> Julia Thompson <[EMAIL PROTECTED]> wrote:
> > Deborah Harrell wrote:

>
http://www.usatoday.com/news/health/2005-05-31-malpractice-suits_x.htm
 <snippage now>
> > 
> > Fear of getting sued leads an alarming number of
> > doctors to practice "defensive medicine," such as
> > ordering unnecessary tests and avoiding risky
> > procedures, a survey found.  The practice has been
> > around for decades, and is no secret to many
> patients. But the survey of 824 Pennsylvania doctors
> suggests it
> > is surprisingly common, researchers said.... 
> > 
> > Ninety-three percent of the Pennsylvania doctors
> [from
> > high-liability specialties] surveyed in 2003 said
> they
> > sometimes or often practiced "defensive medicine"
> > because of malpractice concerns.  "That means they
> > engaged in unsound practices that exposed patients
> >to potential harm," said Dr. Peter Budetti, a
> > physician-lawyer and public health professor at
> > University of Oklahoma Health Sciences Center. He
> > called the numbers staggering....

{I don't completely agree with that statement - frex
ordering extra lab tests when a few are completely
justified only adds to the expense, not any extra
danger.  He was a bit hyberbolic there.}

> So, I'm wondering something now about my own most
> interesting experience in a hospital....
> 
> I gave birth to twins almost 21 months ago.  10 days
> before I gave 
> birth, an ultrasound was performed for the purpose
> of determining the 
> position of each fetus.  They were both head-down,
> and I'd given birth 
> to a fairly large baby previously, so my doc and I 
> were on the same page, vaginal delivery.
> 
> I was induced <sniplet> and the first baby, the 
> one who'd been lower down for at least a couple of
> months at that point, 
> was born without any major incident.  <sniplet>
 
> Then it was time to deliver the second twin.  SOP in
> this case seems to 
> be, rupture the amniotic sac and deliver.  Well...
><sniplet> when his sac was ruptured, he decided he
> didn't like the 
> position he'd been in for entirely too long. 
> Attempts to turn him 
> manually failed, so the doc was left with 2 choices:
>  breech delivery or 
> quick, unplanned c-section.  She opted with the
> breech delivery, and 
> apparently shocked the rest of the medical personnel
> in the room; 
> apparently, that just isn't *done* at that
> particular hospital.
> 
> Now, I think it was the best thing for everyone
> directly involved -- it 
> was over more quickly, once she made the decision, I
> didn't have an 
> incision in my abdomen to recover from, and I think
> it carried less risk 
> to the baby, given that she'd had some experience in
> breech deliveries <sniplet> 
 
> So, in that case, what would be the "defensive"
> action?  The breech delivery or the c-section?

I think this was more of a judgement call; both
courses have potential risks/bad outcomes (of course,
so does vaginal delivery!), so your doc made her best
call -- and it worked out fine.  I don't recall
precisely what the time-to-delivery is in an emergency
C-section, although I think it's ~ 7-10 minutes; if
blood/oxygen flow is compromised for that time, and
breech birth time is shorter, the risk to the baby
would be lesser (as you noted, not having your gut
sliced-n-diced was better for you).

Defensive medicine that would have involved possible
*increased* risk would have been to electively
C-section without a try at vag deliv.  [my opinion]

Debbi
who read yesterday that women docs have suicide rates
*130% higher* than non-physician women (male docs have
a 40% higher suicide rate than non-doc men)

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