our ob unit has just stopped doing vbacs. now all previous c-sections will be repeats and those showing up in labor (unless precipping in the bed) will be stat sections.
apparently anesthesia is tired of having to stay in house for them and the obs are, too. they were constantly grumbling among themselves... but she's your patient, you told her you'd do the vbac, not me... yada, yada, yada...
if doc's did more to prevent the primary c-section, this wouldn't be so bad - but with all the social inductions and sections for ftp (aka. failure to be patient) and cpd (aka. couldn't produce a real diagnosis), the future for lady partsl birth around here looks grim.
where are the feminists when you need them. :chair:
We did have a ER drop-in challenge them. She refused to sign consent for a c-section. They told her they would not care for her. She was in relatively early labor w/ no problems. They told her to go deliver some place else. None of the docs were willing to deliver her lady partslly, especially without seeing her prenatally. Of course if she had come in delivering precip, they'd have had no choice.
This sounds as though it has EMTALA violation written all over it - just "told her to go deliver some place else"? I'd think they would have to at least make arrangements for transfer of care.
An article just came out where I am living. We have the lowest c-section rate in the country at 21% due in part to our willingingess to do vbac's. I am so glad that it's an option here. I would refuse a section just based on the fact that I had one before. That's major surgery. When will people learn to follow evidence based practice.
This sounds as though it has EMTALA violation written all over it - just "told her to go deliver some place else"? I'd think they would have to at least make arrangements for transfer of care.
Well, she was in rather early labor - if vag, she would have been sent home. But since she was a previous section and refusing a repeat, what could they do? She had care at the clinic and should have gone to the county hospital to deliver, as they would have her records. They simply told her to go where she should have gone in the first place. She was not in advanced labor.
We have the problem all the time of pts. having clinic care and then not going to 'county' to deliver as they are suppose to do. The special insurance they have through that system won't pay our hospital like regular medicaid or private ins. With that said, let me clarify --
This situatation had nothing to do with money, but the patient refusing a repeat section in a hospital with OBs who are not allowed to do VBACs per current policy.
I have no problem with VBAC's as long as it's the mother's choice and not that of the insurance company.
Would you have a problem with TOLACs being mandated by the insurance co?? I'm not trying to be smart, just trying to get at where you're coming from.
I personally don't have a problem with insurance mandating a TOLAC, then if that doesn't work, OR if there's a valid medical reason NOT to TOLAC/VBAC, then do a repeat C. This from the person who wishes insurance would stop covering circs....:offtopic:
The almighty insurance dollar speaks volumes, any way you look at it.
My daughter had an elective repeat section this past Saturday. Thank God she did. She had a very short cord. The OB said it would have been a very risky lady partsl delivery. There's no way to pick up on a short cord via ultrasound.
My daughter had an elective repeat section this past Saturday. Thank God she did. She had a very short cord. The OB said it would have been a very risky lady partsl delivery. There's no way to pick up on a short cord via ultrasound.
Congrats to you and yours, Dutchie. Glad all went well.
if doc's did more to prevent the primary c-section, this wouldn't be so bad - but with all the social inductions and sections for ftp (aka. failure to be patient) and cpd (aka. couldn't produce a real diagnosis), the future for lady partsl birth around here looks grim.
where are the feminists when you need them. :chair:
that's shocking isn't it. can i suggest tho' that we all have a hand in this. we meaning nurses midwives women & doctors. we all play our part in the appalling overuse of technology around birth! i went to a conference last week and one of the presenters talked about being bold! we must be women's advocates and encourage them to learn, make their own decisions and stop relying on health professionals to decide for them! how amazing would things be if every person who cared for labouring women just once a week said "no. i'm not going to do that...its not evidence based, it increases the chances of x y and z, and if you wish it done, do it yourself.":idea: we are womens advocates and we don't need to be feminists to do that...we just need to be bold!!!!!:balloons::balloons::balloons::balloons::balloons:
bagladyrn, RN
2,286 Posts
This sounds as though it has EMTALA violation written all over it - just "told her to go deliver some place else"? I'd think they would have to at least make arrangements for transfer of care.