Re: Bearing the kimono - CD rate
From: Jamie (ajfields@pine-net.com)
Sat Mar 4 16:18:12 2006
You must mean no one with power. Because there are plenty of women who
do give a rat's ass. Unfortunately, they don't get to call the shots.
At Sat, 4 Mar 2006, RModugno@aol.com wrote:
>
>In a message dated 3/4/2006 10:52:01 A.M. Eastern Standard Time,
>sdoesterling-obgyndotnet@yahoo.com writes:
>
>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
>
>And so where is your gold medal? Oh, they didn't give you one!
>
>Plaintiff's attorney; (after patient has sued you for not doing a timely
>c.section which would have prevented the chorio, which would have prevented the
>cerebral leukomalacia, which "caused the cerebral palsy") Dr Osterling, why
>did you not do a repeat cesarean? ( Said in jest, but it could happen!)
>
>Our Cesarean "Task force" at the hospital disbanded after it was determined
>that no one gave a rat's ass.
--
JFields, RN, BSN
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