Re: ACOG statement
From: Larry Glazerman (l.glazerman@rcn.com)
Tue Nov 28 04:41:38 2006
Garry:
Well stated, as usual.
On Nov 27, 2006, at 10:59 PM, Garry E. Siegel, M.D. wrote:
> Just catching up. . .
>
> 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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