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Re: VBA3CFrom: Braun, R. Daniel (rbraun@iupui.edu)Mon Feb 16 04:41:30 2004
This is where we seem to be headed. Dan R. Daniel Braun, MD "If everyone likes you, you're doing something wrong." Kinky Friedman I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude. Andy Rooney -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of laure Sent: Saturday, February 14, 2004 4:30 AM To: Multiple recipients of list OB-GYN-L Subject: RE: VBA3C Hi, I am a obgyn form Spain, so I hope you forgive my English. I work in the Spanish National Health Service. Our legal presure in growing geometrically as USA but here, all the hospitals acredited to make maternalfetal medicine have a 24/7 anestesist and obgyn. VBAC is always the first line of actuaction, unlless the reasons for the first C/S persist, but after the second C/S we always make a third C/S. The posibilities of a VBA2C are so little that the risk of uterine rupture together with the highest risk of a nonprogramed C/S is not asumible. This is the recomendation of the Spanish Obgyn Society (SEGO). I never saw o know any problem with this, womens accepts the C/S. In any case, law is form all. In Spain, abortion is legal only after some conditions, and without congenital defects,only before 12w. The fetus has its rights, so if a woman doesn´t find a doctor who accept a VBA2C, she is not able to do it. Any damage to the fetus is delictive for her, and for the doctor is he has accepted the VBA2C (very vey improbably). It is not a problem of women against doctor, is a problem of jail for both, more for the doctor of course. You could also ask a judge to make an order for proceed with a third c/s, without mother´s permisssion. -----Mensaje original----- De: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]En nombre de Charlie Chambers Enviado el: Viernes, 13 de Febrero de 2004 06:41 a.m. Para: Multiple recipients of list OB-GYN-L Asunto: Re: VBA3C First off, would ask that you identify yourself as to profession, location. Secondly, I can certainly assure you that this is not related to money though some of the lay public frequently assumes this is our motive for every decision. When the VBAC rates were low, we were accused of doing c/s for monetary reasons. When VBAC rates were high, I watched a news program in Minneapolis that suggested we were putting patients at untold risk in order to save money, now we are accused of doing c/s for all the money we make. The VBAC rates have gone up because our national organization set a standard that is impossible for many hospitals to support VBAC. Uterine rupture despite informed consent by all parties involved is an almost GUARANTEED lawsuit. Most of us have come to accept lawsuits as part of the norm of doing obstetrics, but a lawsuit of this proportion can now put us completely out of business given current malpractice insurance rates. Then, why do we do it? Not for the money, but because we love our jobs, and the families that we are privileged to provide care. ************************************************************************* Charlie Chambers Hood River, OR cchamber@alumni.rice.edu "No matter where you go... there you are." Dr. Buckaroo Banzai ************************************************************************ On Feb 12, 2004, at 6:28 PM, Chrisa93@aol.com wrote: =09
In a message dated 2/12/2004 6:17:12 PM Eastern Standard Time, RModugno@aol.com writes: Perhaps if you practiced in the adversarial climate of the sue-happy US, Annemarie, you would understand why the VBAC is rapidly becoming a thing of the past. Most US obstetricians would rather defend a complication from a repeat cesarean section than face a $1million+ award from a jury in a brain-damaged baby case following uterine rupture., despite the rarity of such an occurrence. While I am not insensitive to the financial realities of practicing, at least you admit that not allowing your patient the choice of having a VBAC has to do with money and not what is truly in the patient's best interest. Chris
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