Re: VBAC, immediate availabilty and change in hospital policy
From: art fougner, md (evsono@pipeline.com)
Mon Feb 12 18:01:47 2001
30 mins to get to hospital - no in-house anesthetist - probably no
in-house scrub nurse - does this sound safe???
art
At Mon, 12 Feb 2001, D. Ashley Hill, MD wrote:
>
>At Mon, 12 Feb 2001, Kelly Shanahan, MD, FACOG wrote:
>>
>>But what about those of us that live and practice 30 minutes away from
>>the closest hospital --and only another small community hospital to boot
>>and that is on hte other side of a mountain?
>
>Kelly- On the one hand ACOG and trial lawyers will mandate that you stay
>"in house" the entire time a patient is undergoing a trial of labor
>after prior cesarean. On the other, you have other patients who might
>need you for serious obstetric or other medical problems. Should those
>patients be denied access to their doctor while you sit on the labor
>unit for many hours waiting for your patient to deliver? You chose to
>practice in a smaller community, but it is not your fault that the
>community does not have a larger hospital capable of providing in-house
>OB and anesthesia services, nor is it your fault that your patients live
>in a smaller town and thus have the potential risk of delivering at a
>smaller hospital (no neonatal ICU, sometimes no bloodbank, often no
>in-house services like anesthesia).
>
>Economically, I'm not sure how an OB in a small town is going to be able
>to afford to attend to VBAC patients for hours and hours, since he or
>she will not be seeing patients in the office during the entire labor
>process (ie a VBAC patient arrives at 2cm with ruptured membranes and
>has an 18 hour labor). I envision small-town OBs getting sued, and
>leaving the area for a larger community, or hospitals paying for
>in-house OB coverage (which is not cheap), or patients who want a VBAC
>relocating to larger communities a few weeks before their due date in
>order to deliver at a larger hospital.
>
>DAH
>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Orlando, Florida
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
|
|
