--
Richard Chudacoff, MD
Beer is living proof that God loves us and wants us to be happy.
Benjamin Franklin
Heaven grant that the burden you carry may have as easy an exit as it had an
entrance.
[Prayer To A Pregnant Woman]
-Desiderius Erasmus
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
Siegel, M.D.
Sent: Thursday, July 08, 2004 6:48 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Elective Induction - something goes wrong
What a great can of worms that has been opened here.
I will induce people at 39w0days (OK, I might cheat a day or two to
38w5d)electively if:
1. The dates are solid.
2. The cervix is favorable, meaning no need for ripening. In multips,
this is 2 cm./50% and able to undergo amniotomy based on office exam. In
primigravidas, I'm very unlikely to do this unless 3 cm./100% or
thereabouts.
3. The patient understands that this is elective, voluntary, and being
done for mutual convenience. In reality, this means that it is a day
that I'll be on call (i.e. I don't set up patients for my partner
without asking all involved).
4. If it doesn't feel right, well, I either don't mention it or
decline.
Thus, if someone, for lack of a better way to say it, is tired of being
pregnant and asks for an elective induction, I'm game if the above are
satisfied. If not, well, I tell them that it won't work and let's not
do anything until past their due date or if they become favorable.
Whether you agree or not, using common sense and experience has,
fortunately, resulted in uniformly good outcomes. I cannot remember
when I had to do a section in those circumstances, and it is rare that
someone who comes in by 7:30 AM is pregnant at 5 PM (just had one
recently that didn't deliver until 8:30 PM).
I bet that many other private practice docs do this, too, to a degree.
Garry
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
