VBAC twins

[nimbus]

Call me crazy but this doesn’t seem like the best situation to reduce c-section rates. They put the mother and babies at unnecessary risk in order to prove a point. And how many OB’s actually have the skills to do this? It’s reminiscent of large animal veterinary practice.

Twin's Difficult Birth Put A Project Designed To Reduce C-Sections To The Test

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[jwk]

Seems really hard to quantify any real results in a low volume hospital. A reduction from 31% to 27% in a hospital that does 100 deliveries a month? Wonder what their normal monthly variation is?

 

[dhb]

Seems really hard to quantify any real results in a low volume hospital. A reduction from 31% to 27% in a hospital that does 100 deliveries a month? Wonder what their normal monthly variation is?

Move out of the way: Mr 20k deliveries coming through 😉

 

[jwk]

Move out of the way: Mr 20k deliveries coming through 😉

😉

 

[anbuitachi]

Feels like there are many ways to reduce C section rates of the OBGYNs/insurance got together.. The above is probably not a very efficient way. how about having insurance not cover elective C sections and any C sections after that? Waiting longer for patient to dilate.... i think some places are already increasing this. etc

 

[deleted126335]

Tort reform will definitely lower the C-section rate.


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[deleted162650]

Pass legislation banning OB’s from making dinner reservations.

 

[nimbus]

Pass legislation banning OB’s from making dinner reservations.

Yep! That’ll put a stop to the FTP (in time for dinner) indication.

 

[anonperson]

Call me crazy but this doesn’t seem like the best situation to reduce c-section rates. They put the mother and babies at unnecessary risk in order to prove a point. And how many OB’s actually have the skills to do this? It’s reminiscent of large animal veterinary practice.

Twin's Difficult Birth Put A Project Designed To Reduce C-Sections To The Test

I have never regretted doing a c section but I have regretted not doing a c section.

Unless there is meaningful tort reform, there will never be a real decline in the c section rate. All of this is feel good BS for the general public.

You can bet if little Timmy can't color between the lines, the parents will try to go after the physicians, and there will be a scumbag lawyer readily available to take the case.

If insurance companies try to deny payment for excess c sections, all that will happen is physicians will cherry pick their patients and refuse to take on patients with risk factors for c section ( older age, obese, htn etc). Now these patients will have reduced access to care and likely a higher rate of c section as well.

 

[Noyac]

Pass legislation banning OB’s from making dinner reservations.

I personally love it when the OB’s have dinner plans. Let’s clear the deck before the day is finished so we can all sleep quietly tonight.

 

[Ronin786]

I have never regretted doing a c section but I have regretted not doing a c section.

Unless there is meaningful tort reform, there will never be a real decline in the c section rate. All of this is feel good BS for the general public.

You can bet if little Timmy can't color between the lines, the parents will try to go after the physicians, and there will be a scumbag lawyer readily available to take the case.

If insurance companies try to deny payment for excess c sections, all that will happen is physicians will cherry pick their patients and refuse to take on patients with risk factors for c section ( older age, obese, htn etc). Now these patients will have reduced access to care and likely a higher rate of c section as well.

That's actually not true. It's been studied and the c-section rate increase is not commiserate with litigation. Neither has it been associated with reimbursement.

It does appear the biggest factor is increased fetal monitoring and closer observation of OB patients. Anytime a baby gets a decel, the OB is there ready to cut. And who's going to say no when you see a non-reassuring strip, even though nothing seems to indicate that fetal heart monitoring improves maternal/fetal mortality.

 

[anonperson]

That's actually not true. It's been studied and the c-section rate increase is not commiserate with litigation. Neither has it been associated with reimbursement.

It does appear the biggest factor is increased fetal monitoring and closer observation of OB patients. Anytime a baby gets a decel, the OB is there ready to cut. And who's going to say no when you see a non-reassuring strip, even though nothing seems to indicate that fetal heart monitoring improves maternal/fetal mortality.

I do obstetrics and I am telling you litigation drives the c section rate significantly. Why would I lie about this? What you are describing is exactly why. Not sure why you don't even realize that based on your example.

This is the same for my partners and the other OBs in my community. It comes up in our meetings regularly.

If there is a questionable tracing (which is the vast majority) and there is an adverse fetal outcome of any type, there is an army of lawyers ready to take on a lawsuit. It doesn't matter if the events are related (they usually aren't) but a jury of lay people will drop the hammer. There are regular commercials on TV advertising this.

Read any throwaway OB journal. There is usually a section on lawsuits and their outcomes. Hint, they are usually related to bad fetal outcomes and a lawyer claiming a delay in c section.

Why do you think OBs perform c sections on patients who request them (purely elective) instead of trying to convince them otherwise? Any bad outcome will potentially destroy your career. Not worth the headache.

Reimbursement plays no role in c section rates. I get paid an extra $80 for a c section and now have to round for 2 or 3 days.

Although fetal monitoring has not decreased fetal mortality it has been shown to decrease infant seizures.

 

[facted]

There was a great article from UCSF. They went from a private model to a hospitalist one where hospitalist was always in house and did the sections.

24-Hour OBs, Midwives Lead to Less C-Sections

Big drop in sections. Don't tell me OB convenience doesn't play a role in section rate. We've all been there.

 

[nimbus]

I have never regretted doing a c section but I have regretted not doing a c section.

Unless there is meaningful tort reform, there will never be a real decline in the c section rate. All of this is feel good BS for the general public.

You can bet if little Timmy can't color between the lines, the parents will try to go after the physicians, and there will be a scumbag lawyer readily available to take the case.

If insurance companies try to deny payment for excess c sections, all that will happen is physicians will cherry pick their patients and refuse to take on patients with risk factors for c section ( older age, obese, htn etc). Now these patients will have reduced access to care and likely a higher rate of c section as well.

Do you have any insight or opinion on delivering twins as a vbac? What percent of OB’s would attempt this? I’ve never seen one although I don’t do OB anesthesia anymore.

 

[Hoya11]

I have never regretted doing a c section but I have regretted not doing a c section.

Unless there is meaningful tort reform, there will never be a real decline in the c section rate. All of this is feel good BS for the general public.

You can bet if little Timmy can't color between the lines, the parents will try to go after the physicians, and there will be a scumbag lawyer readily available to take the case.

If insurance companies try to deny payment for excess c sections, all that will happen is physicians will cherry pick their patients and refuse to take on patients with risk factors for c section ( older age, obese, htn etc). Now these patients will have reduced access to care and likely a higher rate of c section as well.

appreciate your opinion on this forum.. we anesthesiologists dont like when people give us their opinion on anesthesia, and im sure that as an expert in your field, non-experts citing one random study and forming a strong opinion about a controversial topic in your field must be frustrating . personally, i know what i dont know, and i am not an OB, and i respect the education of an OB related to OB, and if they say they need a c section im going to do it...

and i would expect you to avoid having/sharing your opinions about anesthesia with anesthesiologists for the same reason, let the expert do their thing..

people spend their life forming opinions about stuff. it always amazes me how people can have such strong opinions about things, that are counter to the expert opinion, without being an expert themselves...

 

[anonperson]

There was a great article from UCSF. They went from a private model to a hospitalist one where hospitalist was always in house and did the sections.

24-Hour OBs, Midwives Lead to Less C-Sections

Big drop in sections. Don't tell me OB convenience doesn't play a role in section rate. We've all been there.

I'm more likely to tolerate watching a questionable strip if I'm in the hospital and can do a c section in 5 minutes versus managing a questionable strip if I'm at home and need 20 to 30 minutes to get in.

I won't deny convenience has played a role in some instances but it does not tell the entire story. My group shares call so we are in house for each one but my c section rate is 28%.

The guy at my hospital with the lowest c section rate (13%) has to drag his a$$ from home 30 minutes away. The main difference is he tolerates $hitty fetal tracings while others would do a c section. He usually gets away with it but has been burned once or twice .

 

[anonperson]

Do you have any insight or opinion on delivering twins as a vbac? What percent of OB’s would attempt this? I’ve never seen one although I don’t do OB anesthesia anymore.

Technically, the party line from ACOG is that it is acceptable The reality is that most OB GYNs would not. I know my group isn't doing it nor are we interested

Honestly, the idea of VBAC sounds great and very feel good. I do them on select patients but am generally not thrilled. Patient gets to have a vaginal delivery blah blah blah.

But I've seen the horror show of a uterine rupture with a dead baby and a mom who nearly died just in the last 12 months.

For ACOG and the policy makers, that is just the cost of doing business. You know, you can't make a cake without breaking a couple of eggs etc.

But tell that to the parents with a dead kid or the mom who nearly bled to death. Or the OB GYN/Anesthesiologist who get stuck taking care of the patient in this situation. It's traumatic and sobering.

Having a scheduled boring c section doesn't seem too bad.