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Transport in utero (was Severe PIH 34 weeks) From: Joanne Bulley, MD (islesannie@gmail.com) Tue May 29 21:37:13 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)" Previous message: Dr Eberhard Lisse: "Re: Realities of Cuban Healthcare" In reply to: Henry Gregor: "Re: Severe PIH 34 weeks" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)" My experience at one small level 1 hospital mirros Hank's. We filled out the antidumping paperwork with the signatures from all involved parties. At the approx 150 bed hospital here in Keene - when I practiced the rule was definitely the transport in utero. In the early years before Dartmouth hitchcock built a new hospital - there were frequently days when there was no room at the inn. I transported by helicopter and ambulance to various sites: Burlington, VT; Springfield, MA; Worcester, MA; Brig & Women's in Boston (the yusually tried to not take ours for some reason) & St Margaret's (now Tufts New England) - also in Boston or the Boaton area. One weekend I had transports both days. One of them was a women with 28 week twins (if I recall that Gest age correctly). When I got the 4th or 5th hospital to say "no room at the inn" -- I really pushed them: that even if right now they had "no room" in the NICU - wasn't it true that I had always been taught to transport in utero? - and that even if they were really tight with beds - it was STILL in the BEST interest of mom & Babes to transport now and deal with the NICU bed crunch there with the right experts on hand than for me to deliver at our level 1 hospital. They had no argument whatsoever and said to send the Mom and they would figure how to best manage - and that even if they didn't have room in the next 24 hours - perhaps a very nearby Boston Hopsital would open up by the time they delivered. They delivered at that hospital in the next 24 hours - got superb care and are healthy young men now. I still care for their mom and we reminisce periodically about that night trying to get a room in some inn with a NICU! And getting her there before the predicted storm grounded the transport systems! I think this is one where a helicopter was on the way to get her and went back to home base and then we had to get the ambulance to transport. Her husband was on a business trip and called me periodically to make sure where he was supposed to go to look for his wife! Joanne At Mon, 28 May 2007, Henry Gregor wrote: > > 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. > > 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 > -- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)" Previous message: Dr Eberhard Lisse: "Re: Realities of Cuban Healthcare" In reply to: Henry Gregor: "Re: Severe PIH 34 weeks" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Transport in utero (was Severe PIH 34 weeks)"

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