Re: OB: Suspected Macrosomia (long)
From: art fougner, md (evsono@pipeline.com)
Fri Feb 13 15:35:42 2004
would be interesting to see a risks v benefits analysis for vaginal
delivery.
art
At Fri, 13 Feb 2004, Anna Meenan, MD wrote:
>
>Ooops, my apologies again, this time to Chris. It was Annemarie who
>accused us of putting $ before patients, not Chris.
>
>Chris actually does have a somewhat valid point about how the risks v.
>benefits of VBAC can be and frequently are slanted every which way when
>presented to patients. Someone from the list sent me a copy of his VBAC
>consent form a long time ago, and it was fairly well-balanced as far as
>the risks of either VBAC or scheduled repeat c-sec, but I can't remember
>who it was that sent it to me and I can't find it anymore either.
>
>We have been unable to offer VBAC at our hospital because anesthesia
>won't guarantee that all their guys will agree to come in and stay
>in-house during a VBAC. Also, our department obstetricians are divided
>on whether they will come in or not, so if someone REALLY wants a VBAC,
>we tell them to wait til labor starts, then if the right people are on
>call they can have a VBAC. And the hospital has been blasted in the
>editorial pages of the newspaper by a local midwife for not being able
>to guarantee a VBAC to every woman who wants one. We just can't win.
>
>--
> Anna Meenan, MD
>
>At Fri, 13 Feb 2004, Anna Meenan, MD wrote:
>>
>>And to the lister who accused us of making all of our decisions based on
>>money (Chris, I think?): There are over 100 grade school and high school
>>teachers in my state who make more money than I do, to work far fewer
>>hours a year, and with far less education. Obviously, I am teaching the
>>wrong subject.
>>
>>--
>> Anna L. Meenan, MD, FAAFP
>> Clinical Assistant Professor of Family and Community
>> Medicine, University of Illinois College of Medicine
>>
>>At Fri, 13 Feb 2004, Richard Chudacoff, MD wrote:
>>
>>>Why do people think that doctors are out to hurt them, when they seek care
>>>from the doctor in the first place?
>>>
>>>--
>>>Richard Chudacoff, MD
>>>
>>>I believe we are on an irreversible trend toward more freedom and
>>>democracy - but that could change.
>>>Dan Quayle
>>>
>>>-----Original Message-----
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
>>>Len2976@aol.com
>>>Sent: Friday, February 13, 2004 2:03 PM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: OB: Suspected Macrosomia (long)
>>>
>>>Many years ago when I was in the AF stationed in California I saw a patient
>>>who was alternating visits between the AFB and a private MW. She planned a
>>>homebirth, but came for appointments to have a place to go in the event of
>>>complications. This patient also refused most labs, including glucola
>>>screening.
>>>
>>>As she approached her last weeks, it was clear the infant was large.
>>>Despite all counseling (shoulder dystocia, FTP, PPH), she was emphatic about
>>>the home birth.
>>>
>>>The day she delivered, I got a call from her MW. She had had a 10 1/2 #
>>>baby with the delivery complicated by a shoulder dystocia and she also had a
>>>4th degree perineal laceration. The patient came to the L&D unit with her
>>>husband, but she had been advised to come in without the baby, get repaired,
>>>and then sign out "AMA." According to the parents, the baby was "fine,"
>>>but the laceration occurred during efforts to deliver the shoulders.
>>>
>>>I did do the repair (under pudendal anesthesia) since as a dependent she was
>>>entitled to care. Nothing anyone could say could convince either of them
>>>the risk they had taken and in their mind everything was fine.
>>>
>>>Lenora McCall, CNM
>>>
--
art fougner, md
ich bin ein New Yorker
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