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Re: tire forceps and vacuums? From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL) Mon Oct 16 02:52:20 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Atkinson, Samuel M: "Re: CVA prior to pregnancy." Previous message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Prophylactic MgSO4" In reply to: David Priver: "Re: tire forceps and vacuums?" Next in thread: Ronald Ainsworth: "Re: Retire forceps and vacuums?" Very nicely put. Thank you! Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of David Priver Sent: Sunday, October 15, 2006 11:02 PM To: Multiple recipients of list OB-GYN-L Subject: Re: tire forceps and vacuums? One can only wonder what skills obstetricians will be left with as we continue down the path toward universal Ceasarian sections. The time may not be far off when a vaginal delivery will be an unusual event. As someone who continues to use forceps as a technique to simplify an otherwise difficult birth, I am wondering how the profession will deal with the impending epidemic of placenta accretas which is sure to occur in the not too distant future. Every time we section an 18 year old, we should be cognizant of the fact that at some point in time, she will be having a 4th or 5th section, and that carries an accreta risk which is not small. Forceps deliveries are entirely safe and effective when done properly. Sadly, ACOG has missed the boat by issuing the absurd guideline that a primip with an epidural should endure a 3 hour 2nd stage before forceps are employed. One need only take a look at a vulva after 3 hours of pushing to realize that forceps applied then are almost certain to be difficult and traumatic. The edema of the tissues after 3 hours of valsalva is usually quite extensive and not at all conducive to operative vaginal delivery. The time to apply forceps is when progress ceases, even if it's only 30-45 minutes. As this sort of a judgment requires clinical skills, I am not surprised that it is no longer being taught. Most likely, those who currently teach residents don't know how to do forceps deliveries themselves. It is indeed sad that our profession has elected to give away the skills which were once so valuable to patients. David M. Priver, MD At Sun, 15 Oct 2006, Cesar Molina wrote: > >According to Mr.Foley, the forceps is directed to a museum.I think this is >n >20% of residents develop the skills to use it. The youger obstetricians >prefer cs than a forceps. I had the chance in my formation to get very good >skills with forceps, but the enviroment to use it are the worse. When you >are goint to use it, is like a terrific event in delivery room. All the >nurse and other personal run to the room, like if some person (baby or >mother), will be sacrificated. The pacient´s husband put a dramatic face >e >better. What happened ? > >2006/10/14, Bernard Cristalli <bcrist@club-internet.fr>: >> >> Andrew, >> Would you section a woman with a baby at the low part of the pelvis, >> rather than perform a low forceps? >> Let's teach obstetricians or the next step will be to ban vaginal >> deliveries. >> BC >> >> Andrew Folley a écrit : >> > As a follow up to the industrialization of obstetrics, does anyone >> > wish to defend the postion that moms and babies would be better off if >> > vacuums, forceps and breech deliveries were "outlawed" in the obsteric >> > suites? I have spent the last 25 years trying to hone my skills in >> > these areas but I wonder if we should simply say that there is no >> > longer any place for forceps and vacuums in obstetrics. C-sections >> > certainly have their risks but I think we would all agree that for the >> > most part they have become a very, very safe procedure. Maybe it is >> > time to put the vacuum and forceps on the museum shelf??? andrew >> > >> >> From: garrys@mindspring.com (Garry E. Siegel, M.D.) >> >> Reply-To: ob-gyn-l@obgyn.net >> >> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >> >> Subject: Re: 'How childbirth went industrial' >> >> Date: Fri, 13 Oct 2006 21:08:27 -0500 >> >> >> >> Today, my partner and I were lamenting the demise of forceps skills >> >> today, as our junior partner did a section on someone fully dilated >> >> after pushing for a long while (CNM patient who pushed longer than 3 >> >> hours, primigravida with an epidural) that sounds like she might have >> >> been "deliverable" by an obstetrician more comfortable with operative >> >> vaginal delivery. >> >> >> >> Garry >> >> >> >> -- >> >> Garry E. Siegel, M.D. >> >> Private Practice >> >> Roswell, GA >> > >> >> -- >> ÐÏࡱá >> Next message: Atkinson, Samuel M: "Re: CVA prior to pregnancy." Previous message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Prophylactic MgSO4" In reply to: David Priver: "Re: tire forceps and vacuums?" Next in thread: Ronald Ainsworth: "Re: Retire forceps and vacuums?"

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