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Re: BreechFrom: Len2976@aol.comWed Dec 15 02:55:10 2004
Glen-- I have found that after 15 years of nurse-midwifery practice in the USAF and 13 years in civilian private practice, there are significant differences in the way you must practice in these settings. When I was in the Air Force I worked with obstetricians who were very skilled at both forceps (even mid) and vaginal breech deliveries in selected (counseled) patients. My own daughter was a mid forceps birth at Wilford Hall Medical Center in San Antonio, Texas. Several of these obstetricians received their training in these skills courtesy of the OB Residency Program at Wilford Hall. In the late 1980's, I had the pleasure of working with one W.H.M.C. alumni who brought the C/S rate at Andrews down to 11% from the 22% it was when he arrived. Besides a nearly 100% "trial labor" policy for patients with prior C/Ss, a critical daily grand rounds session had all the other obstetricians re-evaluate their rationale for doing C/Ss for FTP and fetal distress. Unfortunately the reality of private practice changes things and this same physician does not do vaginal breech deliveries today. I would not be surprised to hear that the C/S rate in his private practice equates with the average in other practices. Lenora McCall, CNM USAF (ret) LtCol
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