OB-GYN-L Messages for February, 2001: Re: Gel, Pit, & VBAC tragedy

Re: Gel, Pit, & VBAC tragedy

From: Kathi Wilson

wilsonk@gtn.on.ca

Wed Feb 28 20:13:51 2001

> 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

I do stand corrected, John, although, in fact, what occurred here still contravenes the SOGC recommendations. Our MFM guys have staunchly and firmly decided that no VBAC in our hospital will get pg's of any sort. Foley's only for cervical ripening. (So forgive me for confusing the issues a bit :-)

> 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 ;)
> ).

Um, is that the "teaching turnips to fly"... can't remember where it's from, tho'. (And not to be confused with Les Nessman pitching turkeys out of helicopter on WKRP).

> 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.

I agree with you here, John. Although, in Ontario, hospitals are now going down to Texas (where all the nurses have gone, or seem to go...) and re-recruiting them to return to Canada. Offering bonuses and relocation costs. Bit of panic, there, because there is also a nursing shortage in the US. Wonder what the market value of a nurse will be?

Part of the problem is also that fewer full-time jobs become available -- more nurses are being hired as casual and part-time (thereby avoiding benefits and so on) as a cost-savings measure, at least where I am. We recently lost an excellent new grad (but just had really gotten acclimatized to high-risk) to North Carolina, because she couldn't get a full-time job in our area. Yes, there are a shortage of nurses, but there's also a shortage of full-time jobs. The other problem is beginning to become a downward spiral problem -- morale in nursing is so low that it's become an unattractive career to enter. Fewer people (women, mostly) are choosing to enter nursing as a profession.

Same thing has happened to teaching in Ontario, BTW. Nobody wants to become a teacher anymore. Our neo-con gov't (which is trying to privitize education) has made teaching such a horrific job, so stressful and demoralizing, that teachers colleges are having a hard time attracting good or enough candidates. We are facing a horrendous shortage in the next five years. Guess we'll just park 'em all in front of computers and hope for the best. Same for patients, too, eh?

-- 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

Women's Insurance Checklist from Auto Insurance Quote

use when must restrict search to only the ob-gyn-l forum...
Enter search keywords:
	Returns per screen: Require all keywords: