Re: CS response time

From: Efrain Ramirez (eramirez@icepr.com)
Mon Jul 17 20:51:59 2000


Joe - I have written to Dr. Zinberg before and the answer was ambiguous as this one - how can an issue so important as the understanding of 'immediate available" be left to local institutions - so in contast with the so called "standard of care". Lawyers will be laughing at this argument- I understand that the College has a terrible dilemma - trying to lower the C/S rate AND allowing VBAC's --BUT they should be completely honest and say "VBAC's should be done only in institutions where immediate delivery can be done' --period - problem is that they glued the VBAC issue with abruptio, etc, BIG mistake -

Dan is absolutely right - the courts will decide all this issue -as always!!!

Dan is absolutely right - the courts will decide all this issue -as always!!!

BTW

im·me·di·ate (ī-mź¹dź-īt) adjective 1. Occurring at once; instant: gave me an immediate response. 2. a. Of or near the present time: in the immediate future. b. Of or relating to the present time and place; current: "It is probable that, apart from the most immediate, pragmatic, technical revisions, the writer's effort to detach himself from his work is quixotic" (Joyce Carol Oates). 3. Close at hand; near: in the immediate vicinity. See Synonyms at CLOSE. 4. Next in line or relation: is an immediate successor to the president of the company. 5. Directly apprehended or perceived: had immediate awareness of the scope of the crisis. 6. Acting or occurring without the interposition of another agency or object; direct. [Middle English immediat, from Old French, from Late Latin immediātus : Latin in-, not. See IN-1 + mediātus, past participle of mediāre, to be in the middle. See MEDIATE.] - im·me¹di·ate·ness noun

At Mon, 17 Jul 2000, Joe Cutchin wrote: >
>Sometime last fall I had written to ACOG and complained about the
>word"immediate" in terms of MD availability.I found Dr Zoinberg's
>response and am posting for your interest.
>Dear Dr Cutchin.
>Your recent e-mail regarding the Practice Bulletin "Vaginal Birth after
>Previous Cesarean Delivery"has been forwarded to me as Vice President of
>Practice Activities.Unfortunately,Ken Heland is no longer with the
>College and I have been asked to respond.
>As indicated in the enclosed editorial in our newsletter ACOG Today,the
>term "immediate" was used in this document to highlight the urgent need
>for intervention in the event of uterine rupture.In contrast to other
>obstetric emergencies such as placenta accreta,VBAC is a purely
>procedure that allows for reasonable precautions in assuming this small
>but significant risk.In addition,recognition that certain situations
>require less than a 30 minute reponse time does not represent new
>College policy.As explained in "Guidelines for Prenatal Care 4th Ed"
>examples of situations mandating expeditious delivery include
>"hemmorrhage from placenta accreta,prolapse of the umbilical cord,and
>uterine rupture".Therefore the Practice Bullitin merely emphasizes this
>point.
>The definition of "immediate available" remains a local decision,based
>on each institution's available resources and geographic location.
>I hope this information is helpful to you.
>Sincerely,
>Stanley Zinbery,MD,MS,FACOG
>Vice President,Practice Activities
>
>--
> Joseph H. Cutchin MD FACOG 4105463125
> 314 West Carroll Street 4105463128 Fax
> Salisbury,Maryland 21801
>
> http://www.penobgyn.com
>

--
"Do not take life too seriously. You will never get out of it alive."

Marianne Williamson





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