Re: Twins and VBAC
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Nov 14 16:00:03 2005
That's the bottom line - litigation - in a few years from now a new ACOG
Practice Bulletin will probably say that, although there are no RCT
addressing this issue, the consensus is that they should only be
attempted in tertiary centers under "strict surveillance" ..I've seen
this movie before..
Ef
>At Sun, 13 Nov 2005, Myer S. Bornstein wrote:
>
>I AGREE WITH Hank, Lynn's statement, with a little editing, so it just
>doesn't speak to the issue of VBAC twins and change my wife to spouse,
>significant other, etc should be broadcast to the world at large. When I
>started in my residency our section rate was under 6%, we delivered breeched
>twins (with V&E)) etc without thought of litigation. When I gave up
>obstetrics last year, breeches, twins, etc got sectioned, and would only do
>a rare VBAC. It is the climate we are in now, "SUE, SUE, SUE:
>
>Myer
>
>--
>Myer S. Bornstein, MD, MMM, FACOG, FACPE
>
> _____
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry
>Gregor
>Sent: Sunday, November 13, 2005 11:58 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Twins and VBAC
>
>Very lucidly expressed Lynn. How many of us have heard so many times to just
>practice good medicine based on good data, or EBM (whatever that may be at
>any particular moment in time)? Unfortunately that is not the whole of the
>issue and I believe your commentary should be a classic entry in many a
>text and journal.
>
>Hank
>
>"Lynn D. Montgomery, M.D." <apgar10@montanadsl.net> wrote:
>
>I think it is important to make a point that both sides have alluded to, but
>not addressed directly. First, I am personally not aversed to laboring a
>VBAC with twins. Second, I have tried from the beginning of my career to
>not practice medicine based on legal protection. However, unfortunately as
>things have evolved, even the most noble among us has had to come to grips
>with the reality of obstetric practice in our current climate. The fact is,
>that even in the best of circumstances, we can get sued. This (or these)
>suits can devastate anyone of us, both personally and professionally,
>representing the loss of years of effort on our part to achieve what we
>have. As such, practicing medicine based just on the "data" isn't practical
>for any of us any longer. By necessity, we now have an obligation to
>ourselves to implement only those practices we are totally comfortable wi!
>th both personally, as well as professionally. Society, in turn, must
>accept this fact, just as they have accepted the climate that allows our
>personal lives to become vulnerable to every two bit ambulance chaser.
>Therefore, in this case of twins and VBAC, in my heart of hearts, I feel
>that she will likely do fine, but if she doesn't, it is not only her life,
>but my life, the life of my wife, children, office staff, etc who are
>affected.
>
>Lynn
>
>Lynn D. Montgomery, M.D.
>
>Maternal-Fetal Medicine, OB/GYN
>
>Rocky Mountain Women's Health
>
>2835 Fort Missoula Rd., Suite 304
>
>Missoula, Montana, 59804
>
>406-549-0978
>
>fax 406-549-0987
>
>e-mail: apgar10@montanadsl.net
>
> _____
>
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--
Have the courage to be ignorant of a great number of things, in order
to avoid the calamity of being ignorant of everything.
Sydney Smith (1771 - 1845)
~walt whitman~
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