Re: VBAC
From: ainsron (ainsron@sbcglobal.net)
Wed Apr 13 11:37:20 2005
So what happens to them when you are on call and they refuse a RCS?
Ronald E. Ainsworth
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD
Sent: Wednesday, April 13, 2005 7:11 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
What if you are covering your group and you are the only one of 5 who does not do VBACs? I'm considering buying a video camera for those patients so that when I say I do not do them, and highly suggest a repeat c-section but if you refuse the c-section you understand that legally I cannot operate without your permission.
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez
Sent: Monday, April 11, 2005 6:46 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
It is soooooo simple not to offer VBAC...!!! How many patients would
walk away -??? very few - and I would be glad if they do!!
>At Mon, 11 Apr 2005, RModugno@aol.com wrote:
>
>This guest editorial from OB/GYN News says it all.
>
>Robert Modugno MD MBA FACOG
>
>Guest Editorial
>Informed Consent for Attempted VBAC
>
>Dennis J. Sinclitico, J.D.
>
>MR. SINCLITICO is an attorney specializing in medical malpractice law in
>Long Beach, Calif.
>There are certain topics that we just can't discuss enough, and attempted
>vaginal birth after a previous cesarean section is one of those. VBAC and
>informed consent for VBAC seem to be the topics du jour in every obstetrics
>program.
>The number of VBACs seems to have declined following concerns about the ris
>for uterine rupture. Some physicians prefer elective C-sections to VBAC
>because of large monetary awards in medical malpractice lawsuits dealing w th
>VBAC, such as a $30 million judgment in Philadelphia.
>Is there life after this death for VBAC? As your friendly defense lawyer, I
>can tell you those are hard cases to defend.
>A recent prospective, multicenter study that provides the first solid data n
> the risks of VBAC showed that only (0.7%) of 17,898 women who attempted VB C
>for a term singleton developed uterine rupture. Only 12 term infants in th
>VBAC group developed hypoxic-ischemic encephalopathy, 7 of them in the
>uterine-rupture subgroup. The absolute risk for hypoxic ischemic encephalop thy
>was approximately 1 case per 2,000 women attempting VBAC at term (N. Engl. .
>Med. 2004;351:2647-9).
>Even though the risks of a bad outcome are small—and ongoing statis ics
>support that—those statistics take flight when you're in the witnes chair and a
>catastrophically affected infant is with a parent in another witness chair.
>You'll notice that when speakers at meetings present statistics about the
>risks or benefits of VBAC, there are no photographs of a catastrophically
>affected infant. But the jurors will see that. When a case goes to trial, t e
>focus is on the care and treatment provided by a specific physician for a
>specific patient with a specific kind of outcome. In that setting, the risk seem
>much different than they do in studies.
>That's why most obstetricians are voting to do cesarean section instead of
>VBAC. They've seen the results in accounts from their peers, in discussions in
>the literature, and in the media.
>While there were only 12 cases of hypoxic ischemic encephalopathy in the
>recent multicenter study, if we assume that each of those cases went to tri l
>and the plaintiffs won only 10% of the large award in the Philadelphia case
>that totals $36 million, plus untold millions of dollars spent defending th se
>cases.
>If you choose to provide VBAC, I suggest getting informed consent in the
>patient's handwriting. Most informed-consent documents are forms, and that' a
>problem. They're not individualized to any degree and to any specificity. E en
>though your consent process might be substantial, the extent to which you a d
> your staff provided informed consent is poorly documented in a form.
>Absent an individualized, specified consent document, what happens is that
>the mother says in court, “I don't know. …He shoved it in f ont of me and I
>just signed.†That's what the plaintiff will say in almost every s tuation.
>Having the mother write out her informed consent is a lot better for your
>defense. Better yet—pull out the video camera and document the cons nt process.
>Simply having a form with a signature acknowledging that the consent proces
>has taken place is a prescription for disaster. That won't fly in court.
--
I think I will do nothing for a long time but listen,
And accrue what I hear into myself...and let sounds
contribute toward me.
~walt whitman~
