Originally Posted by Ironica
Then your situation is very different from the OP's, I guess, since she's an FP doctor and (should be) able to attend VBACs.
Unfortunately, the new decision effectively bans me from attending VBACs. Technically I can - but only if OB and anesthesia stay in house with me, and OB doesn't intend to. In many bigger hospitals there are "house physicians" who are paid, often by the institution, sometimes by the groups of physicians that utilize their services to stay in house and manage any emergencies and sometimes to do deliveries for practicing docs who can't come or choose to stay in their office seeing patients. In teaching hospitals, usually faculty rotate call and staying in house and are then available for emergencies as well. In a small setting like my hospital, with only 6 docs who attend births, and only 2 who do surgery, the OBs don't want to stay in house for even their own clients let alone mine. And really, I don't think there is any way they can bill for their time if they did stay in house for my clients - except for many a consult fee if I formally consulted them on every client. I don't induce or augment VBACs (except under very specialized circumstances) so if OB were to sit in house for my VBAC clients, they could be looking at hours and hours of time. Realistically, it's hard to expect them to do that - especially when it's not something billable. It's a really hard sell to my 67 yr old back up OB to convince him to stay with me in the hospital for 12-14 hours while a VBAC client labors.
So, for now, I'm done attending VBACs I guess. I will likely refer my clients to one of the hospitals about 45 minutes away that has some midwives (I'm going to call and make sure they attend VBACs)
If a client feels strongly and wants to make a case with our administration I'll be behind her, but right now I don't have such a client - every client so far that I've told this whole story to is more inclined to schedule a repeat than to either be referred elsewhere or to stay here and insist.
I hate not being able as a non-surgical provider to not attend VBACs, because I believe that having a non-surgeon attend you decreases your chance of surgery - for all laboring mamas, really, but especially for VBACs!