Re: induction of breech at term
From: R. Daniel Braun (rd.braun@gmail.com)
Wed May 20 14:48:19 2009
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The only "Simply Awful" breech that I had in my 40+ yrs of delivering babies
was a patient who presented with the buttocks visible on the
perineum(Rumping??) after a 4 hour labor. Everything went fine until the
head got hung up. Apgar 1-3-9
Dan
On Wed, May 20, 2009 at 1:46 PM, Richard Chudacoff <
rchudacoff@mylinuxisp.com> wrote:
> If a patient presents breech in labor and she progresses rapidly and
> successfully, deliver her breech. However, condoning breech inductions is
> like condoning VBAC inductions; it may work, but more likely you will get
> sued without a sufficient defense for any little complication
>
> Richard Chudacoff, MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Charlie
> Chambers
> Sent: Wednesday, May 20, 2009 7:42 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: induction of breech at term
>
> Perhaps I wasn't clear. We are working on a protocol to address
> vaginal breech deliveries. We have had much debate whether to mandate
> whether medically indicated inductions would be allowed in this
> protocol. I wanted to get the group's input with this issue. I
> understand that some of you believe that doing vaginal breech
> deliveries are currently a "crapshoot" medicolegally. Let's just
> assume that tenet. However, I've had a very long look at the data and
> current national guidelines which do not view this as absolutely
> foolhardy. I also understand that lawyers will find any opportunity to
> exploit the system but that applies to entire field of obstetrics as
> well. I plan to go forward doing whatever I believe is the best
> medical care guided by evidence and not be wholly led by attorneys or
> by fear. Realizing that when the opportunity arises any of us by
> circumstance could be forced out of our chosen profession by the legal
> profession.
>
> So, going back to my original question, those of you that still
> perform vaginal breech deliveries, what are your opinions about
> allowing medically indicated inductions?
>
> Thanks.
> **************************************************************************
> Charlie Chambers
> Hood River, OR USA
> cchamber@alumni. rice. edu
>
> "I'm a goin fishin.
> Yeah, I'm goin fishin
> And my baby's goin fishin too!"
> Taj Mahal
>
> ************************************************************************
>
> On May 20, 2009, at 6:35 AM, Richard Chudacoff, MD wrote:
>
> > That is different than have an induction protocol for breech
> > deliveries
> >
> > Richard Chudacoff, MD, FACOG
> > Las Vegas International Center for Advanced Gynecologic Care
> > (Specializing in Minimally and Non-Invasive Surgery)
> >
> > -----Original Message-----
> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> > Charlie
> > Chambers
> > Sent: Wednesday, May 20, 2009 5:56 AM
> > To: Multiple recipients of list OB-GYN-L
> > Subject: Re: induction of breech at term
> >
> > Thanks everyone for your input. The hospital is approaching this issue
> > from the ACOG guideline which states that patients should have a
> > version or offer for cesarean section. However, it is reasonable to
> > offer a trial of labor under the guidance of "hospital specific
> > protocol". The hospital is driving the desire to have such a protocol.
> > I'm trying to guide the committee into coming up with a sound
> > document. In addition, a consent is being generated which is pretty
> > intimidating. I find this approach no different than some of the
> > consents for VBAC that I've seen passed around. I do believe the net
> > effect will be to convince all patients to have a cesarean section.
> >
> **************************************************************************
> > Charlie Chambers
> > Hood River, OR USA
> > cchamber@alumni. rice. edu
> >
> > "I'm a goin fishin.
> > Yeah, I'm goin fishin
> > And my baby's goin fishin too!"
> > Taj Mahal
> >
> > ************************************************************************
> >
> > On May 19, 2009, at 2:20 PM, Richard Chudacoff wrote:
> >
> >> Charlie
> >>
> >> It seems like nobody on this list wants to give you any support for
> >> your
> >> breech protocol. On the other hand, as good friends, we are telling
> >> you
> >> that you probably should not support a breech protocol. Personally
> >> I think
> >> just supporting a protocol such as this jeopardizes your medical
> >> career. So
> >> you may want to think this thing over. As Art says, just my opinion;
> >> it
> >> could be wrong
> >>
> >> Richard Chudacoff, MD, FACOG
> >>
> >> -----Original Message-----
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
> >> fougner, md
> >> Sent: Tuesday, May 19, 2009 1:59 PM
> >> To: Multiple recipients of list OB-GYN-L
> >> Subject: Re: induction of breech at term
> >>
> >> Whoever writes such a protocol may find himself in an institution.
> >>
> >> Just my opinion. I could be wrong.
> >>
> >> Art
> >>
> >> At Tue, 19 May 2009, Charlie Chambers wrote:
> >>>
> >> . I've
> >>> looked over a number of other institutions who have protocols as
> >>> well.
> >>>
> >
> ***************************************************************************
> >> *
> >>
> >> --
> >> art fougner, md
> >> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
> >>
> >
>
--
R. Daniel Braun, MD FACOG(L) ABMP CMTh
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
--
R. Daniel Braun
“Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
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The only "Simply Awful" breech that I had in my 40+ yrs of delivering babies was a patient who presented with the buttocks visible on the perineum(Rumping??) after a 4 hour labor. Everything went fine until the head got hung up. Apgar 1-3-9<br>
<br>Dan<br><br><div class="gmail_quote">On Wed, May 20, 2009 at 1:46 PM, Richard Chudacoff <span dir="ltr"><<a href="mailto:rchudacoff@mylinuxisp.com">rchudacoff@mylinuxisp.com</a>></span> wrote:<br><blockquote class="gmail_quote" style="border-left: 1px solid rgb(204, 204, 204); margin: 0pt 0pt 0pt 0.8ex; padding-left: 1ex;">
If a patient presents breech in labor and she progresses rapidly and<br>
successfully, deliver her breech. However, condoning breech inductions is<br>
like condoning VBAC inductions; it may work, but more likely you will get<br>
sued without a sufficient defense for any little complication<br>
<div class="im"><br>
Richard Chudacoff, MD, FACOG<br>
<br>
-----Original Message-----<br>
</div><div class="im">From: <a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a> [mailto:<a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a>] On Behalf Of Charlie<br>
Chambers<br>
</div><div class="im">Sent: Wednesday, May 20, 2009 7:42 AM<br>
To: Multiple recipients of list OB-GYN-L<br>
Subject: Re: induction of breech at term<br>
<br>
</div><div><div></div><div class="h5">Perhaps I wasn't clear. We are working on a protocol to address<br>
vaginal breech deliveries. We have had much debate whether to mandate<br>
whether medically indicated inductions would be allowed in this<br>
protocol. I wanted to get the group's input with this issue. I<br>
understand that some of you believe that doing vaginal breech<br>
deliveries are currently a "crapshoot" medicolegally. Let's just<br>
assume that tenet. However, I've had a very long look at the data and<br>
current national guidelines which do not view this as absolutely<br>
foolhardy. I also understand that lawyers will find any opportunity to<br>
exploit the system but that applies to entire field of obstetrics as<br>
well. I plan to go forward doing whatever I believe is the best<br>
medical care guided by evidence and not be wholly led by attorneys or<br>
by fear. Realizing that when the opportunity arises any of us by<br>
circumstance could be forced out of our chosen profession by the legal<br>
profession.<br>
<br>
So, going back to my original question, those of you that still<br>
perform vaginal breech deliveries, what are your opinions about<br>
allowing medically indicated inductions?<br>
<br>
Thanks.<br>
**************************************************************************<br>
</div></div><div class=3D"im">Charlie Chambers<br>
Hood River, OR USA<br>
cchamber@alumni. rice. edu<br>
<br>
"I'm a goin fishin.<br>
Yeah, I'm goin fishin<br>
And my baby's goin fishin too!"<br>
Taj Mahal<br>
<br>
************************************************************************<br>
<br>
</div><div class="im">On May 20, 2009, at 6:35 AM, Richard Chudacoff, MD wrote:<br>
<br>
> That is different than have an induction protocol for breech<br>
> deliveries<br>
><br>
> Richard Chudacoff, MD, FACOG<br>
> Las Vegas International Center for Advanced Gynecologic Care<br>
> (Specializing in Minimally and Non-Invasive Surgery)<br>
><br>
</div><div class="im">> -----Original Message-----<br>
> From: <a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a> [mailto:<a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a>] On Behalf Of<br>
</div><div class="im">> Charlie<br>
> Chambers<br>
> Sent: Wednesday, May 20, 2009 5:56 AM<br>
</div><div><div></div><div class="h5">> To: Multiple recipients of list OB-GYN-L<br>
> Subject: Re: induction of breech at term<br>
><br>
> Thanks everyone for your input. The hospital is approaching this issue<br>
> from the ACOG guideline which states that patients should have a<br>
> version or offer for cesarean section. However, it is reasonable to<br>
> offer a trial of labor under the guidance of "hospital specific<br>
> protocol". The hospital is driving the desire to have such a protocol.<br>
> I'm trying to guide the committee into coming up with a sound<br>
> document. In addition, a consent is being generated which is pretty<br>
> intimidating. I find this approach no different than some of the<br>
> consents for VBAC that I've seen passed around. I do believe the net<br>
> effect will be to convince all patients to have a cesarean section.<br>
><br>
> **************************************************************************<br>
> Charlie Chambers<br>
> Hood River, OR USA<br>
> cchamber@alumni. rice. edu<br>
><br>
> "I'm a goin fishin.<br>
> Yeah, I'm goin fishin<br>
> And my baby's goin fishin too!"<br>
> Taj Mahal<br>
><br>
> ************************************************************************<br>
><br>
> On May 19, 2009, at 2:20 PM, Richard Chudacoff wrote:<br>
><br>
>> Charlie<br>
>><br>
>> It seems like nobody on this list wants to give you any support for<br>
>> your<br>
>> breech protocol. On the other hand, as good friends, we are telling<br>
>> you<br>
>> that you probably should not support a breech protocol. Personally<br>
>> I think<br>
>> just supporting a protocol such as this jeopardizes your medical<br>
>> career. So<br>
>> you may want to think this thing over. As Art says, just my opinion;<br>
>> it<br>
>> could be wrong<br>
>><br>
>> Richard Chudacoff, MD, FACOG<br>
>><br>
>> -----Original Message-----<br>
>> From: <a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a> [mailto:<a href="mailto:ob-gyn-l@obgyn.net">ob-gyn-l@obgyn.net</a>] On Behalf Of art<br>
>> fougner, md<br>
>> Sent: Tuesday, May 19, 2009 1:59 PM<br>
>> To: Multiple recipients of list OB-GYN-L<br>
>> Subject: Re: induction of breech at term<br>
>><br>
>> Whoever writes such a protocol may find himself in an institution.<br>
>><br>
>> Just my opinion. I could be wrong.<br>
>><br>
>> Art<br>
>><br>
>> At Tue, 19 May 2009, Charlie Chambers wrote:<br>
>>><br>
>> . I've<br>
>>> looked over a number of other institutions who have protocols as<br>
>>> well.<br>
>>><br>
><br>
***************************************************************************<br>
>> *<br>
>><br>
>> --<br>
>> art fougner, md<br>
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton<br>
>><br>
><br>
<br>
</div></div></blockquote></div><br>
raun, MD FACOG(L) ABMP CMTh<br>Professor Emeritus<br>Dept. of Obstetrics and Gynecology<br>Indiana U. School of Medicine<br><br><br>R. Daniel Braun<br>
<br> “Science without Religion is LAME; Religion without Science is BLIND"<br> Einstein 1941<br>
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