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Re: Severe PIH 34 weeksFrom: Henry Gregor (henrygregor@yahoo.com)Mon May 28 23:48:20 2007
Jamie, one could almost imagine your sounding harsh, shrill, judgmental and sarcastic with your postive expression of hope for transports before birth. OTOH, I did say in utero transports...only way I know that can be done is by sending Moms before delivery occurs. FWIW, I've worked in a number of small hospitals, especially as a locums. Its been my experience in many many observed situations that smaller hospitals are more than willing and anxious to send these Moms out early, and bend over backwards to do so. IMO one factor that works against this is our COBRA laws which can apply draconian penalties on institutions shipping laboring patients out if someone using the good old ex post facto retrospectiscope decides the patient was too much at risk for delivery to have been sent. I have seen a small hospital which sent a preterm patient in labor with a breech by ems ambulance about twenty miles up the road to a regional hospital get hit with $50K fine ( and that was some time ago, more in today's bucks I'm sure)...even though the patient arrived with oodles of time ...because an anonymous complaint came out of the larger hospital alledging the patient was turned away in labor. I never could figure how the hospital didn't prevail...perhaps it was the usual cheaper to settle scenario. The other most common limitation I've seen has involved a scenario in which acceptance of the transfer wasn't obtainable from the higher level hospital because of bed limitations. (Hard to take from my line of thinking....seems there's never a turn down for accepting the newborns, and I've always thought it better for their moms to labor and deliver in a hallway gurney outside a NICU than be kept at the smaller location.) More than once I've worked the phones to regional intsitutions trying to get acceptance of a labor patient, even going cross border to neighboring states, or seen other ob's doing likewise, sweating it out to get a transport acccomplished in time to benefit mom and babe. 'course this is all anecdotal to my experience, but its been in multiple states. When I did some travelling locums I was always, for the most part, impressed with the attitudes and performances of small hospital birthing staffs, both md and non-md re this issue. I think it'd be interesting to hear from other listers. I might have been rose colored specs...maybe after some info from others, or more specifics from your experience, I might better understand the background leading to your choice of words. Hank Jamie <ajfields@pine-net.com> wrote: Maybe it will encourage rural hospitals to ship at risk babies inside mom rather than fiddle around waiting for delivery and then transporting a sick baby.
At Sat, 26 May 2007, Henry Gregor wrote:
>
-- JFields, RN, BSN
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