Re: Arrest of dilatation;next question
From: Jamie (ajfields@pine-net.com)
Thu Aug 3 16:48:23 2006
In total agreement.
At Thu, 3 Aug 2006, Henry Gregor wrote:
>
>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
>
> Get on board. You're invited to try the new Yahoo! Mail Beta.
>
--
JFields, RN, BSN
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