As a family physician I still supervise residents who perform deliveries and do deliveries myself. This weekend was one of those where I found myself at the hospital a lot more than I’m used to.

To get the point of this story you need to know the following:

1) A lot of teaching is done in the Socratic method where the teacher (that’s me) asks the resident (Andres in this case) questions to which the teacher  knows the answer.  In theory the teacher is trying to get the resident to remember the answer because of the active learning required to retrieve the answer from distant memory cell.  Many residents suspect that often the teacher is asking  something to which only he or she knows the answer and the resident will never answer correctly. This makes makes the teacher (me) look really smart and is known as “pimping the resident.”

2)  Pitocin is a medicine which is given in small doses to women who are in need of delivery to cause contractions and hasten labor and in large doses to those already delivered to clamp down the uterus

3) A twin pregnancy occurs naturally in about 1 in every 100 pregnancies

4) Evidence-based medicine is the practice of medicine using empirically derived evidence as opposed to anecdotes and clinical experience. The Cochrane database is an accepted place to go for evidence based medicine. The evidence for the use of Pitocin prior to the placenta coming out is that bleeding associated with childbirth might be reduced but other risks might outweigh the benefit…

The Anecdote:

Andres to nurse: Placenta is out!

Nurse: Pitocin is going!

Me (pimping): Andres, do you know why we wait until after the placenta is out to hang the pitocin at this hospital?

Andres: No

Me: The evidence is that if you give it before the placenta is out you will reduce bleeding. Because of the theoretical risk to an undiagnosed twin, we wait. If you give such a large dose of Pitocin you could kill a twin. Now that everyone gets ultrasounds I suspect it isn’t a concern and is a holdover from when you never knew how many babies were coming until the last placenta was out.The risk of undiagnosed twins today is probably overrated. I do remember when I was a medical student at Charity…

Nurse (clearly wanting to stop the story): We’ve had 3 undiagnosed twins this year that I know of. Some folks just don’t get prenatal care…

All my deliveries this weekend were singletons….

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