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Bearing the kimono - CD rateFrom: S Osterling M.D. (sdoesterling-obgyndotnet@yahoo.com)Sat Mar 4 08:50:43 2006
> I work with a group of 6 who do about 1000 deliveries a year. Our section rate for all comers is 19%. We are 20-25% of my hospital's volume, and if the hospital average is 30%, there are some folks out there that must be well above 30 to drag our numbers up. I'd love to say this was do to my effort, skill or what have you, but when I first joined the group in 2000, it was 14% (all the docs were "senior"). We have hired two more younger physicans, with 5 yrs post residency experience and all willing to do operative deliveries. With us young docs on board, the rate bumped to 19%. We are going to hire two new grads and I'm predicting a rate of 25%. We currently do VBACs, but it is a trial of labor for the doctor as well as the patient. My hospital requires the MD to be in house for a VBAC. Last call, I took over a lady with one prior section who ruptured her membranes 4 hours prior to my arrival. My partner had her teed up for a CD because of no labor. I examined her. She was high and the prior CD had pulled her cervix up anteriorly, but her pelvis was a nice bowl. I sat on her for 4 hours to see if labor would begin, then gave her pitocin up to ten. This got her in a pattern. Once her cervix got to 4 cm, I turned off the pitocin and she progressed by her self. At 4 am she got chorio. At 6 am she got complete and I delivered her vaginally at 6:50 am, ten minutes before going off shift. What is the better choice - the patient loved me for saving her the section, but her baby went to the ICN for the infection. And I had to be in house in a 4x8 foot call room for 24 hours. (That is my definition of solitary!). I also sit on the QA committee and its mantra is that a CD rate is not a measure of quality of obstetrics. I agree with this, but i think of it as a negative appy rate prior to the CT scan era. It does tell you something. S. Osterling M.D. California
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