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Re: IUD and PIDFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Sat May 29 16:50:09 1999
Well said, Geff. Kielland forcep rotations remain the saving grace that justifies the existence of an obstetrician. Otherewise, the midwife can deliver the baby, the nurse practitioner place the IUD, and we can teach surgeons to do our sections, hysterectomies, etc. FWIW, I would place this IUD in the patient *after* a long discussion, and I sure as hell hope that the midwife employed by my practice would discuss this case with a supervising MD *prior* to placement (and I don't care who puts it in, but the MD needs to be involved in the decision making). As it turns out, she recently put an IUD in a 48 YO nullip who only had been seen once in our practice, and had a laundry list of gyn complaints, including infertility in the past, endometriosis, etc. My partner got pulled into the room during attempted placement to complete the placement, without the benefit of reviewing the history. I had the pleasure of seeing the patient a couple of months later for problems, and when I reviewed her history, I reviewed it with our CNM and pointed out that I personally would have been reluctant to put it in, and that she needs to run cases that aren't straightforward by one of the MDs prior to placement. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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