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Re: Assistants at CESAREAN SectionFrom: kathleen [tash] robb bodor (Tash.Robb-Bodor@worldnet.att.net)Mon Aug 5 19:32:08 1996
Frank Thibault wrote: > > At 01:30 PM 8/2/96 -0500, you wrote: > >To List members: > > > >How do listmembers feel about the use of physicians as first assistants > >at Cesarean Section? While other operations may be performed without > >other physicians in attendance, it has been our position that another > >physician, competant to perform the Cesarean, be present in order to > >adequately assist in the operation. > > > >sincerely, > > > >Douglas Krell MD FACOG > >Santa FE, N.M. USA > > > > It is imperative to have a second physician in the room at the time of > Cesarean. I know that with good assistants one physician is all that is > necessary for the surgery. However if the baby has problems, some one has > to be available for it's resusitation. > > Long ago in a dark and dreary place, I delivered a baby by c-section that > was not breathing. I had the scrub nurse compress the uterus while I > resusitated the baby. As I started to regown the nurse anesthetist informed > me we had no BP. I told her to speed up the iv. She informed me it was > out. I did a quick subclavian vein stick and we were back at work. Mother > and baby did fine. There were some immediate policy changes at our > hospital. I still see the mother, but she decided that child was all she > wanted. > > You need adequately trained people to take care of anesthesia, surgery, and > baby. Usually that means 3 physicians. Pediatric intensive care nurse may > be fine for baby, and a good nurse anesthetist is fine, but a weak link can > give ulcers and lawsuits. > > We usually have an instrument tech and a nurse assistant scrubbed. I have > one of my partners assist if we plan a Cesarean hysterectomy. > > Frank Thibault, MD, FACOG > Benton, Ark. USAWhile I agree with the idea of having two OB MDs present at a birth in our setting this is how we do it: 1. Attending CNM as first assistant (no MDs do vag deliveries as a rule- CNMs are in private practice and MDs contract with hospital to provide b/u coverage) 2. Consultant MD as surgeon (MD truns pt. back over to CNM for follow up if uncomplicated) 3. Peds MD 4. CRNA (no MDs on staff for anesthesia) Beleive me if the CNMs could get out of first assistant we would... we are not reimbursed by any insurance companies to provide this service.
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