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Re: VBAC Hospital ProtocolFrom: Braun, R. Daniel (rbraun@iupui.edu)Sat Oct 2 06:13:56 1999
The differing management of individuals based on degree is unfortunate but it happens frequently. Certainly, from a standpoint of qualifications, there should be no difference between the FP's and the NP's. ACOG guidelines require that a person with cesarean privileges(not necessarily an OBGYN) be immediately available. This looks as though it is discriminatory against NP's. Is it legal to do such????? Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN 46202 OBGYN.net International Representative for United States -----Original Message----- From: Joseph Shaeffer [mailto:jescnm@earthlink.net] Sent: Friday, October 01, 1999 8:12 PM To: Multiple recipients of list OB-GYN-L Subject: VBAC Hospital Protocol Dear listers, I'm a CNM in an HMO practice in the Pacific Northwest, I deliver in a tertiary care hospital with a level three NICU, the hospital has a family practice residency affiliated with it, and an OB fellow program, approximately 2500 deliveries occur each year, with a mix of OB/GYN physicians, family physicians that are not priveledged to do operative deliveries and nurse midwives that deliver approximately 20% of the babies, we have a backup arrangement with a five person OB/Gyn group for consultation and collaboration. OB/Gyn physicians have not been required to be in house 24 hrs/day, we do have 24hr anesthesia coverage. Because of the latest ACOG bulletin regarding VBAC management mandating that an OB/Gyn be "immediately" available, the following OB/Gyn department protocol has just arrived on my desk, please read it and forward any comments that you might have:
>From the Chair of the OB Committee: 1: Nurse Midwives may no longer care for and deliver VBAC's in hospital 2: Family Medicine physicians with OB privileges must get an Obstetrician consult during pregnancy, have the consult on the chart and notify the obstetrician when the patient is admitted and in labor Do you find this protocol makes sense in addressing the ACOG bulletin? Does it bother you as much as I that a family physician that may do 10 births a year and cannot begin a c/section is allowed to manage the VBAC patient and the CNM who does 100 deliveries a year cannot? Thank you in advance for your comments,
-- Joseph Shaeffer ARNP/CNM Spokane, Washington
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