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Thursday
Sep152011

Comment of the Week: "Better response to ALL obstetric emergencies"

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By Jill Arnold

We haven’t done a Comment of the Week for awhile. JoyCNM left this on the post, Bringing Back the VBAC. Thank you, Joy.

I’m glad to hear more discussion about the third step in this discussion, better response to ALL obstetric emergencies, instead of focusing on just uterine rupture.  Having been a nurse for 10 years prior to becoming a midwife, I have seen the poor response capable in a small community hospital to any obstetric emergency.  On off hours, there might be only ONE anesthesiologist for the entire hospital.  This was the case in my last employ where we delivered 300-400 babies a year.  If we had an emergency when someone else was having an appendectomy at 3 in the morning, we waited, sometimes up to the magical “30 minutes” for the other anesthesiologist to get there.  Small community hospitals use this scenario to say they do not have the resources to employ an anesthesiologist just for the OB floor and they, therefore, cannot do VBACs.  I have always asked myself, no shouted to myself, “What about all the other OB emergencies?”  If you can’t handle uterine rupture, you can’t handle other OB emergencies, and therefore you shouldn’t have an OB unit!  This need for “readily” or “immediately” available emergency response has been the smoke screen for preventing VBACs in many hospitals for many years.

 

 

 

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Reader Comments (7)

Commenting just to voice my complete agreement with the above. :)

September 15, 2011 | Unregistered CommenterKathryn

don't give them any ideas! They'll say All csections all the time!

September 15, 2011 | Unregistered CommenterGuesty Mcguesterson

YUP. I wanted to respond "WOO HOO" to this comment yesterday, because I am constantly thinking EXACTLY the same thing. And Guesty, I hope you're wrong, but in some ways that's exactly what has happened.... and why we have to FIGHT for Mother-friendly birth and VBAC.

September 16, 2011 | Unregistered CommenterJennifer

Double yes!

Quote from a Time Magazine article, The Trouble with Repeat Cesareans:

Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study.

http://www.time.com/time/magazine/article/0,9171,1880665-2,00.html

September 16, 2011 | Unregistered CommenterKK

AMEN!! I live in an area with a concentrated population surrounded by farmland. We have several community hospitals in the area, but the nearest hospitals that do VBAC are 40+ miles away. I try to gently point this out to pregnant moms (and really anyone else who will listen) when the topic of VBAC or just birth choices in general comes up. I think it's really unfortunate that they are choosing hospital birth based on safety, not realizing the lack of staffing if something goes wrong -- their main reason for going to the hospital! I really do feel that this situation DOES lead to more scheduled inductions for "optimal staffing." Another unfortunate result (in our area at least) is women being pressured to get an epidural before they really feel they need it because they're told they may not be able to get it later (because the anesthesiologist is going home for the day). Of course they're not told this on the hospital tour, only when they are already in labor (probably being induced), perhaps feeling vulnerable and not willing or able to stand up for their rights to receive pain management when and how they need it. I feel that it's extremely sexist -- can you imagine any other patient being told they won't have access to pain management because of staffing issues? But I digress. Besides the ethical problem of threatening lack of access to pain medication, performing interventions based on staffing rather than the woman's individual labor can only lead to complications and worse outcomes.

September 16, 2011 | Unregistered CommenterRebecca M.

Completely agree that uterine rupture is just one of the many possible issues that might require a rapid response, and that the argument against VBAC doesn't hold water. If a hospital/practice feels they can't respond to VBAC issues, then they logically cannot handle other emergencies and patients are likely no safer than those choosing homebirth, and perhaps even less so, due to a false sense of security.
To me, one of the things that makes homebirth a safe option (compared to a community hospital birth) is a good relationship between the midwife and backup physician, whereby the doctor can be waiting at the hospital with a response team, and deliver the baby virtually as fast as if the mother was in the hospital and the team was called in by the hospital labor nurse. We have had such situations occur, such as a footling breech in labor, where the time from arrival at the hospital to delivery was approximately 12 minutes, due to such communication. Of course patients who labor at great distance from a facility would be at a bit higher risk.
Just my 2c.

September 16, 2011 | Unregistered CommenterHenry Dorn MD

Only one anesthesiologist for the whole hospital? Ha! We have less than that. One CRNA, who is sitting at home. NO docs in house. NO OR team in house. Yup, that's why I birth my babies at home, if there is a problem, I'll call ahead and will very likely beat the team in.

September 17, 2011 | Unregistered CommenterRenee
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