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Re: Birth Plans From: jay kulkin (jkulkin@mindspring.com) Sun Jun 22 19:00:37 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Ronald Helm: "Re: galactorrhe" Previous message: jay kulkin: "Re: More pay for 1 day?" Maybe in reply to: CNMPAT@aol.com: "Birth Plans" Next in thread: Garry E. Siegel, M.D.: "Re: Birth Plans" Reply: Garry E. Siegel, M.D.: "Re: Birth Plans" Kelly, Many of us on the list are a "little older" and have seen things like preps & enemas" done as routine. I have to laugh after training at a hospital doing 15,000 deliverys/year. Everyone was shaved and everyone got an SSE.( no it's not a contest if you know what that means). Many women in the 1980's were seeing physicians who wouldn't change their practice because of the way they were trained. This comes from the time when physicians set the standards of medical care and what you learned in training was ethched in stone. It was also during the time of malpractice-mania so doc's didn't dare deviate from the way they were trained. If you had an adverse outcome, but you followed protocol, you could at least defend yourself. I think this spurred the development of birth plans, as women wanted to regain some contol over their care. Clear liquids in labor would be heresy to that training. A second stage over 2 hours????? That was something you would only suggest after a few margaritas. Docs, we can't even decide how many days a patient needs to stay in the hospital anymore. We aren't allowed to do medically necessary procedures. I see birth plans as a minor issue. I've been following patient requests for years. As Burger King says, "have it your way". Any one of us can follow standards of care and allow patients to have a birth in the style they prefer. It's called customer service. Lets concentrate on the big stuff-being certain that standards are followed by MCO's and physicians alike. Jay At 05:46 PM 6/22/97 -0500, you wrote: > >>I have been reading birth plans recently in an attempt to familiarize >>myself with the requests of patients who prepare them. Throughout my >>residency and first year of practice, I have not encountered anyone who has >>requested or prepared a birth plan. > >I think birth plans must be a West Coast thing -- I never saw one in 4 years >of med school (Charlottesville, VA), 4 years of residency (Temple, >Philadelphia, PA) or my first 3 years in practice (suburban Philadelphia). >Lots of my patients here (Lake Tahoe, CA) write birth plans. >> > >>I feel it is my responsibility to adhere to the patient's requests, however >>I am concerned with medico-legal liability concerning certain issues. > >I tell my patients I will TRY to respect their wishes but they must trust my >judgement. I tell them my number one priority is healthy mom/healthy baby, >number two is a pleasant birth experience for the couple and number three is >having all this happen before my bedtime :-) . Frankly, most of the things >on their lists are things I've never even SEEN done (enemas, shaving) >> > >>1) Eating during labor > >I allow clear liquids and popsicles, maybe an occasional cracker. In my >"when to go to the hospital" talk during the course of prenatal care, I tell >them it's okay to eat lightly once labor begins, but don't eat anything that >would gross you out coming back up, i.e., pizza. > >>2) Ambulation with epidural > >Our anesthesiologists aren't keen on "walking epidurals" and our hospital is >very concerned about potential liability in case of a fall. > >>3) Cord clamping after the pulsations cease > >I usually put the baby on mom's belly and allow dad to cut the cord. I >haven't had many requests for waiting for the cord to stop pulsing, but I >don't see a problem with it. mom can hold baby for as long as she wants, >with the usual caveat of "if the baby's doing ok" >>4) No IV access > >Don't routinely put in ivs unless she wants drugs, needs pit, is getting >dehydrated or strip is flat and worrisome after oral hydration. >> >I, being of Irish descent, tell my patients to remember Murphy's law of >birth plans -- don't get too attached or too adamant about your plan 'cause >that will guarantee you'll be strapped to ivs and monitors and having a >c-section. > >Kelly >Kelly Shanahan, MD >S. Lake Tahoe, CA > -- Jay M. Kulkin, MD, MBA, FACOG Medical Resource Group 1117 Perimeter Center West Suite 510 East Atlanta, Georgia Phone:770-392-3475 e-mail: medresourcegroup@mindspring.com Next message: Ronald Helm: "Re: galactorrhe" Previous message: jay kulkin: "Re: More pay for 1 day?" Maybe in reply to: CNMPAT@aol.com: "Birth Plans" Next in thread: Garry E. Siegel, M.D.: "Re: Birth Plans" Reply: Garry E. Siegel, M.D.: "Re: Birth Plans"

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