Re: EFM
From: Cesar Molina (cemolar777@gmail.com)
Mon Jul 9 12:19:42 2007
In your place. Can nurse call the phisician directly, without consult with
the phisycian in the beedroom???
2007/7/9, Barbara Nicol <blnicol@ix.netcom.com>:
>
> First, I'm gonna assume that this is a completely hypothetical case,
> because I know you wouldn't post this much identifying data on a public
> list.
>
> That said, I've encountered variations on this exact case over my career,
> and I've got a few comments to make:
>
> (1) with this kind of tracing, I have certainly seen cases of bad
> outcomes, but I've also seen great babies. This also goes with my
> understanding of the literature - you just don't know whether this baby is
> okay or not, but without decels, I don't believe that labor is injuring the
> baby further, if it is even injured at all. However, it always makes me
> worry about the baby's CNS when I don't see variability.
>
> (2) the baby could have mec aspiration regardless of the mode of delivery
> at this point, and even with excellent delivery gases. This also needs to
> be clear to everyone.
>
> (3) It's great that the RNs are speaking up. It's important to share
> their concerns with the patient.
>
> (4) In other words, this is exactly the moment to involve the patient in
> the decision, sharing with her the doubts and discussion of the team. Her
> personal perspective is extremely important in this decision! If she is
> someone who basically wanted a CS all along, and is only planning one or two
> births in her lifetime, her risk/benefit analysis might be quite different
> from someone who plans 10 births or who strongly values vaginal delivery in
> itself (for whom CS would therefore be much more morbid) and who therefore
> strongly values only doing CS for strict indications. You've got a
> situation where experienced and caring providers have a difference of
> opinion - she's got a right to know that!
>
> My point: It would be ethically wrong to "order a CS" in this situation
> unless the patient is informed of the differing opinions of the team. It's
> not so clearcut. Sure, I'm willing to "order a CS" in a case of cord
> prolapse, but in this situation, I believe that the correct thing to do is
> to ask the patient's physician or midwife to discuss the options, risks and
> benefits with the patient - maybe jointly with you - and have her make an
> informed choice. Be really honest about the limitations of FHR (the RNs
> also may not be aware of its limited predictive ability) and the risks of CS
> and see what her values and wishes are.
>
> and then hope for good luck!
>
> Barb Nicol, M.D., F.A.C.O.G.
>
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