Re: OB: NY Cesarean Boom
From: art fougner, md (evsono@pipeline.com)
Tue Dec 12 07:23:22 2006
Perhaps the cumulative dose-response curve of exposure to "the vapors?"
Art
At Mon, 11 Dec 2006, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>Odd personality...same guy that once refused to come in to evaluate someone that was complete because he didn't think they needed an anesthetic.
>
>He would have wanted me to call it an 'emergency', which technically it wouldn't have been, to do it sooner.
>
>Just when I think I understand anesthesia folks, they go and throw another curve at me.
>
>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 ainsron
>Sent: Monday, December 11, 2006 3:24 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: OB: NY Cesarean Boom
>
>Why would he wait six hours? They always treat all ob patients as if they
>have a full stomach anyway.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Glen Elrod
>MD
>Sent: Saturday, December 09, 2006 4:32 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: OB: NY Cesarean Boom
>
>Richard,
>
>Does everyone in your practice do the same thing? I certainly can see me
>doing that with my patients, but I know for a fact my partners wouldn't
>back me up on it (ie, do an elective c-section even IF I had
>appropriately counselled them and documented it) if I happened to be
>away that day.
>
>With breech and repeats added, what would you say your overall c-section
>rate is.
>
>I discussed this patient with the anesthetist on call and got an
>interesting response. It was around 9pm on the first night that she
>asked me to section her. Knowing full well there wasn't any immediate
>indication for section I questioned the anesthetist on how he would
>proceed IF I had chosen to section her. His response was that in the
>absence of an emergent reason, he would require her to be NPO for 6
>hours. You do the math...thats 3am for a scheduled start time. Ughh!
>
>Glen
>At Fri, 8 Dec 2006, Richard Chudacoff, MD wrote:
>>
>>I don't know. I offer every patient an elective primary c-section at their
>>new OB visit, right after I tell them I will induce them at 39 weeks. Those
>>patients who do not leave my practice after that first visit (which rarely
>>happens) usually get induced, unless they deliver before 39 weeks. My
>>c-section rate, including primary electives, but not including breeches and
>>VBACS (those are 100%) is about 7%.
>>
>>Personally, I would have sectioned her on demand. Was it really worth the
>>risk? Had you delivered her vaginally and had any untoward event, or if she
>>got septic, or had the baby been born 'bad'in an otherwise uneventful
>>delivery you wouldn't have had ANY defense. Unfortunately in America, we
>can
>>ONLY practice defensive medicine.
>>
>>--
>>Richard Chudacoff, MD, FACOG
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jefferson
>>Delfino
>>Sent: Friday, December 08, 2006 11:30 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: OB: NY Cesarean Boom
>>
>>God save C-section. I know you will say I´m a brazilian world wide
>c-section
>>leader but it´s easier and safe and there´s no reason to be afraid.
>>
>>Jefferson Delfino
>>
>>---------- Início da mensagem original -----------
>>
>> De: ob-gyn-l@obgyn.net
>> Para: "Multiple recipients of list OB-GYN-L" ob-gyn-l@dns.obgyn.net
>> Cc:
>> Data: Fri, 8 Dec 2006 07:53:36 -0600
>> Assunto: RE: OB: NY Cesarean Boom
>>
>>> I had a primip at 41 wks come in ruptured two mornings ago. After 8
>>> hours of observation she had not gone into labor. At that point she
>>> requested a c-section. I gave her all sorts of reason why it wasn't
>>> indicated etc etc, and proceeded on with an induction. My partner then
>>> subsequently sectioned her after 6 hours of no change at 4cm with
>>> adequate contractions. I think she had been ruptured and 'in labor' for
>>> 38 hours by then.
>>>
>>> Given that I don't really have any beef with doing elective cesarean
>>> sections if I've had a good long time to discuss it with them, I felt
>>> almost like I did her a disservice by not giving in to her desires and
>>> doing her section right away.
>>>
>>> I whole-heartedly think it will hit 50% and sooner rather than later.
>>>
>>> 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 Joe
>>> Cutchin
>>> Sent: Thursday, December 07, 2006 4:00 PM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: Re: OB: NY Cesarean Boom
>>>
>>> Two reasons: First is patient desire. Second is that physician does not
>>> want to spend 7 years in graduate training and find his life's career
>>> threatened by junk science( I include EFM) and a debunked lousy legal
>>> system. As Art would say, I might be wrong but I've been there. Joe C
>>>
>>> acmidwife@netscape.net wrote:
>>> > Why so high, Joe C? What leads you to believe it will reach 50%? Just
>>> > curious. ac mase CNM
>>> >
>>> > -----Original Message-----
>>> > From: forcep@intercom.net
>>> > To: ob-gyn-l@dns.obgyn.net
>>> > Sent: Thu, 7 Dec 2006 9:11 AM
>>> > Subject: Re: OB: NY Cesarean Boom
>>> >
>>> > Our rate here now is 35%. Some time ago I predicted 50% and I think I
>>> > will be proven correct. Joe C
>>> >
>>> > art fougner, md wrote:
>>> >
>>> > > The number of Caesarean births has shot up 7 percent at the city's
>>> 44
>>> > > maternity hospitals, according to a report released yesterday.
>>> > > > In all, 28.6 percent of city-hospital births were delivered via
>>> > > C-section in 2004, up from 26.6 percent in 2003.
>>> > > > >
>>> >
>>> http://www.nypost.com/php/pfriendly/print.php?url=http://www.nypost.com/
>>> seven/12052006/news/regionalnews/caesarean_baby_boom_regionalnews_carl_c
>>> ampanile.htm
>>> > > > --
>>> > > art fougner, md
>>> > > "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>> > > > >
>>> >
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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