Re: VBAC revisited
From: Robert J. Carpenter, Jr. MD (zygote@icsi.net)
Thu Jul 24 15:02:32 2003
You did properly! Also inform them in no uncertain terms that if you are sued for a
VBAC adverse outcome that you will provide testimony concerning their actions
which contributed to the adverse outcome. In most jurisdictions that will open the
golden coffers of punitive damages for which they will not be insured. It makes the
point that if they are going to place you in the unteneable position to do what you
know is wrong that they will really suffer for their arrogance!
On 9 Jul 2003 at 19:14, art fougner, md wrote:
> Guy
>
> 1) show em in big letters the ACOG "Immediately Available"
> recommendation.
> 2) as long as you feel you are acting in the best interests of your
> patients and you, change nothing. 3) ask Marilyn, Joe or Dean to find
> you examples of large jury awards in ruptured uterus cases to add an
> exclamation point to your position.
>
> art
>
> 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
> >
>
> --
> art fougner, md
> ich bin ein New Yorker
>
--
Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
St. Luke's Medical Tower
Houston,TX 77030-2339
713-795-4600
