OB-GYN-L Messages for December, 2004: Re: Obstetric Services

Re: Obstetric Services

From: Anna Meenan, MD

annam@uic.edu

Sat Dec 18 12:52:37 2004

-- Anna Meenan, MD

At Sat, 18 Dec 2004, Charlie Chambers wrote: > >--Apple-Mail-1-527681942 >Content-Transfer-Encoding: 7bit >Content-Type: text/plain; > charset=US-ASCII; > delsp=yes; > format=flowed > >I've always wished that we could get everyone collectively together, >and first, decide how much are we going to spend this year on >healthcare for everyone? Now that we've got that decided, what do you >want to pay for with that money? You want to have free vaccinations for >everyone? Okay, but we can't afford to give new livers to ex alcoholics >and drug abusers. > >************************************************************************ >**** >

>-- >************************************************************************ >Charlie Chambers >Hood River, OR

>cchamber@alumni.rice.edu > >"Almost anything you do will seem insignificant but it is very important >that you do it....You must be the change you wish to see in the world" > -- Mahatma Ghandi. >************************************************************************ >******* >************************************************************************

> >On Dec 18, 2004, at 5:42 AM, Joanne Bulley, MD wrote: > >> This comes from the various dicsussions around VBAC and Breech that >> have >> been going on ... >> >> Now, as one who stopped Ob Sept 1998 ... maybe I shouldn't comment ... >> butwho knows -- I could end up moving and joining a group that wants OB >> .. >> >> All the small hopsitals have a major quandry ... no in-house OR team >> and Anesthesia. Heck, there are hospitals in NH that I know of where >> the OB patients are instructed to call a certain number BEFORE (or AS) >> they are coming in to L&D because the staff then are called to come >> in!!! So there are not even Ob nurses in the hospitals at all times. >> It >> $costs$ less to pay the staff to be on call than always in house. >> >> So ... (as was alluded to in an earlier post) ... if the *best* thing >> for Mom / Baby is to ALWAYS have "decision to incision" of 15 minutes >> (after all any uterus can rupture, any cord could be a vasa previa) ... >> WHO WILL PAY ... in the US for sure - but other places as well? >> >> Should there be a nationally funded account that pays to always have a >> surgical RN, Scrub tech and Anesthesia NP or MD in house? And another >> team that is "on call" for the emergency appys etc? Does this "team" >> come in when there is a laboring patient or be there 24/7/365? >> >> If the "safest" thing for Mom & Babe is the 15 minute stat C/S >> capability ... then it will need to be funded by something other than >> re-imbursements for actual deliveries ... >> >> As the smaller hospitals keep halting OB services ... and after that >> first baby (avg labor 18 hours), subsequent births have avg labors of 6 >> hours -- with many being 2 hours or less. They can't go to the nearest >> big unit - which may be 3 or more hours away. Even here in Keene, NH >> (maybe the 4th largest city in NH) it is 75 minutes to the nearest >> tertiary center (Dartmouth-Hitchcock in Lebanon). >> >> Comments? >> >> Joanne >> >> -- >> Joanne Bulley, MD >> Keene, NH, USA >> >> "Every gun that is made, every warship launched, every rocket fired, >> signifies in the final sense a theft from those who hunger and are not >> fed, >> those who are cold and are not clothed." >> >> President Dwight D. Eisenhower >> April 16, 1953 >> >--Apple-Mail-1-527681942 >Content-Transfer-Encoding: 7bit >Content-Type: text/enriched; > charset=US-ASCII > ><fontfamily><param>Lucida Grande</param>Joanne > >I think that's a great idea to somehow fund having a crew and MD >available in the hospital paid out of some sort of general fund. Of >course, the big question is where to derive the money. > >In my opinion, part of the problem with U.S. healthcare is the desire >to have perfect cutting edge healthcare for Wal Mart prices. As long >as we are paying dollars for high price meds, 24 week neonatal >rescucitations, transplants in questionable candidates, etc; we can't >pay for basic quality healthcare like contraception, 24 hour in house >OB coverage in rural hospitals. > >I've always wished that we could get everyone collectively together, >and first, decide how much are we going to spend this year on >healthcare for everyone? Now that we've got that decided, what do you >want to pay for with that money? You want to have free vaccinations >for everyone? Okay, but we can't afford to give new livers to ex >alcoholics and drug abusers. > ></fontfamily> > ><fontfamily><param>Helvetica</param>**************************************************************************** > ><fontfamily><param>Helvetica</param>****************************************************************************

>Charlie Chambers > >Hood River, OR > >cchamber@alumni.rice.edu > >"Almost anything you do will seem insignificant but it is very >important > >that you do it....You must be the change you wish to see in the world" > > -- Mahatma Ghandi. > >******************************************************************************* > >*******************************************************************************

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