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Re: Elective Pitocin Induction of a patient in breechFrom: mark decker (mdecker@nconnect.net)Sun Dec 7 07:06:29 1997
><< << Monica Hemingway wrote: > > I am a registered nurse practicing currently in labor and delivery. > > Is this being routinely done around the country or the world for that > > matter? A pitocin induction of a breech patient? > -- > << Bernard Cristalli MD CNGOF responded: > > << Sure! I do it every day >--------------------------------------------------------------------------- > >--------------------------------------------------------------------------- > " Sure! I WOULD do it every day" >--------------------------------------------------------------------------- > > Andrew Folley MD FACOG Toledo ---------------------------------------------------------------------------- I use pitocin on favorable breeches if I would use it on a vertex ---------------------------------------------------------------------------- presenting fetus. that is indications the same as far as I am concerned. ---------------------------------------------------------------------------- I just watch progress closely. I enjoy doing breech deliveries. I respect the increased risk issues but am not afraid of them..just respect the need for thoughtful caution. few of my patients decline version. 83-86% successful in my experience..and if that fails few decline vaginal delivery trial - 85% successful trials of vaginal delivery. these comments are in regards to favorable breeches. I have had footlings in labor that get cut too of course but not very many. I counsel my patients on versions and suggest version trials then breech vaginal over c-sections. opinion of mine - unfortunately I also counsel them on dual legal standards of care and that they have the right to compel me to do a c-section which likely is of no benefit to the fetus and IS less beneficial to the mother. I also tell them I don't like being compelled by legal constraints to be to be an active participant to increased morbidity and mortality risks for mom <ok ok absolute death risk is still low but morbidity is very high and likely to be greater except in the face of the worst nightmare vaginal delivery>. I also tell them I am the doctor and I do this for a living - I have this knowledge of how things usually go - I have the experience and they don't of seeing breech deliveries - and they have the fear of the unknown and I don't - and that I just covered permanent arm injury risks and I know it sticks in their minds like a neon sign....so...If they elect for a c-section I will not be their enemy and harp on them about it..I tell them I will be positive in my interactions with them and respect their decision if they decide for the section. that's how I approach vaginal breech - pitocin as asked and my general approach - not asked but like all of us I don't mind giving my un requested opinion on issues from time to time..:):):):)
-- mark decker md multi specialty ob-gyn practice west bend wi Mark H Decker MD Ob-Gyn Mid West USA Multispecialty Clinic
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