“Advanced” Birth Centers

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nimbus

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What could possibly go wrong? Maybe they’ll stock some whole blood. They may be hiring soon.

“Snow, the retired OB-GYN with Women’s Care, said the group plans to open an advanced birth center in the Tampa or Orlando area.

The advanced birth center concept is an improvement on midwife care that enables deliveries outside of hospitals, he said, as the centers allow women to stay overnight and, if necessary, offer anesthesia and C-sections.”








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My vote for worst anesthesia job of all time.
 
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The ASC of childbirth. It will be like any other ASC. OB/midwives will constantly be pushing the boundaries of who is appropriate for this to drive revenue when they can’t get enough healthy patients. “Oh she’s not pre-eclamptic, just gestation HTN” “Her BMI is only 39.9” “But all 4 of her previous c-sections were uncomplicated”. Not to mention it’s all PE backed so I’m sure patient safety will be number one priority... Sounds like a disaster waiting to happen.
 
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Sounds like a great job for CRNAs to staff independently. Jackpot.
 
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Private insurance, healthy skinny patients? Sign me up!

But probably they will be overweight diabetic crunchy anti epidural prospective mothers that call you at 3 am for the epidural and can't sit still while the partner and midwife stare daggers at you.
 
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Will they have a neonatologist in house 24/7? Gonna be expensive.
 
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I work at a birthing center in a rural setting. Cash cow. I usually do a 12 or 24 hr shift and maybe do 1-2 epidurals a shift many times less. The permanent guys though make a ton of bread and the full time is 7 24 hr shifts. I enjoy those shifts.
 
Tampa is not rural.
And I didn’t think anything could make ob less desirable.
 
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I work at a birthing center in a rural setting. Cash cow. I usually do a 12 or 24 hr shift and maybe do 1-2 epidurals a shift many times less. The permanent guys though make a ton of bread and the full time is 7 24 hr shifts. I enjoy those shifts.
How is 1-2 epidurals in a 24 a cash cow? Are the patients Saudi princesses who tip well?
 
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Private insurance, healthy skinny patients? Sign me up!

But probably they will be overweight diabetic crunchy anti epidural prospective mothers that call you at 3 am for the epidural and can't sit still while the partner and midwife stare daggers at you.
Yeah I actually sort of enjoy OB during daylight hours, but the midwife and doula and birth plan au-natural-until-it's-not phenomenon can ruin that too.

Some "advanced" birthing center sounds like a magnet for the crazy. Hopefully they open one up near here, and it pulls the nuts away from our place.
 
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Private insurance, healthy skinny patients? Sign me up!

But probably they will be overweight diabetic crunchy anti epidural prospective mothers that call you at 3 am for the epidural and can't sit still while the partner and midwife stare daggers at you.
Cue the Whale Song music. Many of those skinny blonde private insurance L/D patients will suck the blood out of you six ways from Sunday. Guarantee there will also be Doulas running amuck as well as the RN BSN MSN CRNMs. And to top it off you are also talking Florida. Didn’t that state learn after the office-based plastic surgery disaster situation 10-15 years ago? Ask me how I really feel.
 
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Yeah I actually sort of enjoy OB during daylight hours, but the midwife and doula and birth plan au-natural-until-it's-not phenomenon can ruin that too.

Some "advanced" birthing center sounds like a magnet for the crazy. Hopefully they open one up near here, and it pulls the nuts away from our place.
There already is a birthing center pulling a lot of local interesting personalities away from us... until they have a complication and present to us late, as has happened before.
 
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I work at a birthing center in a rural setting. Cash cow. I usually do a 12 or 24 hr shift and maybe do 1-2 epidurals a shift many times less. The permanent guys though make a ton of bread and the full time is 7 24 hr shifts. I enjoy those shifts.
I never knew anesthesiologist staffed these places. I thought these would be anti physician, and all about natural everything. With Midwives running wild.
These people want epidurals? How interesting.
 
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Cue the Whale Song music. Many of those skinny blonde private insurance L/D patients will suck the blood out of you six ways from Sunday. Guarantee there will also be Doulas running amuck as well as the RN BSN MSN CRNMs. And to top it off you are also talking Florida. Didn’t that state learn after the office-based plastic surgery disaster situation 10-15 years ago? Ask me how I really feel.
This is Florida.
It continues to thrive on sketchy, non boarded, overseas trained, general surgeons calling themselves cosmetic surgeons, different specialty trained think they can be anesthesiologists, lay people run recovery houses, constant deaths and yet people continue to flock there for their high hip riding BBLs.
And then end up on the news.
 
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Im confused here. I do some moonlighting at a birthing center. The center has obstetricians for deliveries and c/s. They have OB urgent care. Its more like a modified office building.
 
Im confused here. I do some moonlighting at a birthing center. The center has obstetricians for deliveries and c/s. They have OB urgent care. Its more like a modified office building.
I have questions. How many units of blood are there in house? How far to nearest referral center? If patients are actually appropriately selected, I’m sure escalations of care are rare, but not never. I’m curious what kind of contingencies are in place for the unanticipated PPH.
 
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Yes, I’m also interested in what is all available at these places for emergencies in terms of supplies and staff. Also is there a neonatalogist in house or available?
 
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Yes, I’m also interested in what is all available at these places for emergencies in terms of supplies and staff. Also is there a neonatalogist in house or available?
I've never had a neonatologist in house at any of the 1000-2000 deliveries / year hospitals I've worked at. I've had to take over neonatal resus more times than I can count. Don't love doing it but I can't just stand there and let the "NNP" flounder. Preemie anatomy is no joke and they really don't know how to respond when resus measures are not working.

And I'm in a major metro where you at least have anesthesiologists in house... I can't even imagine what goes on in rural hospitals with only nurses around.
 
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No its not just nurses running around. The OBs take call from home. We do not have to be in house unless an epidural is running. Blood is 5 minutes away at the main hospital. We have 2 ors with a full complement of meds and airway equipment.
 
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No its not just nurses running around. The OBs take call from home. We do not have to be in house unless an epidural is running. Blood is 5 minutes away at the main hospital. We have 2 ors with a full complement of meds and airway equipment.


I don’t see a compelling reason (except 💰) to build a birthing center if there is a legit hospital 5 minutes away. Does it exist solely to skim healthy patients with good insurance away from the hospital?
 
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I've never had a neonatologist in house at any of the 1000-2000 deliveries / year hospitals I've worked at. I've had to take over neonatal resus more times than I can count. Don't love doing it but I can't just stand there and let the "NNP" flounder. Preemie anatomy is no joke and they really don't know how to respond when resus measures are not working.

And I'm in a major metro where you at least have anesthesiologists in house... I can't even imagine what goes on in rural hospitals with only nurses around.
I don’t remember preemie anatomy. High lung pressures right? Some vessels that are supposed to close aren’t? Something like that? lol
Good on you. My responsibility is to the mother although I can’t just stand there but I don’t do enough OB to take over preemies and I have come close pretty recently. But I hated the feeling maybe I would have fumbled too outside of the airway and emergency drugs.
Why are places like this a thing? This needs to be reported for patient safety.
 
No its not just nurses running around. The OBs take call from home. We do not have to be in house unless an epidural is running. Blood is 5 minutes away at the main hospital. We have 2 ors with a full complement of meds and airway equipment.
So why the hell is this called a birthing center? This is way more than that since it has a whole ASC for OB Sections.
What’s the appeal for women to go here versus the hospital five minutes away?
Is it just me who thought birthing centers were the centers run by midwives and everything was natural?
 
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I've never had a neonatologist in house at any of the 1000-2000 deliveries / year hospitals I've worked at. I've had to take over neonatal resus more times than I can count. Don't love doing it but I can't just stand there and let the "NNP" flounder. Preemie anatomy is no joke and they really don't know how to respond when resus measures are not working.

And I'm in a major metro where you at least have anesthesiologists in house... I can't even imagine what goes on in rural hospitals with only nurses around.
We didn’t have an in-house neonatologist for my first 14yrs here; resuscitated/intubated my share of newborns. But one bad outcome at the hospital and now we have in-house neonatology. In reality the cost of one newborn lawsuit in my neck of the woods would cover the cost of in-house neo for 30+yrs.
 
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Isn't that why ASCs exist?

It’s because most hospital OB units are dirty overcrowded non private and full of incompetent inexperienced providers - and people want better than that. Same reason people come to ASCs. The dysfunction at the hospital is at DMV level and is intolerable to many who don’t have to be there

I had one child in a small private catholic hospital and had a great experience .

My next child was born in a big academic hospital which was horrible and , although I respect what the hospital offers, for most routine cases it’s not necessary and not worth the headache. However a blood bank available would make me feel a lot better

If hospitals want all delivering patients to come there and feel safe all under one roof with a neonatologist and blood back , they can’t have the OB units be so dysfunctional and dirty or people will inevitably look elsewhere . Same as for total joints
 
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It’s because most hospital OB units are dirty overcrowded non private and full of incompetent inexperienced providers - and people want better than that. Same reason people come to ASCs. The dysfunction at the hospital is at DMV level and is intolerable to many who don’t have to be there

I had one child in a small private catholic hospital and had a great experience .

My next child was born in a big academic hospital which was horrible and , although I respect what the hospital offers, for most routine cases it’s not necessary and not worth the headache. However a blood bank available would make me feel a lot better

If hospitals want all delivering patients to come there and feel safe all under one roof with a neonatologist and blood back , they can’t have the OB units be so dysfunctional and dirty or people will inevitably look elsewhere . Same as for total joints
I don’t know about all this. I can only think of two hospitals I have worked where I would classify their OB floor as dirty. A lot of the hospitals I have been in have had clean and fancy OB suites
But all of them are always dysfunctional.
 
No its not just nurses running around. The OBs take call from home. We do not have to be in house unless an epidural is running. Blood is 5 minutes away at the main hospital. We have 2 ors with a full complement of meds and airway equipment.
That just makes zero sense to me. Glad it works for you strictly from the $ standpoint.

Curious - are you fully separate from the hospital or connected through some hallway to a separate building? Is it owned by the same entity? We can't get blood in 5 minutes and we're part of the hospital. We needed blood at one of our hospital-owned ASCs across the street and the lab about had a fit releasing blood to be taken outside the hospital.
 
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We didn’t have an in-house neonatologist for my first 14yrs here; resuscitated/intubated my share of newborns. But one bad outcome at the hospital and now we have in-house neonatology. In reality the cost of one newborn lawsuit in my neck of the woods would cover the cost of in-house neo for 30+yrs.
Haven’t done peds since residency and I’m not gonna start with neonatal resuscitation. If you are delivering babies you need a neonatologist available. Full stop. Don’t try to save money on my liability
 
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That just makes zero sense to me. Glad it works for you strictly from the $ standpoint.

Curious - are you fully separate from the hospital or connected through some hallway to a separate building? Is it owned by the same entity? We can't get blood in 5 minutes and we're part of the hospital. We needed blood at one of our hospital-owned ASCs across the street and the lab about had a fit releasing blood to be taken outside the hospital.

I don’t think the blood is 5 minutes away. It’s in the hospital that is a 5 minute drive away. So probably more like 15-20min on a good day. It takes every bit of 5 minutes to get 2 units of emergency release blood from blood bank to OR where I work, and that’s in the same building just 2 floors up.
 
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Haven’t done peds since residency and I’m not gonna start with neonatal resuscitation. If you are delivering babies you need a neonatologist available. Full stop. Don’t try to save money on my liability
They are "available", just 30min away. In practice, this means when a mom with no prenatal care ends up in your OR with street clothes on, all you get is a fumbling NNP. I'm sure the ones at real NICUs are decent enough at algorithmic resus, but in my community setting with a rinky dink NICU, it's not really the case.

I don't really feel that I'm liable if I compassionately take over when they ask me to -- at that point the baby is practically dead anyway. I'm probably wrong here though.

What's more curious to me is how the OBs are fine delivering without competent neonatology on site. Their liability hinges on neonatal outcome way more than mine.
 
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They are "available", just 30min away. In practice, this means when a mom with no prenatal care ends up in your OR with street clothes on, all you get is a fumbling NNP. I'm sure the ones at real NICUs are decent enough at algorithmic resus, but in my community setting with a rinky dink NICU, it's not really the case.

I don't really feel that I'm liable if I compassionately take over when they ask me to -- at that point the baby is practically dead anyway. I'm probably wrong here though.

What's more curious to me is how the OBs are fine delivering without competent neonatology on site. Their liability hinges on neonatal outcome way more than mine.
You are probably wrong. This is America. You are a rich doctor who took it upon themselves to assist. Someone will come after you one day. Good luck. Understandably it’s difficult to say no but you are putting yourself in the bullseye.
Have you saved all of them?
What fumbles have you seen with the NNP?
 
You are probably wrong. This is America. You are a rich doctor who took it upon themselves to assist. Someone will come after you one day. Good luck. Understandably it’s difficult to say no but you are putting yourself in the bullseye.
Have you saved all of them?
What fumbles have you seen with the NNP?
Inadequate BMV (either technique or not identifying and clearing mechanical obstructions), inability to secure airway with multiple prolonged attempts, inability to identify or treat pulmonary/circulatory pathology (PTX, effusions, CDH, hemorrhage/hypovolemia, sepsis etc).

No, I haven't saved all of them by any means.. generally speaking the easiest saves are the ones that just need an airway. Anything more complicated deserves a real neonatologist (or pedi anes).
 
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Inadequate BMV (either technique or not identifying and clearing mechanical obstructions), inability to secure airway with multiple prolonged attempts, inability to identify or treat pulmonary/circulatory pathology (PTX, effusions, CDH, hemorrhage/hypovolemia, sepsis etc).

No, I haven't saved all of them by any means.. generally speaking the easiest saves are the ones that just need an airway. Anything more complicated deserves a real neonatologist (or pedi anes).
You are awesome. Good for you.
What kind of documentation if any do you place in the baby’s chart?
And it’s sick to me that babies are dying (which can happen with or without a neonatologist) but they are not interested in having one available with such a large number of births.
I guess not many have died yet. Very sad.
 
That just makes zero sense to me. Glad it works for you strictly from the $ standpoint.

Curious - are you fully separate from the hospital or connected through some hallway to a separate building? Is it owned by the same entity? We can't get blood in 5 minutes and we're part of the hospital. We needed blood at one of our hospital-owned ASCs across the street and the lab about had a fit releasing blood to be taken outside the hospital.
Not connected at all to the hospital. The hospital is literally less than a mile from the birthing center. In house neonatology, OB present for all deliveries.
 
What happens when a no prenatal care meth head with 3 prior c sections comes in with a placental abruption? (Real scenario that is unfortunately relatively common).

I could see this concept working when things go well. Unfortunately we cannot predict when $hit hits the fan.
 
What happens when a no prenatal care meth head with 3 prior c sections comes in with a placental abruption? (Real scenario that is unfortunately relatively common).

I could see this concept working when things go well. Unfortunately we cannot predict when $hit hits the fan.
Prepare for the worst. Get a medevac plan asap. I worked in a “hospital” thousands of miles away from land. We had less resources there then this birthing center.
 
What happens when a no prenatal care meth head with 3 prior c sections comes in with a placental abruption? (Real scenario that is unfortunately relatively common).

I could see this concept working when things go well. Unfortunately we cannot predict when $hit hits the fan.
something tells me their insurance isnt going to be accepted at the birthing center
 
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If it's a birthing center, there is some component of triage. I don't think you can transfer an actively laboring patient etc. I'm not sure if EMTALA rules would apply though. Even if they didn't, logistically transferring a patient like that would be tough.
 
Prepare for the worst. Get a medevac plan asap. I worked in a “hospital” thousands of miles away from land. We had less resources there then this birthing center.
You had zero liability working at that hospital because of Feres Doctrine.

I wouldn't touch one of these birthing centers that didn't have OB, peds, or blood readily available. (In another building a short drive away isn't readily available.) Whatever they're paying you it's not enough.
 
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We didn’t have an in-house neonatologist for my first 14yrs here; resuscitated/intubated my share of newborns. But one bad outcome at the hospital and now we have in-house neonatology. In reality the cost of one newborn lawsuit in my neck of the woods would cover the cost of in-house neo for 30+yrs.

Was anesthesiologist sued for that bad outcome?
 
The real question is would doctors still work in these settings if pay was the same and they couldn't skim facility fees compared to a hospital?
 
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How does one actually get a malpractice policy somewhere like this? OB scares the life out of me. Maybe I’m traumatized but have had several AFEs in the last few years and ran to help the docs on L&D. My GOD. The coagulopathy and RV dysfunction. None would have lived without the MTP and ICU. Two have gone onto ECMO.

My wife was healthy and low risk and she still delivered at the big center. Because here is the thing- all these hippies say, “what did women do before all this medical stuff for childbirth?” THEY DIED, KAREN. THEY DIED.
 
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