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Re: Breech dilemmaFrom: Dr. P. Peterman (peterman@proteus.com)Tue Mar 3 11:00:16 1998
>>Remember, no money, no insurance. Under other circumstances I certainly >>would have confirmed with an US. > >If you don't have means to rpovide indigent patients with care they need, >then refer them to those who do. > >>Again, her IP care is out of our control. > >Then why are you providing AP care?? If you cna't do her IP care, then you >shouldn'tdo her AP care. >This is like seeing one person for a complete pre-surgical evaluation for a >CABG and then meeting the surgeon, for the first time, in the O.R. right >after the anesthesiologist has injected the Pentothal (or whatever they use >these days) > >>> In consenting this patient for >>> delivery (by c-section or vaginal) you will have to address these issues >>> when outlining the overall risk to her. >> >>They have been. She doesn't want a section. > >If you're not going to do the delivery, you can't do teh consent. > >>> She has two things in her favor for breech delivery: a previous breech >>> and multiparity. Her gestational age is not in her favor (other >>> factors: cervix?, EFW?). If this EFW is greater than six pounds, I >>> might consider CAT pelvimetry (my clinical pelvimetry is a little rusty) >>> to document pelvic adequacy. >> >>Sorry, we'all is just lo tech project dwellers I'm afraid. > >I work in a county Hospital and go to outlying clinics and provide care to >just this same kind of patient. We have the capacity to get ultrasounds for >them and to provide ECV's for them. >I believe that 20 years ago when I was the program director in Chattanooga, >the state had programs for the management of these patients to provide both >AP and IP care. >> >>>From my original post:"Please no flames about illegal immigrants, CNMs, >>breeches, etc, etc. And note that I haven't revealed who her AP provideris >>anyway. >> >It doesn't matter about any of these initials or demographic >characteristics. If you can't provide her IP care, you should refer her to >whoever can for her AP care. > DR KLEIN, THANK YOU FOR RESPONDING TO THIS. YOU SAVED ME THE TROUBLE OF DOING SO BY STATING THE OBVIOUS. FOR THE RECORD. I DON'T FLAME NURSE MIDWIVES, OR TREAT THEM ANY DIFFERENTLY THAN ANY OTHER HEALTH CARE PROFESSIONAL. P.Peterman.
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