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Re: Practice Protocol: BREECHFrom: Dr Eberhard W Lisse (el@lisse.NA)Thu Dec 21 14:25:12 1995
At 12:25 PM 21/12/95, Jason Gardosi wrote: [...] >Interesting...I would like to see some evidence that primip breeches fare worse if they are properly selected and worked up. We have all heard about or experienced the bad case, but I have yet to see a problem if the proper protocol is followed. In horror stories, it usually wasn't. I don't need that. All textbooks I have say you can do it either way and that's that.
[...]
>I think the onus of proof should always be on those who want to intervene, so the ball is in your court, esteemed inter-continental colleagues... Breech delivery is an intervention in its own right by the way. So is induction, stimulation and augmentation and epidural aneasthetics. The only reason we are discussing this here is because in the US too many interventions are being done and far too many Cesareans. This has become a financial problem as the insurances don't pay for that. Ligitation doesn't help either. So the rate must go down, no matter what. Apparently it is felt in the US that you can't reduce the number of emergency Cesars so one goes after the elective indications. I have visited teaching hospitals in the US with 25% C/S rates and a further 20% Forceps and Vacuums. Sure one should reduce that. As written here before we have 9% C/S in the national hospital and 10% in my district hospital, with less then 1% Vacuums and virtually no Forceps. We don't *NEED* to bring the C/S numbers down, in fact it has been argued we should bring them up to 15% trying to anticipate low Apgar scores. The risk to the mother is of course higher because of the general anaesthetic but marginally so. The risk for the baby in a vaginal delivery is much higher, and in a primip it is for me unacceptable, it is a simple as that. Even if the ligitation aspect doesn't affect me because I am a civil servant I still don't think I can show a paper in the NEJM or other journal of repute to the family of a brain damaged or dead baby. This is all beside the fact by the way, Jason, that my FRCOG says I must section them :-)-O el
-- Dr. Eberhard W. Lisse \ / Swakopmund State Hospital <el@lisse.NA> * | Resident Medical Officer Private Bag 5004 \ / +264 64 461503 (pager) 461005 (home) 461004 (fax) Swakopmund, Namibia ;____/ Zone/Domain Contact for the NA-DOM Vice-Chairman, Board of Trustees, Namibian Internet Development Foundation, an Association not for Gain. NAMIDEF is the Namibian Internet Service Provider.
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