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Re: A caseFrom: Richard Chudacoff, MD (richardc@bcm.tmc.edu)Mon Dec 2 16:29:59 1996
>I would not fault anybody for inducing this patient, so don't get >distracted from my main point by that issue. But I have to disagree with >the way you frame this. The default condition in obstetrics (in all of >medicine, actually) should always be to do nothing, unless there is good >reason to believe that intervention will benefit the patient. IMHO, >having to "give one good reason" for not intervening is a manifestation >of a backwards way of clinical reasoning; it tacitly assumes that >invervention is correct unless proven otherwise. > In residency I had a wise teacher who said that before 36 weeks you look for ways of keeping the patient pregnant, and after 36 weeks reasons that the fetus should be delivered. The question is not whether to do or not to do, but to deliver the fetus while it is still healthy, and at the earliest indication of maturity and/or fetal distress. The difference between FPs and OBs is the intensive experience in obstetrics. True, some FPs have loads more experience that some OBs, but on a whole I think that our expertice is respected for, although we tend to pull the trigger earlier than non-OBs, we do for good reasons. We, OBs, manage labor, rather than let labor manage us. You never get sued for delivering a healthy baby too soon, but watch out if you deliver a healthy baby too late. IMHO
-- Richard Chudacoff, MD Assistant Professor, OB/GYN Baylor College of Medicine
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