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Re: Gel, Pit, & VBAC tragedyFrom: John Robertson MD (John.Robertson@medispecialty.com)Wed Feb 28 08:24:59 2001
At Wed, 28 Feb 2001, Kathi Wilson wrote: > >Efrain Ramirez wrote: > >> ACOG's VABC guidelines were issued on October 1998 - fui!! >> >> by what it's written - the obstetrician was not present -right? > >But Vancouver is not in the great US of A, Efrain. However, the OB in question *did* contravene SOGC guidelines, which advise >against the use of prostaglandins in VBACs. Not exactly. Here is what The SOGC said in 1997 about VBACs and prostiglandins b) Use of Prostaglandins The safety of prostaglandin gel use in women with pre-vious low segment sections has not been established and further research is needed. Prostaglandin preparations may be associated with very strong uterine contractions, and there are little data available on their use in women with uterine scars. At this time, if prostaglandin gel is to be used in the presence of a low segment Caesarean section scar, the woman must understand the limitation of knowl-edge in this area, and the immediate availability of physicians and resources to respond to an emergency must be provided Actually what this article realy shows is the break down of the "medical system" in the broad sense that there are not enough well trained nurses looking after high risk nurses. These nurses were not just thrown in to the deep end to see if they could swim, they were thrown off a cliff to see if they could fly! (anyone know where that reference comes from ;) ). The goverenment's refusal to train adequate numbers of nurses, and to pay them appropriately when they are working has lead to to few nurses entering the system and too many heading south (to the US of A). End result is stretched resources with fresh grads being overworked. I'm suprised this story didn't have LPN (licenced practical nurses) or PCAs (Patient care aids) in it. These people are required to have less training and are paid less by the government, so the government sees them as a quick fix for the problem. John
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>346 Platts Lane,
-- J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9 (604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
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