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Re: OB: Planned Home Birth After Previous CesareanFrom: Glen Elrod (dr99645@yahoo.com)Fri May 2 15:01:42 2008
Fran, I appreciate that you call ahead to the hospital. But, why is it a courtesy and not a requirement? I can't figure why transferring a patient from one hospital to another without an accepting physician is considered dumping, but transferring a patient from a free standing birth center to the hospital by telling the husband to drive them is not. We have a very large certified direct entry midwifery population where I practice and only 4 board certified OB/Gyn physicians. Unfortunately, everything he said in the article is how we all feel, that we are being dumped on without any recourse, nearly always with patients that are told half truths or lies about what we do at the hospital. How best would you fix or deal with this issue? Glen
>----- Original Message ---- Whether or not you consider the choice of home birth or home VBAC valid, the options available to mothers in hospitals are shrinking. More women are being told that they cannot attempt a VBAC, even when all circumstances are optimal (previous vaginal birth, average size baby, adequately progressing labor). Women will not accept this. Midwives are becoming increasingly restricted in the local hospitals and we now only have one full time and one part time midwife with hospital privileges. At one time the number was NINE. Many women have previous experience with midwifery care, and will not accept what they see as depersonalized care from a physician who may or may not attend their births. Most of the time, they are left at the mercy of the nursing staff (some better than others obviously). When I stopped doing hospital births (my sponsoring physician decided not to sponsor my privileges any longer), many of my clients who had planned hospital births switched to home births. When I do have to transport a patient, I call ahead with "report," accompany the patient to the hospital, and bring a good prenatal record, but without an arrangement with the hospital and/or obstetrician, this is a courtesy rather than a requirement. If you look back to the 1970's when the rule was 'once a section, always a section,' home birth midwives accepted well screened clients who requested a VBAC. Their statistics were excellent, partly because they did not use epidural's nor induction/augmentation (including herbal, castor oil, or other 'natural' stimulants). They were so good, in fact, that physicians and hospitals started allowing, even encouraging, VBAC's for their clients. The more liberal practices in hospitals decreased the number of home births since the hospital option had become more attractive. It was not until inductions (specifically cytotec) became common practices in women attempting VBAC that we started to see elevated risk. Now, the C-section rate is around 30% in this area. Many women are not comfortable with this, especially when they hear that VBAC's are no longer allowed. Even on this list, people frequently cite even higher percentages of operative delivery as probable or even desirable. The only way to reverse this increasing interest in home birth (and home VBAC) is to reverse some of the trends occurring in the hospitals. Running the hospital midwives out of town by threatening their autonomy has left less qualified midwives in their place. Many local communities have neither hospital nor out of hospital VBAC or midwifery options, leaving more and more women to attempt unassisted home birth (google that!). Due to EMTALA laws, the OB on call will be required to manage the care for women who transport from home births. Having an agreement with local midwives allows the obstetrician to have input into their practices. I you don't choose to enter into such an agreement, don't be surprised at what walks in the door. PEACE, Fran Wilson, CNM Wild Rose Women's Clinic http://www.wildrosemidwife.com
> Date: Fri, 2 May 2008 12:24:06 -0500
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