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Re: VBAC, immediate availabilty and change in hospital policy From: ainsron@msn.com Sat Feb 10 21:04:15 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Cheri Van Hoover: "Re: VBAC, immediate availabilty and change in hospital policy" Previous message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: Embolization for Uterine Fibroids" In reply to: M. Kelly Shanahan, MD: "VBAC, immediate availabilty and change in hospital policy" Next in thread: Cheri Van Hoover: "Re: VBAC, immediate availabilty and change in hospital policy" I practice at a small hospital in Northern CA also, and our unit manager also got a bug shoved up her butt recently by a risk management lawyer for the Adventist Health System. We're now wrestling with similar problems, but the numbers are even tighter. We have only three OB's, each in separate practices, but we are quite compatible and work together well and have reached the consensus that we will be inhouse when VBACs are in active labor. We have only two anesthesiologists, so you can imagine how they feel about the whole VBAC issue. They want to be notified when VBACs are in house, but stay in house? Not on your life. One would prefer we don't even do them. We also have three CNMs, one who works for one of the docs - so she will do what she is asked. The other two are in private practice and I provide primary B/U for them, we have a good relationship and they understand that our backs are against the wall. The two do quite a few VBACs, and with discussion now turning to having the MD in house for VBACs, they are bothered by the fact that we will no longer let them do VBACs. However it doesn't make sense for them to be labor sitting while we are also tied to the hospital. We do have a dedicated cesarean section room and our OB nurses are now trained to set up the room and scrub until the OR crew arrives. We can almost always meet the 30 minute rule for "decision to incision," but 17 minutes is a real stretch except under the most ideal conditions - during the day, anesthesia between cases, OR crew available, etc. I went through residency at the time when Cragin's famous saying, "once a cesarean section, always a cesarean section" was the law. Looks to me that at smaller hospitals, it may soon be resurrected. > >Hey guys, I've missed you but between the two year old, abusy practice, >writing a book and the WOmen's health and pregnancy & birth forums, I >just don't have the time to get here. > >Living at 6300 feet, covered with snow six months out of the year, we >are often a bit behind the times -- our hospital CEO has just gotten a >bug up his butt about the whole VBAC/immediately available thing. I >read the archives from 1999 when this issue first arose, but didn't come >up with an answer to the question my little hospital (and me, as chair >of the ob/gyn dept) is wrestling with: > >How many of you in community hospital situations take in house call when >you have a VBAC in active labor? > >Does anesthesia and an OR crew stay in house then too? > >We are trying to develop a policy (not the "no more VBACs here" that the >CEO wanted!) to both CYA and provide good care to the patients. THere >are 6 obs in 2 different practices (with bad blood between them), 6 FPs >who deliver babies and 6 anesthesiologists. 5/6 obs agree to stay in >house at night (or in hte office --none of our offices are more than 2 >min away), we will train the ob nurses to scrub, the FPs will give up >doing VBACs, but anesthesia is the sticking point -- more so about a >VBAC in labor during the day when all hte OR rooms are running. > >What do you guys do? (BIg academic programs where you already have an >attending in house and a bunch of residents running around don;t count! >I'm talking private practice, community hopital. Paul Prior -- what did >you do?) > >Thanks, as ever > >Kelly >Kelly Shanahan, MD, FACOG >S. LAke Tahoe, CA -- Ronald E. Ainsworth,MD Next message: Cheri Van Hoover: "Re: VBAC, immediate availabilty and change in hospital policy" Previous message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: Embolization for Uterine Fibroids" In reply to: M. Kelly Shanahan, MD: "VBAC, immediate availabilty and change in hospital policy" Next in thread: Cheri Van Hoover: "Re: VBAC, immediate availabilty and change in hospital policy"

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