"Fetal EKG may reduce C-sections"

Fetal EKG may reduce C-sections
Florida researchers are developing a fetal electrocardiogram, or EKG,
designed to monitor an unborn baby's heart rate during labor, which
could reduce the need for Caesarean sections.
at http://www.washtimes.com/national/20...5957-6357r.htm

could reduce the need for Caesarean sections.

What a very poorly written article. It is really muddies up the issues.

The equivocal nature of fetal heart rate tracing interpretation does
contribute to unnecessary c-sections. The most recent attempt at an
alternative more reliable measure of fetal status during labor was
NellCor's fetal pulse oximetry project. It was successful in the sense
that the technology did help distinguish between "ugly looking heart
rate tracing, but the baby's okay" versus "this baby really does need
out." But it wasn't successful in the sense of becoming widely adopted
and having an impact on obstetric practice. OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation. I doubt this technology is going to help the
problems of fetal monitoring in labor.

Fetal EKG could help in diagnosing fetal arrhythmias, but this would
not change the care of most moms and babies out there.

alath wrote:

OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation.

I hear this said a lot, and I'm sure that there is
at least an element of truth in it (though I'm equally sure
it's not the entire story). What I wonder is what we really
know for sure about *why* the lawyers are breathing down
their necks. Obviously, the cases that are potential
lawsuits are the ones where there is a bad outcome. I know
several studies show that the more involved the patient
is in the decision making, the less likely the patient is
to sue (this is typically one explanation offered as to
why midwives get sued less than OBs, even when there are
bad outcomes). I would imagine another factor is that in
a country where access to medical care is uncertain for
the vast majority, suing is one way to ensure that a child
who has chronic health problems as a result of something
that happened during the birth will have access to decent
quality medical care for life. I'm sure a lot of people
would throw out the notion that it's ambulance chasing
lawyers, though I don't know how big a role that plays.
I'm sure some of it is a common law legal system that
considers what is *common* rather than what is *right*
(e.g., if it's the standard of care, it's okay even if
it's flawed as a form of care).
Anyway, it just seems to me that we talk a lot
about CYA medicine, and I'm sure it's an issue, but we
don't seem to do a lot of good thinking about *why* the
legal pressures are there. I rather suspect that tort
reform isn't going to do much good, but it's the only
solution I ever seem to hear mentioned.

Best wishes,
Ericka

Ericka Kammerer wrote:
alath wrote:

OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation.

I hear this said a lot, and I'm sure that there is
at least an element of truth in it (though I'm equally sure
it's not the entire story). What I wonder is what we really
know for sure about *why* the lawyers are breathing down
their necks. Obviously, the cases that are potential
lawsuits are the ones where there is a bad outcome. I know
several studies show that the more involved the patient
is in the decision making, the less likely the patient is
to sue (this is typically one explanation offered as to
why midwives get sued less than OBs, even when there are
bad outcomes). I would imagine another factor is that in
a country where access to medical care is uncertain for
the vast majority, suing is one way to ensure that a child
who has chronic health problems as a result of something
that happened during the birth will have access to decent
quality medical care for life. I'm sure a lot of people
would throw out the notion that it's ambulance chasing
lawyers, though I don't know how big a role that plays.
I'm sure some of it is a common law legal system that
considers what is *common* rather than what is *right*
(e.g., if it's the standard of care, it's okay even if
it's flawed as a form of care).
Anyway, it just seems to me that we talk a lot
about CYA medicine, and I'm sure it's an issue, but we
don't seem to do a lot of good thinking about *why* the
legal pressures are there. I rather suspect that tort
reform isn't going to do much good, but it's the only
solution I ever seem to hear mentioned.

Best wishes,
Ericka

I think part of it is that people don't expect things to go wrong
when they go to a hospital. When it does go wrong, it's assumed that it
must be the doctor's fault. Add all the new tests and procdures which
might have prevented it, and you have lawsuits. This causes more and
more procedures to become mandatory. I think midwives aren't sued as
much because their patients probably have more realistic expectations
on what is going to happen.

I don't think tort reform is the answer, either, but I would like
frivious lawsuits thrown out.

Renee

Renee wrote:

Ericka Kammerer wrote:

alath wrote:


OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation.

I hear this said a lot, and I'm sure that there is
at least an element of truth in it (though I'm equally sure
it's not the entire story). What I wonder is what we really
know for sure about *why* the lawyers are breathing down
their necks. Obviously, the cases that are potential
lawsuits are the ones where there is a bad outcome. I know
several studies show that the more involved the patient
is in the decision making, the less likely the patient is
to sue (this is typically one explanation offered as to
why midwives get sued less than OBs, even when there are
bad outcomes). I would imagine another factor is that in
a country where access to medical care is uncertain for
the vast majority, suing is one way to ensure that a child
who has chronic health problems as a result of something
that happened during the birth will have access to decent
quality medical care for life. I'm sure a lot of people
would throw out the notion that it's ambulance chasing
lawyers, though I don't know how big a role that plays.
I'm sure some of it is a common law legal system that
considers what is *common* rather than what is *right*
(e.g., if it's the standard of care, it's okay even if
it's flawed as a form of care).
Anyway, it just seems to me that we talk a lot
about CYA medicine, and I'm sure it's an issue, but we
don't seem to do a lot of good thinking about *why* the
legal pressures are there. I rather suspect that tort
reform isn't going to do much good, but it's the only
solution I ever seem to hear mentioned.


I think part of it is that people don't expect things to go wrong
when they go to a hospital. When it does go wrong, it's assumed that it
must be the doctor's fault. Add all the new tests and procdures which
might have prevented it, and you have lawsuits. This causes more and
more procedures to become mandatory. I think midwives aren't sued as
much because their patients probably have more realistic expectations
on what is going to happen.

I think that is probably also part of it. I think the
whole package feeds on itself in a virtuous cycle--more time
with the patient = more informed patient = more realistic
expectations = more participation in decision making = more
ownership = fewer lawsuits. And actually, this one is the
best in that the lawsuits it prevents are the ones that *ought*
to be prevented (lawsuits where there really isn't malpractice
despite a bad outcome). Of course, as long as it takes a lawsuit
to ensure that a child gets the care he or she needs, many would
sue their best friends to ensure that.

I don't think tort reform is the answer, either, but I would like
frivious lawsuits thrown out.

On the face of it I like the idea of throwing out frivolous
lawsuits. However, I wonder how many *truly* frivolous lawsuits
there really are. If frivolous lawsuits comprise only a small
fraction of the lawsuits and it would cost a lot of money to
eliminate them (or if it would require draconian laws that would
get in the way of legitimate suits), then perhaps it's not worth
the price. I'll tolerate some waste if it's cheaper than fixing
the problem ;-)

Best wishes,
Ericka

"Ericka Kammerer" wrote in message
...
Renee wrote:
I don't think tort reform is the answer, either, but I would like
frivious lawsuits thrown out.

On the face of it I like the idea of throwing out frivolous
lawsuits. However, I wonder how many *truly* frivolous lawsuits
there really are. If frivolous lawsuits comprise only a small
fraction of the lawsuits and it would cost a lot of money to
eliminate them (or if it would require draconian laws that would
get in the way of legitimate suits), then perhaps it's not worth
the price. I'll tolerate some waste if it's cheaper than fixing
the problem ;-)

The inherent problem with the idea of preventing frivolous lawsuits is that,
until the case is presented to the court, there's no way to know whether
it's frivolous or not. *Someone* has to make that determination, and making
that determination is going to cost something. Now, I think there are some
rules in some (if not all states) that require paying the other party's
court costs if you're found to have brought a malicious/frivolous suit, but
I'm not sure that this is always practical or enforced (because the party
bringing a suit against, say, a multimillion dollar corporation, probably
couldn't afford to pay the company's legal costs under any circumstances).
Perhaps there ought to be penalties brought against *lawyers* if they
frequently bring suits that are found to be clearly without merit, but by
and large, I don't think there's any way to weed out frivolous lawsuits that
won't simply reduce access to the court system for the meritorious ones as
well.
--
Be well, Barbara

"Ericka Kammerer" wrote in message
...
alath wrote:

OB's these days are feeling
the lawyers breathing down their necks. If there is any question,
they're going to recommend a c-section out of medicolegal
self-preservation.

I hear this said a lot, and I'm sure that there is
at least an element of truth in it (though I'm equally sure
it's not the entire story). What I wonder is what we really
know for sure about *why* the lawyers are breathing down
their necks.

Oddly, not ONE birth trauma attorney has told a jury that OBs are routinely
closing birth canals up to 30% and routinely KEEPING birth canals closed
when babies get stuck.

Someone correct me if I am wrong.

Birth trauma attorneys apparently need OB experts who will tell the truth -
but there aren't any OB experts who will tell the truth.

More to the point, OB experts are telling obvious lies and there are no OB
experts who can be found to tell this to a jury...

And for some odd reason, birth trauma attorneys can't simply point out the
obvious OB lies.

Before I get to The Four OB Lies, it is worth it to note that it is a
violation of the AMA's Principles of Medical Ethics for physicians
to engage in fraud and deception, as in,

"[AMA physician[s] shall...strive to expose those physicians...who engage in
fraud or deception."

"[AMA p]hysician[s] shall...seek changes in those requirements which are
contrary to the best interests of the patient."

"[AMA p]hysician[s] shall...make relevant information available to patients,
colleagues, and the public..."
http://www.psych.org/psych_pract/eth...nions53101.cfm

OBs who are AMA members should be STRIVING to tell juries about The Four OB
Lies!

THE FOUR OB LIES...

OB LIE #1. After MASSIVE change in the AP pelvic outlet diameter was
clinically demonstrated in 1911 and radiographically demonstrated in 1957,
the authors of Williams Obstetrics began erroneously claiming that pelvic
diamaters DON'T CHANGE at delivery.

OB LIE #2. After Ohlsen pointed out in 1973 that pelvic diameters DO
change - the authors of Williams Obstetrics began erroneously claiming that
their most frequent delivery position - dorsal - widens the outlet.

OB LIE #3. After I pointed out in 1992 that dorsal CLOSES - and so does
semisitting - the authors of Williams Obstetrics - put the correct
biomechanics in their 1993 edition - but kept in their text (in the same
paragraph!) - the dorsal widens bald lie that first called my attention to
their text...

OB LIE #4. OBs are actually KEEPING birth canals closed when babies get
stuck - and claiming they are doing everything to allow the birth canal open
maximally. (ACOG Shoulder Dystocia video - also forceps and vacuum births
are performed with the mother in lithotomy.)

See Make birth better: Dan Rather, before you leave CBS...
http://health.groups.yahoo.com/group...t/message/2983

I noted some of the OB lies in an Open Letter to the FTC years ago...
http://home1.gte.net/gastaldo/part2ftc.html


Obviously, the cases that are potential
lawsuits are the ones where there is a bad outcome.

Yep

snip

I'm sure some of it is a common law legal system that
considers what is *common* rather than what is *right*
(e.g., if it's the standard of care, it's okay even if
it's flawed as a form of care).

LOL - keeping the birth canal closed the "extra" up to 30% when babies get
stuck is pretty "flawed." (!)

Richard Ikeda, MD - then-medical director of the California Medical Board
agreed that OBs are closing birth canals up to 30% - but said there was
nothing he could do - he said he couldn't even have the Board write to OBs
about it - because it was "the community norm."

Anyway, it just seems to me that we talk a lot
about CYA medicine, and I'm sure it's an issue, but we
don't seem to do a lot of good thinking about *why* the
legal pressures are there.

OBs *have* to keep closing birth canals up to 30% and keeping birth canals
closed when babies get stuck - BECAUSE of legal pressure - because stopping
would be tantamount to admitting the obvious criminal negligence that
sometimes escalates to criminally negligent homicide - i.e. - some babies
die unexplained deaths and OBs themselves have indicated that closing the
birth canal FAR LESS than 30% can kill.

I rather suspect that tort
reform isn't going to do much good, but it's the only
solution I ever seem to hear mentioned.


I'm still wondering why not one birth trauma attorney has told the jury that
OBs are closing birth canals up to 30% and keeping birth canals closed when
babies get stuck.

The "extra" up to 30% routinely denied is quite relevant what with all the
"big baby"/"small pelvis" rhetoric.

Todd

PS I'm also still wondering why Henci Goer - who puts herself out there as
being "the other side" - is saying nothing about OBs closing birth canals up
to 30% and keeping birth canals closed when babies get stuck.

Remember, **MDs** are supposed to be seeking to expose physicians engaging
in fraud and deception.

What's keeping "the other side" quiet?

Todd Gastaldo wrote:


Oddly, not ONE birth trauma attorney has told a jury that OBs are routinely
closing birth canals up to 30% and routinely KEEPING birth canals closed
when babies get stuck.

It's not odd. That information is irrelevant in our legal
system. A doctor who is practicing in accordance with standards
of care is pretty much not going to be convicted of anything. In
US law, "everyone else does it" is a valid legal argument unless
there is a specific law forbidding the action. Until and unless
there is agreement in the profession that it's not acceptable,
or that there are conditions in which it is unacceptable, it is
an irrelevant legal argument.

Best wishes,
Ericka

THE POWER OF THE JURY...

(IF TODD AND ERICKA WERE ON THE SAME JURY...)

"Ericka Kammerer" wrote in message
...
Todd Gastaldo wrote:


Oddly, not ONE birth trauma attorney has told a jury that OBs are
routinely closing birth canals up to 30% and routinely KEEPING birth
canals closed when babies get stuck.

It's not odd. That information is irrelevant in our legal
system. A doctor who is practicing in accordance with standards
of care is pretty much not going to be convicted of anything. In
US law, "everyone else does it" is a valid legal argument unless
there is a specific law forbidding the action. Until and unless
there is agreement in the profession that it's not acceptable,
or that there are conditions in which it is unacceptable, it is
an irrelevant legal argument.

Best wishes,
Ericka


Ericka,

You snipped the part about the standard of care beinig founded on obvious OB
lies - fraud and deception.

You also snipped the fact that it is a
violation of the AMA's Principles of Medical Ethics for physicians
to engage in fraud and deception, as in,

"[AMA physician[s] shall...strive to expose those physicians...who engage in
fraud or deception."
http://www.psych.org/psych_pract/eth...nions53101.cfm

You also snipped this:

The "extra" up to 30% routinely denied is quite relevant what with all the
"big baby"/"small pelvis" rhetoric.

Ericka, if we were on the same jury hearing a dorsal or semisitting shoulder
dystocia case, as a member of the jury I would be VERY interested to know
that OBs are lying and closing birth canals up to 30% and keeping birth
canals closed when babies get stuck.

This information is QUITE relevant (as I noted) since juries routinely hear
about "big baby" or "small pelvis."

I think other jury member would be very interested as well.

My bet is that no birth trauma attorney has mentioned this relevant info -
again - quite odd given its relevance.

If the judge said the OB lies and birth-canal-closing wasn't to be
considered relevant, I would be informing my fellow jurors regarding jury
nullification of law...

THE POWER OF THE JURY...

According to one website:

"In fact, if you have doubts about the fairness of a law, you have the right
and obligation to find someone innocent even though they have actually
broken the law! John Adams, our second president, had this to say about the
juror: 'It is not only his right but his duty...to find the verdict
according to his own best understanding, judgment, and conscience, though in
direct opposition to the direction of the court.'"
http://www.greenmac.com/eagle/ISSUES...ification.html

It would seem that the power to find someone innocent is also the power to
find them guilty...

Here's how the medico-"legal" "just us" system reportedly gets around jury
nullification of law:

"...judges rarely "fully inform" jurors of their rights, especially their
power to judge the law itself and to vote on the verdict according to
conscience. Instead, they end up assisting the prosecution by dismissing any
prospective juror who will admit to knowing about this right, starting with
anyone who also admits having qualms with any specific law..."

From the same website...
"Why is so little known about what is now called "jury nullification"? In
the late 1800's, a number of powerful special-interest groups (not unlike
many we have with us today) inspired a series of judicial decisions which
tried to limit jury rights. While no court has yet dared to deny that juries
can "nullify" or "veto" a law, or can bring in a "general verdict", they
have held that jurors need not be told about these rights!

"However, jury veto power is still recognized. In 1972 the D.C. Circuit
Court of Appeals held that the trial jury has an "...unreviewable and
irreversible power...to acquit in disregard of the instruction on the law
given by the trial judge. The pages of history shine upon instances of the
jury's exercise of its prerogative to disregard instructions of the judge;
for example, acquittals under the fugitive slave law (473F 2dl 113)"
http://www.greenmac.com/eagle/ISSUES...ification.html

An unreviewable and irreversible power to convict also exists - or so it
seems...

Todd

PS There is another power of the jury - the grand jury. Grand jurors
generally just look at cases the prosecutor brings for indictment - but
grand jurors can look into anything they want - that's the way it is in
Oregon anyway.

Hmmm.. That gives me an idea. : )

Todd Gastaldo wrote:


Ericka, if we were on the same jury hearing a dorsal or semisitting shoulder
dystocia case, as a member of the jury I would be VERY interested to know
that OBs are lying and closing birth canals up to 30% and keeping birth
canals closed when babies get stuck.

This information is QUITE relevant (as I noted) since juries routinely hear
about "big baby" or "small pelvis."

I think other jury member would be very interested as well.

They might be interested, but it would still be largely
irrelevant. You can't convict for malpractice for someone who is
practicing in accordance with the current standard of care.

"In fact, if you have doubts about the fairness of a law, you have the right
and obligation to find someone innocent even though they have actually
broken the law! John Adams, our second president, had this to say about the
juror: 'It is not only his right but his duty...to find the verdict
according to his own best understanding, judgment, and conscience, though in
direct opposition to the direction of the court.'"
http://www.greenmac.com/eagle/ISSUES...ification.html

It would seem that the power to find someone innocent is also the power to
find them guilty...

Not necessarily--the two are very different things. And if
there were a law regarding this issue, it would be quite different.
Then civil law would apply. But the issue of malpractice essentially
revolves around common law, in which case the standard of care is
the main thing.

This is one of the downsides of a common law system, as
opposed to a civil law system. Doctors aren't going to be
convicted for malpractice for doing what the profession accepts
and promotes as standard care. This is not the avenue through
which change will come.

"However, jury veto power is still recognized. In 1972 the D.C. Circuit
Court of Appeals held that the trial jury has an "...unreviewable and
irreversible power...to acquit in disregard of the instruction on the law
given by the trial judge. The pages of history shine upon instances of the
jury's exercise of its prerogative to disregard instructions of the judge;
for example, acquittals under the fugitive slave law (473F 2dl 113)"
http://www.greenmac.com/eagle/ISSUES...ification.html

An unreviewable and irreversible power to convict also exists - or so it
seems...

I seriously doubt it. Refusing to convict someone of
something they may have done is *very* different from convicting
someone of something that isn't demonstrably illegal.

Best wishes,
Ericka