Re: VBAC
From: art fougner, md (evsono@pipeline.com)
Sun Oct 29 15:30:08 2000
and pls tell the HMO's to pay the hospitals sufficient to increase the
nursing staff accordingly.
art
At Sun, 29 Oct 2000, jkulkin wrote:
>
>All of what you say is well documented in the literature. Intermittent monitoring by
>ausculatation is standard accepted management for normal pregnancy and is how we
>practiced for years. Kay, join in if you will. The patients like the attendtion and the
>outcomes.
>
>Jay
>
>Kathi Wilson wrote:
>
>> jkulkin wrote:
>>
>> > We rank 18th in the world in perinatal mortality and I think 8th in maternal
>> > mortality (can't swear to that number...saw it recently and I clearly remember it
>> > wasn't very good..........I think I have it at the office, tune in tomorrow) Our
>> > C-section rate has increased substantially over the past 30 years. Not solely
>> > physicians fault-medical-legal issues, consumer demand etc. Where's the beef?
>> > If the HMO's are stimulatng an improvement in this data it may nort be such a
>> > bad thing. As I recall, ACOG shares this view. You're right, we should look at
>> > emergencies...1/4 of "emergency" C-Sections are done in latent phase.
>> > Am I missing something?
>>
>> Jay, one of the interesting things that has come out of this entire, free-wheeling
>> discussion has been the responses I got to my continuous EFM question. What seemed
>> apparent was that it was done for the majority of women, not because there was a
>> clinical indication, but because there was a shortage of trained staff to provide
>> 1-to-1 care for labouring women. The evidence certainly indicates that supportive
>> care during labour reduces the need for operative intervention, and although that's a
>> sort of "soft" intervention that often gets pooh-poohed, it certainly needs to be
>> carefully considered.
>>
>> The Society of Obstetricians and Gynecologists of Canada has a document on Fetal
>> Health Surveillance in Labour (on their website, if you're interested in wading
>> through it -- it's lengthy) which strongly endorses intermittent auscultation with
>> one-to-one care as the method of choice, with continuous EFM being used only when an
>> indication arises (and that doesn't, however, mean that one-to-one care is
>> abandoned...). In part, this is to help ensure an appropriate rate of Caesarean
>> section.
>>
>> Recently, the Women's Health Council of the Ontario Ministry of Health published a
>> report on "Attaining and Maintaining Best Practices in the Use of Caesarean
>> Sections", which analysed the practices in 4 Ontario hospitals with low section rates
>> (one of which was St. Joseph's Health Centre in London, where I am credentialled -- a
>> level III hosp w/ a 17.4% C/S rate, and we have only 5 true level III hospitals in
>> the province). One of the recommendations was that "all women in Ontario should
>> receive one-to-one supportive nursing care" (or midwifery care...). I think, in
>> providing the best care we can to women, that we can't underestimate the absolute
>> importance of women receiving the human touch during labour in optimizing the
>> outcomes. It's something that the obstetrician leaders at my hospital fight for and
>> we, in large part, manage to do.
>>
>> If you'd like to see the sites I've mentioned, go to:
>>
>> Ontario Women's Health Council:
>>
>> http://www.womenshealthcouncil.com/E/prof_centre/index.html
>>
>> Society of Obstetricians and Gynecologists of Canada:
>>
>> http://www.sogc.org/SOGCnet/index_e.shtml
>>
>> You can go to the "Clinical Practice Guidelines" section without having to be a
>> member (unlike with AGOG...)
>> --
>> Kathi Wilson, RM
>> Ilderton, Ontario, Canada
>> mailto:wilsonk@gtn.on.ca
>> **********************
>> Thames Valley Midwives
>> **********************
>> 346 Platts Lane,
>> London, Ontario, Canada
>>
>> http://tvm.on.ca
>> mailto:info@tvm.on.ca
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
