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Re: ACOG statementFrom: Barbara Nicol (blnicol@ix.netcom.com)Wed Nov 29 07:28:46 2006
> What ... an ad rem argument? No ad hominem attack? Where's the fun in > that? > > /sarc > > Art > Yeah, I know - not up to the list's usual standard. (Hangs head in shame.) Just to prove that I have no sense of humor, I will make one minor correction to my own post - my WA stint was 96-02, not 02-06. It doesn't affect the point I was trying to make, though - actually, it was during the period of the study. Wasn't backing up OOH births then either, but saw some transfers in up there as well. My experience is that the OOH birth is just a reality of practicing obstetrics in this part of the world. You can't act as a consultant or backup, of course, but when the patient walks into your L&D unit as an emergency transfer of care (usually because her midwife told her it was necessary) you get on better if you treat her and the referring midwife with respect, and glean all the information you can from the outside records. My experience is that encouraging the midwife to stay around in the role of supportive visitor aka doula is frequently helpful in building trust; it's much easier to get consent to a CS, for example, if the trusted support person is sitting there nodding her head. Even if she's not nodding her head, it's better to have the discussions in person rather than have the patient on the cellphone with her midwife every 10 minutes and relaying a bunch of questions whose answers would be completely apparent if she were just in the room. Of course, there are memorable exceptions; well, to be fair, there are difficult personalities on the MD side as well. But the majority of OOH providers are pretty reasonable people. 90 percent of us get sued. It's an unbelievably awful experience even when you did nothing wrong, and it's worse when there's some real question on that point. I admit to a lot of frustration and upset when an obvious litogen (e.g. local favorite: refusing GBS prophy because 'antibiotics cause asthma', don't get me started on this nightmare of junk science) walks through the door, but communicating those emotions to the patient just starts things off on the wrong foot altogether, as I'm sure y'all know already. - Barb Nicol, M.D., F.A.C.O.G.
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