Re: Birthing ball consent - Honest!(Long)
From: Anna Meenan, MD (annam@uic.edu)
Sat Jun 19 18:41:43 2004
Pretty interesting. Actually, those things are probably dangerous. Our
nurses tell me that the one they used to have broke while a woman in
labor was sitting on it. I don't think the consent form even mentions
fractured coxxyx or having the cr*p scared out of you as possible
complications.
--
Anna Meenan, MD
At Thu, 17 Jun 2004, RModugno@aol.com wrote:
>
>Yes folks, here's the informed consent of the week!
>
>Robert Modugno MD MBA FACOG
>Marietta, GA
>
>Release for use of birthing ball:
>
>I have requested to use a birthing ball while in labor at______Hospital. I understand that I may bring a birthing ball me to the Hospital or may purchase one from the Hospital during this admission. I understand that I must take the ball with me when I leave the Hospital. The Hospital cannot arrange for disposal or reuse of the ball.
>
>I have received education regarding use of the birthing ball from the individual named below. I understand that there are risks associated with the use of the ball which could cause injury to me and/or my unborn child. These risks include, but are not limited to, loss of balance and falls, fatigue, infection, and aggravation of prior injuries.
>
>I understand that use of the birthing ball at _________Hospital must be approved by my physician or certified nurse midwife. I understand that I may not use the ball after I have received an epidural or if I am in preterm labor. I also understand that if I have had a prior injury or a history of arthritis, I must not use the ball without my physician's consent. I understand that my spouse, friend or family member must be with me at all times when I am using the ball to assist me in case I lose my balance. The Hospital has no duty to supervise me while I am using the ball. I understand that the balls provided by ___________Hospital are intended for use by patients between 5'2" and 5'10". I understand that if I am not within that height range I should not use the ball.
>
>In consideration for permitting me to use the birthing ball while a patient at _________Hospital, I release ________Hospital, my physician, certified nurse midwife, and their agents and employees from any and all claims, damages, responsibilities, and liabilities, which may arise, directly or indirectly, from or in connection with the use of the birthing ball. My spouse, friend or family member has also signed to indicate agreement with the above and understands that I must be supervised at all times.
>
>Patient Signature Witness
>
>Spouse/Significant other Date/Time
>
>Education provided by:____________________________
>
>Education provided by:____________________________
>NOTE: Physician or nurse midwife order required for use of birthing ball
>Education provided by:____________________________
