OB-GYN-L Messages for November, 2006: Re: ACOG statement

Re: ACOG statement

From: Garry E. Siegel, M.D.

garrys@mindspring.com

Mon Nov 27 20:59:02 2006

El is just being El, and is always fun to hear from.

The legal and insurance climates make home birth, right or wrong, have ten-foot pole marks all over it from an obstetrician's perspective, and that's sad.

It is sad that patients who make choices (informed or otherwise) may still blame others (the doctors and/or hospitals) when something goes wrong, as the doctors and hospitals may be poorly known to the patients (especially when the patients have been cared for by midwives and have no relationship with the doctor) and have deep pockets. There are times when I see CNM patients from our own practice, and sense tremendous hostility and distrust from the outset, despite the fine work of our CNMs. It is sad.

It sure seems like home birth in properly selected people is as safe as hospital birth, but we all have anecdotal stories where being in the hospital saved a bad outcome, and had that event occured at home, well, things would have been worse, it seems. From a statistical viewpoint, bad stuff happens so infrequently that it would take a whole lot of births to show a signficant difference in safety between home and hospital deliveries. That said, we all REMEMBER very well the bad stuff--uterine ruptures, prolapsed cords, etc.

So. . .until patients are accountable for their choices, and don't pursue the deep pockets (i.e. the nicest couple devastated by a brain injury, severe shoulder dystocia, etc.), and there is some balance to the justice system in which we operate, I think that home deliveries have to remain for Pizza only from an American obstetrician's perspective. As Art said, it is not worth losing insurance coverage, one's license, etc.--and again, that's sad.

Garry

At Mon, 27 Nov 2006, ainsron wrote: >
>It's not just the legal system per se. My malpractice carrier will not
>cover me for any birth that is a planned out of hospital delivery that I
>agreed to provide backup coverage for. I'm a proponent of patient choice
>and autonomy, but not at the risk of my career or financial ruin to myself
>and my family.
>
>Ronald E. Ainsworth, MD, FACOG
>
>The legal system is definitely the stumbling block, but if OB's were
>really serious about working with and supporting midwives, it might
>be possible to put in place legislation protecting receiving
>hospitals and OB's in all states, not just in Colorado.
>
>Anna Meenan, MD, FAAFP
>
>>I am sorry to hear the tone of some of this discussion. I think
>>this is an entirely appropriate forum for this discussion, and a
>>timely topic. I do value the input of midwives, and think that all
>>of us can benefit by listening to eachother and learning.
>>Name-calling is immature and destructive.
>>
>>I am sorry that ACOG came out with this statement. It flies in the
>>face of many studies which have shown that OOH birth for low-risk
>>women, and attended by a trained midwife, has very low risks to
>>babies (with comparable risks of babies of low-risk mothers born in
>>hospitals), and much lower risks to mothers of interventions,
>>operative vaginal deliveries, and Cesarean sections.
>>
>>Doesn't anyone else on this list wonder how midwives get those good
>>outcomes? What are they doing in OOH births that we aren't doing in
>>the hospital? Obviously, there are lots of diffferences. I wish
>>ACOG would focus on getting the best outcome for both mothers and
>>babies, no matter where the births take place.
>>
>>And, I understand fully the risks we M.D.s take when consulting
>>for OOH midwives. It would be wonderful to figure out ways to make
>>it safe for the doctors to consult when needed. It would also be to
>>the benefit of mothers if midwives and physicians could
>>talk politely and respectfully to eachother. Who knows, maybe we
>>could all learn something in the process.
>>
>>Contrary to some of the beliefs expressed here, I think that as long
>>as women are allowed to make decisions regarding their own health
>>care (which will hopefully be forever), some will choose to give
>>birth out of the hospital, for a myriad of reasons. I would hope
>>that all of us could focus on how to make birth as safe as possible
>>for all mothers and all babies.
>>
>>Danae Steele, M.D.
>>MFM
>>Green Bay, WI

-- Garry E. Siegel, M.D. Private Practice Roswell, GA

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