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Re: Lay Midwife Failed Home Birth VBAC after 3 previous C/S resulting in stiFrom: ainsron (ainsron@sbcglobal.net)Tue Apr 25 08:58:40 2006
My understanding of the Sentinel Event process and root cause analysis is that it is looking at hospital procedures, staffing issues, equipment issues, etc. that may have contributed to the adverse outcome. This case falls out of that arena. A more appropriate venue would be to turn it over to the DA's office for investigation of the individuals involved, so they can consider criminal prosecution. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lyndon Taylor Sent: Saturday, April 22, 2006 2:02 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Lay Midwife Failed Home Birth VBAC after 3 previous C/S resulting in sti No uterine rupture or placental abruption, presumed cord compression causing hypoxia, meconium then fetal asphyxia. The midwife stated that the FHT's became low in the 90's and where faint. On transport, she bypassed the closest hospital. Upon arrival at the hospital the maternal heart rate was 150. The external fetal monitor picked up the maternal pulse at 150. The midwife accompanied the patient. She tried to put on a glove to examen the patient in the hospital. The RN wouldn't allow it. I was called and did a stat bedside ultrasound which verified IUFD with no FHT's. While I was doing the ultrasound and was attempting to inform the family of the IUFD (in spite of the external monitor tracing the maternal heart at 150) the lay midwife said "look there, aren't thoses fetal breathing movements". This exacerbated the bedside confusion of the patient and husband. At that point I had to ask the midwife to leave the room. The midwife and family objected and security had to be called. The C/S (hysterotomy) was done for maternal reasons. Now the hospital wants to call this a sentinel event and wants me to participate in a root cause analysis. I need help. JACHO's site tells you when and why to do it but not how. I still don't think this should be classified as a sentinel event. Lyndon Taylor OB/GYN Oak Park, Illinois
>----- Original Message ----- From: igold@cox.net To: Multiple <mailto:ob-gyn-l@dns.obgyn.net> recipients of list OB-GYN-L Sent: Saturday, April 22, 2006 3:08 PM Subject: Re: Lay Midwife Failed Home Birth VBAC after 3 previous C/S resulting in sti
-- What was the cause of the IUFD? Does anyone know? Was there a uterine rupture? Ingrid Gold, CNM > > From: RModugno@aol.com > Date: 2006/04/22 Sat AM 07:38:10 EDT > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > Subject: Re: Lay Midwife Failed Home Birth VBAC after 3 previous C/S resulting in stil... > > on 4/22/06 6:55 AM Lyndon Taylor said the following: > > The midwife is not on staff at the hospital but the patients family > > practice doctor is. He is known for doing home deliverys but he denies > > any involvement in the patients prenatal care, or any connection to the > > midwife. > > When I was in practice in Chicago, our Ob group was back up for a family > practice group that did home deliveries. In fact the senior FP was head of the > American College of Home Births or whatever. We saw our fair share of > disasters. One case that really sticks in my mind was a patient of ours who left our > practice to have a home birth. She returned to us for the delivery of her term > IUFD. Not saying that it couldn't have happened with us, but....... > > Robert Modugno MD MBA FACOG > Marietta, GA >
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