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Re: OB: Home births**more info From: Garry E. Siegel, M.D. (garrys@mindspring.com) Wed Nov 23 19:05:11 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Raymond Stephen: "Re: PROM and cytotec" Previous message: Larry Glazerman: "Re: PROM and cytotec" In reply to: Garry E. Siegel, M.D.: "OB: Home births" Next in thread: fran wilson: "Re: OB: Home births**more info" Reply: fran wilson: "Re: OB: Home births**more info" Today, I spoke with an attorney/risk manager at our MedMal company, which is Georgia based and physician owned. His first suggestion essentially was the same as what we plan to do, i.e. A clear contract--short and sweet--of the expectations we have for all patients, i.e. regular visits, GBS test, monitoring in labor guidelines, etc. Included in this would be a statement that our practice does not participate in home births. With respect to whether to dismiss the home birthers who had not informed us beforehand, his perspective was interesting. My plan (see posts) was to dismiss all of them outright, mainly to send a message to the grapevine/network of home birthers so that they get a clear signal from our practice that we are not interested in patients planning home births. His point was that dismissing patients, in general, is harmful for "business" (agreed) and generally sends a bad signal (agreed). Furthermore, dismissing these patients would not protect us at all from a liability viewpoint (agreed). He felt that the "new OB contract as above" would send the signal I desire. I disagree, and think we need to send the signal now--loud and clear--as well as in the future, i.e. as any new patients come into the practice, they get the contract. However, I think that sending a letter to the home birthers now, simply stating the facts and clearly stating our position without dismissing them would serve us well. In that regards, I would say: 1. By intention or default, you were dishonest with us, which clearly compromises the relationship. 2. We will continue to care for you if you wish, but we do not sanction home birth in the past or future. What do y'all think? Garry At Mon, 14 Nov 2005, Garry E. Siegel, M.D. wrote: > >I post this with trepidation. > >I do not wish to discuss the merits of home birth. > >This is a question for Obstetricians and CNMs who practice in the US and >are not involved in any facet of home birth by choice. > >Our busy, 2 CNM practice has had a "run" of home births, i.e. the >patients called AFTER they delivered at home as a FYI type call. Our >CNMs in no way engender or encourage home birth, and there is nothing in >our practice that would ever give any hint or idea that we wish to >participate. We think that these patients well know that we're not >going to participate, and they simply come here for antenatal care and >play along/don't mention their ulimate plan to anyone. However, the >word of mouth grapevine may be working here, meaning successful >patients/home attendants may say things like "so and so had antenatal >care here and no one admonished her" or who knows what. BTW, there has >been no such trend with our MD patients. > >My partners and I are grappling with how to clearly tell all patients >(really, the CNM ones) that, in no uncertainly terms, we do not >participate in any care associated with a planned home birth. However, >we don't want to upset or offend other patients. > >We are contemplating a "greeting" type letter to all new CNM Ob patients >that is short and sweet and outlines a few minimum standards of the >practice (i.e. minimum testing and monitoring standards in line with >ACOG, etc.) and has one line--"This practice does not participate in >planned home births" or something like that. > >Thougths? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Raymond Stephen: "Re: PROM and cytotec" Previous message: Larry Glazerman: "Re: PROM and cytotec" In reply to: Garry E. Siegel, M.D.: "OB: Home births" Next in thread: fran wilson: "Re: OB: Home births**more info" Reply: fran wilson: "Re: OB: Home births**more info"

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