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Re: VBACs (long)From: RModugno@aol.comSat Apr 9 14:20:30 2005
In a message dated 4/9/2005 2:22:10 PM Eastern Standard Time, eramirezt@coqui.net writes:
Any thoughts on these cases welcome.
> Garry, you could be in a 12 MD, 50 CNM practic, but ultimately, the responsibility & liability falls on the MD's shoulders, as you know. I would suggest coming to a practice policy agreement in your collaborative practice regarding VBAC.All docs and CNMs should be in agreement regarding the management of the individual patient.. If the patient's expectations are IYHO unreasonable - then you have the right to ask the patient to take her business elsewhere. Ideally this situation should be dealt with sooner than later. Our approach to VBAC's (unencumbered by any data): 1) We tell the patient that the medical literature (usually coming from large academic institutions with many layers of interns, residents, fellows and attendings) is that VBAC's are successful in 70% of cases. 2) We will NOT cervical ripen/induce a patient at 41 weeks or beyond with an unripe cervix with previous C/S. 3) We tell the patient the greatest chance of having a successful VBAC is a previous successful VBAC. 4) The bottom line: Easy VBAC, easy repeat section. Gosh, I must be getting old! Robert Modugno MD MBA FACOG Marietta, GA
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