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Re: VBAC, immediate availabilty and change in hospital policyFrom: ainsron@msn.comSun Feb 11 15:55:57 2001
>Shouldn't it be *their* choice whether or not to be in the hospital even >though one of the obs is also "in-house" for a VBAC? The reality is that the CNMs have to practice under protocols approved by their covering MD and if we say that we won't back them up for VBAC deliveries, they really don't have a choice. On the other hand, we are not autocratic and the decision will be a consensus of those involved. In the giant scheme of things, some will always have a greater voice than others and in this case the choice is limited by ACOGs dictum.
>There are those of us who feel that a midwife attending a labor and birth
I agree that women should be allowed to see whomever they want, if the
services are similar and I feel that the quality of time spent with
laboring patients is definitely in favor of the CNM. Under our
protocols, some high risk patients can be co-managed with consultation
only, others require transfer of care to the OB. In the case of VBAC,
it looks like it is going to require transfer of care. If the patients
want to be seen for prenatal care by the CNMs I work with, with the
knowledge that I will be managing their care in the hospital and
delivery, I don't have a problem with that. I would prefer to have them
for the entire pregnancy, so that we have time to develop a relationship
and dialogue prior to meeting in labor!
>
-- Ronald E. Ainsworth, MD
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