Re: Arrest of dilatation;next question
From: Henry Gregor (henrygregor@yahoo.com)
Thu Aug 3 15:35:29 2006
Jamie, what you wish for is perfectly attractive and desirable. However, and not said in any way to suggest or send a flame, the collaborative practice model suggested lacks one detail. That detail would of course be a collaborative practice tort system and some affordable insurance premiums and some revision of reimbursement systems that recognize responding to an unscheduled, urgent/emergent "transfer" is worthy of a different level of compensation, given the disruption to schedules and nighttime or weekend schedules....sorta' like the way my cousin the plumber gets reimbursed differently for fixing a broken water main at 3 AM Saturday than for dealing with a leaky valve on a scheduled workday call. Therein lies the problem, I think, and there's no past or current developments to suggest that might get worked out....just an opinion.
Hank
Jamie <ajfields@pine-net.com> wrote:
The answer will depend on perspective and this question is likely to
start a flame war on this site. History aside, I'd love to see a
collaborative practice model in place throughout the states, where
professional midwives (not necessarily CNMs, b/c midwifery really isn't
nursing any more than it is medicine) care for self selected low risk
patients and offer home or birth center birth as an alternative, but
with adequate medical backup available for those patients who either
change their minds or do not remain low risk.
At Thu, 3 Aug 2006, emilio porro wrote:
>
>I think that the next step is to ask yourself ,your collegues midwifes
>,your politicians which are the reasons that have brought to this law:to
>avoid medicolegal litigation?unlawful midwifery?safer birth in
>hospital?more money for doctors?insufficient midwife clinical
>preparation(see
>http://freeonlinesurveys.com/rendersurvey.asp?sid=yrbk7l4inlimvqz189647)?(here
>in Italy distance education for midwives doesnt exist.;You must be
>present to theorical and pratical lessons in University (midwifery here
>is a parauniversitary course)
>I would like to know the answer or the answers
>Yours faithfully
>Emilio porro
>
>At Thu, 3 Aug 2006, Jamie wrote:
>>
>>The problem is that in the state where this is occurring, homebirth is
>>not a legal option unless it is unassisted.
>>
>>At Thu, 03 Aug 2006, emilio porro wrote:
>>>
>>>birth is the final result of a dinamic event with three
>>>variabilities:mother, fetus,uterus
>>>example:mother general conditions are good?preeclampsia?narrow pelvis?
>>>uterus:contractions are present?efficient?spastic?
>>>baby: is big,small,adequate for gestational age?fetal presentation?is
>>>suffering in labor?
>>>as only pretty supportive a doula is more than enough.
>>>a midwife must also know (because she has studied for years)obstetrical
>>>semeiotics.
>>>I agree that now is TRENDY tell to the patient what she wants to hear from
>>>You but this is not always professionaly correct.
>>>in obstetrics (that is preventive medicine) I follow the FIVE P RULE :PRIOR
>>>PREPARATION PREVENTS POOR PERFORMANCE.
>>>When a patient comes in hospital she accepts the medical rules of the
>>>hospital (after beeing well informed);as alternative she can have a birth at
>>>home alone or with a midwife who accepts also the medical-legal risks of a
>>>distocycal birth.
>>>Yours faithfully
>>>Emilio Porro M.D.
>>>Como-Italy
>>>http://www.sanbonaventura.com
>>>
>>>>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>>>>Reply-To: ob-gyn-l@obgyn.net
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Subject: Re: Ob: Arrest of dilatation
>>>>Date: Wed, 2 Aug 2006 22:56:45 -0500
>>>>
>>>>Sue:
>>>>
>>>>What's the solution?
>>>>
>>>>I think we would agree that induction with pre-eclampsia at term is
>>>>warranted, and if she's not progressing, she's not progressing.
>>>>
>>>>Her reticence to proceed to a section allowed a fever to develop, and
>>>>she didn't progress, got antibiotics, and still had a section.
>>>>
>>>>Dan, this patient did not have an assessment of her pelvis before
>>>>induction.
>>>>
>>>>Listers, would you expect a CNM or MD to have done so?
>>>>
>>>>Dan, had I personally assessed her pelvis in the office, and told her
>>>>that it was not good, and that the chance of success was poor, I think
>>>>she would have looked at me like I was crazy, and then asked why not
>>>>try. I have not been successful convincing/selling/arguing/cajoling
>>>>patients who are not accepting of honestly given advice and direction,
>>>>and, you know, they don't always do what you want/tell them to do.
>>>>
>>>>Garry
>>>>
>>>>At Wed, 2 Aug 2006, Stmidwife@aol.com wrote:
>>>> >
>>>> >Respectfully, that is why they are going to a midwife for midwifery as
>>>> >opposed to an Obstetrician to participate in the Obstetrics of 2006.
>>>> >
>>>> >Sue
>>>> >
>>>> >In a message dated 8/2/2006 4:19:37 P.M. Pacific Standard Time,
>>>> >ob-gyn-l@obgyn.net writes:
>>>> >
>>>> >You're on the mark, but I truly think that the CNMs are pretty
>>>> >supportive and frankly attract those patients who are dissatisfied
>>>> >elsewhere, and are unrealistic about hospital based Obstetrics in 2006.
>>>> >
>>>> >Garry
>>>>
>>>>--
>>>>Garry E. Siegel, M.D.
>>>>Private Practice
>>>>Roswell, GA
>>
>>--
>>JFields, RN, BSN
>>
>--
>Emilio Porro
>M.D. Ob.Gyn.
>Como
>Italy
>http://www.sanbonaventura.com
>who,whose, with,what,why,where,when,while,watch world wide web
>
--
JFields, RN, BSN
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