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Re: CNM CasesFrom: Lyndon Taylor (lyndontaylor@msn.com)Sat Nov 27 19:37:12 2004
Where do these patients get there information? You said it. Bradley instructors. Send your patients to the hospitals Lamaze instructors and monitor what they are telling patients and life will be a lot smoother.
> ----- Original Message ----- Old Case #1 from late October: Our 2 doctor, 2 CNM practice occasionally has patients who are rather serious about non-intervention. There are times when these patients, who tend to act similarly (like teen-agers, actually, in that their behavior is sooooo predictable), can be exasperating for our very tolerant/understanding CNMs and staff. Furthermore, their desires may be so far below the minimum standard of care as to be frankly dangerous. Thankfully, Moms and Babies are hardy things, and almost always, all turns out fine. I would like to discuss this more off list with those interested listers. For lurkers or those wishing to debate intervention/non-intervention, well, please realize that my spam blocker allows me to screen and delete easily, and I will delete messages at my discretion. Here's the Clinical: This patient presented on a Monday AM: Yesterday, a 36 year old or so 41w2d primigravida presented in early labor at around 8 AM. She was 2 cm per the CNM, and refused any monitoring other than an occasional fetoscope*, didn't allow blood work, and basically sat in L and D all day. At 0300 today, SROM occurred. She was 4 cm. at 8 AM, and 4 cm. at 5 PM, and, when I last heard at 6 PM, she literally walked out of the L and D unit, and hasn't been seen since. Left Tuesday late PM, and eventually delivered at home on Friday AM, and told the CNM via phone the following Monday that she just needed a change of environment, and all was well. After she left Tuesday 5 PM, I sent a dismissal letter out Wednesday AM. Case #2 Monday 30 YO P0010 at 33w6d, CNM patient with long birth plan ("If extraction is necessary, request gentler methods other than forceps/vaccuum extractor") and a chiropractor, presents with SROM/no labor/1 cm/70%/vertex. Saw in the office, and explained need to do GBS culture and cover, and expectant management planned. After the exam, and after she dressed OTW to the hospital, she asked "Do I have to get antibiotics? I have no symptoms of GBS. Can I wait until I have a fever or something?" I can live with patients who are in left field, but this was out of left field from the stadium NEXT DOOR. Where, or where are they getting their information. I am hoping that our CNMs can meet with certain instructors (I believe they're Bradley) and clear the air/set guidelines/work out compromises and information. BTW, she went into labor overnight and just got an epidural. When I asked her how she was doing with pain, the HUSBAND said fine. I looked him in the eye and said nicely, "I didn't ask you. She is my patient," and then I asked her again. Garry :) Always a straight shooter, good or bad, I suppose -- Garry E. Siegel, M.D. Private Practice Roswell, GA
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