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Re: Breech birth conferenceFrom: Henry Gregor (henrygregor@yahoo.com)Fri Feb 18 13:16:14 2005
Some years ago, Obstetrical Gynecologic Survey did a review of studies of breech vaginal delivery...great demonstraton of the reasonableness of vag delivery in properly selected cases, absent concerns for our crazy US tort system. However, discounting that, I remember being impressed by the editor's commentary (Older Dr. Novak) that "...bottom line there is a ..." irreuducilbe minimum fetal injury rate of (I believe he noted five) percent. Went on to say he wouldn't care to have any of his grandchildren subjected to that intrapartum risk. Now, tradeoff of fetal versus maternal risk...certainly a patient autonomy decision right worthy of respect. I did play racquetball regularly then with a fellow who was president of his state's plaintiff''s attorneys association. One of his colleagues reminded me of the vageries of informed patient consent and autonomous decision making, and of the frequency with which perceptions of "informed" consent and "autonomous" decision processes morphed into less than satisfactory "informed consent" / "understanding of risk" issues. Cheerfully pointed out that is why the two of them lived in bigger houses than I, and always would, lol. Of three thousand deliveries, I've done some breech vaginal deliveries, rotations, and forceps...most of which I would not do today. I respect the reticence of any OB who chooses not to go that route, and endorse the comment of yesterday that - sorry - this is the system the American consumer has to contend with, and - I paraphrase only roughly I think - it is what they get unless we all, as consumers, demand and effect change. I don't think that's going to happen easily. Just this afternoon, radio news covered - of all the complex sides of the ongoing debate of the proposal to limit Class Action Suits - a rather sophomoric, whiny voice tape of some congresswoman or senator bemoaning the "gift" to criminally negligent big business, at the expense of aggrieved and mistreated consumers...I mean really, what of the criminally negligent fleecing of the represented plainfiffs who get pennies to the multi dollars of the crimianally usurious plaintiff attorneys?... what of the actual sick asbestos victims who will die before the system - bogged down with class actions suits filled with currently well individuals suing via class action on the basis of potential future risk of injury - get to clear their cases?....just extending the discussion with some moronic hyperbole appropriate to the Congresswoman or Senator being quoted...didn't catch a name. (BTW, another example of the superficial level of journalism that abounds.) Bottom line, tough to be critical of any practitioner attempting to cover the overhead and remain actively engaged in the profession who chooses to be prudent. As for a 27 or 30 percent CS rate...and the point is? I don't accept there is a right rate we clearly know. It's all relative risk benefit, and in a land where the lifetime complexities and risks post bariatric surgery are not raising roadblocks to elective bariatric surgrery, I don't feel compelled to carry the water for that concern. (Should it become an issue in a followup msg, my rate is around twenty percent, with fluctuations, though I cannot give an overall career figure.) Hank Andrew Folley <agfolley@hotmail.com> wrote: The C-Section rate in the US is approaching 30%. I believe 2003 CDC studies show 27%. We are on the verge of offering women elctive primary C-sections. Many of us particularly those over age 45 are still skilled in the art of Obstetrics. I suspect Garry that you did not graduate from a program in the past 15 years?? The trend seems to be away from skilled deliveries. Would you not agree? Andrew Meet the all-new My Yahoo! – Try it today!
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