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Re: Today was a GOOD dayFrom: Betsy Hyde (elishyde@att.net)Sun Mar 2 14:56:43 2008
> >> It was a good day until I decided to tell my friends at OB-Gyn.net >> about it. I'll keep my good days to myself in the future. >> >> Anna Meenan, MD, FAAFP I've been following these posts with some amusement, since it's usually the midwives who get skewered here. I've read and re-read the original post each time it is quoted, and really do not understand why the outrage. Where was the breach in standard of care? Woman is scheduled for a c/s because she is transverse lie. Reasonable plan. Due to unit acuity, she is sent home and asked to reschedule. Also a reasonable plan. What else should be done? Bump someone who is having decels so that a non-emergent case can go first? That doesn't happen at the tertiary care center where I work. This is a basic triage issue. The woman comes back, vertex? So....it doesn't seem that there is any indication to section her at this point, or am I missing something? She's 41 weeks, unstable lie....seems like a reasonable plan to induce her when she is vertex. There are those who induce for far lesser indications. She gets induced with cervidil, hyperstims, has some decels and the cervidil is pulled. And the problem with this management is......? In the real world you watch and wait and see what happens....not rush to the OR as a first response. This is a primip who had a very rapid labor, no signs of labor dystocia, brief period of varible decels, pushed the fetus out in a short period of time before any intervention could occur. And the problem with this management is.......? And standard of care was breached where? I do understand the "running scared" mentality, because I work in an environment with plenty of that. That's why the c/s rate is what it is. I think what some list members are forgetting is that cesarean sections can *also* have significant problems. We recently had a woman with a placenta percreta. I think that abnormal placentation is going to be an increasing problem as our c/s rate increases. Hopefully we have not all abandoned clinical judgment while racing to the OR. Isn't that the art of what we do? Anna, you can share your good days with me anytime!
-- Betsy Hyde CNM Branford, CT
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