Dear David Thank you for seeking to determine and share our common ground. Particularly thank you for your wonderful example of how to be diplomatically constructive in critiquing both research, journal and media usage of same. But most importantly thank you for your contributions to the ozmidwifery list, debates and issues which we have discussed and contributed toward. I wish we could clone and multiply you and all the wonderful collegiate medical practitioners in this country. I also feel that all the problems in our health system can be remedied with co-operation and understanding of each others abilities and interdependency of roles (which I see insufficiently ) so I will endeavour to trim the horns that others perceive in my comments of differences or rather strive to follow your exampleof diplomacy and co-operation. I also hope that we will/should all evolve or multiply the number of practitioners who seek this path, I see more evidence of it in the east - so once again the wise persons are coming from the east, yea even NZ!! Forgive me it may take some time as I develop awareness/sensitivity and the habit of diplomacy. Thank you again for your example keep it coming. Denise Hynd Denise Hynd--- Original Message ----- From: "David Simon" <[EMAIL PROTECTED]> To: "Denise Hynd" <[EMAIL PROTECTED]> Sent: Tuesday, July 24, 2001 6:31 PM Subject: RE: PI > Denise > >YES that has been my understanding though I slipped up in missing my > premium!! > That is the problem with purchasing "insurance" and I may have the > terminology wrong but I thought this was called "claims-based insurance". > When a doctor or midwife stops contributing, they stop being covered, so you > and other MIPPs may also find you need to pay a huge amount on retirement to > continue to have cover for future claims on past events. This has been a > huge issue for doctors, and many who took the cheaper (initially!) insurance > road now regret it, because the product is not as good in the long term as > the (more expensive) medical defence union option. We all have to retire > some day. > I know full well that it is not a level playing field for you in all areas, > but we need to not confuse issues - models of care with say indemnity > issues. Midwives may well find strong allies in medical circles when looking > for change to this indemnity situation as it has been having bad effects in > obstetrics for years - encouraging defensive medicine, encouraging > inappropriate referrals to specialists, driving out GP's (remember Effective > Care includes family doctors as appropriate carers for low risk women), > increasing costs to consumers. > Also, I think that groups of professionals in the same field should always > be trying to find common ground, to encourage dialogue, to realise that our > perceptions of each other as groups of two-headed monsters doesn't quite > seem correct once you meet each other as individuals. I disagree with Joy > Johnston, Jackie Mawson and Jan Ireland on lots of things - even > passionately so on some things no doubt, but that doesn't stop us being > friends or respecting each others views or fighting together on other > issues. Start with one thing you agree on, and build the relationship from > there. > Similarly with the ABC Health Report the other night. Norman Swann > interviewed the author of the study by phone, and she confirmed that her > research confirmed the relative safety of VBAC, but showed that induction in > VBAC increases uterine rupture risk - a small amount if use synto, a large > amount with PG. She said that clinical practice often runs ahead of > research, and that sometimes clinicians have to step back and take stock, > adjust practice. I had written to Norman in a professional conciliatory tone > and he quoted my letter ( a little superficially perhaps) - pointing out > that up to 3000 elective caesars would have to done to prevent one baby > death in VBAC. He didn't (thankfully) dwell on the biased editorial that > accompanied Lyndon-Rochelles paper, and that really was the problem, not the > original research paper. You can listen to the program at www.abc.net.au > I really feel a little disheartened sometimes with the vitriol and division > prevalent on the ozmid forum. It serves no-one. > To follow, the letter I sent Norman. > David > > Subject: Vaginal birth after caesar > > > I note you are going to be discussing VBAC on the health report. > Your promo mentions new research from the US and I presume this is the NEJM > study by Lyndon-Rochelle and the editorial comment by Greene. > As an obstetrician with a particular interest in VBAC I read the article > Lyndon-Rochelle paper with interest. > I believe there are some methodology problems with the study > -it used ICD coding for the data collection rather than chart review. It > is > quite likely that many of the uterine ruptures were in fact scar dehiscence, > by definition benign. > -it is possible that some women who would have planned elective caesar > but > presented in labour with uterine rupture would have been included in the > labour group. > Nevertheless, the study confirms the SAFETY of VBAC, putting the risk of > uterine rupture at 0.5% or 1 in 200, and the risk of a baby dying from > uterine rupture as a result of trying for VBAC only 1 in 2623. The study > also confirms the increased risk of uterine rupture (sometimes justifiable > with informed consent) that induction of labour places on the woman trying > for VBAC. > There is NOTHING new or special about the data presented in the study. > What is controversial is the spin put on the data in the editorial by > Greene. The editorial gives a very one-sided, one could almost say > mischievous, interpretation of the data from the Mozurkewich meta-analysis > (ref14), which indicates that indeed women trying for VBAC have less chance > of fever, but also decreased risk of hysterectomy and transfusion. Why was > this not mentioned? In quoting this study, Greene quotes a 1 in 417 risk of > baby death in VBAC, where in fact the authors note that the risk is much > lower if deaths before onset of labour, or due to prematurity or lethal > abnormalities are excluded. They calculated that between 693 and 3332 women > would need to undergo repeat elective caesar to prevent one baby death from > VBAC. > I hope your analysis of the data in the study, and your advice to the public > will be based on what is actually in the study, not on the editorial > comment. > David Simon > Obstetrician > > > > > > -----Original Message----- > From: Denise Hynd [mailto:[EMAIL PROTECTED]] > Sent: Tuesday, 24 July 2001 10:13 AM > To: David Simon > Subject: Re: PI > > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
