Dr. Ribot -
VBAC is alive and well at Grady Memorial Hospital in
Atlanta - your patient's daughter could receive care with
the (resident) physicians or with the nurse-midwifery
service, either at the main Grady campus or at the
community clinic nearest her home, as many of the
nurse-midwives are in the satellite clinics.
There are other hospitals in the metro Atlanta area
that allow vbacs ... your patient's daughter can also
search the ican-online.org database for this information.
--
Anne Schnedl, CNM
Emory University Nurse-Midwifery Service
Atlanta, GA
Date: Mon, 30 Mar 2009 21:52:12 -0500 (CDT)
From: hribot@mindspring.com (Hugo D Ribot Jr)
To: OB-GYN-L@OBGYN.net
Subject: Re: VBAC dying art>
Message-ID: <200903310252.n2V2qD406494@mail.obgyn.net>
This just came up in a conversation with a long time patient I saw
today. Her daughter is also a former patient who lives 30 minutes away
in the metro Atlanta area.
The daughter had her first baby by C/S elsewhere due to (predictably
enough) a failed induction due to non-reassuring tracing starting with a
green cervix.
The reason for induction was "low fluid". She stated there was nuchal
and other cord entanglement at delivery.
She feels strongly about attempting a VBAC with her next pregnancy.
Trouble is, both mother and daughter have apparently researched this and
they told me that only one doc in Atlanta other than me is doing VBACs.
Actually stated that many hospitals (and OBs) they contacted flat out
told them they will not do trials of labor, no matter if the patient is
a great VBAC candidate with a non-recurring indication for the original
C/S.
I feel that as long as several guidelines are adhered to:
- avoid induction of labor (other than AROM in someone with a huge
Bishop score already contracting)
- avoid usage of prostaglandin agents
- limit use (and dosage) of oxytocin for augmentation to patients
already in true labor with a soft, nearly fully effaced cervix at least
3-4 cms
- avoid trial of labor with any prior vertical uterine incisions
then VBACs are extremely safe and have a 80+% success rate. At least in
my 19 year experience.
--
Hugo D. Ribot Jr., M.D., FACOG
Cartersville, Georgia
Private practice since 1990
2 MDs/3 CNMs/1 NP
------------------------------
Lux venit
------------------------------
------------------------------
--001636163c5f4cc93604666804b7
Content-Type: text/html; charset=ISO-8859-1
Content-Transfer-Encoding: quoted-printable
Dr. Ribot - <br><br>VBAC is alive and well at Grady Memorial Hospital in <br>Atlanta - your patient's daughter could receive care with<br>the (resident) physicians or with the nurse-midwifery<br>service, either at the main Grady campus or at the<br>
community clinic nearest her home, as many of the<br>nurse-midwives are in the satellite clinics.<br><br>There are other hospitals in the metro Atlanta area<br>that allow vbacs ... your patient's daughter can also<br>
search the <a href="http://ican-online.org">ican-online.org</a> database for this information.<br><br>Anne Schnedl, CNM<br>Emory University Nurse-Midwifery Service<br>Atlanta, GA <br><br><br>Date: Mon, 30 Mar 2009 21:52:12 -0500 (CDT)<br>
From: <a href="mailto:hribot@mindspring.com">hribot@mindspring.com</a> (Hugo D Ribot Jr)<br>
To: OB-GYN-L@OBGYN.net<br>
Subject: Re: VBAC dying art><br>
Message-ID: <<a href="mailto:200903310252.n2V2qD406494@mail.obgyn.net">200903310252.n2V2qD406494@mail.obgyn.net</a>><br>
<br>
This just came up in a conversation with a long time patient I saw<br>
today. Her daughter is also a former patient who lives 30 minutes away<br>
in the metro Atlanta area.<br>
<br>
The daughter had her first baby by C/S elsewhere due to (predictably<br>
enough) a failed induction due to non-reassuring tracing starting with a<br>
green cervix.<br>
<br>
The reason for induction was "low fluid". She stated there was nuchal<br>
and other cord entanglement at delivery.<br>
<br>
She feels strongly about attempting a VBAC with her next pregnancy.<br>
Trouble is, both mother and daughter have apparently researched this and<br>
they told me that only one doc in Atlanta other than me is doing VBACs.<br>
Actually stated that many hospitals (and OBs) they contacted flat out<br>
told them they will not do trials of labor, no matter if the patient is<br>
a great VBAC candidate with a non-recurring indication for the original<br>
C/S.<br>
<br>
I feel that as long as several guidelines are adhered to:<br>
<br>
- avoid induction of labor (other than AROM in someone with a huge<br>
Bishop score already contracting)<br>
- avoid usage of prostaglandin agents<br>
- limit use (and dosage) of oxytocin for augmentation to patients<br>
already in true labor with a soft, nearly fully effaced cervix at least<br>
3-4 cms<br>
- avoid trial of labor with any prior vertical uterine incisions<br>
<br>
then VBACs are extremely safe and have a 80+% success rate. At least in<br>
my 19 year experience.<br>
<br>
--<br>
Hugo D. Ribot Jr., M.D., FACOG<br>
Cartersville, Georgia<br>
Private practice since 1990<br>
2 MDs/3 CNMs/1 NP<br>
<br>
------------------------------<br clear="all">Lux venit<br>
--001636163c5f4cc93604666804b7--
------------------------------<br clear="all">Lux venit<br>
