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Re: Shoulder dystocia/legal impactFrom: Anna Meenan, MD (annam@uic.edu)Mon Aug 14 17:42:13 2000
At Sun, 13 Aug 2000, art fougner, md wrote: > >and i suppose she's not going to allow epis as well? this woman is a >manipulator. > >art >
> So, art, a patient who prefers not to have a largely unnecessary surgical procedure is manipulative? And yes, I know the question of whether an episiotomy is necessary in managing a shoulder dystocia is still being debated (we debated it in this forum several months back), but I have never found it to be a particularly useful maneuver and I believe we came to the conclusion that those who were doing them were mainly doing them for the benefit of the lawyers. I am unable to get a sense of whether this patient is being confrontative and demanding or whether she is just trying to educate herself. If she was my patient, I would explain to her that it is virtually impossible to get a good estimate of fetal size prenatally, that shoulder dystocia can occur at almost any term fetal size, give her the statistics on recurrent shoulder dystocia, and document the hell out of the whole conversation. If the baby APPEARED to be smaller than the previous one at term and the lady wanted a vaginal delivery, I would allow a trial of labor with the caveat that a deviation from normal progress with good contractions would generate a strong recommendation for a c-section, and if this occurred, I would again document the hell out of that conversation. If the patient refused c-section during an abnormal or protracted labor, I would document that also, and if a shoulder dystocia occurred, I would carefully follow the ALSO protocol, documenting times and maneuvers every step of the way, being careful to document that any traction used was gentle traction. From my experience as an expert witness in two shoulder dystocia cases, that would pretty well cover all the bases to make the lawyers happy, but I suppose that wouldn't stop her from at least attempting to sue anyway. Well, that's my 2 cents worth, anyway.
-- Anna Meenan, MD, FAAFP
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