Prepared to Give Birth Joyfully

Online Breastfeeding Resources

2012-10-24T19:33:00.001-07:00

If you have issues with breastfeeding, it is best to go see someone in person (lactation consultant, La Leche League leader, friend/relative) so she can help you in your specific situation as well as give you the emotional support that is so valuable when you face challenges in breastfeeding. But if it is in the middle of the night and you have questions, you might try one of the following links.

Mona Gabbay “the breastfeeding doctor” at www.thebreastfeedingdoctor.com
Jack Newman at www.breastfeedinginc.ca
breastfeeding.com

Vaccination Workshop

2012-08-23T08:30:00.000-07:00

In my class, we don't cover vaccines in much detail, but if you're interested in learning more from a natrurapath about what the various vaccines protect against, how they work, and more, you may be interested in checking out Dragonfly Natural Health. Although I haven't personally attended, a previous student of mine went, learned a lot, and recommended it. (As a side note, she did end up vaccinating, but chose an alternative schedule. I mention that because it is informative even if you already plan on vaccinating your child.)

It is a decision that you will be making within the first 24-hours of your baby being born, so it is definitely worth becoming informed, whether by doing your own research, talking to your doctor, etc. before the time comes. You can check out the schedule here, to find out when a workshop in the Los Angeles area may be coming up.

Best of both worlds

2012-08-21T02:53:00.001-07:00

I'm back! After taking some time off, I have another wonderful class in full swing. Although I haven't read this book, I plan to soon. Natural Hospital Birth: The Best of Both Worlds is written by Cynthia Gabriel, who is a medical anthropologist, doula, and mother of three. Since most Bradley couples tend to choose to have their birth in a hospital setting, it would be very applicable for my students (and me)! Dr. Bradley himself recommended birth in a hospital setting, due to the irreducible risk involved in the healthiest, most natural of births, even though the rates of medicated and/or C-section in his own personal practice were about 3%. At any rate, check it out yourself or you can wait till after I read it and put it in my library. I'll let you know what I think!

And if you're wondering, yep, I'm preggers again! Now 17 weeks along, I'm just due just after most of my current students, and will be even with many of my students in my upcoming class. :) So far I've had two natural births in a hospital setting... that is the plan for the third, coming in January 2013!

Augmentation Following Water Breaking

2012-04-14T09:51:00.001-07:00

In class, we extensively discuss the spiral of interventions that add risk and may not necessarily improve the outcomes. Although the downward spiral can be started by almost any intervention, the most common steps into the cycle are induction/augmentation or pain medication.

Here is an interesting link about general induction/augmentation procedures particularly when the bag of waters has ruptured, involving patience and risk.

While these are very important topics that should be discussed with your provider before you yourself are in labor, realize that you may have unknowingly either made decisions about your care or limited your choices by your provider (or the provider's group policies). The provider(s) have a certain way of doing things that may or may not be flexible depending on your desires and individual situation. So, the take home message is to choose your provider carefully! Talk to me if you have questions about finding a provider whose practice lines up with your birth philosophy.

Pregnant and I know it

2012-04-04T22:45:00.002-07:00

Ha ha ha!

More on Vaccines

2012-03-08T13:29:00.000-08:00

One of my former couples recently enjoyed attending a vaccine workshop put on by Dragonfly Natural Health, a naturopathic practitioner. Although I haven't personally attended the workshop yet, I think it would be very interesting and definitely follows along the Bradley Method principle of being a good consumer while making your choices in healthcare. The next workshop is scheduled for April in North Hollywood. Let me know if you attend and what you think!

Unhurried

2012-03-07T13:26:00.001-08:00

A woman will exhale from the work of birth before she begins to inhale the presence of her child and her new identity as a mother. - Mary Esther Malloy, MA, CD(DONA), CLC, AAHCC

A fellow Bradley Method instructor who is also a doula and lives in NY wrote a very interesting article about having an unhurried first meeting between mom and newborn. I hope you enjoy it as much as I did. This sounds appealing to me if/when we have a third little one.

Dr. Rion, D.C.

2012-02-28T10:10:00.000-08:00

Do you think chiropractic and pregnancy don't go together? Think again. Dr. Rion Zimmerman visited us in class last week. He taught us a mini-anatomy lesson about the many ligaments and tendons that involved in pregnancy, the tightness or misalignment of which can cause discomfort and pain, and possibly lead to malpositioned (breech, posterior, etc.) baby.

Dr. Rion sees many pregnant patients for wellness throughout pregnancy. As a dad himself, he also developed some specific stretches and exercises while his wife was pregnant that he could help her with for both the purpose of relieving that tension as well it being another way to be involved. Both moms and coaches in my class enjoyed feeling a good stretch and learning about some exercises.

One exercise in particular that he shared with doing gentle squats using an exercise ball. You put the ball between your back and the wall. When you bend your knees slightly and then return to standing, the ball rolls with you down the wall slightly, giving comfortable support in proper alignment. As Dr. Rion said, you don't have to go down very far to begin to strengthen your legs and gluteal muscles. Strengthening your glutes is not only good for labor and birth, but can also help with urinary incontinence (in combination with kegels) and is another good life-long toning exercise.

Dr. Rion Zimmerman is the owner operator of Flintridge Family Chiropractic and is certified in the Webster technique. If you want to find out more information about the Webster technique, which is used to help allow the baby to turn to the vertex (head down) position, please give Dr. Rion a call or send him an email through his website. There is also a video of some mothers sharing their testimonials on the website.

Presence of Meconium

2012-02-23T23:26:00.002-08:00

In class last week, one of my students had a question about meconium (baby's first stool) presence in the amniotic fluid and possible aspiration. She was wondering about how meconium aspiration syndrome was diagnosed and treated. I found a concise article in the PubMed Health Dictionary about MAS, that pretty well covers the questions asked. It is good to know that in not all cases of presence of meconium in the amniotic fluid is it inhaled requiring treatment and in general there are no long term health effects.

Professional Assistant Coaches

2012-02-16T14:52:00.000-08:00

While we were on the topic of assistant coaches in Class 5, Tracy Hartley, doula and owner of the local B.E.S.T. Doula Service, shared with us about how to work with your hospital birth team to obtain your desires. This is an important topic since sometimes couples who take the Bradley Method classes sometimes feel that their desires differ from the normal hospital policy or the doctor's way of doing things. Hopefully the couple will have prepared ahead of time and openly discussed their desires with their doctor, decided which if any things will be compromised, and written up a clear birth plan (of course, knowing that flexibility is a necessity in childbirth).

One of her tips to use a compliment as a way of stating your preference for something that the doctor may or may not usually support. For example, she told how she had used this tactic with a doctor who alway wants his laboring moms to give birth on their back, legs in stirrups. This position is known to be the worst possible position for comfort of the laboring woman and the ease of exit for the baby, but is the easiest position for the doctor to see and catch. So Tracy kindly said to the OB as the mom was about to start pushing, "Thank you so much for supporting her choice to use an alternative position for giving birth!" He looked surprised and confused, but then didn't make her get on her back! It worked!

While Bradley coaches are trained to be the primary support for the laboring woman, there is something special that another woman can offer. If you have more questions about doulas, their services, costs, benefits, or how to go about hiring a doula, feel free to contact Tracy or visit her website, search for a good fit from the 300+ doulas in DASC (Doulas of Southern California), or let me know.

Finally, Tracy offers to all childbirthing women, the opportunity to participate in The Letters Project. It is basically a personal letter drafted to the hospital administrator where you plan to or have given birth, telling him/her your birth preferences. Simply select your preferences from scroll down menus, edit if desired, print, stick a stamp on it and mail it. The hospitals won't know your preferences if you don't let them know! Let's be part of the change in hospitals offering more choices to birthing women! I just did it and it only take a few minutes!

Evidence for an extra few minutes

2012-02-14T22:51:00.000-08:00

Do you know that it is considered "delayed" cord clamping if it is more than 30 seconds after baby is out?

One of my students asked me for some research to present to her OB that suggests delayed cord clamping is beneficial, since the OB's opinion is that it is better to clamp and cut immediately due to increased risk of jaundice. As a side note, I would like to say that I always recommend my students also do their own research and then consult their personal health care provider to be the best consumer of health care and advocate for your family as possible. Secondly, props to my student for asking about these issues early on to figure out what is best in your situation and what your provider recommends. And thirdly, yay for a doc who is willing to listen to what the "research shows." This is a great example of how medical opinion varies and that in some cases, while the studies do "show," there may be either a delay in the change of the practice or even resistance.

So, to help you my students and consumers of health care on your way to discovering for yourself what is best for you and your family, I wanted to share links to some studies that that you may find interesting, in addition to a previous post of mine.

Very interesting video of grand rounds at University of South Carolina - 2011 Dr. Nicholas Fogelson presenting data to show positive physiologic and clinical outcomes. I watched the whole thing and really recommend it, if you (or your provider) are on the fence about allowing the intervention of "early" cord clamping.
World Health Organization - current commentary in their Reproductive Health Library recommends delaying of cord clamping, with the caution of taking into consideration that there is a increased incidence of jaundice requiring phototherapy which may not be available in underdeveloped countries.
Journal of Midwifery and Women's Health - 2001 literature review showing many benefits in the first week through 2 months of age.

Car seat safety

2012-01-31T23:34:00.000-08:00

Although you already know you need one and have probably registered for or bought the car seat for your baby, it can be a little tricky to make sure you use it correctly. It seems silly to read instructions for something like that, but seriously read them and keep them. More often it is the installation of the car seat (or base rather) that is done incorrectly, but I've seen the baby strapped in incorrectly as well (yes, I did say something). Some of you may be getting close to 36 weeks or more - it is a good time to get it set up and checked out. While the nurse won't let you go home from the hospital without visually seeing the car seat, she won't check the installation for you.

Here is a link to CHP law and from there you can find a place to have your installation of the car seat checked.

Here is a link to a video of how to install the infant seat base.

Here is a link to a video of how secure the baby in the car seat.

Help with breastfeeding

2012-01-30T15:09:00.000-08:00

While breastfeeding your baby is completely natural, we generally don't have much experience in our current society regarding normal, healthy breastfeeding. So last week in class, we had Mariana come speak with us about breastfeeding - the variations in the initial experience, importance of skin-to-skin, milk production, and a basic "how-to" lesson.

Mariana works at Bellies Babies and Bosoms, a cute little store pertaining to all things mama and baby, in Montrose/Glendale and is a lactation consultant. Bellies offers a free prenatal breastfeeding class, as well as a "Going Back to Work" class (fee applies).

She gave us a lot of info, but the take home lesson would be to get help and support if you need it while breastfeeding. There are a number of places to do so, including attending La Leche meetings, but Bellies is another great place to try.

Avoiding Preeclampsia

2012-01-24T23:40:00.000-08:00

The Bradley Method® encourages pregnant moms to follow the Brewer Pregnancy Diet, for MANY reasons, one of which is avoiding preeclampsia, as we learn in class. When you have to pee in a cup at essentially every appointment, one of the things they are looking for is protein in your urine (a symptom involving malnutrition and/or preeclampsia).

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. It can lead to eclampsia, which can cause convulsions and is potentially fatal (2% of cases).

Although it is not a well-understood disease, it is very serious and incurable, generally needing to induce or deliver the baby to avoid further complications. Amazingly, Dr. Brewer discovered a well-balance and high protein diet essentially eradicated this previously unknown disease from a susceptible population of women, repeated through many years. Unfortunately, possibly because it was not a randomized, double-blind trial which would have included the purposeful malnourishment of pregnant mothers to show the non-placebo effect of the diet, the Brewer Pregnancy Diet has not been as widely taught to OB/GYN and therefore as many pregnant moms as you might think.

Remember that eating well for your baby is the single most important thing you can do while he/she is growing inside of you. You might ask your doctor or midwife about their knowledge/recommendation about the Brewer Pregnancy diet and see what they say... let me know!

Bottoms Up

2012-01-24T23:02:00.000-08:00

All but 4% of babies turn to be in the head head down position naturally by the time they are born (yes, some flip during labor although not common). But it can be difficult to know what you can be doing yourself to help Baby turn if baby is in the breech (head up) position when you are in the last half of your third trimester. Unfortunately, most OBs don't offer much by way of support other than offering to schedule a c-section usually right away. Midwives usually have more resources or ideas to offer. Hopefully your provider is one of the types that will actually catch a breech baby, as was always done previously. While it is not possible for everyone, it may be worth looking for a provider who will support a breech birth. Some OBs will do an external version when you full term (usually at least 38 weeks).

While The Bradley Method (and I myself) always recommend that you start with your doctor/midwife to ask for their recommendations, it is also up to you to ultimately make choices and ideally it is best to know what the options are, right? So here a link that you may find interesting if you find yourself (or rather Baby) in this position.

IV fluids

2012-01-23T23:37:00.000-08:00

Although IV fluids during labor seem nominal and almost as though they could only have pros and no cons, a new study reveals at least one potential down side (multiple studies have been published on the topic however). The study indicates that there is a positive and proportional correlation between maternal IV fluids, newborn output (pee), and newborn weight loss in the first several days. It appears as though the newborns may be receiving more than enough fluids (in correlation with the amount given to mom) and are self-regulating by urinating more after birth causing an apparently more dramatic weight loss. The problem with this possibility is that the baby may be deemed "failing to thrive" and formula may be introduced. During these critical days of learning to breastfeed for both mom and babe, milk coming in, bonding, and oxytoxin-release which contributes to the involution of the uterus back to normal size, it is important not to interfere with unnecessary formula and bottles. Read more here.

Terbutaline for pre-term labor

2012-01-11T15:27:00.000-08:00

Source: Effect of Terbutaline on a Fetus

One of my couples was recently seen at a local hospital for painful frequent contractions (at 35 weeks), which turned out not be causing dilation upon examination. The doctor wanted to start her on terbutaline, but did not lay out other options. The couple quickly looked up some info on their phone and contacted their experienced doula for advise. As this couple had learned about husbands advocating for their wives, they asked, "Is this medically necessary? Do we have to do this? Would it be ok to wait, especially since no drug has been proven safe for the baby in utero?" The doctor was very defensive about many drugs being "proven safe," but replied that it would be ok to wait and see what happened. Fortunately, even though this mom was well hydrated, the IV fluids seemed to help space out the contractions, although they did not go away entirely. This precious couple was so relieved that a.) the situation was not so much a major health threat, as a suggestion of the doctor's standard practice, and b.) that they had come to realize in class that sometimes a treatment or intervention is presented as the obvious and only choice, but this may not be the case. In the end, they are looking at the situation positively by seeing how well they were able to work as a team in preparation for when Baby does make its debut.

Interestingly, the drug that the doctor wanted to prescribe (and is commonly prescribed for preterm labor) is actually an asthma drug, used as an "off-label" use for preterm labor. In 2011, the FDA made the manufacturer print on the box that essentially states that it is not safe to use for this purpose due to the potential for serious internal heart problems or death. You may be interested to look up more information about terbutaline and talk to your doctor about this controversial issue. Finally, be encouraged to take care of yourself as absolutely BEST that you can just as we learn in The Bradley Method, with proper nutrition, staying hydrated, getting plenty rest, practicing relaxation, and reducing stress, to try to avoid pre-term labor.

Try a date

2012-01-04T15:21:00.000-08:00

source

Here's a news link a study showing how pregnant women consuming date fruit during the last 4 weeks of pregnancy helped their labor and birth outcomes! Amazing. I don't love dates, but I think it would be worth trying for a few weeks to impact my labor and birth positively. And it is just fruit! No side effects or possible harm to the baby! :) Let me know if you try it!

Your hospital's C-section rate

2012-01-03T14:15:00.000-08:00

source

While the national average is about 1 in 3 births by C-section, the Bradley Method students are significantly much lower at less than 1 in 10. Hopefully you are learning all that you can about how to potentially avoid this serious surgery that is not without risk, and doing all that you can NOW while you are pregnant so that you hopefully do not have a need for a C-section. If you do end up needing a C-section, you can be thankful this amazing technology exists and that you did the absolute best you could for your baby and you.

What about your hospital? Check any CA hospital's rates out here.

The waiting game

2012-01-02T14:47:00.000-08:00

As we learn in class, the average non-induced, first time mom gestates 41 weeks and 1 day, or "8 days past your EDD," in terms of what your doc at a routine OB visit will inform you. That means that a high percentage of women go into labor naturally days to weeks even after this average of "8 days late," which is normal for her and is the exact right timing for when her baby is ready. But it is SOOOOOOOOO hard to wait once you hit that magical EDD. Each passing day seems like an eternity. So you may become very open to suggestion, when the doctor brings up induction and sort of pads the issue with comforts such as your husband/mom/family/etc. can plan accordingly, you will be DONE being pregnant, and it is "safe."

Your baby is worth the wait

We learn in The Bradley Method about the cascade effect of interventions that frequently begins with induction. Each intervention has it's own risks which are compiled with subsequent interventions that may become necessary. We also know that if mom is not feeling supported to continue on, carrying the baby until the baby is ultimately ready, she can be more likely to be induced even if it is for convenience, rather than an actual medical indication.

That is where you coaches come in. I sent a brief list of reminders to the coach of a couple who is currently several days past that elusive EDD and waiting for their bundle of joy to arrive, and I wanted to share the suggestions with you all.

Stay hydrated. It is your job to bring her water/juice. Use a straw, she'll probably drink more. This is good practice for you as a coach to try to remember during labor!
Keep well-nourished and well-rested. Ask her to take naps. You never know when labor will begin and how long it will go, but once it starts, these can be a little difficult to maintain.
Distract her with non-baby stuff while you're waiting for labor to begin. Bring out some old pictures, talk to her about how you met/fell in love, watch a favorite movie.
Talk about the baby. But if she does want to talk about the baby, discuss the name if you haven't decided. Talk about who you think he/she will look like. What personality traits you hope he/she does or does not have. Read baby books to baby.
Go on walks. Multiple per day is good. While she needs to get lots of rest, she also needs to be upright, especially on her feet to help bring the baby down.
Go over a "stress" list. Ask her to answer, "What if anything is weighing on your mind?" Write them down, and address them one by one as to how you are dealing with them together.
Think welcoming thoughts. Talk to baby. Let her hear you beckon the baby come on down. Remind her of her own psychosomatic connection with her physical body.
Help her relax physically with massage. Think about all the stuff that you're planning on doing for her in labor and do that stuff now! You maybe able to fine-tune your skills to what she really prefers.
Make her laugh. You're good at that. She loves to laugh with you. Just commentary about stuff on tv may work. It releases endorphins when she smiles.
Go over your Bradley book. If she doesn't want to, do it by yourself. You'll refresh your memory by reading the B.E.S.T. pg 93-96 (or highlights on pg 97-98), first stage pg 74-75, transition/second stage, pg 86-87.
Check off as much as you can on the list to bring to the hospital and put it in the car. Make sure you know what few key things need to go when it is time.
Encourage her. Most importantly, tell her how she is doing a great job, already caring for your baby so well. Tell her how she is going to do great, when it is just the right time. And that she doesn't need to worry about when that right time is - the baby knows and her body is capable.

When does learning begin?

2012-01-01T20:50:00.000-08:00

Pop quiz: When does learning begin? Answer: Before we are born. Science writer Annie Murphy Paul talks through new research that shows how much we learn in the womb -- from the lilt of our native language to our soon-to-be-favorite foods.

From the Bradley perspective, this video reaffirms The Bradley Method's emphasis on the importance of nutrition, relaxation (dealing with stress in a healthy way), as well as the importance of mom's physical presence immediately upon birth - the baby really does know you already!

Click here if you have about 17 minutes to watch this interesting bit.

Sneaky ways to increase protein

2011-12-11T21:08:00.000-08:00

Brewers Diet for pregnancy (recommended by The Bradley Method&#174) includes 80-100g of protein every day to help a plethora of diseases and risk factors! It can be hard to do if you are not used to eating this much protein or if you are vegetarian or vegan. Go to the website for more info (click "Vegetarian" on menu to the left to find vegetarian or vegan modifications) or here are some suggestions below:

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Ezekiel Bread: available at regular grocery stores, it is an organic, flourless, sprouted wheat whole grain bread (buns, cereals, etc.) and comes in a variety of flavors (sesame, cinnamon raisin, etc). While it only has 4g of protein per slice, it is a COMPLETE protein (most breads are not)
Milk shakes: from non-fat dry milk (reconstituted), ice, fresh/frozen fruit, and/or yogurt
Roasted soy nuts: buy in local grocery stores or health food stores or make your own. Soak soy beans in water in refrigerator for 2 nights, changing water once (use discarded water for soups or plants). Drain and roast in 300 degree oven on lightly oiled and salted pan until light brown.
Cheese, cheese, cheese! Add grated cheese to eggs, sandwiches, casseroles, salads, snacks, on whole wheat crackers and celery.
Cottage cheese: is a cheap and great source of protein! Add to gelatin salad, scrambled eggs, casseroles such as lasagna and other Italian dishes, make vegetable and cracker dips out of blended cottage cheese with onions and spices.
Non-fat dry milk: add to hamburgers, meatballs, meatloaf, casseroles, and breads.
Yogurt: blend with gelatin for interesting fruit salad, use in place of sour cream for dips.
Soy flour: Add to bread (1/4 c.) when baking.
Eggs: Keep hard boiled eggs and deviled eggs in refrigerator for snacking or make custard for dessert.
Sunflower seeds: add to sandwich spreads (chicken salad) and sprinkle on salads.
Wheat germ: buy at grocery or health food store and add to cereal, breads, cookies, baked goods, serve over ice cream.
Brewers yeast or nutritional yeast (nutritional yeast does not contain the essential mineral Chromium): Brewers yeast is a complete protein and can be used to increase needed B vitamins to help combat fatigue. Good for milk production too!
Liver: best source for just about everything! Cook and grind to combine with hamburger.
Granola: make your own from whole grain cereals (oatmeal, 4 grain cereal), wheat germ, coconut, nuts, sesame seeds, sunflower seeds, oil, honey, vanilla, cinnamon.
Combining vegetable proteins to make complete proteins: rice + legumes, corn + legumes, wheat + legumes, wheat + sesame + soy beans, rice + sesame, rice + Brewers yeast, vegetables + mushrooms or nuts or sesame seeds.
Beans and corn: marinated salad of kidney beans, corn, celery, onion and Italian dressing. Serve chili with cornbread. Mexican food!
Dietary Iron: good sources are liver, organ meats, whole grains, beans, pean and corn - necessary for blood manufacture, for increased blood volume of mother and baby. Oxygen-carrying component of blood (hemoglobin) dependent on iron. Also, baby stores iron in liver for postpartum life (draws on it for first 9 months!)

Adapted from The Bradley Method Teacher's Manual pg 249

Delayed cord clamping - a benefit, months later

2011-12-10T20:07:00.001-08:00

These types studies have been out for years, but it is encouraging to see that more mainstream media is getting the word out there, click here to read more from the NY Times.

The general finding from this particular study relating to iron levels, was the babies had a lower incidence of iron deficiency months later if the cord was clamped 3 minutes or later, instead of within 10 seconds. You may think, that is not much time difference, but it is to the baby's iron supply! Or you may wonder, do practitioners actually clamp the cord that quickly... and the answer is, you betcha. If you have not made a request for delayed cord clamping and/or discussed what your doctor's (or her/his partners within the group practice) general practice is, you may find the the cord is clamped in one fell swoop, just as your baby is inhaling its first breath of air. Also, you may want to request that the doctor leave orders that if the baby is born before she arrives to "catch" him/her, that it is ok that the nurses delay cord clamping, otherwise they may just do it right away, as away to begin to quickly check off all the things that they need to "get done."

Talk to your doctor about your preferences, include your desires in your birth plan, and feel free to ask about these types of studies, if necessary.

A different kind of stretching

2011-11-29T14:39:00.001-08:00

In the Bradley Method class, we have learned about various stretches and exercises to help with flexibility and muscle toning, but here is some additional valuable information about another kind of stretch... the perineum, which can help you avoid a tear or episiotomy.
The perineum is the tissue down below between the v (word not written out so that internet content is not flagged as inappropriate) and the a (again, word not written out) that stretches during birth when the baby is crowning and coming through the pelvic outlet. Ideally, you would start this type of regimen about 6 weeks before your EDD (estimated due date) either performed by the pregnant mom on herself or by her partner. It can also be performed by the nurse, midwife or doctor during the actual birth. Click here to read more about how perineum massage can help and how to do it. Thanks to my awesome couple, Athaliah & Jeff, for bringing this handout to my attention!

The machine that goes "ping"

2011-11-22T14:08:00.001-08:00

And now, entirely for entertainment purposes... remember Monty Python?
Here is a funny parody of the "miracle of birth." Just laugh, I'm not posting this in any serious manner - it is simply a spoof.

Remember that my husband is a medical student, so sometimes we just have to make fun of how ridiculous things in the medical profession can be.