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Re: VBAC revisited From: Garry E. Siegel, M.D. (garrys@mindspring.com) Wed Jul 9 19:30:55 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Marilyn Ringstaff: "Re: VBAC revisited" Previous message: art fougner, md: "Re: VBAC revisited" In reply to: art fougner, md: "Re: VBAC revisited" Next in thread: art fougner, md: "Re: VBAC revisited" Agree with all said--stick to your guns. If the hospital/L and D people/yada yada don't like your consent, well, do it and keep a copy in the office chart. For VBACs with whom you have no office chart (i.e. ER drop-ins, or other docs's patients you cover), execute the consent on the spot, and simply make an office chart for that expressed purpose. Garry At Wed, 9 Jul 2003, art fougner, md wrote: > >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 > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Marilyn Ringstaff: "Re: VBAC revisited" Previous message: art fougner, md: "Re: VBAC revisited" In reply to: art fougner, md: "Re: VBAC revisited" Next in thread: art fougner, md: "Re: VBAC revisited"

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