Out-of-hospital C-sections
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I should add, there's a huge cost for staffing an OB unit. You have to have at least 2 nurses (or equivalent) available all the time. That's 6 FTE's per day. Having someone "on call" might work in a low-volume setting, but, as I said, it's fine, until it isn't.
Also when things go south, there's time "from decision to incision" that should be met. IOW, once an OB decides things are bad and an emergent c-section is required, you have (iirc) 30 minutes to get the knife onto the belly. On-call staff usually can't handle that. We took call from home, ONLY if it was a less than 15 minute drive from home to the hospital.
But, back to staffing...nurses, housekeeping, docs, postpartum...
Yeah, it's a tough call. After I retired, our place stopped doing OB because the volume simply wasn't big enough to support it all.
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Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals, siding with a private equity-owned physicians group that says the change will lower costs and give pregnant women the homier birthing atmosphere that many desire.
But the hospital industry and the nation’s leading obstetricians’ association say that even though some Florida hospitals have closed their maternity wards in recent years, performing C-sections in doctor-run clinics will increase the risks for women and babies when complications arise.
“A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next,” Cole Greves, an Orlando perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to KFF Health News. The new birth clinics, “even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.”
The Florida Legislature this spring passed a law allowing “advanced birth centers,” where physicians can deliver babies vaginally or by C-section to women deemed at low risk of complications. Women would be able to stay overnight at the clinics.
Everything in OB is fine...until it isn't.
@George-K said in Out-of-hospital C-sections:
performing C-sections in doctor-run clinics will increase the risks for women and babies when complications arise.
They better have a helicopter pad handy.
And the first they have to use a helicopter to make an emergency transport that will blow a lot of the savings.
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the change will lower costs and give pregnant women the homier birthing atmosphere that many desire.
My first kid was an unplanned C-section. At the point where they made that decision after about 20 hours of unproductive labour, I for one wasn't giving any kind of shit about the homier atmosphere.
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NICU transports are super duper expensive, involving multiple people and pricey equipment. Back in the day, I was continually answering to Admin for neonatal transport costs in and out of the PICU (we did neonatal surgery for the southern part of the province). They forced me to be on a team of fund raisers for the heli-pad, isolette, other stuff, etc. It became a bloody nightmare to staff the transport team, who also did the PICU transports. Your everyday 911 paramedics can’t be trained or equipped to deal with these things. I was constantly asking for more capital/operating money for our team. The thing is, not every low risk birth turns out to be low risk. It’s not uncommon for stuff to be missed prenatally; stuff can also go south real fast even with normal births. NICUs are in teaching hospitals for darn good reasons … with NICU nurses (maybe even 2), a RT, and a neonatologist (or fellow) right there in the delivery room ready to wheel down the hall to the NICU where a cardiologist, a surgeon, anesthetist, sometimes others could be waiting. There’s head stuff, gut stuff, lungs, all sorts of things which can present at birth which need a NICU transport team right there then.
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…. and I don’t want to wager a clue what could happen to the woman giving birth by C/S in a community clinic. I plotted to have my baby in the U.S., in a teaching hospital (as opposed to Canada where epidurals/OBs weren’t the norm) … It was to be a normal birth of a normal baby, tested, monitored to the skies throughout, by me, my husband & my obstetrician… but at 38.5 wks, at 8cm, in the delivery room, my BP bottomed out, then my HR, then well, that affected my baby, so I needed drugs, O2 & thank bloody God there was an anesthetist (actually 2 + a nurse anesthetist) and OB there ready and doing that C/S.
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