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Re: TwinsFrom: Betsy Hyde (elishyde@mindspring.com)Fri Aug 20 20:09:47 2004
On Friday, August 20, 2004, at 08:17 PM, Dr. Ainsworth wrote:
> Should CNM's protocols allow them to follow twins during pregnancy and "Should" is a value-laden term. "Do CNM protocols" is perhaps more appropriate. ACNM requires jointly approved clinical proctice guidelines between CNM and MD. These guidelines may be restrictive, or they may be broad. The guidelines are influenced by local standards, CNM skills, client base. I work in a collaborative OB/CNM practice in which CNMs regularly follow twins during pregnancy. We have standard clinical practice guidelines for twins, which include targeted ultrasound, regular growth profiles, fetal surveillance w/ NSTs and fluid checks in third trimester. Discussion re mode of delivery if they are not vtx/vtx occurs during third trimester. The MDs/CNMs have weekly high risk meetings to arrive at a consensus plan. The vast majority of our vtx/other twins elect labor. Informed consent if not vtx/vtx involves EFW of both twins, presentation of twin B, external version, breech extraction if version is not possible, possible c/s for twin B etc. Once the plan is in place, the CNMs manage the labors, and do the majority of the births with the OB present. We certainly do all of the vtx/vtx twins, with the OB present. If A is vtx and B is something else, the OB is gowned and gloved, and will be in charge of twin B. The last set of twins we had, I was in charge of teaching the resident.
-- Betsy Hyde CNM Branford, CT
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