Re: breech

From: Joanne Bulley, MD (islesannie@yahoo.com)
Thu Dec 23 17:00:06 2004

Dave and Art,

I agree - the training just isn't there anymore. I did learn in residency (1981-85) -- but had limited experience. I did, however, join a practice of two docs 50 & 51 yo. Guys who DID know this - and I made it a point to learn from them and be involved with these cases.

But ... no one is trained - so it is a skill that will be lost in the US for sure -- Canadian and European docs on the list can comment on their situations.

If it is now only OK in the USA for the baby to fall out or do a C/S -- then we should admit it -- and then there would be a gyn surgery residency ( a branch of general surgery?) and the OB woudl fall under midwifery or MFM / Perinatology.

What do the young folks think about that?

I look forward to the comments.

Joanne

PS - when responding please truncate how much you send of prior messages so it doesn't go on & on with other messages.

At Thu, 23 Dec 2004, David Priver, MD wrote: >
>Art,
>I agree with you that arguments about whether vaginal breech delivery is
>safe or not are essentially moot. No one gets trained anymore, so the
>procedure, in the hands of anyone completing residency since, say, 1980
>or so, would most likely not be safe. The more important point is what
>this sort of "dumbing down" of our specialty says about where the field
>of OB/GYN is headed. The same arguments could be carried on about
>forceps deliveries or almost any procedure in which dexterity and
>judgment are required. (Note how episiotomy has been determined to be
>always bad; no longer can one exercise thoughtful judgment. I suspect
>that VBAC will soon be in this same category). What is hard to ignore
>is the sense that there are powers afoot who would prefer to see OB/GYN
>just disappear, to be replaced by far less expensive (and less
>well-trained) alternative practitioners who can catch a baby or, failing
>that, can summon a perinatologist. Perhaps that direction is for the
>best. Maybe it will produce just as good results less expensively. My
>point, however, is that if this is the direction we're going, let's just
>be honest about it and state that it's an economic issue and be done
>with it. That, I think, is preferable to producing junk science like
>the Hannah study.
>DP
>

--
Joanne Bulley, MD
Keene, NH, USA


"Every gun that is made, every warship launched, every rocket fired,
signifies in the final sense a theft from those who hunger and are not fed,
those who are cold and are not clothed."


President Dwight D. Eisenhower
April 16, 1953



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