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Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
Sent: Wednesday, April 13, 2005 11:54 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
Are you not doing them because the facility does not meet the ACOG criteria - 24/7 in-house anesthesia and ob?
Ronald E. Ainsworth
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD
Sent: Wednesday, April 13, 2005 9:49 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
I don't know, since I just joined the group two weeks ago. However, I have made it known that I don't do them (neither does the senior partner) and I guess if I cannot convince them to have a repeat c-section I will labor them under protest. Documenting into the chart my disagreement with the course of management, and how legally to force the surgery will be assault and battery
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
Sent: Wednesday, April 13, 2005 11:38 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
So what happens to them when you are on call and they refuse a RCS?
Ronald E. Ainsworth
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD
Sent: Wednesday, April 13, 2005 7:11 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
What if you are covering your group and you are the only one of 5 who does not do VBACs? I'm considering buying a video camera for those patients so that when I say I do not do them, and highly suggest a repeat c-section but if you refuse the c-section you understand that legally I cannot operate without your permission.
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez
Sent: Monday, April 11, 2005 6:46 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: VBAC
It is soooooo simple not to offer VBAC...!!! How many patients would
walk away -??? very few - and I would be glad if they do!!
>At Mon, 11 Apr 2005, RModugno@aol.com wrote:
>
>This guest editorial from OB/GYN News says it all.
>
>Robert Modugno MD MBA FACOG
>
>Guest Editorial
>Informed Consent for Attempted VBAC
>
>Dennis J. Sinclitico, J.D.
>
>MR. SINCLITICO is an attorney specializing in medical malpractice law in
>Long Beach, Calif.
>There are certain topics that we just can't discuss enough, and attempted
>vaginal birth after a previous cesarean section is one of those. VBAC and
>informed consent for VBAC seem to be the topics du jour in every obstetrics
>program.
>The number of VBACs seems to have declined following concerns about the ris
>for uterine rupture. Some physicians prefer elective C-sections to VBAC
>because of large monetary awards in medical malpractice lawsuits dealing w th
>VBAC, such as a $30 million judgment in Philadelphia.
>Is there life after this death for VBAC? As your friendly defense lawyer, I
>can tell you those are hard cases to defend.
>A recent prospective, multicenter study that provides the first solid data n
> the risks of VBAC showed that only (0.7%) of 17,898 women who attempted VB C
>for a term singleton developed uterine rupture. Only 12 term infants in th
>VBAC group developed hypoxic-ischemic encephalopathy, 7 of them in the
>uterine-rupture subgroup. The absolute risk for hypoxic ischemic encephalop thy
>was approximately 1 case per 2,000 women attempting VBAC at term (N. Engl. .
>Med. 2004;351:2647-9).
>Even though the risks of a bad outcome are small—and ongoing statis ics
>support that—those statistics take flight when you're in the witnes chair and a
>catastrophically affected infant is with a parent in another witness chair.
>You'll notice that when speakers at meetings present statistics about the
>risks or benefits of VBAC, there are no photographs of a catastrophically
>affected infant. But the jurors will see that. When a case goes to trial, t e
>focus is on the care and treatment provided by a specific physician for a
>specific patient with a specific kind of outcome. In that setting, the risk seem
>much different than they do in studies.
>That's why most obstetricians are voting to do cesarean section instead of
>VBAC. They've seen the results in accounts from their peers, in discussions in
>the literature, and in the media.
>While there were only 12 cases of hypoxic ischemic encephalopathy in the
>recent multicenter study, if we assume that each of those cases went to tri l
>and the plaintiffs won only 10% of the large award in the Philadelphia case
>that totals $36 million, plus untold millions of dollars spent defending th se
>cases.
>If you choose to provide VBAC, I suggest getting informed consent in the
>patient's handwriting. Most informed-consent documents are forms, and that' a
>problem. They're not individualized to any degree and to any specificity. E en
>though your consent process might be substantial, the extent to which you a d
> your staff provided informed consent is poorly documented in a form.
>Absent an individualized, specified consent document, what happens is that
>the mother says in court, “I don't know. …He shoved it in f ont of me and I
>just signed.†That's what the plaintiff will say in almost every s tuation.
>Having the mother write out her informed consent is a lot better for your
>defense. Better yet—pull out the video camera and document the cons nt process.
>Simply having a form with a signature acknowledging that the consent proces
>has taken place is a prescription for disaster. That won't fly in court.
--
I think I will do nothing for a long time but listen,
And accrue what I hear into myself...and let sounds
contribute toward me.
~walt whitman~
