Re: VBAC revisited
From: art fougner, md (evsono@pipeline.com)
Wed Jul 9 19:14:20 2003
the only reason i did not suggest involving your malpractice carrier is
that their risk management department might conclude that YOU practice
in an unsafe environment and either drop you or raise your premiums.
art
At Wed, 9 Jul 2003, Efrain Ramirez wrote:
>
>My advice that on the first prenatal visit you tell your patients that
>you are not doing VBAC's because of the situation at your institution
>.. period - I agree with Ron that you should get your malpractice
>carrier involved.. good luck.
>
>- - At Wed, 9 Jul 2003, guy venezia wrote:
>>
>>Believe it or not, I posted a very frustraing VBAC situation here last
>>month.
>>I work about 40 miles outside of chicago in a community of 50,000 pop.
>>Our hospital pushes VBACs, but will not supply in house anesthesia or in
>>house surgical team. If a rupture occurs, we have to call in
>>anesthesia, the surgical team and peds. This takes at least 30 mins to
>>get the baby delivered.
>>Thus, on my potential VBACs, I document a discussion with the patient on
>>availability of anesthesia, surgery and peds.
>>I notify them of the potential time delay, especially on the weekends if
>>an emergency occurs.
>>Well, risk management was up in arms for this documentation. I was
>>called in by a retired ob/gyn to review my VBAC policy and
>>documentation. I was told the L&D nurses were upset at my informed
>>consent and that it will persuade women out of VBACs. I was also told
>>that this was too much documantation. I was also told that the hospital
>>is rewarded for VBACs and low C/S rates!!
>>Can you believe the pressure and deliberate persistance on VBACs by
>>admin. I suggested making more resources available, especially on the
>>weekend when nobody is in house. They stated they could not afford to
>>have anesth and surgery available 24/7 because of the financial cost.
>>Any Thoughts??
>>Guy Venezia, M.D.
>>>-----Original Message-----
>>>From: Garry E. Siegel, M.D. [mailto:garrys@mindspring.com]
>>>Sent: Tuesday, July 08, 2003 6:31 PM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: Re: VBAC revisited
>>>
>>>Um, what is Frankenstein's law?
>>>
>>>Garry
>>>
>>>At Tue, 8 Jul 2003, Braun, R. Daniel wrote:
>>>>
>>>>Boy that is the truth.
>>>>Dan
>>>>
>>>>-----Original Message-----
>>>>From: art fougner, md [mailto:evsono@pipeline.com]
>>>>Sent: Tuesday, July 08, 2003 7:43 AM
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Subject: Re: VBAC revisited
>>>>
>>>>Joe
>>>>
>>>>looks as though Frankenstein's Law applies here.
>>>>
>>>>art
>>>>
>>>>At Tue, 8 Jul 2003, DoctorJoe@aol.com wrote:
>>>>>
>>>>>In a message dated 7/8/03 06:42:40, rbraun@iupui.edu writes:
>>>>>
>>>>>> Hence the need to teach our residents how to use forceps correctly.
>>>>>> Dan
>>>>>>
>>>>>> <snip>
>>>>>>
>>>>>> Hence the view of many that preventing that primary CS is key.
>>>>>>
>>>>>> Lynne Loeffler, CNM, JD
>>>>>>
>>>>>Well, just add THIS news story to the mix.
>>>>>
>>>>>Joe P.
>>>>>
>>>>>--
>>>>>
>>>>>CIMS Alarmed By Highest US Cesarean Rate Ever
>>>>>
>>>>>PONTE VEDRA, Fla., July 8 /PRNewswire/ -- The Coalition for Improving
>>>>>Maternity Services (CIMS) views with alarm the Centers for Disease
>>>>Control's report
>>>>>that the 2002 cesarean rate reached 26.1%, the highest rate ever for
>>>>the U.S.
>>>>>The World Health Organization states that a cesarean rate greater than
>>>>10-15%
>>>>>cannot be justified.
>>>>>
>>>>>"One in four women giving birth by major abdominal surgery is
>>>difficult
>>>>to
>>>>>defend," said Deborah Woolley, CNM, Ph.D., CIMS' Chairperson. "For
>>>>example,
>>>>>there has been no decline in cerebral palsy or shoulder dystocia
>>>>associated with
>>>>>the rise in this operation. Furthermore, studies show that healthy
>>>>women, who
>>>>>should rarely need operative delivery, undergo a large percentage of
>>>>the
>>>>>cesarean sections performed in the U.S."
>>>>>
>>>>>According to The Coalition for Improving Maternity Services, the
>>>>overuse of
>>>>>cesarean section poses considerable danger to the health and
>>>well-being
>>>>of
>>>>>mothers and babies. Compared with vaginal birth, maternal risks
>>>include
>>>>increased
>>>>>risk of death, surgical injury, infection, hemorrhage, deep venous
>>>>clots, and
>>>>>pulmonary embolism. Women are more likely to experience pain and poor
>>>>health
>>>>>after birth, and to require readmission to the hospital. Women having
>>>>unplanned
>>>>>cesareans are more likely to suffer post-partum depression or
>>>>post-traumatic
>>>>>stress syndrome.
>>>>>
>>>>>Otherwise healthy babies born by cesarean are more likely to need
>>>>assistance
>>>>>with breathing, be admitted to intensive care for breathing problems,
>>>>and to
>>>>>develop persistent pulmonary hypertension, a life threatening
>>>>complication.
>>>>>Mothers are more likely to have difficulty forming an attachment to
>>>>their infant
>>>>>and to breastfeed.
>>>>>
>>>>>Long-term and reproductive hazards of cesarean section include chronic
>>>>pelvic
>>>>>pain or bowel problems, infertility, ectopic pregnancy, miscarriage,
>>>>>premature birth, placenta previa (the placenta overlays the cervix),
>>>>placental
>>>>>abruption (the placenta detaches before the birth), and uterine
>>>>rupture. The risk of
>>>>>uterine rupture is 1 in 500 even with planned repeat cesarean versus 1
>>>>in
>>>>>10,000 with an unscarred uterus.
>>>>>
>>>>>Besides improving maternal-infant health, reducing the cesarean rate
>>>to
>>>>an
>>>>>appropriate level would save the national health care system over $2
>>>>billion
>>>>>annually.
>>>>>
>>>>>The rise in cesarean rate is attributable both to the rise in first
>>>>>cesareans, now at 18%, also a new high, and the precipitous fall in
>>>the
>>>>percentage of
>>>>>vaginal births after cesarean (VBACs). CIMS is especially concerned
>>>>about the
>>>>>ongoing increase in first cesareans because most women having a first
>>>>cesarean
>>>>>will go on to have more despite the fact that elective repeat cesarean
>>>>section
>>>>>is more hazardous for the mother and not any safer for the baby.
>>>>>
>>>>>Each subsequent cesarean incrementally increases the likelihood of
>>>most
>>>>>cesarean-related complications, including placenta accreta, (the
>>>>placenta invades
>>>>>the uterus resulting in massive hemorrhage at the delivery). The
>>>>American
>>>>>College of Obstetricians and Gynecologists attributes the 10-fold
>>>>increase in this
>>>>>deadly complication over the last decades to the rise in cesareans.
>>>>>
>>>>>While uterine rupture is slightly more likely with planned vaginal
>>>>birth (5
>>>>>per 1,000 versus 2 per 1,000 for a repeat cesarean), newborn outcomes
>>>>do not
>>>>>differ. With appropriate care, 7 out of 10 women or more laboring
>>>after
>>>>a
>>>>>cesarean will birth vaginally.
>>>>>
>>>>>The decline in the VBAC rate has come about through obstetricians
>>>>>discouraging and outright refusing VBAC, a reversal of policy deplored
>>>>by CIMS. Denial of
>>>>>VBAC forces thousands of women into having major operations they
>>>>neither want
>>>>>nor need.
>>>>>
>>>>>A free copy of The Risks of Cesarean Delivery to Mother and Baby, a
>>>>CIMS Fact
>>>>>Sheet, is available from http://www.motherfriendly.org.
>>>>>
>>>>>SOURCE Coalition for Improving Maternity Services
>>>>>
>>>>>CO: Coalition for Improving Maternity Services
>>>>>
>>>>>ST: Florida
>>>>>
>>>>>SU: WOM
>>>>>
>>>>>Web site: http://www.motherfriendly.org
>>>>>
>>>>>http://www.prnewswire.com
>>>>>
>>>>>07/08/2003 00:01 EDT
>>>>>
>>>>--
>>>>art fougner, md
>>>>ich bin ein New Yorker
>>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>>>
>>--
>>guy
>>
>--
>"The opposite of a correct statement is a false statement.
>But the opposite of a profound truth may well be another profound truth."
>
>Niels Bohr (1885 - 1962)
>
--
art fougner, md
ich bin ein New Yorker
|
|
