Re: induction of breech at term
From: Efrain Ramirez (eramirezt@coqui.net)
Wed May 20 21:02:33 2009
We all have stories.. right now... we don't run the show...
Ef
At Wed, 20 May 2009, R. Daniel Braun wrote:
>
>--001485f5af947e5e13046a5d4e3f
>Content-Type: text/plain; charset=windows-1252
>Content-Transfer-Encoding: quoted-printable
>
>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
>
>--001485f5af947e5e13046a5d4e3f
>Content-Type: text/html; charset=windows-1252
>Content-Transfer-Encoding: quoted-printable
>
>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>
>
>--001485f5af947e5e13046a5d4e3f--
>
--
"Life is what happens to you while you're busy making other plans."- John Lennon
