming in uninvited was disrespecting their professionalism and undermining them. But of course it only works if the midwife recognises a problem and is able to judge whether this is within her level of expertise and act accordingly. In the baby I was involved with, the midwife missed a significant problem and it was only several hours later with a change of shift and a new midwife arrived that medical help was requested.

            There is another issue too-in the NHS there is a problem with bullying, particularly of junior medical staff. In obstetrics, some midwives can be very dismissive of doctors. I’ve been involved in autopsy cases where a midwife over ruled a junior doctor, or where a junior doctor paged a senior doctor but the midwife called the senior and said there was no need to attend. I think if you had a group of dominant midwives (as happened in Morecombe bay with the ‘musketeer midwives’) then junior and even senior doctors might feel pressured or bullied by them and working relationships would be fraught.

          • Dr Kitty
            August 29, 2017 at 10:06 am #

            I used to pop my head around the door and introduce myself to every woman in the delivery suite on my shifts there, just out of politeness. In case of an emergency at least I wasn’t a complete stranger and it was how I had been taught as a student.

            Some of the midwives did not take kindly to this, but I had senior Registrars who were supportive, so I kept doing it.

            Apparently just saying “Hi, I’m Dr Kitty and I just wanted to introduce myself because I’m starting my shift” was unacceptable to some.

          • Empress of the Iguana People
            August 29, 2017 at 12:36 pm #

            Ridiculous. My ob’s partner was at a meeting when I was in labor and popped in once it was over just to say hi and ask how we were. She said it in the typical Midwestern greeting tone rather than the actually concerned about the staff who were looking after me.

          • Busbus
            August 30, 2017 at 6:52 am #

            Just the idea of a midwife going as far as calling a senior doctor to tell him not to come in (presumably this was done out of earshot of the patient…) is mind boggling. Clearly, this in not on the best interest of the mother – otherwise, what harm would there be in at least getting a second opinion? *Shudder*

          • Busbus
            August 30, 2017 at 6:57 am #

            No matter what the medical issue might be, if I ever heard about any doctor actively keeping another doctor away from me (who might have had a different opinion), that would be the end of my professional relationship with them. I would be furious.

          • mabelcruet
            August 30, 2017 at 4:01 pm #

            In my case, it went further than just overriding the junior doctors management-after the baby died, the midwife modified the notes to suggest that she had asked the junior doc to call the senior and the junior had refused. From the investigation, it appears that she told the junior doc that the senior one had seen the CTG and was happy with it, and told the senior doc that the CTG had been redone and was OK. The CTG in question disappeared from the notes before the enquiry.

          • Busbus
            August 31, 2017 at 6:26 am #

            That’s horrifying! Did anything happen after the investigation? Policies/procedures changed? Anyone held responsible?

          • mabelcruet
            September 1, 2017 at 3:57 pm #

            The midwife concerned had been involved in an earlier case with a horrible outcome and was supposed to be closely supervised as a result of the hospital enquiry into that, but somehow she was doing a night shift with minimal supervision. The death was investigated, but the baby was stillborn so at the time the coroner refused to investigate. This was a few years ago, my recollection is that she took early retirement and stopped working. She shouldn’t have been allowed to do night shifts and she was supposed to be getting enhanced supervision but that didn’t happen. The parents litigated against the hospital. Unfortunately, the NHS as a whole is very defensive and closes ranks-sometimes going to litigation is the only way families can get answers. We aren’t good at having an open and transparent investigation process yet.

          • Charybdis
            August 31, 2017 at 9:41 am #

            I wonder if the midwives would wander into the OB- led side to gently undermine the OB’ s and offer “support”?

      • just no
        August 28, 2017 at 6:31 pm #

        Integrating midwives into the system means that those of us who were smart enough to go with an obstetrician and hospital can get stuck with a midwife interfering with our plans at the hospital.

        There’s already enough nature worship/attachment parenting woo appearing in hospitals and worming its way into obstetricians’ brains. We don’t need midwives working with doctors and influencing those doctors.

        • Daleth
          August 31, 2017 at 10:59 am #

          Integrating midwives into the system means that those of us who were
          smart enough to go with an obstetrician and hospital can get stuck with a
          midwife interfering with our plans at the hospital.

          It depends how it’s done. At the hospital where I delivered, you picked the CNM team or an OB from the get-go, and went to all your prenatal visits in the appropriate office (same floor, different offices). If you developed complications during your pregnancy or issues were discovered (e.g., first ultrasound reveals it’s twins), you would get risked out, from CNMs to an OB or even to the MFM team.

          If you picked an OB from the get-go, you would never see a midwife at all — not prenatally, during delivery or during your post-childbirth hospital stay — and they would have no opportunity to interfere with your care.

          Seems like a good way to do it, to me.

          • Empress of the Iguana People
            August 31, 2017 at 12:01 pm #

            I think we could choose, too, but I was risked out by being an “elderly” first timer. Not that I considered anyone but the ob team anyway, so it worked for me.

        • February 11, 2018 at 7:49 am #

          Do CNMs do the woo? I thought they were legit RNs who specialized in childbirth?

          • The Bofa on the Sofa
            February 11, 2018 at 9:16 am #

            Since when do nurses not do the woo?

            Therapeutic touch for example is not unpopular among nurses

          • February 11, 2018 at 10:18 am #

            Huh. Learn something new every day. I guess I always assumed all that education made them pretty much as non-woo as physicians.

      • Azuran
        August 28, 2017 at 7:13 pm #

        Most places have integrated midwives. The problem, mainly with the CPM, is that they do not want to be integrated.
        If they wanted to be integrated, they would be CNM. (But CNMs have to follow evidence based medicine and can be held responsible for their mistakes, they don’t want that)
        And integrating CPM is a ridiculous proposition, they are nowhere near educated enough to be considered seriously by the rest of the medical establishment and giving them any kind of endorsement would be deadly.

      • Ozlsn
        August 28, 2017 at 9:48 pm #

        Midwives here are predominantly within the hospital system (apart from a few independents who tend to overlap with the non-hospital scheme homebirth crowd.) So similarly to the NHS they are paid a salary and don’t lose income by transferring. Talking to a high risk ob the other day he made the comment that “the challenge for obstetricians is to not pathologise birth. The challenge for midwives is to not normalise it.” I think there can be a problem here with midwives holding off requesting interventions because they have (consciously or subconsciously) reassured themselves that birth is normal and that what they are seeing is normal. Experience can help with this obviously – you get better at recognising when something is not normal when you’ve seen it before – but so can going in with the awareness that things can alter very quickly and being willing to get a second opinion.

      • Petticoat Philosopher
        August 28, 2017 at 11:30 pm #

        We already have “fully integrated midwives” in the United States–most certified nurse-midwives practice within the system. Very few do homebirths and my understanding is that they are considered fringe. I know one CNM who was totally on board with homebirth–until she actually got her medical training! CNMs are real and valuable medical professionals. I assume and hope that Dr. Amy’s post is directed at CPMs and other underqualified rogue midwives.

        • MI Dawn
          August 29, 2017 at 8:06 am #

          I trained as a CNM through Frontier School of Midwifery, and had several classmates who became home birth midwives, with MD backup as needed. However, Frontier was (at least in the 1990s) pretty strict about teaching what was normal and what was NOT normal, and getting a patient to the MD STAT. Not one of them would have kept a patient home as long as most of these stories. Yes, they lost some income, but they were sane enough to know a live mom and baby was the desired outcome.

          In NJ, the state is pretty strict about written protocols that you and your backup MD have to sign (you can’t be licensed in the state without backup MD agreement) so if you tried to practice outside those written protocols, you were pretty much screwed.

      • Daleth
        August 31, 2017 at 11:04 am #

        Sending a patient for an OB consult could mean losing that patient and income.

        That doesn’t sound “fully integrated.” The CNMs who work in hospitals, i.e. who are fully integrated into the US system, don’t lose money when they risk out a patient to an OB or MFM. The only “midwives” who lose money by sending their patients to a doctor are the fake midwives who do home births or work for independent, non-hospital-affiliated birthing centers.

        Someone from the UK please correct me if I’m wrong, but my understanding of home births there is that midwives are salaried on the NHS and work in hospitals. The pregnant woman sees midwives for prenatal care, and when she goes into labor, one or two midwives travels from the hospital to her home to attend. Thus, if she develops complications and needs to be transferred, they simply transfer her back to their own hospital. There is no way for them to lose money doing that because they’re paid their salary regardless.

        Is that correct?

    • mabelcruet
      August 28, 2017 at 4:43 pm #

      But that’s not really applicable to the UK though-the vast majority of births are within the NHS system, either in a midwife led unit (these can be stand-alone units, or within a hospital with consultant led obstetric services adjacent). NHS midwives get paid a set salary, its not linked to the number of deliveries they supervise. If all their mums that week needed to be transferred out, they would still get paid. There is a small private midwifery sector (‘independent midwives’) who seem to primarily do homebirths, but the NHS also provides a homebirth option too. I think the independent midwives charge per birth-if the mum needs to be transferred in for obstetric care, that is usually under NHS emergency care, so mum doesn’t have to pay for that aspect (as long as they are entitled to NHS care).

  6. The Bofa on the Sofa
    August 28, 2017 at 1:00 pm #

    I’ve mentioned this before, who are the ones that tell women that their bodies have “failed” if they have a c-section? Midwives, of course.

    For OBs, otoh, a c-section is a perfectly normal outcome.

    • Roadstergal
      August 28, 2017 at 1:13 pm #

      Does an OB say anything after a non-complicated C-section other than “Congrats, here’s your baby”?

      • FormerPhysicist
        August 28, 2017 at 1:18 pm #

        “Don’t lift anything heavier than your baby for 2 weeks.”

        • Sarah
          August 28, 2017 at 1:19 pm #

          I’m off to golf, obv.

          • FormerPhysicist
            August 28, 2017 at 4:36 pm #

            Better than my first OB. The resident did the surgery, because my OB broke his arm skiing the week before I was due.
            But, the OB’s knowledge was still there, and the resident did just fine on a simple, routine, non-emergent surgery. I am glad that when I was given the choice to try laboring for an hour or two more, or go straight to surgery – I chose go straight to surgery. Less stress for everyone.

        • Roadstergal
          August 28, 2017 at 1:22 pm #

          I’m giggling in an inappropriate manner about the variability in your allowed activity depending on whether you have my coworker’s wife’s 11lb-er or a little 6lb-er… “No, honey, a gallon of milk is almost 9lb – if I had just had a little GD, I could do it, but it’s up to you now.”

          • BeatriceC
            August 28, 2017 at 1:36 pm #

            How should this have worked after my CS with YK. He was 504g. This is my current cup of coffee. https://uploads.disquscdn.com/images/0573d6274f3815db4c8057b5731b46cf45967476570d863b5c02cc7f49bea622.jpg

          • mabelcruet
            August 28, 2017 at 4:54 pm #

            Having flashbacks to my dad’s post myocardial infarct recovery period! He was given a list of what he could do with examples, so the first week he was allowed to lift the kettle and make a cup of tea, the second week he could lift a saucepan containing boiled potatoes, the third week he could do light shopping (only one bag though). He drove the cardiac nurse spare with constant questions about ‘is that a kettle with enough water for one cup of tea, or enough for the whole teapot?, and ‘When you say one shopping bag, is that a bag full of potatoes and bananas, or a bag full of crisps and doughnuts?’ He’s an engineer-they tend to be like precision and accuracy. He ended up weighing the kettle and adding water each day in increments, and organised all the kitchen cups in order of weight and size.

          • Who?
            August 28, 2017 at 6:43 pm #

            Love it. My dad has just had five valves replaced, and got much the same information, and had many of the same questions, and yes, was very incremental in his lifting.

            Though he has just had a telling-off from the exercise physiologist for walking too fast, so he’s clearly feeling better.

            And sitting with his patient surgeon and cardiologist, listening to those busy men answering all his questions, was very moving.

          • August 29, 2017 at 3:31 am #

            And I flew from Israel to the US, alone with my newborn son, who weighed slightly over 4 kg, when I was 10 days post C/S, and he was two days post-brit, because my mother was terminally ill and I wanted her to see her first grandchild before she died. No one gave me any instructions about lifting, etc. and I managed just fine. Sometimes the warnings about activity levels are a bit exaggerated, IMO.

          • Who?
            August 29, 2017 at 6:39 am #

            Yes, I think when you are in reasonable condition beforehand some of the rules are a bit draconian-I guess they are for those who really haven’t done a lot to keep moving in the lead-up.

          • fiftyfifty1
            August 29, 2017 at 8:45 am #

            Engineers are my all time favorite patients. It’s true they sometimes waste a bit of time with detailed questions, but they more than make up for it by saving me time giving accurate and organized histories.

            Typical patient: “Oh my god, I have been so sick for so long!”
            Me: “How long? What sort of sickness?”
            TP: “Way too long! It’s like I’ve been hit by a Mack Truck!”

            Engineer: “I have been having fatigue, body aches and fevers up to 102 deg for the last 6 days. This all started 5 days after returning from a camping trip.”

          • Dr Kitty
            August 29, 2017 at 9:54 am #

            LOVE engineers.
            “This is what is wrong.
            This is how it is wrong.
            How can we fix it?”

            Teachers, nurses, doctors and pharmacists on the other hand…

            Teachers will come in with 20 pages of research off the Internet, and will have already decided what is wrong with them and what you should do. It’s not always the correct diagnosis and explaining why is usually quite a struggle.

            Nurses and Doctors, won’t have the pages of research, but will have discussed their case with all their colleagues and will also have made their own diagnosis and decided on a treatment plan which they expect you to implement- it’s usually more sensible than the ones the teachers come up with, but not always.

            Pharmacists are like doctors and nurses, except they’ll have tried every OTC remedy they can get their hands on before they see you and will have STRONG feelings about which medication you ought to prescribe.

          • mabelcruet
            August 30, 2017 at 4:10 pm #

            I’ve a lot of sympathy for poor historians (although I’ve always been told there’s no such thing as a poor historian, just a poor history taker!). When I’m at the vets being interrogated, I’m like ‘well, she’s been a bit off her food. Well, not off as such, just fussy, but she managed to eat the chicken. And a few days ago, she was sick, or maybe it was last week? I think it was the day the postman left the mailbox open and she got in and chewed a letter. Actually, no, that was the other cat. And she’s lost weight over the last few weeks. No, its probably more like a few months, when my mum came to visit she was saying her cat was off her food….’ Honestly, I come out with complete drivel.

          • Azuran
            August 30, 2017 at 5:07 pm #

            That’s not that bad, especially with cats, they are pretty independent and very good at hiding their illnesses.
            Once I asked an owner what was wrong with her cat, she answered with: ‘You’re the vet, you tell me’
            She wasn’t very helpful.

          • mabelcruet
            September 1, 2017 at 4:07 pm #

            I only realised she was losing weight when I was looking through photos of the fur babies, she got really skinny in the last few months but it was quite gradual and I just didn’t notice. She’s getting a hemi thyroidectomy next week (the vet said she’d get a year or two from that, and given her age it was an easier option than radioactive iodine, she would have to go 300 miles away for that). But I’ve got to get some atenolol into her prior to surgery to get her heart rate down-the reason she’s having surgery is because I’ve completely and utterly failed to get carbimazole into her, tried every trick I know and she still won’t take the damn pills!

          • Azuran
            September 1, 2017 at 4:30 pm #

            Yea, pilling cats is horrible. It’s not rare for sick cats to sadly end up being put down or dying because they just won’t let you treat them.

          • mabelcruet
            September 1, 2017 at 5:56 pm #

            My other cat is asthmatic, she’s supposed to be on bricanyl and steroids but she got wise to my tricks. I used to wedge the pills into a chunk of sauted lamb leg steak, or pork or beef. Fish and chicken just flaked apart. But eventually she realised that if I put a little cube of hand carved lightly sauted meat in front of her it was booby trapped. So then we tried inhalers, and she nearly clawed my face off. So she’s now on monthly injections. At least her wheeze stops her hunting, she can’t stalk any more being so noisy.

          • BeatriceC
            September 1, 2017 at 7:08 pm #

            I’m on team injection with the parrots. It’s just so much easier. Though Goofy has gotten wise to my tricks to get him toweled, so I have that challenge, but once he’s all wrapped up, it’s super easy to give him a shot.

          • Azuran
            September 1, 2017 at 8:49 pm #

            I’d go:
            Large dogs
            Small parrots
            Small dogs
            Large parrots

            And way the hell down there: Horses
            I don’t even work with horses anymore, but my grudge against them is endless.

          • BeatriceC
            September 1, 2017 at 9:29 pm #

            I’ve never had to medicate a horse, so I’ll have to take your word for that. Charlotte the macaw takes Xanax. There’s no injectable formulation available. Also, the liquid tastes absolutely awful. It’s worse than Phenobarbital. MrC is the one that has to give her that. She tries to rip fingers off of anybody else who tries, including the vet.

          • Azuran
            September 2, 2017 at 9:11 am #

            When I was still in school, they mainly gave oral TMS to the horses. It was basically a large grain powder and you had to give ridiculous amounts of it. So we had to mix it with molasses and you ended up with around 6, 60ml syringes filled with molasses. Of course, when you gave it to the horse, about half of it ended up on you.
            And of course, injections aren’t much better, because horses. One kicked the vet as she was injecting it, so the needle fell in the box. So the vet made me and my friend look for it.
            No joke, I’ve spent 30 minutes of my life literally looking for a needle in a hay stack.

          • Azuran
            September 1, 2017 at 8:00 pm #

            And compared to that you have my dog, who’s just so ridiculously happy to get his medication he comes running whenever he hears his pill bottle. His excitement and joy about eating such a small treat is seriously off the chart.
            I had to give him vaseline a few times after he got in the garbage can and ate an entire chicken carcass. And he was just eating full spoonfuls of the stuff and kept begging for more.

          • mabelcruet
            September 2, 2017 at 5:29 am #

            If all the meds came in liquid form it would be far easier-she loves cat milk, so I give her the Metacam analgesia in that with no problems. If she’s coping with the anaesthesia then he’s also going to remove her manky tooth, that’s possibly why she’s losing weight as well, a bit painful to eat. The consent form for surgery was horrible-all about risk of death or exanguination. Poor wee cat, she’s going to be sore.

          • Azuran
            September 2, 2017 at 8:54 am #

            That really depends, some liquid medications taste absolutely horrible. Metacam is one of the best tasting one. And it depends on the cat as well.
            I hope everything goes well and she gets better quickly afterwards.

          • BeatriceC
            September 1, 2017 at 7:06 pm #

            I’d rather pill 100 cats than try to give oral meds to a parrot. I do absolutely everything I can via injection. My vet knows I have strong feelings about this and will only prescribe an oral med if there’s no other options. I’d sooner start an IV on a parrot than give an oral med. This even holds true for Goofy, who’s generally plotting my murder. He got sick when MrC was out of town and I still requested injectable meds over oral meds.

          • BeatriceC
            September 1, 2017 at 7:03 pm #

            I’m definitely atypical for a teacher. I fall somewhere between an engineer and a nurse. My experience with the boys’ medical needs has made me a very good historian, but has also meant that I have spent a lot of time in hospitals and have quite a number of doctor, nurse, and pharmacist friends to chat with.

          • Roadstergal
            August 29, 2017 at 1:12 pm #

            I love your dad. That kind of sensible precision delights me.

          • Azuran
            August 28, 2017 at 7:27 pm #

            I was initially told: ‘Nothing over 10lb for 6 weeks’ Then the OB glanced at my 8.8lbs baby and added ‘Except the baby’

          • Empress of the Iguana People
            August 28, 2017 at 8:03 pm #

            and then there’s an older kid who cannot understand why Mommy cannot carry him/her. Especially if you have 2 back to back. My 14 mo is super clingy and jealous of big brother getting attention, having a newborn would just make that so much harder.

          • MaineJen
            August 31, 2017 at 10:51 am #

            My 7 yo asked for me to pick him up this morning. He weighs 52 lbs!!! Luckily I don’t have back problems…yet. And I fear it won’t be too long from now that I’ll be wishing he wanted snuggles from me, the way he does now.

          • BeatriceC
            September 1, 2017 at 7:10 pm #

            MK was 11 months old when YK was born. I wouldn’t wish that on my worst enemy. Those first few months with YK in the NICU, then the first couple months after he came home rank among the most difficult times of my entire life.

        • Gæst
          August 28, 2017 at 9:25 pm #

          I was told 6 weeks, but yeah.

    • Madtowngirl
      August 28, 2017 at 1:51 pm #

      My eyes must have gotten really wide when the attending OB suggested a C-section after my water broke, because he quickly explained that it may be scary for me, but completely routine for him. That definitely made me feel better because to me, “routine” meant a “normal” outcome.

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