Re: homebirth conversation
From: Andrew Folley (agfolley@hotmail.com)
Mon Nov 28 16:10:25 2005
You will find that the majority of Level III hospitals in the US employ
fulltime 24/7 OB and anesthesia services in house. It is cheaper to pay 1
million a year for the services rather than a 7 million dollar law suit for
a breech that comes in with a CNMW as the "senior" OB person in the
hospital. andrew
>From: Joe Cutchin <forcep@intercom.net>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: homebirth conversation
>Date: Mon, 28 Nov 2005 10:44:51 -0600
>
>Ingrid, I regret to say this but due to our current legal system the answer
>to your question is "yes". Joe C
>
>igold@cox.net wrote:
>>If one uses this "arguement", one would then be required to be at the
>>bedside throughout the labor, as something could turn at anytime requiring
>>the OB. Correct?
>>
>>Does it follow that birth should only occur where there is a physician to
>>deal with it 24/7 in house?
>>
>>Ingrid Gold, CNM, Phoenix
>>
>>>From: "Andrew Folley" <agfolley@hotmail.com>
>>>Date: 2005/11/27 Sun PM 10:24:31 EST
>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>Subject: RE: homebirth conversation
>>>
>>>I have been practicing 22 years in OB-Gyn. My philosophy has been that
>>>nurses, midwives, dads and taxi cab drivers can deliver 95% of the babies
>>>with no problems at home or in the back of the car.
>>>My role and that of the hospital is to be there for the 1-5% of
>>>deliveries that rapidly progress into a dire situation jeopardizing the
>>>health of the mother and the baby. Often iit is difficult to predict who
>>>will be the disaster. Minutes in the hands of a skilled practiioner
>>>(OBGyn) makes a difference between life and death for the mom and brain
>>>damage or not for the baby. andrew
>>>
>>>>From: <igold@cox.net>
>>>>Reply-To: ob-gyn-l@obgyn.net
>>>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>>Subject: homebirth conversation
>>>>Date: Sat, 26 Nov 2005 21:50:15 -0600
>>>>
>>>> I have mostly read and not contributed to this discussion. Many of
>>>>you know that I am a CNM practicing in the hospital only, but I did do
>>>>homebirths from 1978-1998. >1200 of them. So, I have more than the 20 or
>>>>so mentioned by some as a
>>>>requirement................................................
>>>> As a practitioner, today I would not attend homebirths. The reasons
>>>>are many, but include the current legal climate in the US and lack of
>>>>liability insurance and backup. I have (honestly) not seen many of the
>>>>horrors that can occur at home that have been mentioned on this list. In
>>>>my practice I only worked with women who were low risk, otherwise they
>>>>had to go to the hospital. So, I have never done a breech at home,
>>>>VBAC,twins, <37 weeks,>42 weeks, Hgb <10, failure to progress, including
>>>>a second stage >2 hours, etc.
>>>> Honestly, I have seen many complications in the hospital which could
>>>>have been prevented if at home (or with true midwifery care, harder and
>>>>harder to provide today. In part because women don't want it!). These
>>>>range
>>>
>>>>from cord prolapse (2 weeks ago I assisted on a c/sec for an iatrogenic
>>>
>>>>prolapse, the OB said he was pushing up the head to put the IUPC in to
>>>>dilute the meconium!) to bradycardia secondary to low BP after epidural,
>>>>to hypertonic contractions from pitocin, etc. I even practiced in a
>>>>hospital where the OB pulled off the baby's scalp with a vacuum.
>>>> We are fortunate to live in an era where we have the knowledge and
>>>>tools to help women give birth more safetly than ever. This knowledge
>>>>can be used safetly at home or in the hospital.
>>>> For those of you who grew up in the hospital environment, I believe
>>>>it is impossible for you to understand homebirth. I had a patient once,
>>>>who was an OB/GYN, and so was her husband. Their patients and collegues
>>>>asked them why they were having a homebirth, when they could have
>>>>anything they wanted in the hospital. They replied "we don't want to
>>>>have to ask". I know that "you guys" can't understand it.
>>>> While I would no longer attend homebirths, if I were to have any more
>>>>children, they would be born at home, as my 1st three were.
>>>>
>>>>Ingrid Gold, CNM, Phoenix
>>>>
>>>
>>
>
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