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Re: Informed Refusal - VBAC From: ainsron (ainsron@sbcglobal.net) Wed Mar 15 15:31:11 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "OBG" Previous message: Efrain Ramirez: "Re: Informed Refusal - VBAC" In reply to: RModugno@aol.com: "Re: Informed Refusal - VBAC" Next in thread: Joe: "Re: Informed Refusal - VBAC" The hospital does have a policy against VBAC. I voted for the policy in committee. However, I still encounter patients who given all the information, refuse a scheduled cesarean section. If they indeed have the ethical right of informed refusal, how do we balance that right against the right of the physician and hospital to say we cannot safely provide for VBAC. They cannot go elsewhere because elsewhere does not exist. Some choose to deliver at home with a midwife - which I see as a far greater risk. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of RModugno@aol.com Sent: Wednesday, March 15, 2006 1:49 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Informed Refusal - VBAC In a message dated 3/15/2006 3:41:39 P.M. Eastern Standard Time, eramirezt@coqui.net writes: At Wed, 15 Mar 2006, Dr. Ainsworth wrote: >The above is from the recent ACOG Committee Opinion on Informed Refusal. >How does that relate to our discussion on the availability of VBAC in a >small hospital? If we tell the patient that we do not have the >recommended capability for immediate availability ... yada...yada, and >they signed an informed refusal for repeat cesarean section, how >effectively would that protect us from the lawyers in case of a bad >outcome? I know many of you would say, if the patient refuses a C/S, >discharge her from your practice and send her somewhere else. However, >in rural locales, there are no suitable alternatives and "St. Elsewhere" >is over an hour and a half away. I also don't think patient refusal of >recommended care is always a reason to discharge a patient. We >sometimes have to agree to disagree. Ron... I strongly believe that if you do not have the facilities to comply with the strict standards set by our College - you cannot offer VBAC - period - it does not matter if the next suitable alternative is across the street or in the moon - if there is a bad outcome everyone will get sued and most probably evryone will have to pay... You know what I would like to see? - a written opinion - from the College - addressing this specific issue - but I doubt very much it will.. Good luck.. Ef I think that the hospital should support the physician, and make it hospital policy - if one cannot maintain the standard outlined in the ACOG guideline.Some rural hospitals have done this. To paraphrase "George in the Bush" : The hospital's either with us or against us. We are having similar angst at present with videotaping of deliveries. BTW Ashley what was the decision taken by your hospital group on videotaping? Robert Modugno MD MBA FACOG Marietta, GA Next message: Richard Chudacoff, MD: "OBG" Previous message: Efrain Ramirez: "Re: Informed Refusal - VBAC" In reply to: RModugno@aol.com: "Re: Informed Refusal - VBAC" Next in thread: Joe: "Re: Informed Refusal - VBAC"

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